Association Between Thoracic Inlet Size and Cervical Anastomosis Outcomes in Esophageal Cancer Surgery

Esophageal cancer surgery is associated with high morbidity and mortality, and anastomotic leakage remains a critical determinant of outcomes. Although thoracic inlet size has been linked to complications in retrosternal reconstruction, its role in posterior mediastinal reconstruction is unclear. In this retrospective study, 67 patients who underwent esophagectomy with posterior mediastinal reconstruction were analyzed. Thoracic inlet measurements were obtained from preoperative computed tomography. Postoperative complications occurred in 29.9% of patients, anastomotic leakage (AL) in 14.9%, and overall 30-day postoperative mortality in 13.4%. The thoracic inlet area (TIA) was significantly lower in non-survivors than in survivors (513.5 vs. 703.3 mm², p = 0.012). Anastomotic leakage was markedly more frequent among non-survivors (66.7% vs. 6.9%). In multivariable analysis adjusted for age and sex, thoracic inlet area remained associated with postoperative mortality; however, the findings should be interpreted cautiously because of the limited sample size and retrospective design. These findings suggest a possible association between thoracic inlet geometry and postoperative outcomes in posterior mediastinal reconstruction; however, larger prospective multicenter studies are required before definitive clinical conclusions can be drawn.