Prognostic Impact of Postoperative Morbidity After Esophagectomy for Esophageal Cancer: Exploratory Analysis of JCOG9907.
To investigate the influence of infectious complications on the outcome of current standard preoperative chemotherapy followed by surgery for clinical stage II/III esophageal cancer.



The impact of postoperative infectious complications on survival after transthoracic esophagectomy remains controversial.



Data from a randomized controlled trial (JCOG9907) were used. Infectious complications were classified into three groups: pneumonia, anastomotic leakage, and others. Univariate and multivariate analyses using the Cox proportional hazard model were performed.



Among the 152 analyzed patients, the incidence of pneumonia, leakage, and overall infectious complication were 22 (14%), 21 (14%), and 54 (36%). Overall survival (OS) of patients with any infectious complication was shorter than that of patients without infectious complication [hazard ratio, HR 1.66, 95% confidence interval, CI, (1.02-2.71)] and progression-free survival (PFS) also tended to be shorter in patients with any infectious complication [HR 1.44, (0.92-2.24)]. The OS of patients with pneumonia was shorter than that of patients without pneumonia [HR 1.82, (1.01-3.29)], and PFS also tended to be shorter in patients with pneumonia [HR 1.50, (0.85-2.62)]. The OS of patients with anastomotic leakage (n = 21) was nearly identical to that for patients without leakage [HR 1.06, (0.52-2.13)] and PFS showed the same tendency [HR 1.28, (0.71-2.32)]. Multivariate analysis revealed that pneumonia tended to compromise OS and PFS [HR 1.66, (0.87-3.17) and HR 1.37, (0.75-2.51)].



These results indicate that postoperative infectious complications may worsen patient prognosis after esophagectomy. Performing esophagectomy without postoperative complications, especially pneumonia, may be beneficial for improving survival outcomes.
*JCOG Data Center/Operations Office, National Cancer Center, Tokyo, Japan †Department of Surgery, Keio University School of Medicine, Tokyo, Japan ‡Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan §Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan ¶Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan ||Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan **International Goodwill Hospital, Yokohama, Japan.
Kozo
K
Kataoka
Hiroya
H
Takeuchi
Junki
J
Mizusawa
Hiroyasu
H
Igaki
Soji
S
Ozawa
Tetsuya
T
Abe
Kenichi
K
Nakamura
Ken
K
Kato
Nobutoshi
N
Ando
Yuko
Y
Kitagawa
D057868:Anastomotic Leak / Q000453:epidemiology; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000453:epidemiology*; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D016019:Survival Analysis