B. M. Hall1, T. Geraci1, J. Machan1, S. Milman1, W. Cioffi1, T. Ng1, S. Monaghan1 1Warren Alpert Medical School of Brown University,Department Of Surgery,Providence, RI, USA
Introduction:
Esophagectomy performed for esophageal cancer is a relatively high morbidity and mortality operation. The immediate morbidities have been shown to have major impacts on patient’s long term survival. Prior research at our institution has found decreased lymphocyte counts to be an independent predictor of mortality in some populations. We hypothesized the lymphocyte count postoperatively would predict outcomes in esophagectomy patients as well.
Methods:
A retrospective review was performed of all esophagectomies for adenocarcinoma performed over 13 years at our center by a single surgeon. The routinely obtained postoperative lymphocyte counts were analyzed for their trend, separating patients into three groups: never low, low with by recovery, and low without recovery. Resolution of lymphopenia was assessed at postoperative day four. Outcomes between these groups were then compared, with the primary end points being all cause mortality and recurrence analyzed with Kaplan Meier curves.
Results:
In total, 207 patients were included in the review with a minimum one year follow up. Our 5 year mortality and recurrence rates were 49% and 44% respectively. Recurrence was significantly higher in patients in patients with persistent lymphopenia [41% (64/158)] compared to those who did recover [13% (5/39)] (p = 0.0019) and those whose counts never dropped [10% (1/10)] (p = 0.0024). For mortality, the persistent lymphopenia group was significantly higher [54% (85/158)] as compared to the two other groups combined [33% (16/49)] (p = 0.0225). There was no significant difference in immediate complications including leak rate and infections, nor hospital length of stay. There were more patients with persistent lymphopenia who had a higher clinical stage (36 vs 13% p = 0.0051) and received neoadjuvant chemotherapy (86% vs 28% p < 0.0001). However, neither of these preoperative factors were predictive of mortality.
Conclusion:
There is a significant increase in the mortality and cancer recurrence rates in those patients whose lymphocyte count drops without recovery following their esophagectomy. These data imply differences in immune responses to the stress of surgery that that can be measured and are indicative of overall outcomes. As a portion of already routine postoperative labs, consideration of lymphocyte trends would an early indicator of potential poor outcomes in these patients.