Surgical and long-term outcomes following oesophagectomy in oesophageal cancer patients with comorbidity.
BACKGROUND
The elucidation of the clinical impact of comorbidities is important to optimize the treatment and follow-up strategy in oesophageal cancer. We aimed to clarify the surgical and long-term outcomes following oesophagectomy in oesophageal cancer patients with comorbidity.


METHODS
A total of 658 consecutive patients who underwent oesophagectomy for oesophageal cancer between 1985 and 2008 at our institution were enrolled. Based on the criteria of comorbidity as we defined it, we retrospectively reviewed and compared the surgical outcomes and survival between the comorbid (n = 251) and non-comorbid group (n = 407).


RESULTS
Postoperative morbidity and mortality were not significantly different between the two groups. The 5-year overall survival rate of the comorbid group was significantly lower (39.3% vs. 45.2%, adjusted HR = 1.31, 95% CI: 1.07-1.62) but the 5-year disease-specific survival rate was not significantly different between the comorbid and non-comorbid groups (53.9% vs. 53.1%, adjusted HR = 1.11, 95% CI: 0.86-1.42). The 5-year incidence rate of death from other diseases in the comorbid group was significantly higher than that in the non-comorbid group (26.7% vs. 14.8%, P < 0.01). The leading cause of death from other diseases was pneumonia.


CONCLUSIONS
Oesophagectomy in oesophageal cancer patients with comorbidity can be safely performed. However, the overall survival after oesophagectomy in these patients was unfavorable because of the high incidence of death from other diseases, especially pneumonia.
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Hiroshi
H
Ichikawa
Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University, Medical and Dental Hospital, Niigata 949-7320, Japan. Electronic address: sugishin@med.niigata-u.ac.jp.
Shin-Ichi
SI
Kosugi
Department of Surgery, Sanjo General Hospital, 5-1-62 Tsukanome, Sanjo-shi, Niigata 955-0055, Japan.
Tatsuo
T
Kanda
Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan.
Kazuhito
K
Yajima
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Takashi
T
Ishikawa
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Takaaki
T
Hanyu
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Yusuke
Y
Muneoka
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Takahiro
T
Otani
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Masayuki
M
Nagahashi
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Jun
J
Sakata
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Takashi
T
Kobayashi
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Hitoshi
H
Kameyama
Division of Digestive and General Surgery, Niigata University, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
Toshifumi
T
Wakai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology / Q000401:mortality; D008171:Lung Diseases / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000401:mortality; D009765:Obesity / Q000453:epidemiology / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D051437:Renal Insufficiency / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies
Comorbidity; Oesophageal cancer; Oesophagectomy