{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T08:56:54Z","timestamp":1781773014844,"version":"3.54.5"},"reference-count":30,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Esophageal cancer surgery is associated with high morbidity and mortality, and anastomotic leakage remains a critical determinant of outcomes. Although thoracic inlet size has been linked to complications in retrosternal reconstruction, its role in posterior mediastinal reconstruction is unclear. In this retrospective study, 67 patients who underwent esophagectomy with posterior mediastinal reconstruction were analyzed. Thoracic inlet measurements were obtained from preoperative computed tomography. Postoperative complications occurred in 29.9% of patients, anastomotic leakage (AL) in 14.9%, and overall 30-day postoperative mortality in 13.4%. The thoracic inlet area (TIA) was significantly lower in non-survivors than in survivors (513.5 vs. 703.3 mm2, p = 0.012). Anastomotic leakage was markedly more frequent among non-survivors (66.7% vs. 6.9%). In multivariable analysis adjusted for age and sex, thoracic inlet area remained associated with postoperative mortality; however, the findings should be interpreted cautiously because of the limited sample size and retrospective design. These findings suggest a possible association between thoracic inlet geometry and postoperative outcomes in posterior mediastinal reconstruction; however, larger prospective multicenter studies are required before definitive clinical conclusions can be drawn.<\/jats:p>","DOI":"10.3390\/curroncol33060353","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:14:58Z","timestamp":1781180098000},"page":"353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Thoracic Inlet Size and Cervical Anastomosis Outcomes in Esophageal Cancer Surgery"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1752-2633","authenticated-orcid":false,"given":"Iskan","family":"Calli","sequence":"first","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, Van Y\u00fcz\u00fcnc\u00fc Y\u0131l University, Van 65080, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Dogan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Van Training and Research Hospital, University of Health Sciences, Van 65300, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halil","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Department of General Surgery, \u00c7am and Sakura Training and Research Hospital, University of Health Sciences, Istanbul 34480, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0648-861X","authenticated-orcid":false,"given":"Mehmet","family":"Bartin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Van Training and Research Hospital, University of Health Sciences, Van 65300, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezgi","family":"Sonmez","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Van Training and Research Hospital, University of Health Sciences, Van 65300, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebahattin","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Van Training and Research Hospital, University of Health Sciences, Van 65300, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s00595-019-01878-7","article-title":"Recent progress in multidisciplinary treatment for patients with esophageal cancer","volume":"50","author":"Watanabe","year":"2020","journal-title":"Surg. Today"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1002\/ags3.12174","article-title":"Recent advancements in esophageal cancer treatment in Japan","volume":"2","author":"Tanaka","year":"2018","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/SLA.0000000000000644","article-title":"A risk model for esophagectomy using data from 5354 patients included in a Japanese nationwide web-based database","volume":"260","author":"Takeuchi","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1097\/00000658-199511000-00008","article-title":"Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer: Comparison of three-field lymphadenectomy with two-field lymphadenectomy","volume":"222","author":"Fujita","year":"1995","journal-title":"Ann. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1097\/SLA.0b013e3182480a6a","article-title":"Reporting of short-term clinical outcomes after esophagectomy: A systematic review","volume":"255","author":"Blencowe","year":"2012","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1053\/j.semtcvs.2004.03.008","article-title":"Quality of life after esophagectomy","volume":"16","author":"Fernandez","year":"2004","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.surg.2010.07.034","article-title":"Impact of anastomotic leak on outcomes after transhiatal esophagectomy","volume":"148","author":"Schuchert","year":"2010","journal-title":"Surgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1111\/j.1442-2050.2008.00866.x","article-title":"The management of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma","volume":"22","author":"Turkyilmaz","year":"2009","journal-title":"Dis. Esophagus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1016\/j.athoracsur.2011.05.121","article-title":"Morbidity and mortality after esophagectomy following neoadjuvant chemoradiation","volume":"92","author":"Merritt","year":"2011","journal-title":"Ann. Thorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1245\/s10434-011-1926-6","article-title":"Intrathoracic anastomotic leakage and mortality after esophageal cancer resection: A population-based study","volume":"19","author":"Lagergren","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S0002-9610(01)00559-1","article-title":"Critical appraisal of the significance of intrathoracic anastomotic leakage after esophagectomy for cancer","volume":"181","author":"Whooley","year":"2001","journal-title":"Am. J. Surg."