Results of the ESOSTAT multiple-center prospective study: analysis of 90-day postoperative morbidity and mortality after radical surgery for esophageal and esophagogastric junction cancer

Objective. To evaluate 90-day morbidity and mortality rates after elective radical surgery for esophageal and esophagogastric junction cancer within the prospective multiple-center study ESOSTAT. Material and methods. The study included 230 patients from 18 oncology hospitals in the Russian Federation and the Republic of Belarus who underwent elective radical esophagectomy for primary esophageal cancer or esophagogastric junction cancer (Siewert I–II) between March 18 and September 18, 2024. Complications were uniformly recorded using the ESODATA system with severity graded according to the Clavien-Dindo classification. Univariate and multivariate logistic regression analyses were performed to identify risk factors of postoperative complications and mortality. Results. The 90-day mortality rate was 8.7%, in-hospital mortality — 4.8%. The overall complication rate was 41.3%, including surgical complications in 26.5% of patients and redo surgeries in 17.4% of cases. The most common complications were pulmonary (22.1%) and anastomotic leakage (11.3%). The mortality rate associated with anastomotic leakage was 19.2%. Multivariate analysis identified female sex (OR=0.732; 95% CI 0.548–0.978; p=0.035), ECOG status 2 (OR=10.142; 95% CI 1.575–65.366; p=0.015), surgery time (OR=1.003; 95% CI 1.001–1.005; p=0.006), and intraoperative blood loss (OR=1.001; 95% CI 1.000–1.002; p=0.027) as independent predictors of complications. Factors independently associated with 90-day mortality were Charlson comorbidity index >4 (OR=1.260; 95% CI 1.062–1.495; p=0.008), complicated course of esophageal cancer (OR=1.560; 95% CI 0.637–2.305; p=0.025), concomitant pulmonary diseases (OR=3.328; 95% CI 1.083–10.227; p=0.036), and any postoperative complication (OR=36.554; 95% CI 15.800–84.521; p<0.001). Conclusion. The ESOSTAT study is the first in Russia and Belarus to evaluate 90-day morbidity and mortality rates after esophagectomy. Our findings are comparable with international registries, support 90-day follow-up period and identify key prognostic factors. Risk factor analysis will allow patient stratification according to the likelihood of adverse outcomes, facilitate more rigorous patient selection, and ultimately improve safety of surgical treatment.