Background: In 1999, Hebert et al. reported that a restrictive strategy of red-cell transfusion was at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients. Blood loss and red-cell transfusion seem to be important factors influencing the outcome of patients who undergo major surgery, such as an esophagectomy. A working group of the Ministry of Health, Labor and Welfare of Japan investigated factors that influenced both the short-term and long-term outcome, including blood loss and red-cell transfusion, in esophageal cancer patients who had undergone esophagectomies.
Aim: To clarify the factors influencing postoperative complications and long-term survival in esophageal cancer patients who have undergone esophagectomies.
Methods: A total of 1992 patients with esophageal cancer who had undergone esophagectomies via thoracotomies in 151 hospitals throughout Japan were enrolled. The relationships between various factors (age, sex, operative time, operative amount of blood loss, units of red-cell transfusion, preoperative complications, and surgeon's experience with performing esophagectomies) and postoperative outcome (postoperative complications and survival period) were analyzed using a logistic regression and a Cox’ proportional hazards model.
Results: The mean patient age was 63.5 +/- 8.6 years, the male vs. female ratio was 87:13, and the preoperative complication rate was 42%. The distributions of Stage 0, I, II, III, and VI diseases were 7%, 17%, 28%, 32% and 16%, respectively. Factors relevant to pneumonia were age, preoperative chronic lung diseases, and amount of blood loss. Factors relevant to anastomotic leakage were preoperative hypertension, preoperative chronic liver diseases, and red-cell transfusion. Factors relevant to infection were preoperative chronic liver diseases and operation time. The only factor relevant to postoperative liver dysfunction was preoperative hypertension. The disease stage and Hb value were prognostic factors. Surgeons who had experienced 100 or more esophagectomies were associated with shorter operation times, less blood loss, and longer patient survival periods than surgeons who had experienced less than 100 esophagectomies.
Conclusions: Decreasing the amount of blood loss and shortening the operation time suppressed the number of postoperative complications. This result was particularly true for experienced surgeons. The survival period of patients whose Hb value was higher was longer than that of patients whose Hb value was lower. Blood loss, operation time, and Hb value are important factors influencing the outcome of an esophagectomy.