The influence of technical complications on postoperative outcome and survival after esophagectomy.
BACKGROUND
The dismal survival associated with esophagectomy for cancer has led to the search for potentially correctable factors responsible for this poor prognosis. Although it is intuitive that technical complications could increase postoperative mortality, the effect on long-term survival is controversial.


METHODS
From 1990 to 2002, 434 patients underwent resection for squamous cell carcinoma of the intrathoracic esophagus. Prospectively collected data were reviewed for the presence of technical complications. Patient, tumor, and operative variables, postoperative outcome, and survival were compared between patients with technical complications and those without. Prognostic factors were assessed by multivariate analysis.


RESULTS
Technical complications occurred in 98 (22.6%) patients. Patients with technical complications had a higher prevalence of cardiac disease, more proximal tumors, and more cervical anastomoses. Technical complications were associated with an increased rate of pulmonary complications (37.8% vs. 10.7%; P<.001) and increased hospital mortality (9.2% vs. 3.3%; P=.025), but no difference in 30-day mortality (2% vs. 1.2%; P=.6). Poor-prognostic factors for survival included male sex, stage III/IV disease, cirrhosis, proximal tumors, and R1/R2 resection, but not technical complications.


CONCLUSIONS
Although immediate postoperative outcome and hospital mortality rates were increased, no effect on long-term survival was seen in patients with complications related to errors in surgical technique.
Ferri
Lorenzo E
LE
Department of Surgery, Division of Esophageal Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
Law
Simon
S
Wong
Kam-Ho
KH
Kwok
Ka-Fai
KF
Wong
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D017219:Gastric Outlet Obstruction / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D013529:Surgical Wound Dehiscence; D015996:Survival Rate