Factors Affecting Hospital Morbidity and Mortality after Esophageal Resection for Esophageal Carcinoma

Abstract

Background: Since its introduction, esophageal resection has been notable for high rates of morbidity and mortality. Despite many retrospective reviews, conclusions regarding which patients may be at undue risk for complications are difficult to infer. Aim of this study was to evaluate the preoperative and postoperative factors affecting the hospital morbidity and mortality following esophageal resection for esophageal carcinoma. The study has been performed to standardize the criteria of patient selection and intensive postoperative care for patients undergoing esophageal surgery for esophageal carcinoma.

Methods: It is a descriptive longitudinal study, performed in department of thoracic surgery, Dhaka Medical College Hospital from 1st July 2015 to 30th June 2016. Total 50 cases were included in this study. Purposive sampling was done and surgical intervention was carried out by surgeon’s ranked assistant professor or above.

Results: Of the 50 collected cases, mean age was 52.10 (±14.69) years with minimum age of 32 and maximum, 80 years. 78% were male and 22% female. 28 (56%) patients underwent one stage esophageal resection for esophageal carcinoma and 22 (44%) patients underwent two stage esophageal resection. Out of 50 patients undergoing esophageal resection, complications occurred in 52% of patients leading to postoperative morbidity, 10% patients died following surgery during hospital stay and uneventful recovery occurred in 38% of patients. Respiratory complication was the leading cause of hospital morbidity (42.30%) following esophageal resection with predominance (30.77%) among stage III patients. Mortality rates were 5.26% in stage I patients, 11.11% in stage II patients and 15.38% in stage III patients. Comparison among different classes of ASA (American Society of Anaesthesiologists) score revealed better post operative outcome in patients with Class I and poor results in Class III patients. Post operative mortality rates of age group 61 to 70 and 71 to 80 were 33.33% and 50% respectively compared to 00.0% in 31-40 age group. Outcome of patients with squamous cell carcinoma and adenocarcinoma were quite similar.

Conclusion: This study showed that respiratory complication was the leading cause of hospital morbidity and mortality following esophageal resection for esophageal carcinoma. Old age, poor lung function test results, high ASA score and stage III disease have been found to be associated with poor post operative outcome after esophageal resection

Journal of Surgical Sciences (2019) Vol. 23 (1) : 3-9