Impact of anastomotic leak vs pneumonia on failure to rescue after transthoracic esophagectomy for cancer

Data about failure to rescue (FTR) after esophagectomy for cancer and its association with patient and procedure-related risk factors are limited. This study aimed to analyze such aspects, particularly focusing on the effect of pneumonia and anastomotic leak on FTR. Patients who underwent an Ivor Lewis esophagectomy for cancer between 2008 and 2022 in 2 tertiary European centers were prospectively identified. Patients were classified and compared according to the type of operation (open, laparoscopic hybrid, robotic hybrid, minimally invasive, or robotic minimally invasive). FTR was defined as in-hospital death after a major complication. Risk factors for FTR were identified using a univariate model. Mortality after pneumonia and anastomotic leak were calculated and compared between the groups. A total of 708 patients were included. There were 355 open procedures (50.1%), 204 laparoscopic hybrid procedures (28.8%), 121 hybrid robotic procedures (17.1%), 15 standard minimally invasive procedures (2.1%), and 11 robotic minimally invasive procedures (1.6%). The overall morbidity was 60.0%, and the FTR rate was 4.5%. Anastomotic leak, pneumonia, postoperative bleeding, sepsis, pulmonary embolism, arrhythmia, and need for blood transfusion were the risk factors significantly associated with in-hospital mortality (P