Abstract
<jats:p>INTRODUCTION: Esophagectomy with immediate esophagoplasty is a high-risk procedure, with the worldwide incidence of postoperative complications reaching up to 65 % and mortality up to 7.8 %, even in high-volume centers. This underscores the need to identify additional predictors of postoperative complications and mortality. OBJECTIVE: Improving outcomes of esophagectomy performed within the Rational Accelerated Perioperative Rehabilitation (RAPOR) program by identifying and minimizing risk factors for complications and mortality. MATERIALS AND METHODS: Between 2012 and 2024, 500 elective esophagectomy with immediate esophagoplasty were performed at the Vishnevsky National Medical Research Center of Surgery. Perioperative management followed the RAPOR program, which includes an interdisciplinary and individualized team approach. Statistical analysis included logistic regression and odds ratio (OR) calculation. RESULTS: Postoperative complications were observed in 29.2 % of patients, pneumonia — in 10 %, anastomotic leakage and graft necrosis — in 6.6 %. Post-esophagectomy mortality was 1.4 %. Risk factors for complications were: age (OR 1.03), comorbidity index (OR 1.17), ASA score (OR 1.46), duration of surgery (OR 1.04), pre-existing pulmonary disease (OR 1.84), history of cardiac arrhythmia (OR 2.16), history of neurological disease (OR 3.03), C-reactive protein level on day 1 (OR 1.01), and lactate level on ICU admission (OR 1.27). Risk factors for postoperative pneumonia were: age (OR 1.03), pre-existing pulmonary disease (OR 2.61) and history of cardiac arrhythmia (OR 2.58), NRS-2002 score (OR 1.52), ASA score (OR 1.78), duration of surgery (OR 1.05), and high intraoperative infusion volume (OR 1.2). Risk factors for anastomotic leakage and graft necrosis included age (OR 1.03). Risk factors for mortality were: high comorbidity index (OR 1.44) and NRS-2002 score (OR 3.15), history of cardiac arrhythmia (OR 6.02), prolonged mechanical ventilation (OR 19.4), and high intraoperative infusion volume (OR 1.7). CONCLUSIONS: Age, comorbidity index, ASA score, duration of surgery, lung diseases, neurological diseases, and cardiac arrhythmias in the medical history are risk factors for postoperative complications. High comorbidity index, NRS-2002 score, cardiac arrhythmias in the medical history, prolonged mechanical ventilation, and large intraoperative fluid infusion volume remain risk factors for mortality.</jats:p>