Impact of atrial fibrillation on long‐term survival following oesophagectomy: a 21‐year observational study

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Oesophagectomy, with or without perioperative chemoradiotherapy, is the gold standard treatment for localized oesophageal cancer. Despite marked improvements in recent decades, surgery is associated with considerable morbidity and mortality.1 Post‐operative atrial fibrillation (AF) is a common complication of oesophagectomy, with a reported incidence of 8–40%.2
The pathophysiological mechanisms underlying post‐operative AF remain incompletely understood, although they are likely related to inflammation, sympathetic activation and oxidative stress, in the presence of a cardiac substrate conducive to AF.11 Evidence informing the prevention and management of post‐operative AF following oesophagectomy is limited; although diltiazem and amiodarone have both been shown to be effective for prophylaxis of post‐operative AF in general thoracic surgery, studies focusing specifically on oesophagectomy are scarce.10
AF has conventionally been considered a minor complication, although it is associated with a range of septic complications, including anastomotic leak and pneumonia, and is hypothesized to represent a marker of a complicated post‐operative course.4 The occurrence of AF following oesophagectomy is associated with prolonged intensive care unit (ICU) and hospital admissions, and increased healthcare expenditure.2 Furthermore, post‐operative AF is correlated with inpatient mortality following oesophagectomy, likely due to its intimate relationship with other complications.5
Few studies have examined the consequences of post‐operative AF on long‐term outcomes. Two articles reported no significant impact on survival at 1‐ and 3‐year follow‐up.4 However, a recent study showed that AF independently predicted post‐discharge mortality at 1 year, though this did not persist for long‐term survival.7 The effects of post‐operative AF on long‐term mortality following oesophagectomy remain uncertain.
The aims of this study were to (i) determine the effect of post‐operative AF on long‐term survival following Ivor‐Lewis oesophagectomy and (ii) identify risk factors for the occurrence of post‐operative AF.
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