title: Patterns of operative mortality following esophagectomy.
abstract: Esophagectomy has one of the highest mortality rates among all surgical procedures. We investigated the type and frequency of complications associated with perioperative mortality after esophagectomy. We performed a retrospective review of all perioperative deaths following esophagectomy for esophageal cancer at the Mayo Clinic, Rochester from 1993 through 2009. Of 1522 esophagectomies, perioperative mortality occurred in 45 (3.0%). The majority who died were male (82%); median age was 72 years (range 46-92). The median age-adjusted Charlson comorbidity score was 6. Twenty-three (51%) underwent neoadjuvant chemoradiotherapy. The type of esophagectomy was transthoracic in 27 patients (60%), transhiatal in eight (18%), tri-incisional in seven (16%), left thoracoabdominal in one (2%), and transabdominal in one (2%). A mean of 3.2 major complications occurred prior to death (median 2.5, range 1-8), with the most common being pulmonary complications occurring in 30 patients (67%) and anastomotic complications in 20 (44%). The primary underlying cause of death was pulmonary complications and anastomotic complications in 18 patients (40%) each, respectively, abdominal sepsis in three (7%), fatal hemorrhage in three (7%), and pulmonary embolism, stroke and multisystem organ failure in one each (2%), respectively. Patients died a median of 19 days (range 3-98) following esophagectomy. Most patients who died following esophagectomy experienced multiple serious complications rather than a single causative event. Major pulmonary and anastomotic complications were implicated in the vast majority of perioperative mortality, and should remain the focus of efforts to improve clinical outcomes.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: C
authors.initials: C
authors.lastname: Schieman
authors.forename: D A
authors.initials: DA
authors.lastname: Wigle
authors.forename: C
authors.initials: C
authors.lastname: Deschamps
authors.forename: F C
authors.initials: FC
authors.lastname: Nichols Iii
authors.forename: S D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: K R
authors.initials: KR
authors.lastname: Shen
authors.forename: M S
authors.initials: MS
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000401:mortality*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D019106:Postoperative Hemorrhage / Q000401:mortality*; D012128:Respiratory Distress Syndrome / Q000401:mortality*; D012189:Retrospective Studies; D012737:Sex Factors