Safety, efficacy, and patient satisfaction after esophagectomy for esophageal neuromotor disease: A single-institution experience.

Objective: Esophagectomy remains the mainstay of treatment for patients with end-stage esophageal neuromotor diseases, yet there are limited data on outcomes after esophagectomy in this population. We sought to characterize the safety and efficacy of esophagectomy for esophageal neuromotor disease. Methods: We retrospectively queried a prospectively collected database of all esophagectomies performed at our institution from 1975 to 2023 for patients without cancer diagnosed with end-stage esophageal neuromotor disease. Operative characteristics, perioperative and functional outcomes, and mortality were evaluated. Patients with and without a previous esophageal operation were compared using χ2 for categorical variables and t test for continuous variables. Results: We identified 237 patients for analysis. The majority were female (57.0%), White (82.7%), and nonsmokers (83.7%). Mean age was 52.4 years. In total, 185 (78.1%) patients had a diagnosis of achalasia, and 72.2% of patients underwent a previous esophageal operation. The majority of esophagectomies (91.6%) were transhiatal, and a gastric conduit was used in 228 patients (96.2%). Anastomotic leak rate was 9.7% (23/237). One-year mortality was 2.5% (6/237). There were no differences in outcomes between patients who had and had not had a previous esophageal operation. Postoperative functional symptoms were reported in 69.7% of patients at first follow-up, and 97 (40.9%) patients required postoperative dilation for symptom management. The majority of patients reported that they felt better (72%) and would undergo esophagectomy again (72%). Conclusions: Esophagectomy for esophageal neuromotor disease is safe and feasible with a gastric conduit, regardless of prior esophageal operations. Despite persistent postoperative functional symptoms, patients have high satisfaction after the procedure.