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Updated: Jul 3, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Complications and survival after Ivor Lewis esophagectomy
A Abu Hejleh1, J Lemties1, I Kreutzer1
1Department of General, Visceral, Thoracic and Transplantation Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Background:
Esophagectomy (OE) remains a complex procedure with a considerable risk of severe postoperative complications. There is conflicting evidence if major postoperative complications impair long-term oncological survival. This retrospective study was designed to retest the hypothesis that complications after OE impact on long-term survival in a large and highly standardized cohort of esophageal cancer patients.
Materials And Methods:
733 patients who underwent Ivor Lewis esophagectomy (IL-OE) for cancer from 2016 to 2021 at our tertiary center were analysed from a prospectively maintained database. Postoperative complications were correlated to overall survival.
Results:
Neither occurrence of major complications ≥ Clavien-Dindo (CD) IIIB (Median OS not reached in both groups, p = 0.45, HR 1.12) nor AL (Median OS not reached for no AL vs. 50 months for AL, p = 0.49, HR 0.96) nor pulmonary complications (Median OS not reached in both groups, p = 0.61, HR 0.76) had an impact on overall survival. However, the necessity for postoperative readmission to ICU (reaICU) had a significant impact on overall survival (Median OS not reached for no reaICU vs. 40 months for reaICU, p = 0.037, HR 1.54). Mean follow up was 27 months.
Conclusion:
Among all variables, only ICU readmission significantly affected overall survival. Postoperative complications and in particular anastomotic leakage after IL-OE, per se, may have a less significant impact on overall survival than previously anticipated. This might be due to a highly sufficient management of complications that progressively avoids requirement of severe septic complications and intensive care treatment.
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