Patterns of operative mortality following esophagectomy

A study in the most recent issue of the Diseases of Esophagus examines patterns of operative mortality following esophagectomy.

Esophagectomy has one of the highest mortality rates among all surgical procedures.

Dr Schieman and colleagues from Minnesota, USA investigated the type and frequency of complications associated with perioperative mortality after esophagectomy.

The researchers performed a retrospective review of all perioperative deaths following esophagectomy for esophageal cancer at the Mayo Clinic, Rochester from 1993 through 2009.

Of 1522 esophagectomies, perioperative mortality occurred in 3%.

51% underwent neoadjuvant chemoradiotherapy

Diseases of the Esophagus

The team observed that the majority who died were male, and the median age was 72 years.

The median age-adjusted Charlson comorbidity score was 6.

The researchers found that 51% underwent neoadjuvant chemoradiotherapy.

The type of esophagectomy was transthoracic in 60%, transhiatal in 18%, tri-incisional in 16%, left thoracoabdominal in 2%, and transabdominal in 2%.

A mean of 3 major complications occurred prior to death, with the most common being pulmonary complications occurring, and anastomotic complications.

The primary underlying cause of death was pulmonary complications and anastomotic complications in 40% each, respectively, abdominal sepsis in 7%, fatal hemorrhage in 7%, and pulmonary embolism, stroke and multisystem organ failure in 1 each, respectively.

The team found that patients died a median of 19 days following esophagectomy.

Dr Schieman's team commented, "Most patients who died following esophagectomy experienced multiple serious complications rather than a single causative event."

"Major pulmonary and anastomotic complications were implicated in the vast majority of perioperative mortality, and should remain the focus of efforts to improve clinical outcomes."