Complications and survival after Ivor Lewis esophagectomy

Background Esophagectomy (OE) remains a complex procedure with a considerable risk of severe postoperative complications. There is conflicting evidence if major postoperative complications impair long-term oncological survival. This retrospective study was designed to retest the hypothesis that complications after OE impact on long-term survival in a large and highly standardized cohort of esophageal cancer patients. Materials and methods 733 patients who underwent Ivor Lewis esophagectomy (IL-OE) for cancer from 2016 to 2021 at our tertiary center were analysed from a prospectively maintained database. Postoperative complications were correlated to overall survival. Results Neither occurrence of major complications ≥ Clavien-Dindo (CD) IIIB (Median OS not reached in both groups, p = 0.45, HR 1.12) nor AL (Median OS not reached for no AL vs. 50 months for AL, p = 0.49, HR 0.96) nor pulmonary complications (Median OS not reached in both groups, p = 0.61, HR 0.76) had an impact on overall survival. However, the necessity for postoperative readmission to ICU (reaICU) had a significant impact on overall survival (Median OS not reached for no reaICU vs. 40 months for reaICU, p = 0.037, HR 1.54). Mean follow up was 27 months. Conclusion Among all variables, only ICU readmission significantly affected overall survival. Postoperative complications and in particular anastomotic leakage after IL-OE, per se, may have a less significant impact on overall survival than previously anticipated. This might be due to a highly sufficient management of complications that progressively avoids requirement of severe septic complications and intensive care treatment.