title: Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer.
abstract: BACKGROUND
  The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE).
  
  
  METHODS
  One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G. The outcomes of interest were operative time, estimated blood loss (EBL), lymph node harvest, length of hospital stay (LOS), major complications, 30-day mortality, and overall survival.
  
  
  RESULTS
  Sixty-four patients (44 %) underwent Open while 71 (49 %) had MIE. An additional (7 %) were converted and classified with MIE. There was no significant difference between MIE and Open in terms of operative time. MIE had less EBL (mean difference = 234 mL, p < 0.001), higher lymph node harvest (mean = 7.4 nodes, p < 0.001), and shorter LOS (median = 1.5 days, p = 0.02). Atrial arrhythmias were the most frequent complication, occurring in 33 % of patients in both the MIE and the Open group (p = 0.988). Thirty-day mortality was 2 % for MIE and 5 % for Open (p = 0.459). Five-year survival was 41 % for MIE and 33 % for Open (p = 0.513). Operative approach, age, gender, BMI, clinical stage, and neoadjuvant therapy did not have any significant effect on the outcomes or overall survival. CCI-G influenced outcomes with operative time, LOS, cardiovascular complication, and anastomotic leak rate, favoring CCI-G 0 compared to CCI-G 3. Overall survival was worse for CCI-G 1 in comparison with CCI-G 0 [hazard ratio (HR) 1.99, p = 0.027].
  
  
  CONCLUSIONS
  MIE is a safe alternative to open esophagectomy for the treatment of locally advanced esophageal cancer. The presence of comorbidities increased operative time, length of hospital stay, and postoperative complications while worsening overall survival.
authors.affiliation: Division of Gastrointestinal and General Surgery, Department of Surgery, and the Digestive Health Center, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR, 97239, USA, dolanj@ohsu.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Dolan
authors.forename: Taranjeet
authors.initials: T
authors.lastname: Kaur
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: Renato A
authors.initials: RA
authors.lastname: Luna
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schipper
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Tieu
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality*; D007902:Length of Stay / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D009367:Neoplasm Staging; D061646:Operative Time; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate