1
|
Yang S, Ni H, Zhang A, Zhang J, Zang H, Ming Z. Impact of postoperative morbidity on the prognosis of patients with hepatocellular carcinoma after laparoscopic liver resection: a multicenter observational study. Sci Rep 2025; 15:1724. [PMID: 39799160 PMCID: PMC11724855 DOI: 10.1038/s41598-024-85020-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 12/30/2024] [Indexed: 01/15/2025] Open
Abstract
The long-term impact of postoperative morbidity following laparoscopic liver resection for hepatocellular carcinoma is unclear. This study aimed to investigate whether the prognosis of hepatocellular carcinoma patients were affected by postoperative morbidity after laparoscopic liver resection. Hepatocellular carcinoma patients who underwent curative-intent laparoscopic liver resection were included. Risk factors of 30-day morbidity were identified using logistic regression analysis. Early (≤ 2 years) and late (> 2 years) recurrence rates, overall survival, and time to recurrence were compared among patients with and without postoperative morbidity. Independent prognostic factors of overall survival and time to recurrence of these patients were investigated using Cox regression analysis. This study included 420 patients, 147 (35%) of whom experienced postoperative morbidity. Diabetes mellitus, cirrhosis, portal hypertension, Child-Pugh grade B, multiple tumors, poor tumor differentiation and intraoperative blood transfusion were risk factors of postoperative morbidity. Patients with postoperative morbidity had higher early and late recurrence rates than those without postoperative morbidity (38.8% vs. 22.4%, P = 0.001; 50% vs. 25.5%, P = 0.001). Postoperative morbidity was associated with decreased overall survival (median: 54.5 months vs. not reached, P < 0.001) and time to recurrence (median: 36.4 vs. 68.2 months; P < 0.001). Postoperative morbidity resulted in a 43% and 92% higher risk of long-term mortality (HR 1.43; 95% CI 1-2.03; P = 0.048) and recurrence (HR 1.92; 95% CI 1.41-2.62; P < 0.001). For hepatocellular carcinoma patients undergoing laparoscopic liver resection, long-term oncologic outcomes are adversely affected by postoperative morbidity. Therefore, it is of great importance for surgeons to prevent and manage postoperative morbidity.
Collapse
Affiliation(s)
- Shiye Yang
- Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China
| | - Haishun Ni
- Department of General Surgery, Nantong Second People's Hospital, 298 Xinhua Road, Gangzha District, Nantong City, 226002, Jiangsu Province, China
| | - Aixian Zhang
- Department of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100080, China
| | - Jixiang Zhang
- Department of Hepatobiliary Surgery, Zhongshan People's Hospital, 2 Sun Wen East Road, Zhongshan City, 528403, Guangdong Province, China
| | - Hong Zang
- Department of Comprehensive Surgery, Hepato-Biliary-Pancreatic Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China.
- Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China.
| | - Zhibing Ming
- Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China.
- Department of Comprehensive Surgery, Vascular Surgery, Nantong First People's Hospital, Affiliated Hospital 2 of Nantong University, 666 Shengli Road, Chongchuan District, Nantong City, 226014, Jiangsu Province, China.
| |
Collapse
|
2
|
Faucher M, Dahan S, Morel B, de Guibert JM, Chow-Chine L, Gonzalez F, Bisbal M, Servan L, Sannini A, Tezier M, Tourret M, Cambon S, Pouliquen C, Mallet D, Nguyen Duong L, Ettori F, Mokart D. The Effect of Postoperative Sepsis on 1-Year Mortality and Cancer Recurrence Following Transhiatal Esophagectomy for Esophageal-Gastric Junction Adenocarcinomas: A Retrospective Observational Study. Cancers (Basel) 2025; 17:109. [PMID: 39796735 PMCID: PMC11719752 DOI: 10.3390/cancers17010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 12/26/2024] [Accepted: 12/30/2024] [Indexed: 01/13/2025] Open
Abstract
INTRODUCTION Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence. METHOD A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022. RESULTS Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11-47); p = 0.038), number of lymph nodes removed (OR: 0. 78 (0.64-0.95); p = 0.011), recurrence at one year (OR: 9.22 (1.66-51.1); p = 0.011), mediastinitis (OR: 17.7 (1.43-220); p = 0.025) and intraoperative driving pressure (OR: 1.77 (1.17-2.68); p = 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07-0.95; p = 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5-18.9; p = 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99-41.0; p < 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36-5.19; p = 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79-0.96; p = 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71-25.32; p < 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70-25.13; p = 0.005). CONCLUSIONS Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Djamel Mokart
- Department of Anesthesiology and Critical Care, Paoli-Calmettes Institute, 13009 Marseille, France; (M.F.); (S.D.); (B.M.); (J.M.d.G.); (L.C.-C.); (F.G.); (M.B.); (L.S.); (A.S.); (M.T.); (M.T.); (S.C.); (C.P.); (D.M.); (L.N.D.); (F.E.)
