Z Gastroenterol 2025; 63(08): e594
DOI: 10.1055/s-0045-1811057
Abstracts | DGVS/DGAV
Kurzvorträge
Komplikationsmanagement in der Chirurgie Freitag, 19. September 2025, 16:10 – 17:38, Vortragsraum 10

Impact of anastomotic leak vs pneumonia on Long-term overall and disease-free survival after transthoracic esophagectomy for cancer

Authors

  • L Giulini

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • M Kemeter

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • L Thumfart

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • F Hüttner

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • P Heger

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • O Koch

    2   SALK – Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Salzburg, Österreich

  • M Grechenig

    2   SALK – Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Salzburg, Österreich

  • M Weitzendorfer

    2   SALK – Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Salzburg, Österreich

  • K Emmanuel

    2   SALK – Paracelsus Medizinische Privatuniversität Salzburg, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Salzburg, Österreich

  • G Capovilla

    3   University of Padova – Italy, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italien

  • F Riccio

    3   University of Padova – Italy, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italien

  • R Salvador

    3   University of Padova – Italy, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italien

  • M Valmasoni

    3   University of Padova – Italy, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italien

  • A R Latorre-Rodriguez

    4   St. Joseph´s Hospital and Medical Center, Norton Thoracic Institute, Phoenix, Vereinigte Staaten

  • S K Mittal

    4   St. Joseph´s Hospital and Medical Center, Norton Thoracic Institute, Phoenix, Vereinigte Staaten

  • P Milito

    5   IRCCS Policlinico San Donato – University of Milan – Italy, Department of General and Emergency Surgery, San Donato Milanese – Milano, Italien

  • S Siboni

    5   IRCCS Policlinico San Donato – University of Milan – Italy, Department of General and Emergency Surgery, San Donato Milanese – Milano, Italien

  • E Asti

    5   IRCCS Policlinico San Donato – University of Milan – Italy, Department of General and Emergency Surgery, San Donato Milanese – Milano, Italien

  • K E Thiel

    6   Paracelsus Medizinische Privatuniversität Salzburg, Research Management, Salzburg, Österreich

  • M K Diener

    1   Klinikum Nürnberg – Paracelsus Medizinische Privatuniversität, Universitätsklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Nürnberg, Deutschland

  • A Dubecz

    7   Helios Clinic Erfurt, Department of Surgery, Erfurt, Deutschland
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Background: Pneumonia and anastomotic leak are the 2 most feared complications after transthoracic esophagectomy for cancer. We have recently demonstrated that both complications have the same impact on in-hospital mortality, but their influence on long-term overall and disease-free survival is merely unknown. Aim of the study was to explore this aspect with a large international, multicentric, retrospective population-based analysis.

Methods: After IRB-Approval, the prospectively maintained databases of 5 tertiary centers (4 in Europe and 1 in the USA) were quired for patients who underwent transthoracic esophagectomy for cancer between 2007 and 2024. Perioperative complications were assessed and the impact of pneumonia and anastomotic leak on long-term overall and disease-free survival was analyzed with the Kaplan-Meier method.

Results: 1452 patients were included [1197 men (82.4%) and 255 women (17.6%)]. Mean age was 64.5 years. Anastomotic leak was registered in 172 patients (11.8%), while pneumonia in 219 (15.1%). Of these, 52 subjects (3.6%) had both complications. Long-term follow-up was available for 1343 patients.

Kaplan-Meier analysis showed that patients who suffered only an anastomotic leak had better overall survival than patients who suffered only pneumonia (3y OS 66.5% vs. 51.9%; 5y OS 61.5% vs. 46.7%). The respective log-rank test comparing the two Kaplan-Meier curves was significant at the 5% level (p=0.008). In contrast, patients who suffered only an anastomotic leak had worse disease-free survival than patients who suffered only pneumonia (3y DFS 55.2% vs. 68.7%; 5y DFS 39.2% vs. 61.8%). The respective log-rank test was highly significant (p<0.001).

Conclusions: Anastomotic leak and pneumonia are both dangerous complications after esophagectomy for cancer. While pneumonia seems to be a more dangerous complication when compared to anastomotic leak with regard to long-term overall-survival, the picture is inverse with respect to disease-free survival.



Publication History

Article published online:
04 September 2025

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