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

L Giulini; M Kemeter; L Thumfart; F Hüttner; P Heger; O Koch; M Grechenig; M Weitzendorfer; K Emmanuel; G Capovilla; F Riccio; R Salvador; M Valmasoni; A R Latorre-Rodriguez; S K Mittal; P Milito; S Siboni; E Asti; K E Thiel; M K Diener; A Dubecz

doi:10.1055/s-0045-1811057

Zeitschrift für Gastroenterologie, Table of Contents

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

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

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

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

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

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

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

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

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

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

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

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

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

³University of Padova – Italy, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italien
A R Latorre-Rodriguez

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

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

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

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

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

⁶Paracelsus Medizinische Privatuniversität Salzburg, Research Management, Salzburg, Österreich
M K Diener

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

⁷Helios Clinic Erfurt, Department of Surgery, Erfurt, Deutschland

Abstract

Full Text

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.