Risk factors of postoperative complications and prognostic factors in patients undergoing esophagectomy reconstructed with colonic interposition

Abstract

Colonic interposition following esophageal resection remains challenging. Few studies have investigated the risk factors for postoperative complications and the prognostic factors in patients who underwent this type of surgery. We evaluated 83 patients who underwent esophagectomy with colonic interposition for esophageal and esophagogastric junction cancers. We analyzed factors associated with postoperative complications using logistic regression analysis and prognostic factors using Cox regression analysis. Postoperative complications occurred in 53.0% of patients, including anastomotic leakage in 22.9%, pneumonia in 19.3%, superficial surgical site infection in 7.2%, and deep surgical site infection in 7.2%. Preoperative malnutrition (odds ratio 5.31, 95% confidence interval 1.64-20.1, P = 0.005), synchronous gastrectomy (odds ratio 7.46, 95% confidence interval 2.15-31.5, P = .001), and upper (odds ratio 4.79, 95% confidence interval 1.05-25.1, P = .044) and middle (odds ratio 2.96, 95% confidence interval 1.01-9.33, P = .049) tumor locations were significantly associated with a higher incidence of postoperative complications. In addition, postoperative complications were independently associated with poor overall survival (hazard ratio 2.17, 95% confidence interval 1.13-4.17, P = .021) and cancer-specific survival (hazard ratio 2.52, 95% confidence interval 1.05-6.04, P = .039). Preoperative malnutrition, synchronous gastrectomy, and upper and middle tumor locations were independent risk factors for postoperative complications. Reducing the incidence of postoperative complications may contribute to improved long-term outcomes.

Keywords: colonic interposition; esophagectomy; malnutrition; postoperative complications.