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Postoperative Complications of Esophageal Cancer
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Postoperative Complications of Esophageal Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 June 2022) | Viewed by 12428

Special Issue Editor

Dr. Koji Tanaka

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Guest Editor
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
Interests: esophageal cancer; surgery; mitochondria; ncRNA; patient safety

Special Issue Information

Dear Colleagues,

Esophagectomy is still associated with significant postoperative morbidity and mortality rates, even after the introduction of new surgical techniques and the improvement of postoperative care. Postoperative complications of esophageal cancer can be very serious and even fatal, and their pathogenesis can be complex. Management and treatment may require experience, especially for less-frequent complications. There are also reports that postoperative complications are associated with prognosis, nutritional status, and quality of life, but there is no consensus. The aim of this Special Issue is to develop our understanding of the pathogenesis and risk factors of complications in esophageal cancer surgery, and to share prevention and treatment strategies to improve short- and long-term outcomes in esophageal cancer. Submissions are welcome, especially original research articles showing innovative findings regarding the diagnosis, monitoring, and treatment of postoperative complications after esophagectomy. Secondarily, we will consider high-interest review articles of exceptional merit.

Dr. Koji Tanaka
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • esophageal cancer
  • esophagectomy
  • postoperative complications
  • pathogenesis
  • risk factors
  • perioperative management
  • prognosis
  • treatment
  • postoperative quality of life

Published Papers (5 papers)

