Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy

Objectives To examine the safety of transthoracic esophagogastrectomy (TTE) in a multi disciplinary cancer center and to determine which clinical parameters influ enced survival and the rates of death and complications. Summary Background Data Although the incidence of cancer at the gastroesophageal junction has been rising rapidly in the United States, controversy still exists about the saf ety of surgical procedures designed to remove the distal esophagus and prox imal stomach. Alternatives to TTE have been proposed because of the reporte dly high rates of death and complications associated with the procedure. Methods Data from 143 patients treated by TTE by one author (1989-1999) were entere d into a computerized database. Preoperative clinical parameters were teste d for effect on death, complications, and survival. Results The patient population consisted of 127 men and 16 women. One hundr ed twenty-one patients had a history of tobacco abuse, and 118 reported the regular ingestion of alcohol. One hundred fifteen patients had adenocarcin oma, 16 had squamous cell cancer, 6 had another form of esophageal tumor, a nd 6 had high-grade dysplasia associated with Barrett epithelia. Fifty-six patients had adenocarcinomas arising in Barrett epithelium. Twenty-eight pa tients were treated with neoadjuvant chemoradiation before surgery. Three p atients died within 30 days of surgery (mortality rate 2.1%), Five patients (3.5%) had a documented anastomotic leak; three died). Overall, 42 patient s had complications (29%). Twenty-six had pulmonary complications (19%). Th e mean length of stay in the intensive care unit was 3.35 days; the mean ho spital length of stay was 13.54 days. The overall 3-year survival rate was 29,6%, Conclusions A high ASA score and the development of complications predicted an increase d length of stay. The presence of diabetes predicted the development of com plication and an increased length of stay. None of the other parameters tes ted predicted perioperative death or complications. Only disease stage, dia betes, and blood transfusion affected overall survival. From these results with a large series of patients with gastroesophageal junction cancers, TTE can be performed with a low death rate (2.1%), a low leak rate (3.5%), and an acceptable complication rate (29%).