Failure to rescue after oesophagectomy. The importance of recording complications. A 20-year retrospective study.

Background

Oesophageal cancer is a rare type of neoplasm in Western countries, yet it ranks as the seventh leading cause of death. Due to its anatomical location, oesophageal surgery is a highly complex procedure. The morbidity and mortality associated with oesophagectomy are significant, highlighting the need for a multidisciplinary approach to minimise complications. The measure of failure to rescue (FTR) reflects surgical outcomes and indicates the capacity to prevent death after a major complication (MC). It serves as a valuable metric for comparing results among different medical centers.

Objective

To evaluate the failure to rescue rate following esophagectomy at a high-volume tertiary oesophageal surgery center.

Methods

This retrospective study analysed FTR, mortality, and morbidity rates following oesophageal surgery from 2003 to 2024. Preoperative, intraoperative, and postoperative variables were assessed across patient groups. Comorbidities were evaluated using the ASA score, and complications were classified according to the Clavien-Dindo classification.

Results

268 patients underwent oesophagectomy during the period of study. 129 (48%) experienced MC. Among these, 25 patients died within the first 90 days after surgery: FTR rate of 19.3%. Univariate and multivariate logistic regression analyses identified respiratory complications, including pneumonia and adult respiratory distress syndrome, as independent factors associated with FTR.

Conclusion

Respiratory complications are identified as the most significant risk factor for FTR following oesophagectomy.