Fræðigrein

Correspondence: Bjarni Geir Viðarsson, bjarnigv@landspitali.is

 

doi 10.17992/lbl.2026.04.886

Key words: Esophagectomy, Esophageal cancer, Low-volume center, Postoperative complications, Esophageal surgery

Introduction: Esophageal cancer is the seventh leading cause of cancer-related death worldwide. Curative treatment typically involves surgery with or without neoadjuvant chemoradiotherapy. The study aimed to describe patient characteristics and evaluate outcomes after partial esophagectomy at a low-volume center in Iceland.

Materials and Methods: This retrospective cohort study included all patients diagnosed with localized esophageal cancer in Iceland from 2015 to 2020 who were accepted for curative esophagectomy. Primary outcomes included postoperative complications, recurrence, and 5-year survival. Complications were categorized using the Clavien-Dindo classification, and descriptive analyses were performed. Recurrence was evaluated with all-cause mortality as a competing event, and survival rates assessed with Kaplan-Meier analysis.

Results: Overall, 33 patients underwent esophagectomy. The median age was 66 years, and 76% were male. Neoadjuvant therapy was administered in 94% of cases. Clavien-Dindo >3a occurred in 45% of patients and anastomotic leakage was the most frequent complication, occurring in 30% of cases. Mortality at 30 and 90 days were 0% and 6%, respectively. Five-year overall survival was 44%, and disease-free survival was 30%. Cumulative incidence of recurrence was 21% after one year and 55% after five years.

Conclusion: Esophagectomy for esophageal cancer in Iceland is associated with acceptable postoperative morbidity and operative mortality despite being performed in a low-volume setting. Although the incidence of anastomotic leakage is somewhat higher than in international cohorts, the 30-day mortality rate is low, and long-term survival is comparable to outcomes reported in Nordic countries.

Figure 1: Differences in cTNM and pTNM staging.

Figure 2: Clavien-Dindo rates among the patient cohort with 95% confidence intervals. If a patient had a complication in more than one grade, the highest grade was chosen.

Figure 3: Kaplan-Meier curves showing A) overall survival and B) disease-free survival.

Figure 4: Cumulative incidence of cancer recurrence and mortality without recurrence as a competing event.

 

Figure V-1: Flow-chart of the study cohort

Table I: Baseline characteristics, tumor features, and surgery related factors for the cohort. Continous variables are presented as median [interquartile range] and categorical variables as counts (%).

 

	Overall (n=33)			Overall (n=33)
Baseline characteristics			Tumor characteristics
Age (years)	66 [57, 71]		Histology
Male	25 (76)		Squamous cell carcinoma	9 (27)
Body mass index (kg/m2)	27,0 [23,8, 32,0]		Adenocarcinoma	24 (73)
Smoking history			Tumor location in the esophagus
Active	8 (24)		Upper	0 (0)
Former	20 (61)		Middle	5 (15)
Never	5 (15)		Lower	27 (82)
History of stroke	3 (9)		Esophagogastric junction	1 (3)
Ischemic heart disease	3 (9)		Aðgerðartengdir þættir
Diabetes	4 (12)		Type of operation
COPD	2 (6)		Open surgery	3 (9)
GFR <60 mL/mín	3 (9)		MIO	24 (73)
Hemoglobin (mmol/L)	121 [113, 134]		Hybrid surgery	6 (18)
ASA flokkun			Resection technique
I	3 (9)		Ivor-Lewis	32 (97)
II	16 (48)		Mckeown	1 (3)
III	14 (42)		Anastamosis method

IV	0 (0)		Linear stapler	27 (82)
Neoadjuvant therapy			Circular stapler	6 (18)
Chemoradiotherapy	29 (88)		Anastamosis location
Chemotherapy only	2 (6)		Brjósthol	32 (97)
Radiotherapy only	0 (0)		Háls	1 (3)
None	2 (6)		Number of lymph nodes resected	16 [13, 22]

 

Abbreviations: ASA, American Society of Anesthesiologists; COPD, chronic obstructive pulmonary disease; GFR, glomerular filtration rate; MIO, minimally invasive operation.

 

Table II: Short-term complications. Continous variables are presented as median [interquartile range] and categorical variables as counts (%).

	Overall (n=33)
30-day mortality	0 (0)
90-day mortality	2 (6)
Anastamosis leak	10 (30)
Severe lymph leak	1 (3)
Gastric perforation	1 (3)
Sepsis	2 (6)
Pneumonia	5 (15)
Respiratory failure	3 (9)
Acute kidney injury	2 (6)
Postoperative atrial fibrillation	3 (9)
Pneumothorax	1 (3)
Pleural fluid	8 (24)
Myocardial infarction	0 (0)
Length of ICU stay (days)	1 [1, 3]
Length of hospital stay (days)	16 [8, 31]
30-day readmission	11 (33)

Abbreviation: ICU, intensive unit