Complicaciones y mortalidad en esofagectomía por cáncer en unidades de medicina intensiva

Darwin Tejera; Micaela Micol; Alejandro Laino; Federico Verga; Jimena Alzugaray; Mauricio Bertullo; Mario Cancela

Authors

Darwin Tejera Universidad de la República, Facultad de Medicina, Cátedra de Medicina Intensiva. Asistente
Micaela Micol Universidad de la República, Facultad de Medicina, Cátedra de Anestesiología. Ex Residente, Anestesióloga
Alejandro Laino Universidad de la República, Facultad de Medicina, Medicina Intensiva. Ex Residente, Médico Intensivista
Federico Verga Universidad de la República. Facultad de Medicina. Cátedra de Medicina Intensiva. Asistente
Jimena Alzugaray Universidad de la República, Facultad de Medicina, Medicina Intensiva. Ex Residente, Médico Intensivista
Mauricio Bertullo Universidad de la República, Facultad de Medicina, Cátedra de Medicina Intensiva. Asistente
Mario Cancela Universidad de la República. Facultad de Medicina. Cátedra de Medicina Intensiva. Ex Profesor Director

Keywords:

ESOPHAGEAL NEOPLASMS, ESOPHAGECTOMY, POSTOPERATIVE COMPLICATIONS, MORTALITY

Abstract

Introduction: esophagectomy is still the most widely used treatment for esophageal cancer.
Objectives: to describe frequency of complications and mortality after esophagectomy to treat complications and mortality of esophagectomy for esophageal cancer.
Method: retrospective, multi-center study between 2001 and 2011. The study included patients who underwent programmed esophagectomy to treat esophageal cancer during their stay in intensive care units.
Results: 224 patients were included in the study, 72% were men, average age was 61 years old and ± 11 standard deviation. Surgical approach was transhiatal in 69.7% of cases and transthoracic in 30.3%. Morbility was 70.5% and mortality 13.8%. Complications identified were respiratory 50.8%, infectious 51.3%, cardiovascular 27.6% and surgical 23.6%. Acute respiratory distress syndrome (p = 0.03), anostomotic leaks (p = 0.001), severe sepsis (p = 0.001), mediastinitis (p = 0.02) and acute renal injury (p = 0.01) were associated to mortality. Severe sepsis was the main cause of death with mediastinal or respiratory focus, or both. In the multivariate analysis, failure of extubation (OR 3.9; IC 95% 1.02-15.30; p = 0.03), intraoperative transfusion (OR 5.6; IC 95% 2.07-15.60; p = 0.001) and severe sepsis (OR 29; IC 95% 1.72-21.30; p = 0.001) were the variables independently associated.
Conclusions: morbimortality rates are high in esophagectomy. The most common complications were respiratory and infectious. Severe sepsis was the main cause of death. Failure to extubate, preoperative radiotherapy, intraoperative transfusion and severe sepsis were associated to greater mortality rates.

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