Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study

Aims: Acute surgical complications after esophageal resection for cancer may decrease the long-term survival. Previous results on this topic are conflicting and no population-based studies are available.

Methods: A prospective, nationwide Swedish study was conducted in 2001-2010. Eligible patients comprised those afflicted by esophageal or cardia cancer and underwent surgical resection in Sweden in 2001-2005. Details concerning patient and tumor characteristics, surgical procedures, and postoperative surgical complications were collected prospectively. Follow-up for mortality, starting from 90 days after the surgery, was done until May 2010. Cox proportional-hazards regression was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for age, tumor stage, sex, histology, comorbidity, surgical approach and surgical radicality.

Results: Among 567 included patients who survived at least 90 days postoperatively, 130 (22.9%) sustained a predefined surgical complication within 30 days of surgery. The adjusted HR of mortality was increased in patients who sustained surgical complications, compared to patients without such complications (HR 1.29, 95% CI 1.02-1.63).

Conclusions: The occurrence of surgical complications might be an independent predictor for poorer long-term survival in patients resected for esophageal cancer, even in patients who survived the postoperative period.