European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Short and Long-term mortality following new-onset atrial fibrillation in patients post oesophageal surgery.
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Essa Hani, Balu Ashwin, Stephens Nathan, Lip Gregory Y H, Welters Ingeborg
Аннотация
INTRODUCTION: Oesophageal cancer is a highly aggressive malignancy that exerts a disproportionate impact on mortality: it is the 11th most common cancer worldwide, yet the 7th leading cause of cancer death. Operative management is the gold standard for a curative approach. New-onset atrial fibrillation (NOAF) is a common complication after esophagectomy. It is unclear if NOAF post-esophagectomy influences long-term mortality.
METHODS: We conducted a retrospective cohort analysis of all patients undergoing esophagectomy for oesophageal cancer at a tertiary UK centre between September 2016 and February 2025. Patients with benign oesophageal disease or prior AF were excluded. Baseline characteristics, perioperative complications, and survival outcomes were extracted from electronic medical records.
RESULTS: A total of 385 patients (mean age 65.1 ± 9.7 years; 20.7% female) were included, of whom 114 (29.6%) developed new-onset atrial fibrillation (NOAF). Patients with NOAF were older than controls (67.8 ± 7.2 vs 63.7 ± 10 years, p < 0.001), with no other significant baseline differences. NOAF was strongly associated with pneumonia (66.7% vs 42.4%, p < 0.001), anastomotic leak (20.2% vs 5.9%, p < 0.001), longer ICU stay (6.9 vs 5.2 days, p < 0.001), higher in-hospital mortality (13.2% vs 1.1%, p < 0.001) and twelve-month mortality (17.5% vs 9.9%, p = 0.047). Survival analysis demonstrated significantly worse outcomes (HR 19.58, 95% CI 2.45-156.52, p = 0.005), with no difference beyond 30 days.
CONCLUSION: NOAF is implicated in nearly 30% of esophagectomy patients and is a significant marker of increased perioperative morbidity and early mortality. NOAF is associated with postoperative complications, in particular pneumonia and anastomotic leak. This affects short-term outcomes but appears to have limited long-term effect.
METHODS: We conducted a retrospective cohort analysis of all patients undergoing esophagectomy for oesophageal cancer at a tertiary UK centre between September 2016 and February 2025. Patients with benign oesophageal disease or prior AF were excluded. Baseline characteristics, perioperative complications, and survival outcomes were extracted from electronic medical records.
RESULTS: A total of 385 patients (mean age 65.1 ± 9.7 years; 20.7% female) were included, of whom 114 (29.6%) developed new-onset atrial fibrillation (NOAF). Patients with NOAF were older than controls (67.8 ± 7.2 vs 63.7 ± 10 years, p < 0.001), with no other significant baseline differences. NOAF was strongly associated with pneumonia (66.7% vs 42.4%, p < 0.001), anastomotic leak (20.2% vs 5.9%, p < 0.001), longer ICU stay (6.9 vs 5.2 days, p < 0.001), higher in-hospital mortality (13.2% vs 1.1%, p < 0.001) and twelve-month mortality (17.5% vs 9.9%, p = 0.047). Survival analysis demonstrated significantly worse outcomes (HR 19.58, 95% CI 2.45-156.52, p = 0.005), with no difference beyond 30 days.
CONCLUSION: NOAF is implicated in nearly 30% of esophagectomy patients and is a significant marker of increased perioperative morbidity and early mortality. NOAF is associated with postoperative complications, in particular pneumonia and anastomotic leak. This affects short-term outcomes but appears to have limited long-term effect.