P1.067. Multinational Comparison of Surgical Approaches and Postoperative Outcomes in Esophageal Cancer: An International Multicenter Cohort Study

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Esophagectomy for esophageal cancer carries substantial morbidity, yet the extent to which institutional surgical strategy—encompassing operative approach, lymphadenectomy extent, and neoadjuvant treatment protocol—determines postoperative complication profiles remains poorly characterized across different geographic practice environments. We performed a retrospective analysis of a prospectively maintained international multicenter database (ISDE) comprising 2,490 patients who underwent curative-intent esophagectomy across four centers (Centers A–D; n=825, 499, 1,012, and 154 respectively). Primary outcomes were postoperative complication rates, in-hospital mortality, and length of stay. Given substantial heterogeneity in neoadjuvant therapy rates (Center A 81.1% versus Center D 11.0%), pathological stage distribution, and lymphadenectomy extent, all cross-institutional comparisons were performed descriptively with formal confounding adjustment deferred to propensity-matched subgroup analyses. Marked inter-institutional variation in surgical strategy was observed. Center A was characterized by near-universal thoracoscopic-laparoscopic esophagectomy (93.7% thoracoscopy), three-field lymphadenectomy, and the highest neoadjuvant treatment rate (81.1%). Center B predominantly underwent open Ivor-Lewis esophagectomy (80.6%), with robotic assistance in 13.6% and concurrent chemoradiotherapy in 46.3%. Center C demonstrated approximately 70% minimally invasive adoption with two-field dissection, while Center D uniformly employed McKeown esophagectomy with selected cervical dissection. Center A exhibited the highest rate of recurrent laryngeal nerve palsy (28.6%) and chylothorax (7.8%), reflecting systematic radical dissection. Despite this, in-hospital mortality was 0.7%, ICU stay was a median of 3 days (IQR 2–3), and postoperative length of stay was 14 days (IQR 12–19). Anastomotic leakage rates were comparable across centers with available data (Center A 9.3%; Center C 10.7%; Center D 11.0%). Recurrent laryngeal nerve injury was lower in centers employing two-field dissection (Center C 8.3%; Center D 15.6%). Operative strategy is the primary driver of postoperative complication phenotype in esophageal cancer surgery. Three-field lymphadenectomy uniquely confers high recurrent laryngeal nerve palsy and chylothorax rates despite low mortality. Valid cross-institutional outcome benchmarking requires rigorous adjustment for neoadjuvant treatment exposure, pathological stage composition, and dissection field extent.