[Outcomes after partial esophagectomy for cancer in Iceland: A population-based study from a low-volume center]

Esophageal cancer is the seventh leading cause of cancer-related death worldwide. Curative treatment typically involves surgery with or without neoadjuvant chemoradiotherapy. The study aimed to describe patient characteristics and evaluate outcomes after partial esophagectomy at a low-volume center in Iceland.

This retrospective cohort study included all patients diagnosed with localized esophageal cancer in Iceland from 2015 to 2020 who were accepted for curative esophagectomy. Primary outcomes included postoperative complications, recurrence, and 5-year survival. Complications were categorized using the Clavien-Dindo classification, and descriptive analyses were performed. Recurrence was evaluated with all-cause mortality as a competing event, and survival rates assessed with Kaplan-Meier analysis.

Overall, 33 patients underwent esophagectomy. The median age was 66 years, and 76% were male. Neoadjuvant therapy was administered in 94% of cases. Clavien-Dindo >3a occurred in 45% of patients and anastomotic leakage was the most frequent complication, occurring in 30% of cases. Mortality at 30 and 90 days were 0% and 6%, respectively. Five-year overall survival was 44%, and disease-free survival was 30%. Cumulative incidence of recurrence was 21% after one year and 55% after five years.

Esophagectomy for esophageal cancer in Iceland is associated with acceptable postoperative morbidity and operative mortality despite being performed in a low-volume setting. Although the incidence of anastomotic leakage is somewhat higher than in international cohorts, the 30-day mortality rate is low, and long-term survival is comparable to outcomes reported in Nordic countries.