},{"key":"ref_14","first-page":"98","article-title":"Predictive factors for anastomotic leakage in the neck after retrosternal reconstruction for esophageal cancer","volume":"55","author":"Kunisaki","year":"2008","journal-title":"Hepatogastroenterology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s10388-018-0619-7","article-title":"Association of level of anastomosis and anastomotic leak after esophagectomy in anterior mediastinal reconstruction","volume":"15","author":"Nishikawa","year":"2018","journal-title":"Esophagus"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.surg.2020.04.021","article-title":"Size of the thoracic inlet predicts cervical anastomotic leak after retrosternal reconstruction after esophagectomy for esophageal cancer","volume":"168","author":"Sato","year":"2020","journal-title":"Surgery"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1007\/s00268-017-4047-y","article-title":"Superior thoracic aperture size is significantly associated with cervical anastomotic leakage after esophagectomy","volume":"41","author":"Mine","year":"2017","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1007\/s00268-014-2819-1","article-title":"Impact of the route of reconstruction on postoperative morbidity and malnutrition after esophagectomy: A multicenter cohort study","volume":"39","author":"Yamasaki","year":"2015","journal-title":"World J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"835","DOI":"10.5833\/jjgs.27.835","article-title":"Evaluation of the thoracic inlet area in retrosternal reconstruction of the esophagus","volume":"27","author":"Shimanuki","year":"1994","journal-title":"Jpn. J. Gastroenterol. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s10388-022-00942-5","article-title":"Predictive impact of the thoracic inlet space on ICG fluorescence blood flow speed in the gastric conduit wall and anastomotic leakage after esophagectomy","volume":"20","author":"Ninomiya","year":"2023","journal-title":"Esophagus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1046\/j.1442-2050.2003.00335.x","article-title":"Comparative anatomical study of the anterior and posterior mediastinum as access routes after esophagectomy","volume":"16","author":"Coral","year":"2003","journal-title":"Dis. Esophagus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.jcma.2011.09.006","article-title":"Reconstruction after esophagectomy for esophageal cancer: Retrosternal or posterior mediastinal route?","volume":"74","author":"Chan","year":"2011","journal-title":"J. Chin. Med. Assoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.21037\/jovs.2019.04.02","article-title":"Robotic substernal esophageal bypass and reconstruction with gastric conduit: Frequently overlooked minimally invasive option","volume":"5","author":"Petrov","year":"2019","journal-title":"J. Vis. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/S0002-9610(01)00763-2","article-title":"A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer","volume":"182","author":"Urschel","year":"2001","journal-title":"Am. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1007\/s10388-019-00705-9","article-title":"The sterno-tracheal distance is an important factor of anastomotic leakage of retrosternal gastric tube reconstruction after esophagectomy","volume":"17","author":"Inoue","year":"2020","journal-title":"Esophagus"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1007\/s10388-024-01089-1","article-title":"Modification of the lesser curvature incision line enhanced gastric conduit perfusion as determined by indocyanine green fluorescence imaging and decreased the incidence of anastomotic leakage following esophagectomy","volume":"22","author":"Zhao","year":"2025","journal-title":"Esophagus"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Ioannidis, O., Anestiadou, E., Koltsida, A., Ramirez, J.M., Fabbri, N., Ubieto, J.M., Feo, C.V., Pesce, A., Rosetzka, K., and Arroyo, A. (2025). Optimizing perioperative care in esophageal surgery: The EUPEMEN collaborative for esophagectomy. Diseases, 13.","DOI":"10.3390\/diseases13080231"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2953","DOI":"10.1097\/JS9.0000000000002274","article-title":"Incidence and treatment of anastomotic leakage after esophagectomy in German acute care hospitals: A retrospective cohort study","volume":"111","author":"Weber","year":"2025","journal-title":"Int. J. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.athoracsur.2024.12.019","article-title":"Anastomotic leak after esophagectomy: Analysis of the STS General Thoracic Surgery Database","volume":"119","author":"Axtell","year":"2025","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Koch, O.O., Singhartinger, F., Wallner, E., Paireder, M., Holzinger, J., Rabl, C., Weitzendorfer, M., and Emmanuel, K. (2025). Austrian Society of Surgical Oncology consensus paper on the classification and treatment of anastomotic leaks after esophageal resections. Eur. Surg.","DOI":"10.1007\/s10353-025-00883-0"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T08:40:38Z","timestamp":1781772038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["curroncol33060353"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33060353","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]}}}