Complications and mortality of surgical therapy for esophageal cancer: 10 years single center experience

This study presents a single-center retrospective study into complications and mortality in the surgical treatment of esophageal cancer between 2006 and 2015. A total of 212 patients with esophageal cancer were operated on at the First Department of Surgery University Hospital in Olomouc in The Czech Republic during this period. Adenocarcinoma was histologically described in 127 patients (59.9%), squamous cell carcinoma in 82 patients (38.7%) and other carcinoma types were described in the remaining 3 patients. The pre-operative staging of esophageal cancer established that patients with early stage disease (T1-2N0M0) had primary surgery and those with advanced stage (T3-4N0-2M0) were treated with neo-adjuvant chemoradiation before surgery. The following surgery was performed; trans-hiatal laparoscopic esophagectomy for 183 patients; Orringer esophagectomy in 4 patients; thoracoscopic esophagectomy in 17 patients and thoracotomy in 30 patients. Respiratory failure with the development of ARDS syndrome and multiple-organ failure occurred in 21 patients. Statistically significant associations between mortality and ASA (p-0.009) and respiratory complications and ASA (p=0.006) were demonstrated. The majority of patients who died were under 60 years of age (p=0.039) and there was significant association between 30-day mortality and tumor stage (p=0.021), gender (p=0.022) and age (p=0.018). A significant association was also identified between tumor stage and fistula in anastomosis, (p=0.043) and the study convincingly established that esophagectomy should be performed in specialized high-volume centers experienced in treatment of this serious malignancy and only by certified oncology surgeons with long-term experience in esophageal surgery.