Prediction of major postoperative complications
and survival for locally advanced esophageal
Somkiat Sunpaweravonga,*, Sakchai Ruangsina,
Supparerk Laohawiriyakamola, Somrit Mahattanobona, Alan Geaterb
aDepartment of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
bEpidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
Received 3 March 2011; received in revised form 21 June 2011; accepted 17 April 2012
Available online 6 June 2012
tant and may help in preselecting patients who are most likely to benefit from surgery, espe-
cially in locally advanced esophageal cancer patients who have poor prognosis.
Objective: To identify the factors associated with the development of pneumonia and anasto-
motic leakage complications, and the survival characteristics in locally advanced esophageal
Methods: A consecutive series of 232 locally advanced esophageal cancer patients (183 men
and 49 women, median age 63 years) who underwent esophagectomy at Prince of Songkla
University Hospital between 1998 and 2007 was analyzed.
Results: There were nine (3.8%) 30-day mortalities. Pneumonia occurred in 53 patients (22.8%)
index was related to leakage (p Z 0.015), while soft-diet dysphagia (p Z 0.009), forced expira-
tory volume in 1 second <75% (p Z 0.0005), type of surgery (McKeown technique) (p Z 0.019),
and long operative time (p Z 0.006) were related to pneumonia. The median survival rate was
13.0 months. Stage 2b patients had longer survival than stages 3 and 4a patients (p Z 0.0001).
Conclusion: Patient body mass index, dysphagia, spirometry, type of surgical technique, and
operative time can help predict the likelihood of pulmonary or leak complications after esopha-
tion in locally advanced cases.
Copyright ª 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights
Background: Predicting the major complications after esophagectomy is impor-
* Corresponding author. Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkla 90110, Thailand.
E-mail address: firstname.lastname@example.org (S. Sunpaweravong).
1015-9584/$36 Copyright ª 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.
Available online at www.sciencedirect.com
journal homepage: www.e-asianjournalsurgery.com
Asian Journal of Surgery (2012) 35, 104e109
locally advanced esophageal cancer patients who under-
went esophagectomy alone at 18 months and the relative
risks (95% CI) of death for treatments compared with
surgery were 0.87 (0.75e1.02) for neoadjuvant chemo-
radiation, 0.94 (0.82e1.08) for neoadjuvant chemotherapy,
However, there was heterogeneity between the random-
ized controlled trials on neoadjuvant chemoradiation for
esophageal cancer. Wijnhoven et al29found that two of the
six meta-analyses examined did not show a significant
survival benefit in patients with resectable esophageal
cancer. Moreover, besides survival outcome, toxicity should
be considered in deciding whether neoadjuvant chemo-
radiation has more benefits than surgery alone.30The
National Comprehensive Cancer Network also recommends
neoadjuvant chemoradiation for locally advanced esopha-
geal cancer.31We did not see the effect of adjuvant or
neoadjuvant chemoradiation on survival rates in our study;
however, this could be due to selective case bias in this
In conclusion, we have demonstrated that preoperative
BMI, dysphagia, pulmonary function test, type of surgical
technique, and operative time may help to predict the
chance of postoperative anastomotic leakage and pneu-
monia in locally advanced esophageal cancer patients,
while stage of disease may help to predict survival.
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