To define “best possible” outcomes in total minimally invasive transthoracic esophagectomy (ttMIE). TtMIE, performed by experts in patients with low comorbidity, may serve as a benchmark procedure for esophagectomy. From a cohort of 1057 ttMIE, performed over a 5-year period in 13 high-volume centers for esophageal surgery, we selected a study group of 334 patients (31.6%) that fulfilled criteria of low comorbidity (American Society of Anesthesiologists score ≤2, WHO/ECOG score ≤1, age ≤65 years, body mass index 19–29 kg/m2). Endpoints included postoperative morbidity measured by the Clavien-Dindo classification and the comprehensive complication index. Benchmark values were defined as the 75th percentile of the median outcome parameters of the participating centers to represent best achievable results. Benchmark patients were predominantly male (82.9%) with a median age of 58 years (53–62). High intrathoracic (Ivor Lewis) and cervical esophagogastrostomy (McKeown) were performed in 188 (56.3%) and 146 (43.7%) patients, respectively. Median (IQR) ICU and hospital stay was 0 (0–2) and 12 (9–18) days, respectively. 56.0% of patients developed at least 1 complication, and 26.9% experienced major morbidity (≥grade III), mostly related to pulmonary complications (25.7%), anastomotic leakage (15.9%), and cardiac events (13.5%). Benchmark values at 30 days after hospital discharge were ≤55.7% and ≤30.8% for overall and major complications, ≤18.0% for readmission, ≤3.1% for positive resection margins, and ≥23 for lymph node yield. Benchmarks at 30 and 90 days were ≤1.0% and ≤4.6% for mortality, and ≤40.8 and ≤42.8 for the comprehensive complication index, respectively. This outcome analysis of patients with low comorbidity undergoing ttMIE may serve as a reference to evaluate surgical performance in major esophageal resection.

Background: Oesophageal cancer resection carries a risk of nutritional disorders. The aim of this study was to estimate weight change after surgery in a population-based setting and to identify nutritional problems that might correlate with weight loss. Methods: Data were collected through the Swedish Esophageal and Cardia Cancer Register, a nationwide registry of oesophageal cancer surgery. Patients who underwent oesophageal cancer surgery between 2001 and 2004 were followed up until April 2005, and data on patient and tumour characteristics and surgical treatment were collected. Six months after surgery the patients were asked to complete a questionnaire about weight and a health-related quality of life questionnaire (European Organization for Research and Treatment of Cancer (EORTC QLQ-C30) with an oesophageal-specific module (EORTC QLQ-OES18)). Results: The response rate to the questionnaire was 76·9 per cent and weight change in 226 patients was analysed. Six months after operation 63·7 per cent had lost more than 10 per cent of their preoperative BMI, and 20·4 per cent had lost more than 20 per cent. Appetite loss, eating difficulties and odynophagia were significantly linked to postoperative weight loss, whereas dysphagia or reflux did not correlate with malnutrition. Conclusion: Malnutrition is a considerable problem after oesophagectomy, and is linked to appetite loss, eating difficulties and odynophagia.