Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer

James Dolan, Taranjeet Kaur, Brian S. Diggs, Renato A. Luna, Paul Schipper, Brandon Tieu, Brett Sheppard, John Hunter

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE). Methods One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G. The outcomes of interest were operative time, estimated blood loss (EBL), lymph node harvest, length of hospital stay (LOS), major complications, 30-day mortality, and overall survival. Results Sixty-four patients (44 %) underwent Open while 71 (49 %) had MIE. An additional (7 %) were converted and classified with MIE. There was no significant difference between MIE and Open in terms of operative time. MIE had less EBL (mean difference = 234 mL, p≤0.001), higher lymph node harvest (mean = 7.4 nodes, p≤0.001), and shorter LOS (median = 1.5 days, p = 0.02). Atrial arrhythmias were the most frequent complication, occurring in 33 % of patients in both the MIE and the Open group (p = 0.988). Thirty-day mortality was 2 % for MIE and 5 % for Open (p = 0.459). Five-year survival was 41 % for MIE and 33 % for Open (p = 0.513). Operative approach, age, gender, BMI, clinical stage, and neoadjuvant therapy did not have any significant effect on the outcomes or overall survival. CCI-G influenced outcomes with operative time, LOS, cardiovascular complication, and anastomotic leak rate, favoring CCI-G 0 compared to CCI-G 3. Overall survival was worse for CCI-G 1 in comparison with CCI-G 0 [hazard ratio (HR) 1.99, p = 0.027]. Conclusions MIE is a safe alternative to open esophagectomy for the treatment of locally advanced esophageal cancer. The presence of comorbidities increased operative time, length of hospital stay, and postoperative complications while worsening overall survival.

Original languageEnglish (US)
Pages (from-to)4094-4103
Number of pages10
JournalSurgical Endoscopy and Other Interventional Techniques
Volume27
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Esophagectomy
Esophageal Neoplasms
Comorbidity
Survival
Length of Stay
Operative Time
Lymph Nodes
Risk Adjustment
Anastomotic Leak
Neoadjuvant Therapy
Mortality
Cardiac Arrhythmias

Keywords

  • Charlson Comorbidity Index
  • Esophageal cancer
  • Esophagectomy
  • Esophagus
  • Minimally invasive esophagectomy
  • Oesophageal cancer

ASJC Scopus subject areas

  • Surgery

Cite this

@article{f4f6e53d9296498c82ffb5e01d6c0408,
title = "Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer",
abstract = "Background The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE). Methods One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G. The outcomes of interest were operative time, estimated blood loss (EBL), lymph node harvest, length of hospital stay (LOS), major complications, 30-day mortality, and overall survival. Results Sixty-four patients (44 {\%}) underwent Open while 71 (49 {\%}) had MIE. An additional (7 {\%}) were converted and classified with MIE. There was no significant difference between MIE and Open in terms of operative time. MIE had less EBL (mean difference = 234 mL, p≤0.001), higher lymph node harvest (mean = 7.4 nodes, p≤0.001), and shorter LOS (median = 1.5 days, p = 0.02). Atrial arrhythmias were the most frequent complication, occurring in 33 {\%} of patients in both the MIE and the Open group (p = 0.988). Thirty-day mortality was 2 {\%} for MIE and 5 {\%} for Open (p = 0.459). Five-year survival was 41 {\%} for MIE and 33 {\%} for Open (p = 0.513). Operative approach, age, gender, BMI, clinical stage, and neoadjuvant therapy did not have any significant effect on the outcomes or overall survival. CCI-G influenced outcomes with operative time, LOS, cardiovascular complication, and anastomotic leak rate, favoring CCI-G 0 compared to CCI-G 3. Overall survival was worse for CCI-G 1 in comparison with CCI-G 0 [hazard ratio (HR) 1.99, p = 0.027]. Conclusions MIE is a safe alternative to open esophagectomy for the treatment of locally advanced esophageal cancer. The presence of comorbidities increased operative time, length of hospital stay, and postoperative complications while worsening overall survival.",
keywords = "Charlson Comorbidity Index, Esophageal cancer, Esophagectomy, Esophagus, Minimally invasive esophagectomy, Oesophageal cancer",
author = "James Dolan and Taranjeet Kaur and Diggs, {Brian S.} and Luna, {Renato A.} and Paul Schipper and Brandon Tieu and Brett Sheppard and John Hunter",
year = "2013",
month = "11",
doi = "10.1007/s00464-013-3066-5",
language = "English (US)",
volume = "27",
pages = "4094--4103",
journal = "Surgical Endoscopy and Other Interventional Techniques",
issn = "0930-2794",
publisher = "Springer New York",
number = "11",

}

TY - JOUR

T1 - Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer

AU - Dolan, James

AU - Kaur, Taranjeet

AU - Diggs, Brian S.

