The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy.
Details
Serval ID
serval:BIB_802A288352C7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy.
Journal
Annals of Surgery
Working group(s)
FREGAT (French Eso-Gastric Tumors) working group FRENCH (Fédération de Recherche EN CHirurgie), AFC (Association Française de Chirurgie)
Contributor(s)
Luc G., Cabau M., Jougon J., Badic B., Lozach P., Cappeliez S., Lebreton G., Alves A., Flamein R., Pezet D., Pipitone F., Iuga BS., Contival N., Pappalardo E., Mantziari S., Vanderbeken M., Tessier W., Briez N., Fredon F., Gainant A., Mathonnet M., Bigourdan JM., Mezoughi S., Ducerf C., Baulieux J., Pasquer A., Baraket O., Poncet G., Vaudoyer D., Enfer PJ., Villeneuve L., Glehen O., Coste T., Fabre JM., Marchal F., Frisoni R., Ayav A., Brunaud L., Bresler L., Cohen C., Aze O., Venissac N., Pop D., Mouroux£££Jérôme£££ J. , Donici I., Prudhomme M., Felli E., Lisunfui S., Seman M., Petit GG., Karoui M., Tresallet C., Ménégaux F., Hannoun L., Malgras B., Lantuas D., Pautrat K., Pocard M., Valleur P.
ISSN
1528-1140 (Electronic)
ISSN-L
0003-4932
Publication state
Published
Issued date
2015
Peer-reviewed
Oui
Volume
262
Number
6
Pages
972-980
Language
english
Abstract
OBJECTIVE: The aim of this study was to the determine impact of severe esophageal anastomotic leak (SEAL) upon long-term survival and locoregional cancer recurrence.
BACKGROUND: The impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results.
METHODS: A multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000-2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence.
RESULTS: From a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04-1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15-1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05-2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20-2.71; P = 0.014) recurrences.
CONCLUSIONS: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.
BACKGROUND: The impact of SEAL upon long-term survival after esophageal resection remains inconclusive with a number of studies demonstrating conflicting results.
METHODS: A multicenter database for the surgical treatment of esophageal cancer collected data from 30 university hospitals (2000-2010). SEAL was defined as a Clavien-Dindo III or IV leak. Patients with SEAL were compared with those without in terms of demographics, tumor characteristics, surgical technique, morbidity, survival, and recurrence.
RESULTS: From a database of 2944 operated on for esophageal cancer between 2000 and 2010, 209 patients who died within 90 days of surgery and 296 patients with a R1/R2 resection were excluded, leaving 2439 included in the final analysis; 208 (8.5%) developed a SEAL and significant independent association was observed with low hospital procedural volume, cervical anastomosis, tumoral stage III/IV, and pulmonary and cardiovascular complications. SEAL was associated with a significant reduction in median overall (35.8 vs 54.8 months; P = 0.002) and disease-free (34 vs 47.9 months; P = 0.005) survivals. After adjustment of confounding factors, SEAL was associated with a 28% greater likelihood of death [hazard ratio = 1.28; 95% confidence interval (CI): 1.04-1.59; P = 0.022], as well as greater overall (OR = 1.35; 95% CI: 1.15-1.73; P = 0.011), locoregional (OR = 1.56; 95% CI: 1.05-2.24; P = 0.030), and mixed (OR = 1.81; 95% CI: 1.20-2.71; P = 0.014) recurrences.
CONCLUSIONS: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.
Pubmed
Web of science
Create date
19/02/2016 19:49
Last modification date
26/09/2019 22:27
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