The Effect of Postoperative Complications after Minimally Invasive Esophagectomy on Long-term Survival An International Multicenter Cohort Study

Laura F.C. Fransen, Gijs H.K. Berkelmans, Emanuele Asti, Mark I. van Berge Henegouwen, Felix Berlth, Luigi Bonavina, Andrew Brown, Christiane Bruns, Elke van Daele, Suzanne S. Gisbertz, Peter P. Grimminger, Christian A. Gutschow, Gerjon Hannink, Arnulf H. Hölscher, Juha Kauppi, Sjoerd M. Lagarde, Stuart Mercer, Johnny Moons, Philippe Nafteux, Magnus NilssonFrancesco Palazzo, Piet Pattyn, Dimitri A. Raptis, Jari Räsanen, Ernest L. Rosato, Ioannis Rouvelas, Henner M. Schmidt, Paul M. Schneider, Wolfgang Schröder, Pieter C. van der Sluis, Bas P.L. Wijnhoven, Grard A.P. Nieuwenhuijzen, Misha D.P. Luyer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

57 Citations (Scopus)


Background: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. Objective: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. Methods: Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. Results: A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25-2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30- 2.58). For all other complications, no significant association with long-term survival was found. Conclusion: The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.

Original languageEnglish
Pages (from-to)E1129-E1137
JournalAnnals of Surgery
Issue number6
Publication statusPublished - 1 Dec 2021

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