Improving postoperative outcomes in esophagectomy for cancer—what is the role of institutional data?

摘要

Dr. Park and colleagues ( ) present the findings from retrospective review of 291 patients who underwent esophagectomy and mediastinal lymphadenectomy for intended curative treatment of esophageal cancer at a single institution. Specifically, the investigators analyzed postoperative 30-day readmission over a >10-year period to identify the incidence of and risk factors that predispose patients to readmission after undergoing esophagectomy. They focused on factors related to, and predictors of readmission. They “ .” Their outcomes are notable for high rates of vocal cord palsy, ascribed by the authors to mediastinal lymph node dissection, and long hospital stay (median 17 days, mean 25.6 days). However, their anastomotic leak rate was 10%, which is what we typically quote patients during the informed consent process and supported by the literature ( ). The mean time from discharge to readmission was about 14 days. Significant univariate characteristics identified through logistic regression analysis were included as covariates in multivariable modeling to determine significant risk factors for readmission. The study identified 39 (13.4%) patients readmitted and concluded the only independent risk factor for readmission was postoperative anastomotic leak (odds ratio 2.884, 95% CI: 1.133–7.343, P=0.026). These patients had significantly higher rates of readmission due to wound problems and anastomotic stricture compared to patients not experiencing anastomotic leak. They did not identify a relationship between vocal cord palsy and postoperative readmission. The authors suggest improvements in surgical techniques aimed at reducing anastomotic leakage and wound problems are means for improvement of surgical outcomes.