Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103483
Revised: February 6, 2025
Accepted: February 26, 2025
Published online: April 27, 2025
Processing time: 113 Days and 21.8 Hours
Esophageal cancer constitutes one of the most aggressive malignant neoplasms associated with poor clinical outcomes. While surgical resection remains the cornerstone of curative intervention, optimization of perioperative care protocols has emerged as an essential strategy to reduce postoperative complications and potentially improve long-term survival rates in patients undergoing esophagec
To identify perioperative factors affecting prognosis after radical esophagectomy, aiming to improve patient outcomes through targeted interventions.
A retrospective study analyzed 378 patients with esophageal cancer who underwent radical esophagectomy (McKeown, Sweet, or Ivor-Lewis procedures) from January 2022 through December 2023. All operations were performed by experienced surgeons following standardized perioperative protocols. The inves
Multivariate Cox proportional hazards analysis identified three independent predictors of survival: Tumor-node-metastasis staging [Hazard ratio (HR) = 2.31, 95% confidence interval (CI): 1.72-3.10, P < 0.001], tumor differentiation (moderate: HR = 1.46, 95%CI: 1.02-2.09, P = 0.038; poor: HR = 2.15, 95%CI: 1.47-3.14, P < 0.001), and extended postoperative analgesic use (> 5 days) (HR = 1.43, 95%CI: 1.08-1.89, P = 0.012). Kaplan-Meier analysis demonstrated significantly lower overall survival rates in patients requiring analgesics for > 5 days compared to ≤ 5 days (P = 0.003), with consistent patterns observed for both opioid (P = 0.019) and nonsteroidal anti-inflammatory drug use (P = 0.028). The extended analgesic group exhibited a higher proportion of elderly patients (48.47% vs 35.57%, P = 0.015), while other baseline characteristics and tumor features remained comparable between groups.
Tumor-node-metastasis staging, tumor differentiation, and duration of postoperative analgesic use independently predict survival following radical esophagectomy, underscoring the significance of optimal pain management protocols.
Core Tip: In this retrospective analysis of 378 patients who underwent radical esophagectomy for esophageal cancer, we identified tumor-node-metastasis staging, tumor differentiation, and extended postoperative analgesic use (> 5 days) as independent predictors of overall survival. Of particular significance was the adverse impact of prolonged administration of both opioids and nonsteroidal anti-inflammatory drugs on survival outcomes. These findings emphasize the critical importance of precise perioperative management, specifically regarding optimal pain control protocols, in enhancing patient outcomes. Further validation through multicenter, prospective studies and investigation of underlying mechanisms is warranted to optimize perioperative care strategies and improve long-term survival rates in this patient population.