Journal Article

Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment

Bona, Davide, Aiolfi, Alberto, Manara, Michele, Bonavina, Luigi

2024

Overview

Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2–10.8; p  < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7–12.3; p  < 0.001) and DFS (5.4 months; 95% CI 1.6–9.1; p  = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51–0.69), 24 (HR 0.64, 95% CI 0.55–0.73), 36 (HR 0.67, 95% CI 0.55–0.79), and 60 months (HR 0.69, 95% CI 0.51–0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up. Graphical abstract

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Adjuvants / Bias / Body mass index / Cancer therapies / Disease-Free Survival / Esophageal cancer / Esophageal Neoplasms - mortality / Esophageal Neoplasms - surgery / Esophagectomy - adverse effects / Female / Histology / Humans / Literature reviews / Lung Diseases - etiology / Lung Diseases - mortality / Male / Medical personnel / Medicine / Medicine & Public Health / Meta-analysis / Mortality / Multivariate Analysis / Observational studies / Patients / Pneumonia / Postoperative Complications - etiology / Postoperative Complications - mortality / Pulmonary embolisms / Quantitative analysis / Respiratory failure / Review / Review Article / Software / Surgeons / Surgery / Survival Rate / Systematic review / Time Factors