Survival Status and Predictors Of Postoperative Mortality in Patients Who Underwent Esophageal Surgeries for Esophageal Malignancies at Selected Governmental Hospitals Ethiopia, Addis Ababa: A Retrospective Cohort Study
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Date
2024-06
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Addis Ababa University
Abstract
Introduction: Cancer is still the leading cause of death worldwide, and esophageal canceris the sixth leading cause of cancer-related deaths. For individuals with esophageal cancer,esophagectomy is the only treatment option available and it has a high risk of both death andmorbidity. Moreover, despite advances in preoperative optimization, surgery, and anesthesia techniques, as well as the introduction of neoadjuvant therapy, the mortality and morbidity associated with esophagectomy persist to be high.
Objective: To assess the Survival status and predictors of postoperative mortality in patients who underwent esophageal surgeries for esophageal malignancies at selected governmental hospitals from 2018-2023 GC Ethiopia, Addis Ababa
Methods: A Retrospective Cohort study was conducted. After the acquisition of data from the chart review, Data was analyzed using R version 4.3.3. Descriptive statistics for categorical variables were reported as frequency and percentages. Kaplan Meier curve and log-rank test were used to estimate the survival curve and the difference in survival among groups within each covariate respectively. After esophageal surgery, the impact of each covariate on the time to death was assessed using the Cox proportional hazard model.
Results: 246 patients who underwent esophageal surgeries for esophageal malignancy at 4governmental hospitals in Addis Ababa were included over 5 years. The mean age of the patients was 52.1 years. 127(51.6%) had a T4 stage Cancer, 166(67.5%) had a tumor size <3.3cm, and Squamous cell carcinoma accounted for 207(84.1%) cases, Epidural Analgesia was the most commonly used analgesic technique 45(18.3%). 30-day mortality was 8.5%, The overall 1,2,3,4and 5-year survival rate were 49.8%, 30.2%, 15.4%, 15.4%, and 10.3% respectively. The median Survival time was 12 months. ASA score of > III. (AHR = 1.93, 95%CI 1.10-3.38), Hospital Acquired Pneumonia (AHR = 1.95, 95%CI: 1.06-3.59). Hypertension (AHR = 2.22, 95%CI: 1.04-4.73), Cervical anastomotic Leak (AHR = 2.17, 95%CI: 1.00-4.67), and sepsis (AHR = 3.69,95%CI: 1.49– 9.11). were identified as an independent predictor of postoperative mortality in the multivariate Cox regression model.
Conclusion: In Ethiopia, patients who underwent esophageal surgeries for esophageal malignancy have a low 5-year survival rate. Patients who develop complications in the postoperative period are more likely to die compared to their counterparts Thus screening, prevention, and early management of postoperative complications is recommended to improve survival rate.
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Keywords
Esophageal Cancer, Esophageal Surgery, Ethiopia, Survival Status