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Langenbeck's Archives of Surgery
Erschienen in: Langenbeck's Archives of Surgery 6/2019

30.08.2019 | Original Article

Inflammatory response and recurrence after minimally invasive esophagectomy

verfasst von: Akihiko Okamura, Kotaro Yamashita, Ryotaro Kozuki, Keita Takahashi, Tasuku Toihata, Yu Imamura, Shinji Mine, Masayuki Watanabe

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 6/2019

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Abstract

Purpose

Esophagectomy for esophageal cancer is a very invasive surgery that induces an intense systemic inflammatory response. Postoperative infectious complications worsen survival after esophagectomy through inflammatory responses, and this study aimed to investigate the impact of the response on disease recurrence.

Methods

We assessed 230 patients who underwent curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. The area under the curve of serum C-reactive protein levels from preoperative day through postoperative day 7 was defined as the cumulative magnitude of postoperative inflammatory response.

Results

Relapse-free survival was compared among quartiles of the area, and fourth quartile showed the worst relapse-free survival. Patients in the fourth quartile were the high group, and others were low group. Compared with low group (n = 173), high group (n = 57) showed significantly worse relapse-free survival and overall survival (P = 0.014 and 0.028, respectively). Multivariate analyses found that high group (P = 0.048) was an independent risk factor for recurrence but not overall survival. Higher body mass index (P < 0.001) and postoperative infections (P < 0.001) were independent risk factors to become high group. However, the influence of high group on recurrence was not affected by postoperative infections in interaction analysis (P = 0.889).

Conclusions

Postoperative intense systemic inflammatory response independently increased the risk of recurrence after curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. Factors associating with intensified inflammatory response are higher body mass index and postoperative infections. Therefore, surgeons should make every effort to prevent postoperative infections to improve the long-term outcomes of patients.
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Metadaten
Titel
Inflammatory response and recurrence after minimally invasive esophagectomy
verfasst von
Akihiko Okamura
Kotaro Yamashita
Ryotaro Kozuki
Keita Takahashi
Tasuku Toihata
Yu Imamura
Shinji Mine
Masayuki Watanabe
Publikationsdatum
30.08.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Langenbeck's Archives of Surgery / Ausgabe 6/2019
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-019-01818-6

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