Efforts to improve surgical outcomes have traditionally focused on improving preoperative patient selection and reducing the risk of postoperative medical complications.
However, strategies to optimize surgical technique have been less well studied.
|27% of patients had complications directly attributable to surgical technique.|
|Journal of the American College of Surgeons|
In this study, investigators from the USA assessed the relationship between complications related to surgical technique and outcomes after esophagogastrectomy for cancer.
The team examined the medical records of 150 consecutive patients undergoing esophagogastrectomy for invasive squamous cell carcinoma or adenocarcinoma.
They collated data on diagnosis, stage of disease, therapies received, surgical approach, patient comorbidities, technical complications, and postoperative medical complications and outcomes.
The primary predictor was surgical complications and the primary outcome was survival.
The team found that of the 150 patients, 27% had complications directly attributable to surgical technique.
At 3 years, 31% of patients with technical complications were alive, compared with 48% without technical complications.
In addition, technical complications were associated with increased length of stay, increased in-hospital mortality, and a higher rate of medical complications.
After controlling for age, medical comorbidities, use of induction therapy, tumor stage, histology, and location, and completeness of resection, a technical complication was highly predictive of poorer survival.
Dr Nabil Rizk's team concluded, "Technical complications have a large negative impact on survival after esophagogastrectomy for cancer".
"Strategies to optimize surgical technique and minimize complications should improve outcomes in this cancer operation".