@article{3120715,
    title = "The impact of cirrhosis on esophageal cancer surgery: An up-to-date meta-analysis",
    author = "Schizas, D. and Giannopoulos, S. and Vailas, M. and Mylonas, K.S. and Giannopoulos, S. and Moris, D. and Rouvelas, I. and Felekouras, E. and Liakakos, T.",
    journal = "AMERICAN JOURNAL OF SURGERY",
    year = "2020",
    volume = "220",
    number = "4",
    pages = "865-872",
    publisher = "HANLEY & BELFUS-ELSEVIER INC",
    issn = "0002-9610",
    doi = "10.1016/j.amjsurg.2020.02.035",
    keywords = "anastomosis leakage;  ascites;  cancer prognosis;  Child Pugh score;  esophagus cancer;  esophagus resection;  follow up;  GRADE approach;  human;  liver cirrhosis;  meta analysis (topic);  mortality rate;  postoperative period;  Preferred Reporting Items for Systematic Reviews and Meta-Analyses;  priority journal;  Review;  systematic review;  treatment duration;  complication;  esophagus tumor;  liver cirrhosis;  meta analysis;  treatment outcome, Esophageal Neoplasms;  Esophagectomy;  Humans;  Liver Cirrhosis;  Treatment Outcome",
    abstract = "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. © 2020 Elsevier Inc."
}