| |
Collapse
|
3
|
Nevins EJ, Chmelo J, Prasad P, Brown J, Phillips AW. Long-term survival is not affected by severity of complications following esophagectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108232. [PMID: 38430703 DOI: 10.1016/j.ejso.2024.108232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/09/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Outcomes following esophagectomy for esophageal cancer have continued to improve over the last 30 years. Post-operative complications impact upon peri-operative and short-term survival but the effect on long-term survival remains debated. This study aims to investigate the effect of post-operative complications on long-term survival following esophagectomy. MATERIALS AND METHODS All patients who underwent an esophagectomy between January 2010 and January 2019 were included from a single high-volume center. Data was collected contemporaneously. Patients were separated into three groups; those who experienced no, or very minor complications (Clavien-Dindo 0 or 1), minor complications (Clavien-Dindo 2), and major complications (Clavien-Dindo 3-4), at 30 days. To correct for short-term mortality effects, those who died during the index hospital admission were excluded. Overall survival was analyzed using Kaplan-Meier and log rank testing. RESULTS The study cohort comprised 721 patients. There were 42.4% (306/721), 29.5% (213/721) and 25.7% (185/721) in the Clavien-Dindo 0-1, Clavien-Dindo 2, and Clavien-Dindo 3-4 group respectively. Seventeen patients (2.4%) died during their index hospital admission and were therefore excluded. There was no significant difference between median survival across the 3 groups (50, 57 and 52 months). Across all 3 groups, overall long-term survival rates were equivalent at 1 (87.5%, 84.9%, 83.2%), 3 (59.7%, 59.6%, 54.2%), and 5 years (43.9%, 48.9%, 45.7%) (p = 0.806). The only factors independently associated with survival in this cohort, were male gender, Charlson comorbidity index, and overall pathological stage of disease. CONCLUSION Long-term survival is not affected by peri-operative complications, irrespective of severity, following esophagectomy. Further study into the long-term quality of life is required.
Collapse
Affiliation(s)
- Edward J Nevins
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Jakub Chmelo
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Pooja Prasad
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Joshua Brown
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, UK; School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK.
| |
Collapse
|
4
|
Geraedts TCM, Weijs TJ, Berkelmans GHK, Fransen LFC, Kouwenhoven EA, van Det MJ, Nilsson M, Lagarde SM, van Hillegersberg R, Markar SR, Nieuwenhuijzen GAP, Luyer MDP. Long-Term Survival Associated with Direct Oral Feeding Following Minimally Invasive Esophagectomy: Results from a Randomized Controlled Trial (NUTRIENT II). Cancers (Basel) 2023; 15:4856. [PMID: 37835550 PMCID: PMC10571988 DOI: 10.3390/cancers15194856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
Advancements in perioperative care have improved postoperative morbidity and recovery after esophagectomy. The direct start of oral intake can also enhance short-term outcomes following minimally invasive Ivor Lewis esophagectomy (MIE-IL). Subsequently, short-term outcomes may affect long-term survival. This planned sub-study of the NUTRIENT II trial, a multicenter randomized controlled trial, investigated the long-term survival of direct versus delayed oral feeding following MIE-IL. The outcomes included 3- and 5-year overall survival (OS) and disease-free survival (DFS), and the influence of complications and caloric intake on OS. After excluding cases of 90-day mortality, 145 participants were analyzed. Of these, 63 patients (43.4%) received direct oral feeding. At 3 years, OS was significantly better in the direct oral feeding group (p = 0.027), but not at 5 years (p = 0.115). Moreover, 5-year DFS was significantly better in the direct oral feeding group (p = 0.047) and a trend towards improved DFS was shown at 3 years (p = 0.079). Postoperative complications and caloric intake on day 5 did not impact OS. The results of this study show a tendency of improved 3-year OS and 5-year DFS, suggesting a potential long-term survival benefit in patients receiving direct oral feeding after esophagectomy. However, the findings should be further explored in larger future trials.
