Skip to main content
Log in

Surgical Outcomes After Esophagectomy in Patients with Achalasia: a NSQIP Matched Analysis With Non-Achalasia Esophagectomy Patients

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

The data on surgical outcomes of esophagectomy in patients with achalasia is limited. We sought to evaluate surgical outcomes in achalasia patients after an esophagectomy versus non-achalasia patients to elucidate if the outcomes are affected by the diagnosis.

Methods

We conducted a retrospective review of the National Surgical Quality Improvement Program database (2010–2018). Patients who underwent an esophagectomy (open or laparoscopic approach) were included. Patients were divided into two groups, achalasia vs non-achalasia patients, and matched using propensity match analysis.

Results

Of the 10,997 esophagectomy patients who met inclusion criteria, 213 (1.9%) patients had a diagnosis of achalasia. A total of 418 patients were included for the final analysis, with 209 patients in each group (achalasia vs non-achalasia). The overall median age was 57 years (IQR 47–65 years), and 48.6% were female. Most underwent an open (93.1%) vs laparoscopic (6.9%) esophagectomy. Overall complication rate was 40%. No difference was identified on overall complications, readmission, reoperation, or mortality between both groups. Postoperative sepsis was significantly higher in the achalasia group, and organ space SSI was higher in the non-achalasia group. Multivariable analysis showed that a diagnosis (achalasia or non-achalasia) was not predictive of reoperation or overall complications.

Conclusion

Esophagectomy outcomes are similar in patients with achalasia vs non-achalasia, and the diagnosis of achalasia does not independently increase the risk of reoperation and overall complications. Finally, regardless of diagnosis, the potential for morbidity following esophagectomy, should to be discussed with patients in the preoperative setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Furuzawa-Carballeda J, Torres-Landa S, Valdovinos MA, Coss-Adame E, Martin Del Campo LA, Torres-Villalobos G. New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol. 2016;22(35):7892-7907.

    Article  CAS  Google Scholar 

  2. Aiolfi A, Asti E, Bonitta G, Bonavina L. Esophagectomy for End-Stage Achalasia: Systematic Review and Meta-analysis. World J Surg. 2018;42(5):1469-1476.

    Article  Google Scholar 

  3. Molena D, Mungo B, Stem M, Feinberg RL, Lidor AO. Outcomes of esophagectomy for esophageal achalasia in the United States. J Gastrointest Surg. 2014;18(2):310-317.

    Article  Google Scholar 

  4. Vela MF, Richter JE, Wachsberger D, Connor J, Rice TW. Complexities of managing achalasia at a tertiary referral center: use of pneumatic dilatation, Heller myotomy, and botulinum toxin injection. Am J Gastroenterol. 2004;99(6):1029-1036.

    Article  Google Scholar 

  5. Banbury MK, Rice TW, Goldblum JR, et al. Esophagectomy with gastric reconstruction for achalasia. J Thorac Cardiovasc Surg. 1999;117(6):1077-1084.

    Article  CAS  Google Scholar 

  6. Devaney EJ, Lannettoni MD, Orringer MB, Marshall B. Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg. 2001;72(3):854-858.

    Article  CAS  Google Scholar 

  7. Miller DL, Allen MS, Trastek VF, Deschamps C, Pairolero PC. Esophageal resection for recurrent achalasia. Ann Thorac Surg. 1995;60(4):922-925; discussion 925-926.

    Article  CAS  Google Scholar 

  8. Orringer MB, Stirling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg. 1989;47(3):340-345.

    Article  CAS  Google Scholar 

  9. Peters JH, Kauer WK, Crookes PF, Ireland AP, Bremner CG, DeMeester TR. Esophageal resection with colon interposition for end-stage achalasia. Arch Surg. 1995;130(6):632-636; discussion 636-637.

    Article  CAS  Google Scholar 

  10. Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B. Resection for achalasia of the esophagus. Hepatogastroenterology. 1991;38(6):470-473.

    CAS  PubMed  Google Scholar 

  11. Tank AK, Kumar A, Babu TL, Singh RK, Saxena R, Kapoor VK. Resectional surgery in achalasia cardia. Int J Surg. 2009;7(2):155-158.

    Article  Google Scholar 

  12. Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surg Endosc. 2017;31(6):2509-2519.

    Article  Google Scholar 

  13. Torres-Landa S, Cohen JB, Swendiman RA, Wirtalla C, Dempsey DT, Dumon KR. Correction to: The Association of Body Mass Index with Postoperative Outcomes After Elective Paraesophageal Hernia Repair. J Gastrointest Surg. 2019;23(8):1719.

    Article  Google Scholar 

  14. Hodari A, Hammoud ZT, Borgi JF, Tsiouris A, Rubinfeld IS. Assessment of morbidity and mortality after esophagectomy using a modified frailty index. Ann Thorac Surg. 2013;96(4):1240-1245.

    Article  Google Scholar 

  15. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking Complications Associated with Esophagectomy. Ann Surg. 2019;269(2):291-298.

    Article  Google Scholar 

  16. Yibulayin W, Abulizi S, Lv H, Sun W. Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol. 2016;14(1):304.

    Article  Google Scholar 

  17. Sabra MJ, Alwatari YA, Wolfe LG, et al. Ivor Lewis vs Mckeown esophagectomy: analysis of operative outcomes from the ACS NSQIP database. Gen Thorac Cardiovasc Surg. 2020;68(4):370-379.

    Article  CAS  Google Scholar 

  18. Biere SS, van Berge Henegouwen MI, Bonavina L, et al. Predictive factors for post-operative respiratory infections after esophagectomy for esophageal cancer: outcome of randomized trial. J Thorac Dis. 2017;9(Suppl 8):S861-S867.

    Article  Google Scholar 

  19. Rickles AS, Iannuzzi JC, Kelly KN, et al. Anastomotic leak or organ space surgical site infection: What are we missing in our quality improvement programs? Surgery. 2013;154(4):680-687; discussion 687-689.

    Article  Google Scholar 

  20. Lee J, Chin JH, Kim JI, Lee EH, Choi IC. Association between red blood cell transfusion and long-term mortality in patients with cancer of the esophagus after esophagectomy. Dis Esophagus. 2018;31(2).

Download references

Author information

Authors and Affiliations

Authors

Contributions

Samuel Torres-Landa, MD, meets all 4 criteria per ICMJE for authorship; Trevor D. Crafts, MD meets all 4 criteria per ICMJE for authorship; Amy E. Jones meets all 4 criteria per ICMJE for authorship; Elizabeth N. Dewey meets all 4 criteria per ICMJE for authorship; Stephanie G. Wood, MD meets all 4 criteria per ICMJE for authorship.

Corresponding author

Correspondence to Stephanie G. Wood MD.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Accepted for the Digestive Disease Week, May 21-23, 2021

Supplementary Information

ESM 1

(DOCX 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Torres-Landa, S., Crafts, T.D., Jones, A.E. et al. Surgical Outcomes After Esophagectomy in Patients with Achalasia: a NSQIP Matched Analysis With Non-Achalasia Esophagectomy Patients. J Gastrointest Surg 25, 2455–2462 (2021). https://doi.org/10.1007/s11605-021-05056-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-021-05056-4

Keywords

Navigation