Risk factors of cervical anastomotic stricture after esophagectomy detected by early postoperative endoscopy

Anastomotic stricture after esophagectomy with cervical reconstruction remains a clinically significant complication, yet effective preventive strategies are limited. This study aimed to clarify the clinical significance of endoscopic findings on postoperative day 14 for predicting subsequent anastomotic stricture.

This retrospective single-center cohort study included 106 patients with esophageal cancer who underwent transthoracic esophagectomy with cervical reconstruction between April 2021 and December 2023. Cervical esophagogastric anastomosis was performed using a triangulating stapling technique with a linear stapler. Endoscopy was performed on postoperative day (POD) 14. Anastomotic stricture was defined as luminal narrowing requiring endoscopic balloon dilation within 1 year. Associations between POD 14 endoscopic findings and subsequent stricture were assessed using multivariable analysis. Exploratory analyses evaluated factors associated with ulcer formation.

Anastomotic stricture occurred in 16 patients (15%). Ulcer formation and esophageal edema on POD 14 were independent risk factors for stricture (both P = 0.03). Greater circumferential ulcer extent was significantly associated with higher stricture risk (P = 0.001). Exploratory analyses showed that elevated C-reactive protein on POD 7 (P = 0.004) and an anastomosis located across the thoracic inlet (P = 0.08) were associated with ulcer formation.

Ulceration observed on POD 14 endoscopy is a significant predictor of subsequent anastomotic stricture after esophagectomy. Early postoperative endoscopic assessment may help identify patients at increased risk of subsequent anastomotic stricture and support risk stratification during postoperative follow-up.