Collapse
Affiliation(s)
- Tessa C. M. Geraedts
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Teus J. Weijs
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Gijs H. K. Berkelmans
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Laura F. C. Fransen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Ewout A. Kouwenhoven
- Department of Surgery, ZGT Hospital Group Twente, 7609 PP Almelo, The Netherlands; (E.A.K.); (M.J.v.D.)
| | - Marc J. van Det
- Department of Surgery, ZGT Hospital Group Twente, 7609 PP Almelo, The Netherlands; (E.A.K.); (M.J.v.D.)
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141-86 Stockholm, Sweden;
- Department of Upper Abdominal Diseases, Karolinska University Hospital, 171-77 Stockholm, Sweden
| | - Sjoerd M. Lagarde
- Department of Surgery, Eramus Medical Center, 3015 CN Rotterdam, The Netherlands;
| | | | - Sheraz R. Markar
- Nuffield Department of Surgery, University of Oxford, Oxford OX3 9DU, UK;
| | - Grard A. P. Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| | - Misha D. P. Luyer
- Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands; (T.C.M.G.); (T.J.W.); (G.A.P.N.)
| |
Collapse
|
5
|
Fransen LFC, Verhoeven RHA, Janssen THJB, van Det MJ, Gisbertz SS, van Hillegersberg R, Klarenbeek B, Kouwenhoven EA, Nieuwenhuijzen GAP, Rosman C, Ruurda JP, van Berge Henegouwen MI, Luyer MDP. The association between postoperative complications and long-term survival after esophagectomy: a multicenter cohort study. Dis Esophagus 2023; 36:doac086. [PMID: 36477850 DOI: 10.1093/dote/doac086] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 05/30/2023]
Abstract
Conflicting results are reported on the association between post-esophagectomy complications and long-term survival. This multicenter study assesses the association between complications after an esophagectomy and long-term overall survival. Five Dutch high-volume centers collected data from consecutive patients undergoing esophagectomy between 2010 and 2016 and merged these with long-term survival data from the Netherlands Cancer Registry. Exclusion criteria were non-curative resections and 90-day mortality, among others. Primary outcome was overall survival related to the presence of a postoperative complication in general. Secondary outcomes analyzed the presence of anastomotic leakage and cardiopulmonary complications. Propensity score matching was performed and the outcomes were analyzed via Log-Rank test and Kaplan Meier analysis. Among the 1225 patients included, a complicated course occurred in 719 patients (59.0%). After matching for baseline characteristics, 455 pairs were successfully balanced. Patients with an uncomplicated postoperative course had a 5-year overall survival of 51.7% versus 44.4% in patients with complications (P = 0.011). Anastomotic leakage occurred in 18.4% (n = 226), and in 208 matched pairs, it was shown that the 5-year overall survival was 57.2% in patients without anastomotic leakage versus 44.0% in patients with anastomotic leakage (P = 0.005). Overall cardiopulmonary complication rate was 37.1% (n = 454), and in 363 matched pairs, the 5-year overall survival was 52.1% in patients without cardiopulmonary complications versus 45.3% in patients with cardiopulmonary complications (P = 0.019). Overall postoperative complication rate, anastomotic leakage, and cardiopulmonary complications were associated with a decreased long-term survival after an esophagectomy. Efforts to reduce complications might further improve the overall survival for patients treated for esophageal carcinoma.
