The effect of complications on the esophageal cancer surgeon: an international survey exploring the impact these have on professional and personal life.

Esophagectomy is one of the highest risk surgical procedures and complications are common. While patient safety remains the primary focus, the impact on healthcare staff-the so-called 'second victims'-is often overlooked. Evidence suggests that a large proportion of surgeons experience emotional, professional, and social consequences following adverse outcomes. Our aims were to explore the effect of complications on personal and professional wellbeing and to identify systems and support required to help surgeons. An online survey, containing questions on surgeon demographics, the impact of surgical complications on personal and professional wellbeing, and current support systems available, was distributed globally to practicing esophageal cancer surgeons. A total of 100 responses were analysed from 30 countries. The median number of esophagectomies performed was 18 (IQR 0-90; n = 100)/annually. The complications with the most significant impact included patient mortality, gastric conduit necrosis and tracheobronchial injury. About 73% of surgeons reported changes in personal relationships and 66% experienced workplace pressures. Support was mainly obtained from colleagues (67%) or family (30%), however, 29% sought no support. 55% felt they received adequate support. About 58% felt under-supported by their particular institution. Complications after esophagectomy significantly affect surgeons' emotional wellbeing and clinical practice. While peer support was valued, many felt under-supported institutionally. These findings highlight the need for structured support systems to protect surgeon wellbeing and maintain safe surgical standards.