Title :

Are thoracotomy and/or intrathoracic anastomosis still predictors of postoperative mortality after esophageal cancer surgery? a nationwide study

Author(s) :

Degisors, Sebastien [Auteur]
Pasquer, Arnaud [Auteur]
Renaud, Florence [Auteur]

Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc) - U1172

Behal, Helene [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Hec, Flora [Auteur]
Gandon, Anne [Auteur]
Vanderbeken, Marguerite [Auteur]
Caranhac, Gilbert [Auteur]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Piessen, Guillaume [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer (JPArc) - U1172


Mariette, Christophe [Auteur]

Journal title :

Annals of surgery

Abbreviated title :

Ann. Surg.

Volume number :

266

Pages :

854-862

Publication date :

2017-11-01

ISSN :

0003-4932

English keyword(s) :

review
thoracotomy
surgery
mortality
esophagus
cervical anastomosis
cancer

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Intrathoracic (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 ...
Show more >Intrathoracic (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. The 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. All 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. Patients 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). Nowadays, 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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Université de Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172
• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T18:17:20Z