Collapse
Affiliation(s)
- Laura F C Fransen
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Rob H A Verhoeven
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical Oncology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Marc J van Det
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Suzanne S Gisbertz
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bastiaan Klarenbeek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC location Academic Medical Center, Amsterdam, The Netherlands
| | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| |
Collapse
|
6
|
Yoshida N, Horinouchi T, Eto K, Harada K, Sawayama H, Imamura Y, Iwatsuki M, Ishimoto T, Baba Y, Miyamoto Y, Watanabe M, Baba H. Prognostic Value of Pretreatment Red Blood Cell Distribution Width in Patients With Esophageal Cancer Who Underwent Esophagectomy: A Retrospective Study. ANNALS OF SURGERY OPEN 2022; 3:e153. [PMID: 37601607 PMCID: PMC10431288 DOI: 10.1097/as9.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Objective This comprehensive analysis aimed to elucidate the mechanism underlying how high pretreatment red blood cell distribution width (RDW) reflects poor prognosis after esophagectomy for esophageal cancer. Background Several cohort studies have reported that preoperative RDW might be a predictive marker for poor prognosis after esophagectomy; however, the underlying mechanism of this relationship has not been elucidated. Methods This study included 626 patients with esophageal cancer who underwent esophagectomy between April 2005 and November 2020. A retrospective investigation of the association between pretreatment RDW and clinicopathological features, blood data, short-term outcomes, and prognosis was conducted using a prospectively entered institutional clinical database and the latest follow-up data. Results Of 626 patients, 87 (13.9%) had a high pretreatment RDW. High RDW was significantly associated with several disadvantageous characteristics regarding performance status, the American Society of Anesthesiologists physical status, respiratory comorbidity, and nutritional status. Similarly, high RDW correlated with frequent postoperative morbidities (respiratory morbidity and reoperation; P = 0.022 and 0.034, respectively), decreased opportunities for adjuvant chemotherapy (P = 0.0062), and increased death from causes other than esophageal cancer (P = 0.046). Finally, RDW could be an independent predictor of survival after esophagectomy (hazard ratio, 1.47; 95% confidence interval, 1.009-2.148; P = 0.045). Conclusion High pretreatment RDW reflected various adverse backgrounds and it could be a surrogate marker of poor prognosis in patients who have undergone esophagectomy for esophageal cancer.
Collapse
Affiliation(s)
- Naoya Yoshida
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Division of Translational Research and Advanced Treatment against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan
| | - Tomo Horinouchi
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kojiro Eto
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuto Harada
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Sawayama
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaaki Iwatsuki
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takatsugu Ishimoto
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Division of Translational Research and Advanced Treatment against Gastrointestinal Cancer, Kumamoto University, Kumamoto, Japan
| | - Yoshifumi Baba
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideo Baba
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
7
|
Yoshida N, Sasaki K, Kanetaka K, Kimura Y, Shibata T, Ikenoue M, Nakashima Y, Sadanaga N, Eto K, Tsuruda Y, Kobayashi S, Nakanoko T, Suzuki K, Takeno S, Yamamoto M, Morita M, Toh Y, Baba H. High Pretreatment Mean Corpuscular Volume Can Predict Worse Prognosis in Patients With Esophageal Squamous Cell Carcinoma who Have Undergone Curative Esophagectomy: A Retrospective Multicenter Cohort Study. ANNALS OF SURGERY OPEN 2022; 3:e165. [PMID: 37601605 PMCID: PMC10431247 DOI: 10.1097/as9.0000000000000165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/12/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To establish the prognostic value of mean corpuscular volume (MCV) in patients with esophageal squamous cell carcinoma (ESCC) who have undergone esophagectomy. BACKGROUND The MCV increases in patients with high alcohol and tobacco consumption. Such a lifestyle can be a risk factor for malnutrition, comorbidities related to those habits, and multiple primary malignancies, which may be associated with frequent postoperative morbidity and poor prognosis. METHODS This study included 1673 patients with ESCC who underwent curative esophagectomy at eight institutes between April 2005 and November 2020. Patients were divided into normal and high MCV groups according to the standard value of their pretreatment MCV. Clinical background, short-term outcomes, and prognosis were retrospectively compared between the groups. RESULTS Overall, 26.9% of patients had a high MCV, which was significantly associated with male sex, habitual smoking and drinking, multiple primary malignancies, and malnutrition, as estimated by the body mass index, hemoglobin and serum albumin values, and the Geriatric Nutritional Risk Index. Postoperative respiratory morbidity (P = 0.0075) frequently occurred in the high MCV group. A high MCV was an independent prognostic factor for worse overall survival (hazard ratio, 1.27; 95% confidence interval, 1.049-1.533; P = 0.014) and relapse-free survival (hazard ratio, 1.23; 95% confidence interval, 1.047-1.455; P = 0.012). CONCLUSIONS A high MCV correlates with habitual drinking and smoking, malnutrition, and multiple primary malignancies and could be a surrogate marker of worse short-term and long-term outcomes in patients with ESCC who undergo esophagectomy.
