Esophagectomy is frequently accompanied by substantial complications with secondary disturbance of the immune system.
After esophagectomy for adenocarcinoma of the distal esophagus, and/or gastroesophageal junction, the majority of patients develops an early recurrence, and dies within 2 years.
|97% died before 60 months|
|Annals of Surgery|
Dr Sjoerd Lagarde and colleagues determined the relevance of perioperative complications on the timing of death due to recurrence.
A consecutive series of 351 patients who underwent esophagectomy for adenocarcinoma of the esophagus and gastroesophageal junction was reviewed.
The research team assessed 351 patients, of which 191 died due to recurrence of esophageal adenocarcinoma.
Of these 191 patients, 40%, 72%, and 97% died before 12, 24, and 60 months, respectively.
Multivariate Cox regression analysis demonstrated that T-stage, lymph node ratio over 0.20 was a significant predictor of death due to cancer recurrence.
The presence of extracapsular lymph node involvement, but not complications were significant factors for the prediction of death due to cancer recurrence.
The researchers found that in the patients who died, the presence of extracapsular lymph node involvement was related to a shorter time interval until death due to recurrence.
The occurrence of complications were significantly related with a shorter time interval until death due to recurrence.
Dr Lagardes' team concluded, "The relation between perioperative complications, and cancer recurrence per se is not causal."
"However, postoperative complications are independently associated with the early timing of death due to cancer recurrence."
"A possible explanation for this phenomenon is that immunologic host factors enhance microscopic residual disease to develop more rapidly into clinically manifest recurrence."