Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence
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Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence. / Kofoed, Steen C; Calatayud, Dan; Jensen, Lone S; Helgstrand, Frederik; Achiam, Michael P; De Heer, Pieter; Svendsen, Lars B; Danish Esophageal, Cardia and Stomach Cancer Group.
I: Journal of Thoracic and Cardiovascular Surgery, Bind 150, Nr. 1, 07.2015, s. 42-8.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with increased risk of recurrence
AU - Kofoed, Steen C
AU - Calatayud, Dan
AU - Jensen, Lone S
AU - Helgstrand, Frederik
AU - Achiam, Michael P
AU - De Heer, Pieter
AU - Svendsen, Lars B
AU - Danish Esophageal, Cardia and Stomach Cancer Group
N1 - Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PY - 2015/7
Y1 - 2015/7
N2 - OBJECTIVE: Intrathoracic anastomotic leakage after intended curative resection for cancer in the esophagus or gastroesophageal junction has a negative impact on long-term survival. The aim of this study was to investigate whether an anastomotic leakage was associated with an increased recurrence rate.METHODS: This nationwide study included consecutively collected data on patients undergoing curative surgical resection with intrathoracic anastomosis, alive 8 weeks postoperatively, between 2003 and 2011. Patients with incomplete resection, or metastatic disease intraoperatively, were excluded. Only biopsy-proven recurrences were accepted.RESULTS: In total, 1085 patients were included. The frequency of anastomotic leakage was 8.6%. The median follow-up time was 29 months (interquartile range [IQR]: 13-58 months). Overall, 369 (34%) patients had disease recurrence, of which 346 patients died of recurrent gastroesophageal carcinoma. Twenty-three patients were alive with recurrence at the censoring date. In the study period, 333 patients died without signs of recurrent disease. The overall median time to recurrence was 66 weeks (IQR: 38-109 weeks). Distant metastases were found in 267 (25%), and local disease recurrence in 102 (9%) patients. Overall, 5-year disease-free survival in patients with leakage was 27%, versus 39% in those without leakage (P = .017). Anastomotic leakage was independently associated with higher risk of recurrence (hazard ratio [HR] = 1.63; 95% confidence interval [CI]: 1.17-2.29, P = .004) and all-cause mortality (HR = 1.57; 95% CI: 1.23-2.05, P < .0001).CONCLUSIONS: Intrathoracic anastomotic leakage increased the risk of recurrence in patients who underwent curative gastroesophageal cancer resection.
AB - OBJECTIVE: Intrathoracic anastomotic leakage after intended curative resection for cancer in the esophagus or gastroesophageal junction has a negative impact on long-term survival. The aim of this study was to investigate whether an anastomotic leakage was associated with an increased recurrence rate.METHODS: This nationwide study included consecutively collected data on patients undergoing curative surgical resection with intrathoracic anastomosis, alive 8 weeks postoperatively, between 2003 and 2011. Patients with incomplete resection, or metastatic disease intraoperatively, were excluded. Only biopsy-proven recurrences were accepted.RESULTS: In total, 1085 patients were included. The frequency of anastomotic leakage was 8.6%. The median follow-up time was 29 months (interquartile range [IQR]: 13-58 months). Overall, 369 (34%) patients had disease recurrence, of which 346 patients died of recurrent gastroesophageal carcinoma. Twenty-three patients were alive with recurrence at the censoring date. In the study period, 333 patients died without signs of recurrent disease. The overall median time to recurrence was 66 weeks (IQR: 38-109 weeks). Distant metastases were found in 267 (25%), and local disease recurrence in 102 (9%) patients. Overall, 5-year disease-free survival in patients with leakage was 27%, versus 39% in those without leakage (P = .017). Anastomotic leakage was independently associated with higher risk of recurrence (hazard ratio [HR] = 1.63; 95% confidence interval [CI]: 1.17-2.29, P = .004) and all-cause mortality (HR = 1.57; 95% CI: 1.23-2.05, P < .0001).CONCLUSIONS: Intrathoracic anastomotic leakage increased the risk of recurrence in patients who underwent curative gastroesophageal cancer resection.
KW - Anastomotic Leak
KW - Esophageal Neoplasms
KW - Esophagogastric Junction
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasm Recurrence, Local
KW - Prospective Studies
KW - Risk Assessment
KW - Stomach Neoplasms
KW - Thorax
U2 - 10.1016/j.jtcvs.2015.04.030
DO - 10.1016/j.jtcvs.2015.04.030
M3 - Journal article
C2 - 25986493
VL - 150
SP - 42
EP - 48
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 1
ER -
ID: 160448416