Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11619

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    P2.07-024 - Predictive factors for postoperative morbidity in patients undergoing esophagectomy for esophageal cancer: (ID 2142)

    09:30 - 09:30  |  Author(s): P. Shivappa
    • Abstract

    Background
    Oschner and DeBakey in 1940, reviewed the world literature of 191 esophageal resections with a 72% mortality rate. Later on with advent of better preoperative, intaoperative and postoperative management advances, the risk of mortality had decreased to less than 10%. Various radical resections were described both in resection of primary (Eg: Transhiatal esophagectomy(THE), transthoracic esophagectomy (TTE),enbloc esophagectomy,etc..,) and lymph node dissection (two field, three field , etc.,). The role of radical surgery is still controversial and its becomes necessary to decide which patient can tolerate a radical procedure in the preoperative setting itself.

    Methods
    We retrospectively analyzed surgical and medical records of 154 patients of carcinoma esophagus operated in a single unit at our center to assess the predictive factors for postoperative morbidity for the period 2006-2012.

    Results
    

    Table 1: Demographic profile of the Patients: Characteristics Number of patients ( Total N = 154) Age Mean Range 55.857 ± 10.3989 20-79 years Sex Male Female 92 62 Histopathological Examination Squamous cell carcinoma Adenocarcinoma Adenosquamous carcinoma 124 28 2 Site of lesion Middle third esophagus Lower third thoracic esophagus and Gastroesophageal tumors 36 118 Duration of symptoms ( Mean ± S.D) Preoperative albumin (gm/dl)( Mean ± S.D) Comorbidities Neoadjuvant treatment 2.481± 1.7684 (Range 1 -12) 3.938 ± 0.3684 (Range 3-4.9) 25 ( COPD-12, Diabetes Mellitus-10, Hypertension-8, Ischemic heart disease-3; Hypothyroidism-3, Previous history of pulmonary Koch’s-3) 10 (6 patients - NACTRT, 4 patients- NACT) Surgery performed Transhiatal esophagectomy Transthoracic esophagectomy 140 14 Complications Pulmonary complications Anastamotic leak Mortality Abdominal infection Chyle leak 18 11 12 ( 7 had pulmonary complication also) 3( All 3 had pulmonary complication ) 2 1( also had pulmonary complication)

    NACTRT- Neoadjuvant chemoradiotherapy, NACT-Neoadjuvant chemotherapy Of 154 patients who underwent esophagectomy at our center, 140 patients underwent THE and 14 underwent TTE. Mean duration of dysphagia was 2.4 months. One hundred and twenty four patients had squamous cell carcinoma and 30 patients had other histological types. Twenty five patients had comorbidities as described in Table.1. Eighteen patients developed postoperative complication of which three died - one case due to massive pulmonary embolism and two cases due topulmonary infection and septicaemia). Twelve patients had anastamotic leak (7.7%), all were managed conservatively. When multivariate regression analysis was performed for the predicted risk factors and development of complication, preop albumin ( less than 4gm/dl) and histological type (non squamous cell carcinoma) were associated significantly with increased post operative complications (Table.2). Abnormal pulmonary function tests though showed increased risk of complications it didn’t attain statistical significance. Table 2: Multivariate logistic regression analysis of predictive factors for early postoperative complications:

    Independent variables Coefficient Standard Error t P Albumin (Less than 4 gm/dl) -0.1505 0.07519 -2.001 0.0472*(significant) Comorbidity (Yes) 0.1012 0.06716 1.507 0.1339 Duration of dysphagia (Absolute dysphagia) 0.004364 0.01576 0.277 0.7823 Histopathological examination ( Non squamous cell carcinoma) -0.1877 0.07332 -2.559 0.0115*(Significant) Neoadjuvant treatment ( Yes) 0.1043 0.1147 0.910 0.3645 Site of lesion ( Middle 3rd) 0.06701 0.06641 1.009 0.3146 Pulmonary function tests (Abnormal) 0.04156 0.02232 1.862 0.0646

    Conclusion
    We achieved a 2% mortality rate during the study period. Preoperative serum albumin and histological subtype were associated with increased postoperative mortality. Neoadjuvant therapy was not associated with increased complication rate.