{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:14:15Z","timestamp":1789456455279,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T00:00:00Z","timestamp":1783209600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team\u2010based decision\u2010making. Gastric conduit viability remains central to safe esophageal reconstruction, with conduit ischemia, torsion, and tension contributing substantially to leak and necrosis. We examined the institutional learning curve of a high\u2010volume esophageal cancer program, focusing on technical standardization of gastric conduit formation and conduit\u2010related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 187 consecutive patients who underwent esophagectomy for locally advanced esophageal cancer between 2019 and 2025 at a tertiary cancer center. For descriptive temporal comparisons, the cohort was divided into two pragmatic phases corresponding to institutional practice before and after routine formalization of the conduit protocol: up to 2022 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009101) and 2023\u20132025 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200986). During program maturation, a standardized gastric conduit protocol was formalized, emphasizing preservation of conduit vascularity, controlled conduit geometry, minimal omental bulk, cervical\u2010first dissection, torsion\u2010free transposition, and selective pyloric management. The primary outcome was composite major conduit\u2010related morbidity, defined per patient as major anastomotic leak, major conduit necrosis, or conduit\u2010related re\u2010exploration. Secondary outcomes included overall leak, vocal cord palsy, chyle leak, Clavien\u2010Dindo grade, 30\u2010day mortality, R0 resection, and lymph node yield. Outcomes were interpreted within the broader context of institutional maturation rather than as a simple calendar\u2010era comparison.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Composite major conduit\u2010related morbidity declined from 8.9% in the earlier phase of the program to 2.3% in the later phase. Within this composite, major conduit necrosis declined from 5% to 0%, while overall leak rates remained stable. Thirty\u2010day mortality was 4.3%, and most complications were minor. Oncologic adequacy was preserved, with R0 resection in 94.7% and a median lymph node yield of 25. Improvements in pathological complete response and recurrence over time paralleled broader changes in neoadjuvant treatment intensity and lymphadenectomy and should not be attributed solely to conduit protocolization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Institutional maturation in esophagectomy was associated with transition from experience\u2010dependent practice to reproducible technical standardization of gastric conduit formation. This learning curve coincided with disappearance of major conduit necrosis without compromising oncologic adequacy. Standardization of conduit construction may represent an important and exportable quality\u2010improvement step in developing high\u2010volume esophageal cancer programs, especially in resource\u2010variable settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70317","type":"journal-article","created":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T16:49:37Z","timestamp":1783270177000},"page":"548-554","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Institutional Learning Curve in Esophagectomy: Technical Standardization of Gastric Conduit Formation and Conduit\u2010Related Outcomes in 187 Consecutive Patients"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8991-5682","authenticated-orcid":false,"given":"Mayank","family":"Tripathi","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"},{"name":"Homi Bhabha National Institute Training School Complex, Anushakti Nagar Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0986-5089","authenticated-orcid":false,"given":"Reshma R.","family":"Balachandran","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8077-1299","authenticated-orcid":false,"given":"Kumar","family":"Vineet","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhaval","family":"Vadodaria","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaibhav","family":"Kushwaha","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohd Irfan","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre and Homi Bhabha Cancer Hospital Homi Bhabha National Institute (Unit of Tata Memorial Centre, Mumbai) Varanasi Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12262-026-04557-3"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2014.02.046"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001098"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000004309"},{"issue":"1","key":"e_1_2_10_6_1","article-title":"Anastomotic Leakage After Esophagectomy for Esophageal Cancer: Definitions, Diagnostics, and Treatment","volume":"34","author":"Fabbi M.","year":"2021","journal-title":"Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000002611"},{"issue":"3","key":"e_1_2_10_8_1","first-page":"813","article-title":"Gastric Conduit Necrosis Following Esophagectomy: An Up\u2010to\u2010Date Literature Review","volume":"43","author":"Kahl A. R.","year":"2019","journal-title":"World Journal of Surgery"},{"issue":"4","key":"e_1_2_10_9_1","first-page":"325","article-title":"Conduit Ischemia After Esophagectomy: A Spectrum of Clinical Manifestations, Prevention, and Management","volume":"34","author":"Konwinski R. R.","year":"2024","journal-title":"Thoracic Surgery Clinics"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(92)90077-H"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/dote\/doae092"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13164899"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.01.30"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2019.07.88"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306074"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.11.141"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70317","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70317","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70317","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:53:59Z","timestamp":1789455239000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,5]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/jso.70317"],"URL":"https:\/\/doi.org\/10.1002\/jso.70317","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,5]]},"assertion":[{"value":"2026-02-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}