Thoracic surgeons have better outcome profiles following esophagectomy: an ACS-NSQIP study

Background: Esophagectomy is still a complex operation with high morbidity. Controversy exists regarding the influence of a surgeon’s training track on perioperative outcomes. We aimed to investigate 30-day surgical complications for esophagectomy patients based on operations performed by thoracic surgeons compared to general surgeons in the ACS-NSQIP database. Methods: Using the NSQIP targeted database, we analyzed patients who underwent esophagectomy between 2016 and 2021. These patients were categorized into two groups based on whether thoracic or general surgeons had performed the operation. Multivariable analysis was used when comparing 30-day perioperative outcomes between the two cohorts controlled for preoperative factors, including demographics, comorbidities, surgical approaches, neoadjuvant therapy, tumor staging, and pathology. Results: A total of 3927 esophagectomy procedures were performed by thoracic surgeons, while general surgeons conducted 2855 cases. Procedures performed by thoracic surgeons had lower pulmonary complications (19.28% vs. 19.93%; aOR = 0.865; p = 0.03) and anastomotic leaks (14.82% vs. 15.9%; aOR = 0.855; p = 0.03) but higher bleeding events (11.36% vs. 9%; aOR = 1.335; p < 0.01) and reoperation rates (18.82% vs. 12.85%; aOR = 1.552; p < 0.01). Further, thoracic surgeon cases had a shorter operation time (358.9 ± 132.5 vs. 393.6 ± 139.7 min; p < 0.01). Conclusion: Considering that pulmonary complications and anastomotic leaks are among the top three causes of mortality following esophagectomy, that antithrombotic therapy is the most significant risk factor for bleeding complications (as opposed to technical issues), and that general surgeons are less inclined to manage postoperative leaks through reoperations, thoracic surgeons may exhibit a more favorable outcome profile in esophagectomy. These differences should be properly addressed in the training of thoracic and general surgeons.