Published online Jan 27, 2022. doi: 10.4240/wjgs.v14.i1.46
Peer-review started: March 25, 2021
First decision: June 16, 2021
Revised: June 29, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 27, 2022
Despite improvements in surgical procedures and peri-operative patients management, the postoperative complications in esophagogastric junction (EGJ) cancer remain high because of technical aspects. Several studies have indicated the negative influence of postoperative infectious complications on long-term survival after gastrointestinal surgery. However, no study has shown the association between postoperative complications and long-term survival of patients with EGJ cancer.
To elucidate influence of postoperative complications on the long-term outcomes of patients with EGJ cancer.
A total of 122 patients who underwent surgery for EGJ cancer at the Keio University were included in this study. We examined the association between complications and long-term oncologic outcomes.
In all patients, the 3-year overall survival (OS) rate was 71.9%, and the recurrence-free survival (RFS) rate was 67.5%. Compared with patients without anastomotic leakage, those with anastomotic leakage had poor median OS (8 mo vs not reached, P = 0.028) and median RFS (5 mo vs not reached, P = 0.055). Among patients with cervical anastomosis, there were not significant differences between patients with and without anastomotic leakage. However, among patients who underwent intrathoracic anastomosis, patients with anastomotic leakage had significantly worse OS (P = 0.002) and RFS (P = 0.005).
Anastomotic leakage was significantly associated with long-term oncologic outcomes of patients with EGJ cancer, especially those who underwent intrathoracic anastomosis. Cervical anastomosis with subtotal esophagectomy may be an option for the patients who are at high risk for anastomotic leakage.
Core Tip: The postoperative complications of gastrointestinal surgery had been reported to have a remarkable effect on the long-term outcomes, but no study had examined this association in esophagogastric junction (EGJ) cancer. This retrospective study found that anastomotic leakage was remarkably associated with the survival of patients with EGJ cancer who underwent intrathoracic anastomosis but not cervical anastomosis. Cervical anastomosis with subtotal esophagectomy may be an option for patients who have a high risk for anastomotic leakage.