title: Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study.
abstract: OBJECTIVE
  The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period.
  
  
  METHODS
  This was a nationwide population-based retrospective cohort study.
  
  
  METHODS
  All hospitals performing oesophageal cancer resections during the study period (1987-2010) in Sweden.
  
  
  METHODS
  Patients operated for oesophageal cancer with curative intent in 1987-2010.
  
  
  METHODS
  Adjusted HRs of all cause, early and late mortality up to 5 years after reoperation following oesophageal cancer resection.
  
  
  RESULTS
  Among 1822 included patients, the 200 (11%) who were reoperated had a 27% increased HR of all-cause mortality (adjusted HR 1.27, 95% CI 1.05 to 1.53) and 28% increased HR of disease-specific mortality (adjusted HR 1.28, 95% CI 1.04 to 1.59), compared to those not reoperated. Reoperation for anastomotic insufficiency in particular was followed by an increased mortality (adjusted HR 1.82, 95% CI 1.19 to 2.76).
  
  
  CONCLUSIONS
  This large and population-based nationwide cohort study shows that reoperation within 30 days after primary oesophageal resection was associated with increased mortality, even after excluding the initial 3 months after surgery. This finding stresses the need to consider any actions that might prevent complications and reoperation after oesophageal cancer resection.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maartje
authors.initials: M
authors.lastname: van der Schaaf
authors.forename: Maryam
authors.initials: M
authors.lastname: Derogar
authors.forename: Asif
authors.initials: A
authors.lastname: Johar
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.forename: James
authors.initials: J
authors.lastname: Gossage
authors.forename: Robert
authors.initials: R
authors.lastname: Mason
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology
keywords: Surgery