Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Abstract

Background Recent evidence suggests that complications after oesophagectomy may decrease short‐ and long‐term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien–Dindo classification. Associations between complications and overall and recurrence‐free survival were assessed using univariable and multivariable Cox regression models. Results Of 430 patients, 292 (67·9 per cent) developed postoperative complications, with 128 (39·8 per cent) classified as Clavien–Dindo grade III or IV. No significant associations were detected between Clavien–Dindo grade and either tumour (T) (P = 0·071) or nodal (N) status (P = 0·882). There was a significant correlation between Clavien–Dindo grade and ASA fitness grade (P = 0·032). In multivariable analysis, overall survival in patients with Clavien–Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0·97, P = 0·915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1·64 (P = 0·007) and 1·74 (P = 0·013) respectively. Conclusion Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.