Background: There is limited knowledge of how co-morbidities influence survival after surgery for oesophageal cancer. This population-based cohort study investigated how Charlson co-morbidity index and specific co-morbidities influenced all-cause and disease-specific mortality.
Methods: Data from all patients who underwent oesophageal cancer surgery in Sweden in 1987-2010, with follow-up until 2012, came from histopathology records, operation charts and nationwide registers. Associations between co-morbidities (Charlson co-morbidity index) and mortality were analysed using Cox proportional hazard regression with adjustment for potential confounding, and presented as hazard ratio (HR) with 95 per cent c.i.
Results: Among 1822 patients there were 1474 deaths (80.9 per cent), of which 1139 (77.3 per cent) occurred between 91 days and 5 years after surgery. Overall all-cause mortality was increased in patients with a Charlson score of 2 or more (HR 1.24, 95 per cent c.i. 1.08 to 1.42), and those with a history of myocardial infarction (HR 1.23, 1.01 to 1.49) or congestive heart failure (HR 1.31, 1.04 to 1.67). Patients with squamous cell carcinoma had increased overall all-cause mortality if they had been diagnosed with cerebrovascular disease (HR 1.35, 1.00 to 1.83) or other cancers (HR 1.36, 1.09 to 1.71), whereas those with adenocarcinoma did not. A Charlson score of 1 or exposure to the co-morbidity groups peripheral vascular disease, chronic pulmonary disease, connective tissue disease, peptic ulcer disease, diabetes and liver disease did not increase mortality. The disease-specific results were generally similar to the all-cause mortality data.
Conclusion: Co-morbidity with a Charlson score of 2 or more, previous myocardial infarction and congestive heart failure were associated with increased mortality after oesophageal cancer surgery undertaken with curative intent.
© 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.