Outcomes of esophagectomy in patients with previous foregut surgery: a matched retrospective cohort study

Esophagectomy is a challenging procedure indicated for esophageal cancer and complex benign esophageal conditions. The primary aim of this study was to determine the impact of previous foregut surgeries on postoperative outcomes following esophagectomy.

A retrospective cohort study was performed on patients undergoing esophagectomy between March 1st, 2008, and December 17th, 2024. Two groups were identified, patients with previous foregut surgery (PFS) and patients without previous foregut surgery (No-PFS). PFS (N = 37) was matched in a 3:1 ratio to patients with No-PFS (N = 111) by age, gender, race, and smoking status with "nearest neighbor" method. Demographics and perioperative variables were collected and compared between both groups. Kaplan-Meier method estimated survival and freedom from long-term complications, such as anastomotic stricture and paraconduit hernia.

Of 349 patients undergoing esophagectomy, 37 had PFS. These included 43% anti-reflux procedures, 35% Heller myotomy for achalasia, and 14% bariatric surgeries. Diagnosis of cancer was an indication for esophagectomy in 59.5% of cases. After matching, significant difference was found regarding operative time (PFS: 463 vs No-PFS: 426 min; p = 0.038). No difference was observed in conversions to open, early complications, reinterventions or leak rate (p value > 0.05). In 3 cases, an interposition graft (colon, jejunum) was used as conduit instead of stomach. As regards freedom from late anastomotic stricture, although not statistically significant, a trend toward a lower freedom from anastomotic stricture was observed in PFS group. The survival analysis, limited to patients with esophageal cancer, indicated higher survival rates in the PFS group (p = 0.06).

PFS does not impact the approach or outcomes of esophagectomy and is safe with no increased risk of complications. Patients with PFS who had indication of esophagectomy for cancer tended to have better survival rates due to earlier detection and lower clinical stages at diagnosis because of more frequent follow-ups.