Postoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality.
BACKGROUND
Major postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclear whether these complications impact equally on long-term outcome.


METHODS
Prospective observational study including the patients admitted to the surgical intensive care unit between January 2009 and October 2011 after elective gastroesophageal and pancreatic surgery. Risk factors for 30-day major postoperative events and long-term outcome were evaluated.


RESULTS
During the study period, 259 patients were consecutively included. Among them, 166 (64%), 54 (21%), and 39 (15%) patients underwent pancreatic surgery, gastric surgery, and esophageal surgery, respectively. Using the Clavien-Dindo classification, 117 patients (45%) developed at least 1 postoperative complication, including 60 (23%) patients with acute respiratory failure, 77 (30%) with sepsis, and 89 (34%) with surgical complications. The median follow-up from the time of intensive care unit admission was 34 months (95% confidence interval, 30-37 months). The 1-year survival was 95% (95% confidence interval, 92-98). Among the perioperative variables, postoperative sepsis and an American Society of Anesthesiologists score higher than 2 were independently associated with long-term mortality. In septic patients, death (n = 16) was significantly associated with cancer recurrence (n = 10; P < .0001). Independent factors associated with postoperative sepsis were a Sequential Organ Failure Assessment score on day 1, a systemic inflammatory response syndrome on day 3, positive intraoperative microbiological samples, Simplified Acute Physiology Score II and an American Society of Anesthesiologists score higher than 2 (P < .005).


CONCLUSIONS
Postoperative sepsis was the only major postoperative event associated with long-term mortality. Postoperative sepsis may reflect a deep impairment of immune response, which is potentially associated with cancer recurrence and mortality.
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France. Electronic address: mokartd@ipc.unicancer.fr.
Djamel
D
Mokart
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Emmanuelle
E
Giaoui
Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France.
Louise
L
Barbier
Service de Biostatistique et Information Médicale, Hôpital Saint Louis, Université Paris Diderot, Paris, France.
Jérôme
J
Lambert
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Antoine
A
Sannini
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Laurent
L
Chow-Chine
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Jean-Paul
JP
Brun
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Marion
M
Faucher
Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France.
Jérôme
J
Guiramand
Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France.
Jacques
J
Ewald
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Magali
M
Bisbal
Réanimation Polyvalente, Département d'anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France.
Jean-Louis
JL
Blache
Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France.
Jean-Robert
JR
Delpero
Service d'Anesthésie-Réanimation, Hopital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
Marc
M
Leone
Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France.
Olivier
O
Turrini
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery; D018281:Cholangiocarcinoma / Q000601:surgery; D017558:Elective Surgical Procedures; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000601:surgery*; D018358:Neuroendocrine Tumors / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D013274:Stomach Neoplasms / Q000601:surgery
Acute respiratory failure; Major cancer surgery; Postoperative sepsis; Prognosis