The role of cardiovascular risk factors on postoperative course after esophageal cancer surgery

Abstract

Background: After an esophagectomy vascularization of the gastric conduit is provided only by the right gastric artery. It is admitted that the risk of anastomotic leakage (AL) is increased by a low blood supply. Patients with esophageal cancer have frequently an impaired cardiac function and/or a atherosclerotic vascular disease (AVD). No data has previously emerged from studies regarding the role of cardiovascular risk factors (CRF) in patients who developed anastomotic leakage (AL) after esophagectomy in curative intent. The main objective was to determine if CRF can predict AL after Ivor-Lewis procedure in patientswith intrathoracic esophageal cancer (EC). Method(s): We performed a retrospective study including all 352 consecutive patients operated on for EC in a curative intent between 2004 and 2014 in 2 referral centers. Patients treated by Ivor-Lewis procedure were analyzed. Nine CRF were identified according international consensus. Dindo Clavien classification was used to define postoperative complication. Predictive factors of ALwere analyzed bymultivariable regression analysis. Result(s): Among 292 patients with EC treated with Ivor-Lewis procedure, 271 (92.8%) patients had one or more CRF. The median age was 64 years [range, 33 - 85], with a male to female sex ratio of 4.4:1. Squamous cell carcinoma (SCC) was present in 141 (73.8%) patients. Among the 111 (38%) patients with postoperative complications, 39 (13.4%) patients developed anastomotic leakage, 15 (5.1%) developed necrosis of the gastric conduit. Others main complications were pneumonia (n537 patients, 12.7%), chylothorax (n513 patients, 4.5%) and hemorrhage (n57 patients, 2.4%). In multivariate analysis, transfusion (odd ratio: 3.030, 95% CI [1.545 - 5.952], p50.001) and CRF>3 (odd ratio: 2.958, 95% CI [1.132 - 7.751], p50.027) were predictive factors of AL. Discussion(s): Patients with >3 CRF have a higher risk of AL after Ivor-Lewis procedure. Further studies should focus on how to improve postoperative outcomes in this population.