Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 103483
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103483
Perioperative risk factors for prognosis in patients undergoing radical esophagectomy: A retrospective study
Shu-Gang Liu, Xin-Jian Xu, Ming He, Ji-Dong Zhao, Lin Pei
Shu-Gang Liu, Department of Traditional Chinese Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Xin-Jian Xu, Ming He, Ji-Dong Zhao, Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Lin Pei, Hebei Key Lab Turbid, Hebei Academy of Chinese Medical Sciences, Shijiazhuang 050000, Hebei Province, China
Co-first authors: Shu-Gang Liu and Xin-Jian Xu.
Author contributions: Xu XJ and Liu SG contributed equally to the study design, data collection, and manuscript drafting, they contributed equally to this article, they are the co-first authors of this manuscript; He M and Zhao JD participated in surgical procedures, data analysis, and clinical interpretation; Pei L supervised the study, revised the manuscript, and oversaw submission; and all authors thoroughly reviewed and endorsed the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Fourth Hospital of Hebei Medical University, approval No. K2021-Approval-039 (5. 25).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin Pei, Professor, Hebei Key Lab Turbid, Hebei Academy of Chinese Medical Sciences, No. 209 Jianhua South Street, Shijiazhuang 050000, Hebei Province, China. peilin3368@sina.com
Received: December 5, 2024
Revised: February 6, 2025
Accepted: February 26, 2025
Published online: April 27, 2025
Processing time: 113 Days and 21.8 Hours
Abstract
BACKGROUND

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 esophagectomy. However, substantial debate persists regarding the relative importance of various perioperative risk factors and their impact on post-resection outcomes.

AIM

To identify perioperative factors affecting prognosis after radical esophagectomy, aiming to improve patient outcomes through targeted interventions.

METHODS

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 investigation gathered data on patient demographics, surgical parameters, tumor pathology (using the 8th edition American Joint Committee on Cancer staging system), and survival outcomes. Statistical analyses utilized Kaplan-Meier estimates and Cox proportional hazards modeling, with adjustment for confounding variables.

RESULTS

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.

CONCLUSION

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.

Keywords: Radical esophagectomy; Perioperative management; Prognostic factors; Postoperative analgesic use; Survival analysis

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.