Surgical Complications Do Not Affect Longterm Survival after Esophagectomy for Carcinoma of the Thoracic Esophagus and Cardia

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Abstract
Background Surgical resection is the only real chance of cure for carcinoma of the esophagus and esophagogastric junction, although it carries considerable postoperative morbidity and mortality. The longterm prognosis for patients undergoing operation depends largely on the pathologic stage of the disease. The real impact of postoperative complications on survival is still under evaluation. Study design A retrospective analysis was performed on patients with squamous cell carcinoma and adenocarcinoma of the thoracic esophagus and esophagogastric junction, undergoing surgical resection between January 1992 and December 2002. For the 522 patients considered for esophagogastroplasty, we analyzed comorbidities, preoperative staging, neoadjuvant treatments, surgical data, histopathology, postoperative surgical or medical complications, and survival. Results Surgical complications occurred in 85 of 522 patients (16.3%); their survival rate was entirely similar to that of the group of patients without surgical complications (p = 0.9). The survival rate was worse for patients with concurrent surgical and medical complications. Analysis of the 99 patients (19%) who had only medical complications postoperatively revealed a survival rate comparable (p = 0.9) with that of the 338 patients (63.7%) with an uneventful postoperative course. The median postoperative hospital stay was 14 days for all 522 patients, and 18 days for patients with medical or surgical postoperative complications. Multivariate analysis of the predictive factors showed that surgical complications do not affect longterm prognosis. Conclusions Surgical complications have no negative impact on survival rates, which seem to depend exclusively on the pathologic stage of the tumor.