Esophagectomy is considered the surgeon’s Achilles heel in a similar manner as Whipple’s procedure or pelvic exenterative surgery. Ensuring that the patient has an uneventful postoperative recovery after an esophagectomy has always proven to be a challenge. Nevertheless, several guidelines have recently been established to provide the same results. This study analyzes the textbook outcomes (TO) and survival outcomes of the first 100 esophagectomies compared with international standards.

A retrospective analysis of a prospectively maintained electronic patient database was performed between January 2019 and July 2024. Patients who underwent esophagectomy during this period were included in the study. The postoperative outcomes were analyzed based on the updated TO for gastroesophageal cancer surgery defined by the Dutch Upper GI Cancer Audit (DUCA) group. According to Kaplan‒Meier curves and Cox regression analysis, TO correlated with survival outcomes.

A total of 100 patients underwent esophagectomy during the reference period. Eighty-nine patients underwent transthoracic McKeown esophagectomy, nine patients underwent the transhiatal procedure, and two patients underwent the Ivor–Lewis procedure. Fifty-one patients underwent a minimally invasive approach (MIA), of whom 29 underwent total (thoracic and abdominal) MIA and 22 underwent hybrid MIA. TO was achieved in 41% of the cases. The attainment of textbook outcomes positively correlated with overall survival, i.e., 53 months vs. 31 months (p value = 0.005 ).

Although seemingly challenging, TO for esophagectomy can be attained by adhering to standard surgical practices, even in a resource-constrained setting. Patients with TO have better oncological outcomes.