The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management…

Cohort studyAnnals of surgery· Sep 2026

The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.

Lorenzo Giorgi, Nadia Guidozzi, Riadh Salem … Sheraz R Markar

Esophageal SurgeryCohort studyPrognosisQ1IF 6.2

Anastomotic leak needing reoperation nearly doubles adjusted death risk after esophagectomy

The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.

Lorenzo Giorgi … Sheraz R Markar

Annals of surgery · Sep 2026 · Q1 in Surgery

Background

Historical evidence suggesting anastomotic leak is associated with increased recurrence and poor survival is limited by heterogeneous definitions and outdated management.

Purpose

To determine the impact of severity of esophageal anastomotic leak (anastomotic leak), standardized by ECCG grading, on long-term survival within a contemporary multicenter cohort.

Methods

An international multicenter cohort across 17 high-volume European centers.

n = 2905 patients

Results

Leaks requiring reoperation were linked to about 50% higher adjusted risk of death

HR 1.51 (95% CI 1.04 to 2.18)

CI excludes the null - significant

More results

Out of 2905 patients, 425 (14.6%) developed an anastomotic leak.

No significant survival deficits were observed for leaks treated conservatively or with no-surgical intervention.

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Conclusion · 1 of 2

Anastomotic leak requiring surgical reintervention was associated with impaired survival.

Conclusion · 2 of 2

This relationship identifies a high-risk clinical profile and represents a critical target for future research into strategies for clinical stabilization and risk mitigation.

The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.

The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.

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