Collapse
Affiliation(s)
- Naoya Yoshida
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan
| | - Ken Sasaki
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-shi, Kagoshima, Japan
| | - Kengo Kanetaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasue Kimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Tomotaka Shibata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Hasama, Oita, Japan
| | - Makoto Ikenoue
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Yuichiro Nakashima
- Department of Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, Miniami-ku, Fukuoka, Japan
| | - Noriaki Sadanaga
- Department of Surgery, Saiseikai Fukuoka General Hospital, Chuo-ku, Fukuoka, Japan
| | - Kojiro Eto
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan
| | - Yusuke Tsuruda
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-shi, Kagoshima, Japan
| | - Shinichiro Kobayashi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomonori Nakanoko
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Kosuke Suzuki
- Department of Gastroenterological and Pediatric Surgery, Oita University, Hasama, Oita, Japan
| | - Shinsuke Takeno
- Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, Miniami-ku, Fukuoka, Japan
| | - Masaru Morita
- Department of Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, Miniami-ku, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastroenterological Surgery, National Hospital Organization, Kyushu Cancer Center, Miniami-ku, Fukuoka, Japan
| | - Hideo Baba
- From the Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Chuoku, Kumamoto, Japan
| |
Collapse
|
8
|
Liu ZP, Chen WY, Zhang YQ, Jiang Y, Bai J, Pan Y, Zhong SY, Zhong YP, Chen ZY, Dai HS. Postoperative morbidity adversely impacts oncological prognosis after curative resection for hilar cholangiocarcinoma. World J Gastroenterol 2022; 28:948-960. [PMID: 35317056 PMCID: PMC8908289 DOI: 10.3748/wjg.v28.i9.948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/25/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown.
AIM To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.
METHODS Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS).
RESULTS Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo vs 31.0 mo, respectively, P = 0.003; RFS: 16.0 mo vs 26.0 mo, respectively, P = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, P = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, P = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, P < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, P < 0.001) after curative resection for HCCA.
CONCLUSION Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.
Collapse
Affiliation(s)
- Zhi-Peng Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wei-Yue Chen
- Department of Clinical Center of Oncology, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Yan-Qi Zhang
- Department of Health Statistics, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yan Jiang
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Jie Bai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yu Pan
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Shi-Yun Zhong
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Yun-Ping Zhong
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Zhi-Yu Chen
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Hai-Su Dai
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| |
Collapse
|
9
|
Comment on "The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study". Ann Surg 2021; 274:e740-e741. [PMID: 33055580 DOI: 10.1097/sla.0000000000004288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Fransen LFC, Berkelmans GHK, Asti E, van Berge Henegouwen MI, Berlth F, Bonavina L, Brown A, Bruns C, van Daele E, Gisbertz SS, Grimminger PP, Gutschow CA, Hannink G, Hölscher AH, Kauppi J, Lagarde SM, Mercer S, Moons J, Nafteux P, Nilsson M, Palazzo F, Pattyn P, Raptis DA, Räsanen J, Rosato EL, Rouvelas I, Schmidt HM, Schneider PM, Schröder W, van der Sluis PC, Wijnhoven BPL, Nieuwenhuijzen GAP, Luyer MDP. The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study. Ann Surg 2021; 274:e1129-e1137. [PMID: 31972650 DOI: 10.1097/sla.0000000000003772] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. METHODS Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. RESULTS A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25-2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30-2.58). For all other complications, no significant association with long-term survival was found. CONCLUSION The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.
Collapse
Affiliation(s)
- Laura F C Fransen
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Emanuele Asti
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Felix Berlth
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Andrew Brown
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Elke van Daele
- Department of Surgery, University Center Ghent, Ghent, Belgium
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Peter P Grimminger
- Department of General-, Visceral-, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Christian A Gutschow
- Center for Visceral, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Gerjon Hannink
- Department of Operating Rooms and MITeC Technology Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arnulf H Hölscher
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Sjoerd M Lagarde
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stuart Mercer
- Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Magnus Nilsson
- Division of Surgery, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Piet Pattyn
- Department of Surgery, University Center Ghent, Ghent, Belgium
| | - Dimitri A Raptis
- Center for Visceral, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Jari Räsanen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ernest L Rosato
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Ioannis Rouvelas
- Division of Surgery, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Henner M Schmidt
- Center for Visceral, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland
| | - Paul M Schneider
- Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Schröder
- Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany
| | - Pieter C van der Sluis
- Department of General-, Visceral-, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| |
Collapse
|
11
|
Li LQ, Liang L, Sun LY, Li C, Wu H, Zhang YM, Zhang WG, Wang H, Zhou YH, Gu WM, Chen TH, Li J, Liang YJ, Xu QR, Diao YK, Jia HD, Wang MD, Zhang CW, Shen F, Huang DS, Yang T. Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2551-2560. [PMID: 33934940 DOI: 10.1016/j.ejso.2021.04.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/04/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC. METHODS The data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity. RESULTS Among 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126-1.451; P < 0.001) and recurrence (1.187; 1.058-1.331; P = 0.004). CONCLUSION This large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important.
