title: Major post-operative complications predict long-term survival after esophagectomy in patients with adenocarcinoma of the esophagus.
abstract: BACKGROUND
  Esophagectomy provides the best opportunity for a long-term cure despite its high post-operative morbidity. We reviewed our institutional records to evaluate the impact of major post-operative complications on the long-term survival of patients following esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.
  
  
  METHODS
  We identified 241 patients who underwent esophagectomy as a curative procedure at our tertiary referral center. All consecutive patients with locally advanced adenocarcinoma of the esophagus who underwent neoadjuvant treatment followed by esophagectomy were analyzed. Complications were graded according to the Clavien scale. Patients were compared according to the complication grade (grades 0-1-2 vs. grades 3-4). Overall survival and disease-free survival were calculated using the Kaplan-Meier method, and survival curves were compared using log-rank tests. Factors predictive of survival were determined using multivariate analysis.
  
  
  RESULTS
  A total of 116 patients underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma of the esophagus. Fifty-four patients (46.5 %) developed post-operative complications. The post-operative mortality rate was 4.3 % (five patients). Patients with grade 3-4 complications had decreased overall survival and disease-free survival rates (p = 0.006 and 0.045). Grade 3-4 complications and positive nodes were found to be contributing factors to survival (p = 0.027 and 0.005).
  
  
  CONCLUSIONS
  Our single-institution study found that major morbidity had a negative impact on long-term survival in patients who underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.
authors.affiliation: Department of Digestive Surgery, University Hospital of Bordeaux, Maison du Haut-Lévêque, Avenue de Magellan, 33000, Bordeaux, France, guillaume.luc33@yahoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Luc
authors.forename: Marlène
authors.initials: M
authors.lastname: Durand
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011014:Pneumonia / Q000209:etiology; D011183:Postoperative Complications; D012128:Respiratory Distress Syndrome / Q000209:etiology; D012189:Retrospective Studies