Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study
Menée sur une cohorte de 1 822 patients atteints d'un cancer de l'œsophage traité par résection entre 1987 et 2010, cette étude rétrospective évalue, du point de vue de la mortalité spécifique et de la mortalité toutes causes confondues à 5 ans, l'intérêt d'une seconde intervention chirurgicale dans les 30 jours suivant la première opération
Objectives : The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period. Design : This was a nationwide population-based retrospective cohort study.Setting All hospitals performing oesophageal cancer resections during the study period (1987–2010) in Sweden. Participants : Patients operated for oesophageal cancer with curative intent in 1987–2010. Primary and secondary outcomes Adjusted HRs of all cause, early and late mortality up to 5 years after reoperation following oesophageal cancer resection. Results : Among 1822 included patients, the 200 (11%) who were reoperated had a 27% increased HR of all-cause mortality (adjusted HR 1.27, 95% CI 1.05 to 1.53) and 28% increased HR of disease-specific mortality (adjusted HR 1.28, 95% CI 1.04 to 1.59), compared to those not reoperated. Reoperation for anastomotic insufficiency in particular was followed by an increased mortality (adjusted HR 1.82, 95% CI 1.19 to 2.76). Conclusions : This large and population-based nationwide cohort study shows that reoperation within 30 days after primary oesophageal resection was associated with increased mortality, even after excluding the initial 3 months after surgery. This finding stresses the need to consider any actions that might prevent complications and reoperation after oesophageal cancer resection.