The Effect of Postoperative Sepsis on 1-Year Mortality and Cancer Recurrence Following Transhiatal Esophagectomy for Esophageal-Gastric Junction Adenocarcinomas: A Retrospective Observational Study

Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence. A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022. Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11-47); = 0.038), number of lymph nodes removed (OR: 0. 78 (0.64-0.95); = 0.011), recurrence at one year (OR: 9.22 (1.66-51.1); = 0.011), mediastinitis (OR: 17.7 (1.43-220); = 0.025) and intraoperative driving pressure (OR: 1.77 (1.17-2.68); = 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07-0.95; = 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5-18.9; = 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99-41.0; < 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36-5.19; = 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79-0.96; = 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71-25.32; < 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70-25.13; = 0.005). Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.