Collapse
Affiliation(s)
- Lin-Qiang Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Liang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Li-Yang Sun
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Chao Li
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China
| | - Yao-Ming Zhang
- The Second Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou, Guangdong, China
| | - Wan-Guang Zhang
- Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong Wang
- Department of General Surgery, Liuyang People's Hospital, Liuyang, Hunan, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Pu'er, Yunnan, China
| | - Wei-Min Gu
- The First Department of General Surgery, the Fourth Hospital of Harbin, Harbin, Heilongjiang, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People's Hospital, Ziyang, Sichuan, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qiu-Ran Xu
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China; Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yong-Kang Diao
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hang-Dong Jia
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ming-Da Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China
| | - Cheng-Wu Zhang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China.
| | - Dong-Sheng Huang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China; Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
| | - Tian Yang
- Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Navy Medical University, Shanghai, China.
| |
Collapse
|
12
|
Ueda K, Murakami J, Tanaka T, Nakamura T, Yoshimine S, Hamano K. Postoperative Complications and Cancer Recurrence: Impact on Poor Prognosis of Lower Lobe Cancer. Ann Thorac Surg 2020; 109:1750-1756. [PMID: 32057809 DOI: 10.1016/j.athoracsur.2019.12.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 09/03/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous reports suggest that lung cancer in the lower lobe is associated with a poorer prognosis than upper lobe disease. However, the reason remains controversial. We evaluated the relationship among the affected lobe, postoperative infectious complications, and cancer recurrence in patients who underwent lobectomy for clinical stage I lung cancer. METHODS We retrospectively reviewed 422 cases of resected lung cancer. We recorded the postoperative complications that developed within 30 days after surgery. The covariates included in the outcome analysis were patient demographic variables, surgical approach, laterality, affected lobe, tumor size, histologic type, tumor grade, pleural lavage cytology, pleural invasion, lymphovascular invasion, and lymph node metastasis. RESULTS Lower lobectomy was associated with significantly poorer recurrence-free (excluding nonspecific death) and overall survival than upper lobectomy. According to a stepwise multiple Cox proportional hazards analysis, lower lobectomy, lymph node metastasis, tumor grade, and pleural invasion were independent predictors of recurrence. The following postoperative complications were significantly associated with cancer recurrence and predominantly developed after lower lobectomy: any grade ≥3 complications (n = 61), space/organ surgical site infection of any grade (n = 55), and any infection requiring antibiotics (n = 61). CONCLUSIONS The current study revealed a significant relationship among the site of resection (upper or lower lobe), cancer recurrence, and occurrence of infectious complications. We must clarify the role of preventing infectious complications in improving the early- and long-term outcomes of lower lobe cancer.
Collapse
Affiliation(s)
- Kazuhiro Ueda
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan; Department of General Thoracic Surgery, Kagoshima University Graduate School of Medicine, Kagoshima, Japan.
| | - Junichi Murakami
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiki Tanaka
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Tamami Nakamura
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Sota Yoshimine
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| |
Collapse
|
13
|
Saunders JH, Yanni F, Dorrington MS, Bowman CR, Vohra RS, Parsons SL. Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection. Br J Surg 2019; 107:103-112. [DOI: 10.1002/bjs.11318] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/02/2019] [Accepted: 07/01/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear.
Methods
All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien–Dindo classification (grades 0–V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan–Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination.
Results
Some 1100 patients were included, with a median age of 69 (range 28–92) years; 48·1 per cent had stage III disease and cancer recurred in 428 patients (38·9 per cent). Complications of grade III or higher occurred in 244 patients (22·2 per cent). The most common complications were pulmonary (29·9 per cent), with a 13·0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10·0 and 9·6 per cent respectively. Patients with a grade III–IV leak did not have significantly reduced overall survival compared with those who had grade 0–I complications. However, patients with grade III–IV non-leak-related complications had reduced median overall survival (19·7 versus 42·7 months; P < 0·001) and disease-free survival (18·4 versus 36·4 months; P < 0·001). Cox regression analysis identified age, tumour stage, resection margin and grade III–IV non-leak-related complications as independent predictors of poor overall and disease-free survival.
