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Ann Surg. 2017 Nov;266(5):854-862. doi: 10.1097/SLA.0000000000002401.

Are Thoracotomy and/or Intrathoracic Anastomosis Still Predictors of Postoperative Mortality After Esophageal Cancer Surgery?: A Nationwide Study.

Author information

1
*Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, France †University Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France ‡Inserm, UMR-S 1172, Lille, France §Department of Digestive and Oncological Surgery, E. Herriot University Hospital, Lyon, France ¶Claude Bernard Lyon 1 University, Lyon, France ||SIRIC OncoLille, Lille, France **Hox-Com Analytiques, Paris, France ††Department of Pathology, UniversityLille, Centre de Biologie et de Pathologie, University Hospital, Lille, France ‡‡Department of biostatistics, UniversityLille, University Hospital, Lille, France.

Abstract

BACKGROUND:

Intrathoracic (vs cervical) anastomosis and a thoracotomy (vs absence) have previously been associated with increasing postoperative mortality (POM). Recent improvements in surgical practices and perioperative management may have changed these dogmas.

OBJECTIVES:

The aim of this study was to evaluate the impact of performing intrathoracic anastomosis and/or thoracotomy on POM after esophageal cancer surgery in recent years.

METHODS:

All consecutive patients who underwent esophageal cancer surgery with reconstruction between 2010 and 2012 in France were included (n = 3286). Patients with a thoracoscopic approach were excluded (n = 4). We compared 30-day POM between patients having received intrathoracic (vs cervical) anastomosis and between those having received a thoracotomy or not. Multivariate analyses and propensity score matching were used to adjust for confounding factors.

RESULTS:

Patients had either cervical (n = 548) or intrathoracic (n = 2738) anastomosis. Thirty-day POM was higher after cervical anastomosis (8.8% vs 4.9%, P < 0.001). Having received a thoracotomy (n = 3061) was associated with a decreased risk of 30-day POM (5.3% vs 9.3%, P = 0.011). After adjustment for confounding factors, cervical anastomosis was associated with 30-day POM [odds ratio (OR) 1.71; 95% confidence interval (CI) 1.05-2.77); P = 0.032], whereas performing a thoracotomy was not associated with 30-day POM (OR 0.97; 95% CI 0.51-1.84; P = 0.926).

CONCLUSIONS:

Nowadays, intrathoracic anastomosis provides a lower 30-day POM rate compared to cervical anastomosis, and performing a thoracotomy is not associated with POM. Systematic anastomosis neck placement or thoracotomy avoidance is not a relevant argument anymore to decrease POM.

PMID:
28742697
DOI:
10.1097/SLA.0000000000002401
[Indexed for MEDLINE]

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