Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study

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.