Conclusion
Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival.
Collapse
Affiliation(s)
- J H Saunders
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - F Yanni
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M S Dorrington
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - C R Bowman
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - R S Vohra
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - S L Parsons
- Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| |
Collapse
|
14
|
de Almeida JR, Yao CM, Ziai H, Staibano P, Huang SH, Hosni A, Hope A, Bratman SV, Monteiro E, Gilbert RW, Brown DH, Gullane PJ, Irish JC, Su J, Xu W, Goldstein DP. Postoperative wound infections, neutrophil-to-lymphocyte ratio, and cancer recurrence in patients with oral cavity cancer undergoing surgical resection. Oral Oncol 2019; 97:23-30. [DOI: 10.1016/j.oraloncology.2019.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
|
15
|
Yang T, Liu K, Liu CF, Zhong Q, Zhang J, Yu JJ, Liang L, Li C, Wang MD, Li ZL, Wu H, Xing H, Han J, Lau WY, Zeng YY, Zhou YH, Gu WM, Wang H, Chen TH, Zhang YM, Zhang WG, Pawlik TM, Wu MC, Shen F. Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma. Br J Surg 2019; 106:1228-1236. [PMID: 31276196 DOI: 10.1002/bjs.11231] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/05/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative complications have a great impact on the postoperative course and oncological outcomes following major cancer surgery. Among them, infective complications play an important role. The aim of this study was to evaluate whether postoperative infective complications influence long-term survival after liver resection for hepatocellular carcinoma (HCC). METHODS Patients who underwent resection with curative intent for HCC between July 2003 and June 2016 were identified from a multicentre database (8 institutions) and analysed retrospectively. Independent risk factors for postoperative infective complications were identified. After excluding patients who died 90 days or less after surgery, overall survival (OS) and recurrence-free survival (RFS) were compared between patients with and without postoperative infective complications within 30 days after resection. RESULTS Among 2442 patients identified, 332 (13·6 per cent) had postoperative infective complications. Age over 60 years, diabetes mellitus, obesity, cirrhosis, intraoperative blood transfusion, duration of surgery exceeding 180 min and major hepatectomy were identified as independent risk factors for postoperative infective complications. Univariable analysis revealed that median OS and RFS were poorer among patients with postoperative infective complications than among patients without (54·3 versus 86·8 months, and 22·6 versus 43·2 months, respectively; both P < 0·001). After adjustment for other prognostic factors, multivariable Cox regression analyses identified postoperative infective complications as independently associated with decreased OS (hazard ratio (HR) 1·20, 95 per cent c.i. 1·02 to 1·41; P = 0·027) and RFS (HR 1·19, 1·03 to 1·37; P = 0·021). CONCLUSION Postoperative infective complications decreased long-term OS and RFS in patients treated with liver resection for HCC.
