Esophageal cancer surgery 5-year survival rate and predictors of operative mortality—a single-center analysis: Esophageal cancer surgery survival rate

Vítor Patrício Correia; José Paulo Freire; Luís Castro; Helder Matos; Andreia Barão; Teresa Braga; Rosário Rosa; Luís Miranda

doi:10.28982/josam.8326

Authors

Vítor Patrício Correia Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0002-9308-4586
José Paulo Freire Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0002-9739-9585
Luís Castro Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0002-7017-1791
Helder Matos Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0001-7614-560X
Andreia Barão Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0002-5952-5544
Teresa Braga Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0009-0005-7893-0798
Rosário Rosa Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0003-0964-1069
Luís Miranda Department of Surgery - Unidade Local de Saúde Santa Maria https://orcid.org/0000-0003-4281-3627

DOI:

https://doi.org/10.28982/josam.8326

Keywords:

Esophagus, Esophageal neoplasms, Esophagectomy, Survival Rate, Neoadjuvant Therapy

Abstract

Background/Aim: Esophagectomy remains the primary curative option for esophageal cancer; however, survival outcomes vary based on treatment strategies, tumor staging, and surgical techniques. This study evaluated the survival rates of patients undergoing esophagectomy and assessed factors influencing postoperative prognosis.

Methods: A retrospective observational study was conducted of 75 patients undergoing esophagectomy between 2017 and 2024 at a single tertiary center. Fifty-nine patients had esophageal and gastroesophageal junction malignancies and were non-randomly allocated to one of three treatment arms: primary surgery, neoadjuvant chemoradiotherapy (CROSS) followed by surgery, and perioperative chemotherapy (FLOT) followed by surgery. Survival analysis was performed using Kaplan-Meier estimates, and prognostic factors were assessed using multivariate statistical tests.

Results: The overall 5-year survival rate was 32%. Patients in the FLOT group had a higher survival rate than patients in the CROSS and primary surgery groups. However, the difference was not statistically significant (P=0.121). Pathological staging significantly impacted survival, with stage I patients having a 52% 5-year survival rate. McKeown esophagectomy was associated with the lowest survival rate (11%); transhiatal esophagectomy exhibited the highest anastomotic leak rate (50%). The Surgical Apgar Score (SAS) was a strong predictor of perioperative risk (AUC=0.94, P<0.001).

Conclusion: Postoperative pathological staging remains the strongest predictor of survival in esophageal cancer surgery. While neoadjuvancy showed promising trends, additional studies are necessary to optimize patient selection and evaluate the role of active surveillance strategies in long-term outcomes.

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