Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy
Masaru Hayami MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Masayuki Watanabe MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Correspondence
Masayuki Watanabe, MD, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake 3-chome, Koto-ku, Tokyo 135-8550, Japan.
Email: [email protected]
Search for more papers by this authorNaoki Ishizuka PhD
Department of Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorShinji Mine MD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYu Imamura MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkihiko Okamura MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTakanori Kurogochi MD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorKotaro Yamashita MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorMasaru Hayami MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorCorresponding Author
Masayuki Watanabe MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Correspondence
Masayuki Watanabe, MD, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 8-31, Ariake 3-chome, Koto-ku, Tokyo 135-8550, Japan.
Email: [email protected]
Search for more papers by this authorNaoki Ishizuka PhD
Department of Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorShinji Mine MD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorYu Imamura MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAkihiko Okamura MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorTakanori Kurogochi MD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorKotaro Yamashita MD, PhD
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
Search for more papers by this authorAbstract
Background
Postoperative complications after esophagectomy for esophageal cancer have a negative effect on patients’ survival. Although postoperative complications are more frequently observed after salvage esophagectomy than after planned esophagectomy, the effects of postoperative complications on long-term oncologic outcomes after salvage esophagectomy remain unclear.
Methods
This retrospective study of 70 esophageal cancer patients after definitive chemoradiotherapy (dCRT) compared long-term outcomes between those with and without complications. The association between morbidity and overall survival (OS) was evaluated by a Cox regression analysis. To identify the risk factors for pulmonary complications, logistic regression analysis was carried out.
Results
Postoperative complications occurred in 42 (60.0%) patients. Pulmonary complications and anastomotic leakage occurred in 23 (32.9%) and 9 (12.9%) patients, respectively. Overall complications and anastomotic leakage did not affect long-term outcomes. Survival was significantly worse for patients with pulmonary complications. Radiation dose (<60 Gy), response to dCRT (complete), ypStage (0-II), residual disease (R0), and pulmonary complications (negative) were independent factors related to a favorable OS. BMI (<20 kg/m2), ASA-PS (2-3), and radiation dose (>60 Gy) were significant factors affecting the occurrence of pulmonary complications.
Conclusions
Development of postoperative pulmonary complications was independently associated with poor prognosis in patients who underwent salvage esophagectomy after dCRT.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
Supporting Information
Additional Supporting Information may be found online in the supporting information tab for this article.
| Filename | Description |
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| jso24941-sup-0001-SuppFig-S1.tif1.5 MB | Supporting Figure S1. |
| jso24941-sup-0002-SuppFig-S2.tif2 MB | Supporting Figure S2. |
| jso24941-sup-0003-SuppTab-S1.doc63.5 KB | Supporting Table S1. |
| jso24941-sup-0004-SuppTab-S2.doc42.5 KB | Supporting Table S2. |
| jso24941-sup-0005-SuppTab-S3.doc64.5 KB | Supporting Table S3. |
| jso24941-sup-0006-SuppTab-S4.doc53 KB | Supporting Table S4. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1 Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. Jama. 1999; 281: 1623–1627.
- 2 Kato H, Sato A, Fukuda H, et al. A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708). Jpn J Clin Oncol. 2009; 39: 638–643.
- 3 Kato K, Muro K, Minashi K, et al. Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for stage II-III esophageal squamous cell carcinoma: JCOG trial (JCOG 9906). Int J Radiat Oncol Biol Phys. 2011; 81: 684–690.
- 4 Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999; 17: 2915–2921.
- 5 Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg. 2002; 123: 175–183.
- 6 Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ. Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg. 2007; 94: 1059–1066.
- 7 Tachimori Y. Role of salvage esophagectomy after definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg. 2009; 57: 71–78.
- 8 Nakamura T, Hayashi K, Ota M, et al. Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg. 2004; 188: 261–266.
- 9 Takeuchi H, Saikawa Y, Oyama T, et al. Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. World J Surg. 2010; 34: 277–284.
