Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer

Background: Oesophagectomy has a high risk of postoperative morbidity. The impact of postoperative complications on overall survival of oesophageal cancer remains unclear. This meta-analysis addressed the impact of complications on long-term survival following oesophagectomy. Methods: A search of PubMed and Cochrane Library databases was undertaken for systematic review of papers published between January 1995 and August 2016 that analysed the relation between postoperative complications and long-term survival. In the meta-analysis, data were pooled. The main outcome was overall survival (OS). Secondary endpoints included disease-free (DFS) and cancer-specific (CSS) survival. Result: A total of 357 citations was reviewed; 21 studies comprising 11 368 patients were included in the analyses. Overall, postoperative complications were associated with significantly decreased 5-year OS (hazard ratio (HR) 1.16, 95 per cent c.i. 1.06 to 1.26; P = 0.001) and 5-year CSS (HR 1.27, 1.09 to 147; P = 0.002). Pulmonary complications were associated with decreased 5-year OS (HR 1.37, 1.16 to 1.62; P < 0.001), CSS (HR 1.60, 1.35 to 1.89; P < 0.001) and 5-year DES (HR 1.16, 1.00 to 1.33; P = 0.05). Patients with anastomodc leakage had significantly decreased 5-year OS (HR 1.20, 1.10 to 1.30; P < 0-001), 5-year CSS (HR 1.81, 1.11 to 2.95; P = 0.02) and 5-year DFS (HR 1.13, 1.02 to 1.25; P = 0.01). Conclusion: Postoperative complications after oesophagectomy, including pulmonary complications and anastomotic leakage, decreased long-term survival.