• Kexun Li, Simiao Lu, Longlin Jiang, Changding Li, Jie Mao, Wenwu He, Chenghao Wang, Kangning Wang, Guangyuan Liu, Yunchao Huang, Yongtao Han, Xuefeng Leng, and Lin Peng.
• Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China (UESTC), Chengdu, China; Department of Thoracic Surgery I, Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Kunming, China.
• J. Thorac. Cardiovasc. Surg. 2024 Dec 20.

BackgroundEsophageal squamous cell carcinoma is a prevalent and aggressive gastrointestinal tumor, particularly in East Asia. However, there is a lack of consensus on the long-term survival outcomes of intrathoracic anastomosis and cervical anastomosis following esophagectomy. This study aims to provide a comprehensive summary of the long-term survival outcomes of these 2 anastomosis techniques.MethodsWe employed data drawn from the Sichuan Cancer Hospital and Institute Esophageal Cancer Case Management Database from January 2010 to December 2017. Patients were stratified into 2 distinct groups according to the anatomical location of anastomosis following esophagectomy: those who underwent intrathoracic anastomosis (IA) (IA group) and those who underwent cervical anastomosis (CA) (CA group). To account for potential confounding factors and baseline imbalances between the 2 groups, propensity score matching was employed.ResultsThe CA group exhibited longer overall survival compared with the IA group, with a median overall survival of 49.10 months versus 35.87 months (hazard ratio, 1.118; 95% CI, 1.118-1.412; P < .001). Additionally, survival rates at 1, 3, and 5 years were higher in the CA group (87%, 59%, and 48%, respectively) compared with the IA group (86%, 50%, and 39%, respectively). The significance persisted even after propensity score matching (hazard ratio, 1.164; 95% CI, 1.013-1.336; P < .001), inverse probability of treatment weighting, and overlap weighting were applied. The survival difference between CA and IA was attributed to varying extents of lymph node dissection, particularly in the upper mediastinal zone (P < .001).ConclusionsOur study suggests that there could be the potential survival advantage of CA over IA in patients undergoing esophagectomy for esophageal squamous cell carcinoma.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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