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

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.