Abstract Background Esophagectomy is a complex procedure associated with a high rate of complications. Although primarily performed for esophageal cancer, elective esophagectomy is undertaken infrequently for benign conditions including end-stage achalasia and recalcitrant strictures. Given the benign nature of the indication, the acceptable threshold for complications in this patient population may be lower than that for malignant conditions. Data on surgical outcomes for this benign indications are very limited, but are necessary to inform a shared decision-making process with patients. This international study aims to evaluate peri-operative outcomes in patients undergoing elective esophagectomy for benign conditions. Methods Patients who underwent elective esophagectomy for benign pathology between 01/2007 and 12/2024 were identified from prospectively collected databases from five high volume institutions across North America and Europe. Data on demographics, comorbidities, surgical techniques, intra and postoperative complications (by Clavien-Dindo grade), ICU admissions, long-term complications, and mortality were collected. Descriptive statistics were used to analyze patient characteristics and surgical outcomes. Results Eighty-three cases (55% male, 55 years (44–64)) were identified with recalcitrant strictures (57%) and end-stage achalasia (36%) as the most common indications. Most had prior endoscopic (55%) or surgical (31%) interventions. The three-hole esophagectomy was the most common procedure (57%), and a minimally invasive approach was performed in 65% (n = 54). Complications (Table 1) occurred in 72% (n = 60), including pneumonia (23%), anastomotic leakage (23%), and recurrent laryngeal nerve palsy (11%). Major complications (CD III-V) affected 36% (n = 31), with a reoperation rate of 17% (n = 14) and mortality of 1% (n = 1). Anastomotic strictures requiring dilatation occurred in 20% (n = 19) during follow-up. Conclusion Esophagectomy for benign conditions, despite being performed on a younger and healthier population, is associated with high risk of post-operative complications similar to that reported for cancer, and a significant rate of recurrent dysphagia. Elective esophagectomy for benign conditions should be considered judiciously by patients and surgeons and only as a last resort after failure of all other forms of therapy.
Cusin et al. (Fri,) studied this question.