Risk factors associated with failure to rescue after minimally invasive Ivor Lewis esophagectomy

To explore the clinical factors associated with failure to rescue (FTR) among patients who underwent minimally invasive Ivor Lewis esophagectomy (MIE).

Retrospective analysis of all adults (≥ 18 years) who underwent a MIE from September 2013 to September 2023. FTR was defined as mortality rate among patients who developed any postoperative complication (any Clavien-Dindo grade). Univariable logistic regression was used to determine which factors were associated with FTR and those significant at p < 0.05 were entered into a multivariable model. Additionally, a stratified analysis was performed to explore the factors associated with FTR among those patients who developed life-threatening complications (Clavien-Dindo 4).

A total of 282 consecutive patients underwent MIEs during the study period. Of these, 138 (49%) developed at least one complication and 11 (4%) were classified as FTR. On univariable analysis, patients > 75 years of age or with cardiac comorbidities were 4 times more likely (OR 3.98, 95% CI 1.11-14.20, p = 0.033) and 4.7 times more likely (OR 4.70, 95% CI 1.19-18.58, p = 0.028) to experience FTR, respectively. Multivariable analysis revealed that age ≥ 75 years (OR 2.86, 95% CI 0.76-10.75, p = 0.120) and cardiac comorbidities (OR 3.75, 95% CI 0.91-15.50, p = 0.061) were associated with increased odds of FTR. Additionally, stratified univariable analysis among patients who developed life-threatening complications (Clavien-Dindo 4) showed no association with FTR.

Age and cardiac comorbidities are risk factors associated with FTR in patients undergoing MIE. These findings highlight the importance of preoperative risk stratification and optimization, as well as patient-provider shared decision-making, to reduce perioperative morbidity and mortality. Further studies are needed to develop perioperative strategies to reduce the rates of failure to rescue and improve the overall survival of this population.