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Short-term outcome for high-risk patients after esophagectomy. / Dutch Upper GI Cancer Audit Group.
In: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, Vol. 36, No. 1, 31.12.2022.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Short-term outcome for high-risk patients after esophagectomy
AU - Plat, Victor D.
AU - Stam, Wessel T.
AU - Bootsma, Boukje T.
AU - Straatman, Jennifer
AU - Klausch, Thomas
AU - Dutch Upper GI Cancer Audit Group
AU - Heineman, David J.
AU - van der Peet, Donald L.
AU - Daams, Freek
N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.
PY - 2022/12/31
Y1 - 2022/12/31
N2 - Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection; however, it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Of 5,438 patients, 945 and 431 high-risk patients underwent TTE and THE, respectively. After propensity score matching, mortality (6.3 vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥ 3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0 vs. 2.2%, P = 0.020). Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice, these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.
AB - Transthoracic esophagectomy (TTE) for esophageal cancer facilitates mediastinal dissection; however, it has a significant impact on cardiopulmonary status. High-risk patients may therefore be better candidates for transhiatal esophagectomy (THE) in order to prevent serious complications. This study addressed short-term outcome following TTE and THE in patients that are considered to have a higher risk of surgery-related morbidity. This population-based study included patients who underwent a curative esophagectomy between 2011 and 2018, registered in the Dutch Upper GI Cancer Audit. The Charlson comorbidity index was used to assign patients to a low-risk (score ≤ 1) and high-risk group (score ≥ 2). Propensity score matching was applied to produce comparable groups between high-risk patients receiving TTE and THE. Primary endpoint was mortality (in-hospital/30-day mortality), secondary endpoints included morbidity and oncological outcomes. Additionally, a matched subgroup analysis was performed, including only cervical reconstructions. Of 5,438 patients, 945 and 431 high-risk patients underwent TTE and THE, respectively. After propensity score matching, mortality (6.3 vs 3.3%, P = 0.050), overall morbidity, Clavien-Dindo ≥ 3 complications, pulmonary complications, cardiac complications and re-interventions were significantly more observed after TTE compared to THE. A significantly higher mortality after TTE with a cervical reconstruction was found compared to THE (7.0 vs. 2.2%, P = 0.020). Patients with a high Charlson comorbidity index predispose for a complicated postoperative course after esophagectomy, this was more outspoken after TTE compared to THE. In daily practice, these outcomes should be balanced with the lower lymph node yield, but comparable positive node count and radicality after THE.
KW - Charlson comorbidity index
KW - mortality
KW - population-based
KW - propensity score matching
KW - transhiatal esophagectomy
KW - transthoracic esophagectomy
UR - http://www.scopus.com/inward/record.url?scp=85145954621&partnerID=8YFLogxK
U2 - 10.1093/dote/doac028
DO - 10.1093/dote/doac028
M3 - Article
C2 - 35724560
VL - 36
JO - Diseases of the esophagus
JF - Diseases of the esophagus
SN - 1120-8694
IS - 1
ER -
ID: 30842709