Optimal classification and management of complications after curative esophagectomy for cancer: In the era of neoadjuvant chemoradiotherapy and minimally invasive surgery

Esophageal cancer is the sixth most deadly cancer worldwide and its incidence is rising. Esophagectomy has always been the standard curative treatment, but it is associated with morbidity and mortality rates of 50–65% and 2–5%, respectively. Since 2010, the standard curative treatment of esophageal cancer is expanded with chemotherapy and radiation prior to esophagectomy. This resulted in a 5-year overall survival of 50–60%. Recently, there have been several other changes in the surgical esophageal cancer treatment, such as the introduction of minimally invasive esophagectomy and the transthoracic approach. These changes may affect the occurrence and severity of complications after esophagectomy. Transparency about complications and their relative severity after the implementation of neoadjuvant chemoradiotherapy and minimally invasive transthoracic esophagectomy contributes to the quality of care for patients with esophageal carcinomas. Knowing that the accuracy of reporting surgical complications varies between 63 and 85%, registration methods need improvement and standardization. Unfortunately, scientific studies on this topic are scarce. Thus, several chapters of this thesis focus on the value of complication registration methods and severity classifications after esophagectomy for cancer. Furthermore, the thesis evaluates the influence of recent treatment changes in esophageal cancer on the incidence of complications after esophagectomy. By discussing these questions in the field of complications after esophagectomy, we hope to provide an insight in the importance of qualitative complication registry and the influence of changing treatment methods on postoperative outcomes after esophagectomy for cancer.