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Inflammatory response and recurrence after minimally invasive esophagectomy

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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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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

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

Authors
  1. Akihiko Okamura
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  2. Kotaro Yamashita
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  3. Ryotaro Kozuki
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  4. Keita Takahashi
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  5. Tasuku Toihata
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  6. Yu Imamura
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  7. Shinji Mine
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  8. Masayuki Watanabe
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Contributions

Study conception and design: all authors. Acquisition of data: all authors. Analysis and interpretation of data: Okamura, Watanabe, Yamashita, Mine. Drafting manuscript: Okamura, Watanabe, Yamashita, Mine. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Masayuki Watanabe.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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The authors declare that they have no conflict of interest.

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Okamura, A., Yamashita, K., Kozuki, R. et al. Inflammatory response and recurrence after minimally invasive esophagectomy. Langenbecks Arch Surg 404, 761–769 (2019). https://doi.org/10.1007/s00423-019-01818-6

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  • DOI: https://doi.org/10.1007/s00423-019-01818-6

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