• 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 Nilsson, Francesco 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, WijnhovenBas P LBPLDepartment of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands., NieuwenhuijzenGrard A PGAPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., LuyerMisha D PMDPDepartment of Surgery, Catharina Hospital, Eindhoven, the Netherlands., and EsoBenchmark Collaborative.
• Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
• Ann. Surg. 2021 Dec 1; 274 (6): e1129-e1137.

BackgroundEsophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity.ObjectiveAlthough 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.MethodsData 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.ResultsA 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.ConclusionThe occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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