title: Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence.
abstract: BACKGROUND
  Esophagectomy is frequently accompanied by substantial complications with secondary disturbance of the immune system. After esophagectomy for adenocarcinoma of the distal esophagus and/or gastroesophageal junction, the majority of patients develops an early recurrence and dies within 2 years. The aim of this study was to determine the relevance of perioperative complications on the timing of death due to recurrence.
  
  
  METHODS
  A consecutive series of 351 patients who underwent esophagectomy for adenocarcinoma of the esophagus and gastroesophageal junction was reviewed.
  
  
  RESULTS
  Of the 351 included patients, 191 patients (54%) died due to recurrence of esophageal adenocarcinoma. Of these 191 patients, 77 (40%), 138 (72%), and 186 patients (97%) died before 12, 24, and 60 months, respectively. Multivariate Cox regression analysis demonstrated that T-stage, lymph node ratio >0.20, the presence of extracapsular lymph node involvement, but not complications were significant factors for the prediction of death due to cancer recurrence. However, in the patients who died, multivariate Cox regression analysis demonstrated that not only the presence of extracapsular lymph node involvement but also the occurrence of complications were significantly related with a shorter time interval until death due to recurrence.
  
  
  CONCLUSIONS
  The relation between perioperative complications and cancer recurrence per se is not causal. However, postoperative complications are independently associated with the early timing of death due to cancer recurrence. A possible explanation for this phenomenon is that immunologic host factors enhance microscopic residual disease to develop more rapidly into clinically manifest recurrence.
authors.affiliation: Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands. sjoerdlagarde@hotmail.com
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Johannes D
authors.initials: JD
authors.lastname: de Boer
authors.forename: Fiebo J W
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.forename: Huug
authors.initials: H
authors.lastname: Obertop
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors