Aim: The incidence of esophageal malignancies is higher in cirrhotic patients due to the fact that cirrhosis and esophageal cancer share common risk factors. Our goal was to define the impact of cirrhosis on postoperative outcomes following esophagectomy for esophageal cancer.
Methods: This study was performed according to the PRISMA guidelines. Eligible studies were identified through search of PubMed, Scopus, and Cochrane (end-of-search date: March 8th, 2019). A meta-analysis was conducted using random effects modeling.
Results: We included 12 observational studies reporting on a total of 1938 patients who underwent surgery for esophageal cancer. Cirrhotic patients were more likely to develop postoperative pulmonary complications (OR: 2.60; 95% CI: 1.53-4.42), ascites (OR: 37.77; 95% CI: 10.95-130.28) and anastomotic leak/fistula within 30 days (OR: 2.81; 95% CI: 1.05-7.49) after esophageal cancer surgery. Cirrhotic patients had higher 30-day (OR: 3.04; 95% CI: 1.71-5.39) mortality rate. Liver disease did not appear to influence 90-day (OR: 2.84; 95% CI: 0.94-8.93) or late mortality rates (at a mean of 24 months of postoperative follow up) (OR: 1.70; 95% CI: 0.53-5.51). Esophagectomy for carcinoma in Child-Turcotte-Pugh class A cirrhotic patients was associated with significantly lower 30-day mortality rates compared to class B patients (OR: 0.14; 95% CI: 0.04-0.54).
Conclusions: Cirrhotic patients have higher odds of developing pulmonary complications, ascites, and anastomotic leak during the first postoperative month. Although, 30-day mortality was higher among cirrhotic patients after esophagectomy, liver disease does not seem to influence long-term prognosis.
Keywords: Child-turcotte-pugh; Cirrhosis; Esophageal cancer; Esophageal surgery; Esophagectomy; Meta-analysis.
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