• Sébastien Degisors, Arnaud Pasquer, Florence Renaud, Hélène Béhal, Flora Hec, Anne Gandon, Marguerite Vanderbeken, Gilbert Caranhac, Alain Duhamel, Guillaume Piessen, Christophe Mariette, and FREGAT working group.
• *Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, Lille, France †University Lille, UMR-S 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, France ‡Inserm, UMR-S 1172, Lille, France §Department of Digestive and Oncological Surgery, E. Herriot University Hospital, Lyon, France ¶Claude Bernard Lyon 1 University, Lyon, France ||SIRIC OncoLille, Lille, France **Hox-Com Analytiques, Paris, France ††Department of Pathology, UniversityLille, Centre de Biologie et de Pathologie, University Hospital, Lille, France ‡‡Department of biostatistics, UniversityLille, University Hospital, Lille, France.
• Ann. Surg. 2017 Nov 1; 266 (5): 854-862.

BackgroundIntrathoracic (vs cervical) anastomosis and a thoracotomy (vs absence) have previously been associated with increasing postoperative mortality (POM). Recent improvements in surgical practices and perioperative management may have changed these dogmas.ObjectivesThe aim of this study was to evaluate the impact of performing intrathoracic anastomosis and/or thoracotomy on POM after esophageal cancer surgery in recent years.MethodsAll consecutive patients who underwent esophageal cancer surgery with reconstruction between 2010 and 2012 in France were included (n = 3286). Patients with a thoracoscopic approach were excluded (n = 4). We compared 30-day POM between patients having received intrathoracic (vs cervical) anastomosis and between those having received a thoracotomy or not. Multivariate analyses and propensity score matching were used to adjust for confounding factors.ResultsPatients had either cervical (n = 548) or intrathoracic (n = 2738) anastomosis. Thirty-day POM was higher after cervical anastomosis (8.8% vs 4.9%, P < 0.001). Having received a thoracotomy (n = 3061) was associated with a decreased risk of 30-day POM (5.3% vs 9.3%, P = 0.011). After adjustment for confounding factors, cervical anastomosis was associated with 30-day POM [odds ratio (OR) 1.71; 95% confidence interval (CI) 1.05-2.77); P = 0.032], whereas performing a thoracotomy was not associated with 30-day POM (OR 0.97; 95% CI 0.51-1.84; P = 0.926).ConclusionsNowadays, intrathoracic anastomosis provides a lower 30-day POM rate compared to cervical anastomosis, and performing a thoracotomy is not associated with POM. Systematic anastomosis neck placement or thoracotomy avoidance is not a relevant argument anymore to decrease POM.

51 keywords...

hide…