Background. Severe postoperative complications (SPCs) may occur after curative esophagectomy for cancer and are associated with prolonged hospital stay, augmented costs, and increased in-hospital mortality. However, the effect of SPCs on survival after esophagectomy is uncertain. Aim. To assess the impact of severe postoperative complications (SPCs) on long-term survival following curative esophagectomy for cancer, we conducted a systematic search of PubMed, MEDLINE, Scopus, and Web of Science databases up to December 2023. The included studies examined the relationship between SPCs and survival outcomes, defining SPCs as Clavien–Dindo grade > 3. The primary outcome measure was long-term overall survival (OS). We used restricted mean survival time difference (RMSTD) and 95% confidence intervals (CIs) to calculate pooled effect sizes. Additionally, we applied the GRADE methodology to evaluate the certainty of the evidence. Results. Ten studies (2181 patients) were included. SPCs were reported in 651 (29.8%) patients. The RMSTD overall survival analysis shows that at 60-month follow-up, patients experiencing SPCs lived for 8.6 months (95% Cis −12.5, −4.7;p< 0.001) less, on average, compared with no-SPC patients. No differences were found for 60-month follow-up disease-free survival (−4.6 months, 95% CIs −11.9, 1.9;p= 0.17) and cancer-specific survival (−6.8 months, 95% CIs −11.9, 1.7;p= 0.21). The GRADE certainty of this evidence ranged from low to very low. Conclusions. This study suggests a statistically significant detrimental effect of SPCs on OS in patients undergoing curative esophagectomy for cancer. Also, a clinical trend toward reduced CSS and DFS was perceived.
背景：癌症根治性食管切除术后可能发生严重术后并发症（SPCs），其与住院时间延长、费用增加及院内死亡率升高相关。然而，SPCs对食管切除术后生存率的影响尚不明确。目的：为评估癌症根治性食管切除术后严重并发症对长期生存的影响，我们系统检索了截至2023年12月的PubMed、MEDLINE、Scopus和Web of Science数据库。纳入研究均探讨SPCs与生存结局的关系，并将SPCs定义为Clavien-Dindo分级>3级。主要结局指标为长期总生存期（OS）。我们采用限制性平均生存时间差（RMSTD）及95%置信区间（CIs）计算合并效应量，并应用GRADE方法评估证据质量。结果：共纳入10项研究（2181例患者），其中651例（29.8%）报告发生SPCs。RMSTD总生存分析显示，在60个月随访期内，发生SPCs的患者平均生存时间较无SPCs患者减少8.6个月（95% CI -12.5至-4.7；p<0.001）。60个月无病生存期（-4.6个月，95% CI -11.9至1.9；p=0.17）与癌症特异性生存期（-6.8个月，95% CI -11.9至1.7；p=0.21）均未发现显著差异。GRADE证据质量评估显示该证据质量介于低至极低等级。结论：本研究表明，在接受癌症根治性食管切除术的患者中，SPCs对总生存期存在统计学显著的有害影响。同时观察到癌症特异性生存期与无病生存期降低的临床趋势。
肿瘤(癌症)患者之家