AU - Luna, Renato A.

AU - Schipper, Paul

AU - Tieu, Brandon

AU - Sheppard, Brett

AU - Hunter, John

PY - 2013/11

Y1 - 2013/11

N2 - Background The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE). Methods One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G. The outcomes of interest were operative time, estimated blood loss (EBL), lymph node harvest, length of hospital stay (LOS), major complications, 30-day mortality, and overall survival. Results Sixty-four patients (44 %) underwent Open while 71 (49 %) had MIE. An additional (7 %) were converted and classified with MIE. There was no significant difference between MIE and Open in terms of operative time. MIE had less EBL (mean difference = 234 mL, p≤0.001), higher lymph node harvest (mean = 7.4 nodes, p≤0.001), and shorter LOS (median = 1.5 days, p = 0.02). Atrial arrhythmias were the most frequent complication, occurring in 33 % of patients in both the MIE and the Open group (p = 0.988). Thirty-day mortality was 2 % for MIE and 5 % for Open (p = 0.459). Five-year survival was 41 % for MIE and 33 % for Open (p = 0.513). Operative approach, age, gender, BMI, clinical stage, and neoadjuvant therapy did not have any significant effect on the outcomes or overall survival. CCI-G influenced outcomes with operative time, LOS, cardiovascular complication, and anastomotic leak rate, favoring CCI-G 0 compared to CCI-G 3. Overall survival was worse for CCI-G 1 in comparison with CCI-G 0 [hazard ratio (HR) 1.99, p = 0.027]. Conclusions MIE is a safe alternative to open esophagectomy for the treatment of locally advanced esophageal cancer. The presence of comorbidities increased operative time, length of hospital stay, and postoperative complications while worsening overall survival.

AB - Background The aim of this study was to examine the impact of the Charlson Comorbidity Index-Grade (CCI-G) on predicting outcomes and overall survival after open and minimally invasive esophagectomy (MIE). Methods One hundred and forty-six patients who underwent esophagectomy between 1995 and 2011 for stage II and III cancer were selected and separated into open esophagectomy (Open) and MIE groups. Risk adjustment was performed using the CCI-G. The outcomes of interest were operative time, estimated blood loss (EBL), lymph node harvest, length of hospital stay (LOS), major complications, 30-day mortality, and overall survival. Results Sixty-four patients (44 %) underwent Open while 71 (49 %) had MIE. An additional (7 %) were converted and classified with MIE. There was no significant difference between MIE and Open in terms of operative time. MIE had less EBL (mean difference = 234 mL, p≤0.001), higher lymph node harvest (mean = 7.4 nodes, p≤0.001), and shorter LOS (median = 1.5 days, p = 0.02). Atrial arrhythmias were the most frequent complication, occurring in 33 % of patients in both the MIE and the Open group (p = 0.988). Thirty-day mortality was 2 % for MIE and 5 % for Open (p = 0.459). Five-year survival was 41 % for MIE and 33 % for Open (p = 0.513). Operative approach, age, gender, BMI, clinical stage, and neoadjuvant therapy did not have any significant effect on the outcomes or overall survival. CCI-G influenced outcomes with operative time, LOS, cardiovascular complication, and anastomotic leak rate, favoring CCI-G 0 compared to CCI-G 3. Overall survival was worse for CCI-G 1 in comparison with CCI-G 0 [hazard ratio (HR) 1.99, p = 0.027]. Conclusions MIE is a safe alternative to open esophagectomy for the treatment of locally advanced esophageal cancer. The presence of comorbidities increased operative time, length of hospital stay, and postoperative complications while worsening overall survival.

KW - Charlson Comorbidity Index

KW - Esophageal cancer

KW - Esophagectomy

KW - Esophagus

KW - Minimally invasive esophagectomy

KW - Oesophageal cancer

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U2 - 10.1007/s00464-013-3066-5

DO - 10.1007/s00464-013-3066-5

M3 - Article

C2 - 23846365

AN - SCOPUS:84892792975

VL - 27

SP - 4094

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JO - Surgical Endoscopy and Other Interventional Techniques

JF - Surgical Endoscopy and Other Interventional Techniques

SN - 0930-2794

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