Type

Journal Article

Authors

John V Reynolds
Narayanasamy Ravi
Claire L Donohoe
Naoimh OʼFarrell
Caroline Daly
Laura Healy
Sinead King
Alex Zaborowski
Orla Mc Cormack

Subjects

Medicine & Nursing

Topics
surgery female esophagectomy esophagogastric junction male incidence pathology epidemiology comorbidity middle aged risk factors atrial fibrillation aged survival rate c reactive protein esophageal neoplasms gastrectomy neoplasm staging postoperative complications hospital mortality retrospective studies therapy adult humans aged 80 and over age factors

New-onset atrial fibrillation post-surgery for esophageal and junctional cancer: incidence, management, and impact on short- and long-term outcomes. (2014)

Abstract To study new-onset postoperative atrial fibrillation in patients with esophageal and junctional cancer. Retrospective cohort study from a prospective data base. Atrial fibrillation (AF) is common after thoracic and esophageal surgical procedures. The full spectrum of risk factors, associations, and implications are unclear. All patients undergoing multimodal therapy or surgery with curative intent from 2006 to mid-2013 were studied. New-onset AF was recorded prospectively. Risk factors, management and resolution, association with other complications, and impact on in-hospital mortality and longer-term oncologic outcomes were analyzed in retrospective cohort analysis. A total of 473 patients (mean age: 63 years; 73% male) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy. Ninety-six (20%) patients developed new-onset AF, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively (P=0.05). Age, diabetes, neoadjuvant therapy, and cardiac history predisposed (P<0.05) to AF, and AF was significantly (P<0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein (CRP) (P<0.05) but not with anastomotic leak/conduit necrosis or mortality. Amiodarone was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge. At a median follow-up of 40 months (7-109 months), the median survival was 40 months versus 53 months in the AF and non-AF cohorts, respectively (P=0.353) CONCLUSIONS: New-onset AF is common, linked to age, diabetes, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation. For most, it resolves, with no impact on oncologic outcomes.
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Full list of authors on original publication

John V Reynolds, Narayanasamy Ravi, Claire L Donohoe, Naoimh OʼFarrell, Caroline Daly, Laura Healy, Sinead King, Alex Zaborowski, Orla Mc Cormack

Experts in our system

1
J V Reynolds
Trinity College Dublin
Total Publications: 206
 
2
N Ravi
Trinity College Dublin
Total Publications: 61
 
3
Claire L Donohoe
Trinity College Dublin
Total Publications: 38
 
4
Sinead King
Trinity College Dublin
Total Publications: 7