Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality
Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Society for Thoracic & Cardiovascular Surgery
2024-03-01
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| Series: | Journal of Chest Surgery |
| Subjects: |
| Summary: | Background: Data on perioperative outcomes of emergent versus elective resection in
esophageal cancer patients requiring esophagectomy are lacking. We investigated whether
emergent resection was associated with increased risks of morbidity and mortality.
Methods: Data on patients with esophageal malignancy who underwent esophagectomy
from 2005 to 2020 were retrospectively analyzed from the American College of
Surgeons National Surgical Quality Improvement Program database. Thirty-day complication
and mortality rates were compared between emergent esophagectomy (EE) and
non-emergent esophagectomy. Logistic regression assessed factors associated with complications
and mortality.
Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%)
had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic
shock, and 44% had bleeding requiring transfusion. The EE group had higher American
Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal
esophagectomies and diversions were performed in the EE group. After EE, the rates of
30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia,
prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that
of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin,
higher ASA class, and fragility were associated with increased complications and mortality.
McKeown esophagectomy and esophageal diversion were associated with a higher risk of
postoperative complications. EE was associated with 30-day postoperative complications
(odds ratio, 2.39; 95% confidence interval, 1.66–3.43; p<0.0001).
Conclusion: EE was associated with a more than 2-fold increase in complications compared
to elective procedures, but no independent increase in short-term mortality. These
findings may help guide data-driven critical decision-making for surgery in select cases of
complicated esophageal malignancy. |
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| ISSN: | 2765-1606 2765-1614 |