Collapse
Affiliation(s)
- T Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - K Liu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - C-F Liu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Q Zhong
- Department of Anaesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - J Zhang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - J-J Yu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - L Liang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - C Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - M-D Wang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Z-L Li
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - H Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - H Xing
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - J Han
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - W Y Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
- Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Y-Y Zeng
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian, China
| | - Y-H Zhou
- Department of Hepatobiliary Surgery, Pu'er People's Hospital, Yunnan, China
| | - W-M Gu
- First Department of General Surgery, Fourth Hospital of Harbin, Heilongjiang, China
| | - H Wang
- Department of General Surgery, Liuyang People's Hospital, Hunan, China
| | - T-H Chen
- Department of General Surgery, Ziyang First People's Hospital, Sichuan, China
| | - Y-M Zhang
- Second Department of Hepatobiliary Surgery, Meizhou People's Hospital, Guangdong, China
| | - W-G Zhang
- Department of Hepatic Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - T M Pawlik
- Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - M-C Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - F Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
16
|
Zhao B, Zhang J, Mei D, Luo R, Lu H, Xu H, Huang B. Does high body mass index negatively affect the surgical outcome and long-term survival of gastric cancer patients who underwent gastrectomy: A systematic review and meta-analysis. Eur J Surg Oncol 2018; 44:1971-1981. [PMID: 30348605 DOI: 10.1016/j.ejso.2018.09.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/05/2018] [Accepted: 09/16/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Whether high body mass index (BMI) was associated with increased postoperative complications and unfavorable prognosis of gastric cancer (GC) patients remain controversial. In the present study, we performed a systematic review and meta-analysis to evaluate the impact of high BMI on surgical outcome, postoperative complications and long-term survival of GC patients. METHODS The related studies were identified by searching PubMed and Embase databases. According to the BMI, all GC patients were classified into BMI ≥25 kg/m2 group and BMI <25 kg/m2 group. The relevant data was extracted and pooled effect size was assessed using a fixed effect model or random effect model. RESULTS A total of 36 relevant studies involving 30,642 GC patients were included in this meta-analysis. The results indicated that high BMI patients had longer operation time, fewer number of retrieved lymph nodes and larger amount of intraoperative blood loss than other patients, regardless of open gastrectomy or laparoscopic gastrectomy. In addition, the risk of postoperative complications was significantly higher in the patients with BMI ≥25 kg/m2 than in those with BMI <25 kg/m2, especially for infectious complications. However, high BMI had no negative impact on postoperative mortality and long-term survival of GC patients. CONCLUSION Despite the increased surgical difficulty and postoperative complications, high BMI was not associated with the prognosis of GC patients. To reduce the risk of postoperative complications, more meticulous operation technique and improved perioperative management should be necessary for high BMI patients.
Collapse
Affiliation(s)
- Bochao Zhao
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Jingting Zhang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Di Mei
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Rui Luo
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Huiwen Lu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Huimian Xu
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China
| | - Baojun Huang
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, 110001, PR China.
| |
Collapse
|
17
|
Hsu HY, Yu MC, Lee CW, Tsai HI, Sung CM, Chen CW, Huang SW, Lin CY, Jeng WJ, Lee WC, Chen MF. RAM score is an effective predictor for early mortality and recurrence after hepatectomy for hepatocellular carcinoma. BMC Cancer 2017; 17:742. [PMID: 29121890 PMCID: PMC5680811 DOI: 10.1186/s12885-017-3748-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/01/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Liver resection had been regarded as a standard treatment for primary hepatocellular carcinoma (HCC). However, early mortality and recurrence after surgery were still of major concern. RAM (Risk Assessment for early Mortality) scoring system is a newly developed tool for assessing early mortality after hepatectomy for HCC. In this study, we compared RAM scoring system with ALBI and MELD scores for their capability of predicting short-term outcome. METHODS We retrospectively reviewed patients with hepatocellular carcinoma who were treated with hepatectomy at Chang Gung Memorial Hospital between 1986 and 2015. Their clinical characteristics and perioperative variables were collected. We applied RAM, albumin-bilirubin (ALBI), and model for end-stage liver disease (MELD) scoring systems to predict early mortality and early recurrence in HCC patients after surgery. We investigated the discriminative power of each scoring system by receiver operating characteristic (ROC) curve and area under the ROC curve (AUC). RESULTS A total of 1935 patients (78% male) who underwent liver resection for HCC were included in this study. The median follow-up period was 41.9 months. One hundred and forty-nine patients (7.7%) died within 6 months after hepatectomy (early mortality). All the three scoring systems were effective predictor for early mortality, with higher score indicating higher risk of early mortality (AUC of RAM = 0.723, p < 0.001; AUC of ALBI = 0.682, p < 0.001; AUC of MELD = 0.590, p = 0.002). Cox regression multivariate analysis demonstrated that the RAM class was the most significant independent predictor of early mortality after surgery, while MELD grade failed to discriminatively predict early mortality. In addition to early mortality, the RAM score was also predictive of early recurrence in HCC after surgery. CONCLUSIONS This study demonstrated that RAM score is an effective and user-friendly bedside scoring system to predict early mortality and early recurrence after hepatectomy for HCC. In addition, the predictive capability of RAM score is superior to ALBI and MELD scores. Further study is warranted to validate our findings.
Collapse
Affiliation(s)
- Heng-Yuan Hsu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Hsin-I Tsai
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Chang-Mu Sung
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Chun-Wei Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Shu-Wei Huang
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Cheng-Yu Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Wei-Chen Lee
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
| | - Miin-Fu Chen
- Department of Surgery, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan, 333 Taiwan, Republic of China
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| |
Collapse
|