To analyse the features of severe postoperative complications in patients with esophageal cancer.

Methods A total of 3 171 patients underwent esophagectomy in Department of Thoracic Surgery, West China Hospital between January 2009 and December 2013, among whom 153 suffered from severe postoperative complications and were transferred to intensive care unit(ICU) for a second time, with the readmission rate of 4.82%. The baseline information, incidence of complicaitions and treatment outcomes were retrospectively analyzed. Meanwhile, the literatures published before February 2014 concerning complications following esophagectomy were also retrieved.

Sixty-eight patients with readmission to ICU died. Pulmonary complication was the most frequent and lethal cause resulting in readmission to ICU [morbidity, 2.7%(85/3171); mortality, 1.1%(35/3171)], followed by anastomotic complication [morbidity, 0.9%(29/3171); mortality, 0.5%(15/3171)] and cardiovascular complication [morbidity, 0.3%(10/3171); mortality, 0.2%(5/3171)]. Acquired pneumonia attack following non-pulmonary complication could increase death risk significantly. Multivariate logistic regression analysis indicated that the time interval to readmission was an independent risk factor for death (P=0.044, OR=2.151, 95% CI: 1.022-4.528). Literature analysis demonstrated that the leading severe complications following esophagectomy by order were shock and surgical infection before 1950, anastomotic leak and pulmonary complications between 1950 and 1980, and pulmonary, anastomotic and cardiovascular complications after 1980.

Esophagectomy remains high risk of severe postoperative complications causing in-hospital mortality. Readmission to ICU could reflect the severity of complications following esophagectomy. Pulmonary complication is now the most frequent cause of postoperative death after esophagectomy, followed by anastomotic and cardiovascular complications.