- 10 Yamashita K, Makino T, Miyata H, et al. Postoperative infectious complications are associated with adverse oncologic outcomes in esophageal cancer patients undergoing preoperative chemotherapy. Ann Surg Oncol. 2016; 23: 2106–2114.
- 11 Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016; 264: 305–311.
- 12 Kataoka K, Takeuchi H, Mizusawa J, et al. Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: exploratory analysis of JCOG9907. Ann Surg. 2016; 265: 1152–1157.
- 13 Saeki H, Tsutsumi S, Tajiri H, et al. Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg. 2017; 265: 527–533.
- 14 Kinugasa S, Tachibana M, Yoshimura H, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004; 88: 71–77.
- 15 Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg. 2004; 198: 42–50.
- 16 Rutegard M, Lagergren P, Rouvelas I, et al. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol. 2012; 38: 555–561.
- 17 Sobin LH, Gospodarowicz MK, Wittekind C (eds). TNM classification of malignant tumors. Oxford: Wiley-Blackwell; 2010.
- 18 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205–213.
- 19 Okamura A, Takeuchi H, Matsuda S, et al. Factors affecting cytokine change after esophagectomy for esophageal cancer. Ann Surg Oncol. 2015; 22: 3130–3135.
- 20 Matsuda S, Takeuchi H, Kawakubo H, et al. Correlation between intense postoperative inflammatory response and survival of esophageal cancer patients who underwent transthoracic esophagectomy. Ann Surg Oncol. 2015; 22: 4453–4460.
- 21 Hiramatsu T, Sugiyama M, Kuwabara S, et al. Effectiveness of an outpatient preoperative care bundle in preventing postoperative pneumonia among esophageal cancer patients. Am J Infect Control. 2014; 42: 385–388.
- 22 Mackay MR, Ellis E, Johnston C. Randomised clinical trial of physiotherapy after open abdominal surgery in high risk patients. Aust J Physiother. 2005; 51: 151–159.
- 23 Watanabe M, Mine S, Nishida K, et al. Improvement in short-term outcomes after esophagectomy with a multidisciplinary perioperative care team. Esophagus. 2016; 13: 337–342.
- 24 Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002; 50: 430–433.
- 25 Ida S, Watanabe M, Yoshida N, et al. Sarcopenia is a predictor of postoperative respiratory complications in patients with esophageal cancer. Ann Surg Oncol. 2015; 22: 4432–4437.
- 26 Takeuchi H, Ikeuchi S, Kawaguchi Y, et al. Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg. 2007; 31: 2160–2167.
- 27 Teoh AY, Yan Chiu PW, Wong TC, et al. Functional performance and quality of life in patients with squamous esophageal carcinoma receiving surgery or chemoradiation: results from a randomized trial. Ann Surg. 2011; 253: 1–5.
- 28 Movsas B, Raffin TA, Epstein AH, Link CJ, Jr. Pulmonary radiation injury. Chest. 1997; 111: 1061–1076.
- 29 Lee HK, Vaporciyan AA, Cox JD, et al. Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters. Int J Radiat Oncol Biol Phys. 2003; 57: 1317–1322.
- 30 Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol. 2002; 20: 1167–1174.
- 31 Kim HJ, Suh YG, Lee YC, et al. Dose-response relationship between radiation dose and loco-regional control in patients with stage II-III esophageal cancer treated with definitive chemoradiotherapy. Cancer Res Treat. 2017; 49: 669–677.
- 32 Markar S, Gronnier C, Duhamel A, et al. Salvage surgery after chemoradiotherapy in the management of esophageal cancer: is it a viable therapeutic option? J Clin Oncol. 2015; 33: 3866–3873.
- 33 Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012; 379: 1887–1892.
- 34 Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012; 256: 95–103.
- 35 Palanivelu C, Prakash A, Senthilkumar R, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position-experience of 130 patients. J Am Coll Surg. 2006; 203: 7–16.
- 36 Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: who really benefits from this high-risk surgery? Ann Surg Oncol. 2015; 22: 4438–4444.
- 37 Miyata H, Yamasaki M, Takiguchi S, et al. Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol. 2009; 100: 442–446.