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Research

13 pages, 1362 KiB  
Article
C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies
by Florian Richter, Anne-Sophie Mehdorn, Thorben Fedders, Benedikt Reichert, Jan-Hendrik Egberts, Thomas Becker and Julius Pochhammer
J. Clin. Med. 2022, 11(19), 5654; https://doi.org/10.3390/jcm11195654 - 26 Sep 2022
Cited by 5 | Viewed by 1480
Abstract
Introduction: The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate [...] Read more.
Introduction: The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate the predictive value of CRP in RAMIE. Material and Methods: Patients undergoing RAMIE or completely open esophagectomy (OE) at our University Center were included. Clinical data, CRP- and Procalcitonin (PCT)-values were retrieved from a prospectively maintained database and evaluated for their predictive value for subsequent postoperative infectious complications (PIC) (AL, gastric conduit leakage or necrosis, pneumonia, empyema). Results: Three hundred and five patients (RAMIE: 160, OE: 145) were analyzed. PIC were noted in 91 patients on postoperative day (POD) 10 and 123 patients on POD 30, respectively. Median POD of diagnosis of PIC was POD 8. Post-operative CRP-values in the robotic-group peaked one and two days later, respectively, and converged from POD 5 onward compared to the open-group. In the group with PIC, CRP-levels in the robotic-group were initially lower and started to differ significantly from POD 3 onward. In the open-group, increases were already noticed from POD 3 on. Procalcitonin levels did not differ. Best Receiver operating curve (ROC)-results were on POD 4, highest negative predictive values at POD 5 (RAMIE) and POD 4 (OE) with cut-off values of 70 mg/L and 88.3 mg/L, respectively. Conclusion: Post-operative CRP is a good negative predictor for PIC, after both RAMIE and OE. After RAMIE, CRP peaks later with a lower cut-off value. Full article
(This article belongs to the Special Issue Postoperative Complications of Esophageal Cancer)
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18 pages, 4228 KiB  
Article
A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
by Pang-Chieh Hung, Hsuan-Yu Chen, Yu-Kang Tu and Yung-Shuo Kao
J. Clin. Med. 2022, 11(17), 5025; https://doi.org/10.3390/jcm11175025 - 26 Aug 2022
Cited by 7 | Viewed by 6171
Abstract
Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high [...] Read more.
Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high anastomosis leakage rates among these three types of conduits has not been reported. The aim of this network meta-analysis was to investigate the rate of anastomotic leakage (AL) among the three procedures to determine the best esophageal substitute or the future direction for improving the conventional gastric pull-up (GPU). Methods: We searched PubMed, Cochrane, and Embase databases. We included esophageal cancer patients receiving esophagectomy and excluded patients with other cancer. The random effect model was used in this network meta-analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment of studies in the network meta-analysis, and funnel plots were used to evaluate publication bias. The primary outcome is anastomosis leakage; the secondary outcomes are stricture formation, length of hospital stays, and mortality rate. Results: Nine studies involving 1613 patients were included in this network meta-analysis. The trend results indicated the following. Regarding anastomosis leakage, free jejunal flap was the better procedure; regarding stricture formation, colon interposition was the better procedure; regarding mortality rate, free jejunal flap was the better procedure; regarding length of hospital stay, gastric pull-up was the better treatment. Discussion: Overall, if technically accessible, free jejunal flap is a better choice than colon interposition when gastric conduit cannot be used, but further study should be conducted to compare groups with equal supercharged patients. In addition, jejunal flap (JF) cannot replace traditional gastric pull-up (GPU) due to technical complexities, more anastomotic sites, and longer operation times. However, the GPU method with the supercharged procedure would be a possible solution to lower postoperative AL. The limitation of this meta-analysis is that the number of articles included was low; we aim to update the result when new data are available. Funding: None. Registration: N/A. Full article
(This article belongs to the Special Issue Postoperative Complications of Esophageal Cancer)
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14 pages, 782 KiB  
Article
The Association between Neoadjuvant Radio-Chemotherapy and Prolonged Healing of Anastomotic Leakage after Esophageal Resection Treated with EndoVAC Therapy
by Philippa Seika, Matthias Biebl, Jonas Raakow, Nadja Berndt, Linda Feldbrügge, Max Magnus Maurer, Eva Dobrindt, Peter Thuss-Patience, Johann Pratschke and Christian Denecke
J. Clin. Med. 2022, 11(16), 4773; https://doi.org/10.3390/jcm11164773 - 16 Aug 2022
Cited by 5 | Viewed by 1262
Abstract
(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive [...] Read more.
(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive esophagectomy between 2013 and 2022 were analyzed. A total of 26 patients received EVT for AL after esophagectomy between 2010 and 2021. We compared a cohort of 13 patients after treatment with EVT for anastomotic leakage after neoadjuvant radiochemotherapy (nRCT) with a control group of 13 patients after neoadjuvant chemotherapy (nCT) using inverse propensity score weighting to adjust for baseline characteristics between the groups. EVT therapy was assessed regarding patient survival, treatment failure as defined by a change in treatment to stent/operation, duration of treatment, and secondary complications. Statistical analysis was performed using linear regression analysis. (3) Results: Time to EVT after initial tumor resection did not vary between the groups. The duration of EVT was longer in patients after nRCT (14.69 days vs. 20.85 days, p = 0.002) with significantly more interventions (4.38 vs. 6.85, p = 0.001). The success rate of EVT did not differ between the two groups (nCT n = 8 (61.54%) vs. nCT n = 5 (38.46%), p = 0.628). The rate of operative revision did not vary between the groups. Importantly, no mortality was reported within 30 days and 90 days in both groups. (4) Conclusions: EVT is a valuable tool for the management of AL after esophageal resection in patients after nRCT. While the success rates were comparable, EVT was associated with a significantly longer treatment duration. Anastomotic leakages after nRCT often require prolonged and multimodal treatment strategies while innovative strategies such as prophylactic endoVAC placement or use of a VAC-Stent may be considered. Full article
(This article belongs to the Special Issue Postoperative Complications of Esophageal Cancer)
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10 pages, 1156 KiB  
Article
Usefulness of Procalcitonin as a Predictor of Long-Term Prognosis in the Early Postoperative Period after Esophagectomy for Esophageal Cancer
by Eisuke Booka, Hirotoshi Kikuchi, Ryoma Haneda, Wataru Soneda, Sanshiro Kawata, Tomohiro Murakami, Tomohiro Matsumoto, Yoshihiro Hiramatsu and Hiroya Takeuchi
J. Clin. Med. 2022, 11(12), 3359; https://doi.org/10.3390/jcm11123359 - 11 Jun 2022
Cited by 2 | Viewed by 1261
Abstract
The aim of this study was to investigate the relationship between serum procalcitonin (PCT) levels after esophagectomy and infectious complications and long-term prognosis. A total of 105 patients who underwent esophagectomy between 2012 and 2019 were stratified into two groups: PCT-High group of [...] Read more.
The aim of this study was to investigate the relationship between serum procalcitonin (PCT) levels after esophagectomy and infectious complications and long-term prognosis. A total of 105 patients who underwent esophagectomy between 2012 and 2019 were stratified into two groups: PCT-High group of ≥1 ng/mL and PCT-Low group of <1 ng/mL. The clinical outcomes and prognostic factors were compared between the two groups 2 postoperative days (POD), 4 POD, and 7 POD after esophagectomy. As the postoperative days passed, the association between PCT and infectious complications became stronger, and the positive predictive value was 100% at 7 POD. At 2 POD, there was no significant association between PCT elevation and infectious complications. Patients in the PCT-Low group had significantly worse overall survival (OS) and recurrence-free survival (RFS) than those in the PCT-High group at 2 POD (p = 0.026 and p = 0.011, respectively). In multivariate analysis, advanced pathological stage (hazard ratio (HR), 5.348; 95% confidence interval (CI), 2.299–12.500; p < 0.001) and PCT-Low group at 2 POD (HR, 3.673; 95% CI, 1.116–12.092; p = 0.032) were also independent predictors of worse OS. PCT in the early postoperative period after esophagectomy could be a good predictor of prognosis. Full article
(This article belongs to the Special Issue Postoperative Complications of Esophageal Cancer)
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12 pages, 560 KiB  
Article
The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer
by Yuto Kubo, Koji Tanaka, Makoto Yamasaki, Kotaro Yamashita, Tomoki Makino, Takuro Saito, Kazuyoshi Yamamoto, Tsuyoshi Takahashi, Yukinori Kurokawa, Masaaki Motoori, Yutaka Kimura, Kiyokazu Nakajima, Hidetoshi Eguchi and Yuichiro Doki
J. Clin. Med. 2022, 11(11), 3219; https://doi.org/10.3390/jcm11113219 - 5 Jun 2022
Cited by 7 | Viewed by 1704
Abstract
Background: Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear. Methods: This study included 115 patients with thoracic [...] Read more.
Background: Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear. Methods: This study included 115 patients with thoracic esophageal squamous cell cancer who underwent MIE between January 2018 and January 2020. We retrospectively evaluated the association between perioperative fluid balance from during surgery to postoperative day (POD) 2, and postoperative complications. Results: The patients were divided into lower group and higher group based on the median fluid balance during surgery and at POD 1 and POD 2. We found that the higher group at POD 1 (≥3000 mL) was the most important indicator of postoperative complications, such as acute pneumonia within 7 days after surgery, and anastomotic leakage (p = 0.029, p = 0.024, respectively). Moreover, the higher group at POD 1 was a significant independent factor for acute postoperative pneumonia by multivariate analysis (OR: 3.270, 95% CI: 1.077–9.929, p = 0.037). Conclusion: This study showed that fluid overload at POD 1 had a negative influence on postoperative complications in patients with esophageal cancer. The fluid balance must be strictly controlled during the early postoperative management of patients undergoing esophageal cancer surgery. Full article
(This article belongs to the Special Issue Postoperative Complications of Esophageal Cancer)
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