Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer

• Published in: BJS open Vol. 2; no. 5; pp. 276 - 284
• Main Authors: Booka, E, Takeuchi, H, Suda, K, Fukuda, K, Nakamura, R, Wada, N, Kawakubo, H, Kitagawa, Y
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.09.2018; John Wiley & Sons, Ltd
• Subjects: Bias; Cancer therapies; Esophageal cancer; Esophagus; Library associations; Medical libraries; Medical prognosis; Meta-analysis; Morbidity; Mortality; Studies; Surgery; Systematic Review; Systematic Reviews; Japan
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1002/bjs5.64

Oesophagectomy has a high risk of postoperative morbidity. The impact of postoperative complications on overall survival of oesophageal cancer remains unclear. This meta-analysis addressed the impact of complications on long-term survival following oesophagectomy. A search of PubMed and Cochrane Library databases was undertaken for systematic review of papers published between January 1995 and August 2016 that analysed the relation between postoperative complications and long-term survival. In the meta-analysis, data were pooled. The main outcome was overall survival (OS). Secondary endpoints included disease-free (DFS) and cancer-specific (CSS) survival. A total of 357 citations was reviewed; 21 studies comprising 11 368 patients were included in the analyses. Overall, postoperative complications were associated with significantly decreased 5-year OS (hazard ratio (HR) 1·16, 95 per cent c.i. 1·06 to 1·26; P = 0·001) and 5-year CSS (HR 1·27, 1·09 to 1·47; P = 0·002). Pulmonary complications were associated with decreased 5-year OS (HR 1·37, 1·16 to 1·62; P < 0·001), CSS (HR 1·60, 1·35 to 1·89; P < 0·001) and 5-year DFS (HR 1·16, 1·00 to 1·33; P = 0·05). Patients with anastomotic leakage had significantly decreased 5-year OS (HR 1·20, 1·10 to 1·30; P < 0·001), 5-year CSS (HR 1·81, 1·11 to 2·95; P = 0·02) and 5-year DFS (HR 1·13, 1·02 to 1·25; P = 0·01). Postoperative complications after oesophagectomy, including pulmonary complications and anastomotic leakage, decreased long-term survival.