Knowledge of risk factors for complications after esophageal resection for cancer is sparse, and prospective population-based studies are lacking.
Dr Pernilla Viklund and colleagues identified risk factors for complications after resection for esophageal or cardia cancer.
The research team conducted a prospective, nationwide, population-based study from 2001 to 2003 in Sweden.
Details about tumor characteristics and stage, surgical procedures, and complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register.
The team scrutinized medical records and specific charts from surgical procedures, histopathology reports, and intensive care units.
|There were more respiratory complications with transthoracic vs transhiatal approach|
|Annals of Surgery|
Multivariable logistic regression analyses were used to estimate relative risks and their 95% confidence intervals.
Among 275 patients undergoing surgical resection for esophageal or cardia cancer, 44% had at least one predefined complication.
The team ntoed that operation by low-volume surgeons were followed by more anastomotic leakages than those by surgeons with higher volume.
The researchers observed that hand-sewn and stapled anastomoses did not differ regarding risk of anastomotic leakage.
Among cardia cancer patients, transthoracic approach resulted in more respiratory complications compared with transhiatal approach.
The team found that older age, adjuvant oncologic therapy, and higher preoperative bleeding volume slightly increased the risks of complications.
However, the researchers found no influence of sex or tumor stage.
Dr Viklund's team commented, “High-volume esophageal surgeons seem to lower the risk of anastomotic leakage.”
“More large-scale studies are warranted to establish the roles of the other potentially important risk factors suggested in our study.”