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Updated: Sep 15, 2025
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Evaluating the Impact of Mental Disorders on Outcomes Following Esophagectomy for Cancer: A Systematic Review and
Dimitrios Papaconstantinou1, Theano Perri2, Nikolaos Christodoulou3
1Department of Digestive Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Background:
Esophageal cancer, the sixth leading cause of cancer-related deaths globally, imposes significant physical and psychological burdens on patients. Psychiatric comorbidities, such as anxiety and depression, are prevalent among esophagectomy patients and may adversely affect postoperative outcomes, quality of life, and survival. However, their clinical impact remains understudied and heterogeneous in existing literature.
Objectives:
This systematic review and meta-analysis evaluates the prevalence and clinical significance of perioperative mental disorders in esophageal cancer surgery, assessing their association with postoperative outcomes.
Data Sources:
A comprehensive search of Medline, Embase, CINAHL, CENTRAL, and Web of Science was conducted from inception to March 2025. (Keywords included "esophageal cancer," "esophagectomy," "anxiety," "depression").
Review Methods:
PRISMA-guided analysis included 11 studies (n = 24 411 patients). Studies reporting preoperative psychiatric comorbidities or postoperative mental disorders (PMD) were eligible. Risk of bias was assessed using ROBINS-I. Random-effects meta-analyses pooled mortality risk, PMD incidence, and associated risk factors.
Results:
Preoperative psychiatric comorbidities (11.8%-28.8%) increased mortality risk by 33% (RR 1.33, 95% CI 1.15-1.55, p < 0.001). PMD incidence was 29.8% (95% CI 21.2%-38.4%), with anxiety being the most common (29.5%). Key risk factors included stage III disease (OR 3.2, 95% CI 1.66-6.2), postoperative complications (OR 2.32, 95% CI 1.55-3.49), female gender (OR 1.35, 95% CI 1.07-1.69), and higher Charlson Comorbidity Index (OR 1.04, 95% CI 1.01-1.06).
Conclusions:
Mental disorders significantly impact esophagectomy outcomes, elevating mortality, and complicating recovery. Proactive screening and multidisciplinary mental health support are warranted, particularly for high-risk patients.
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