Severity of esophageal anastomotic leak significantly affects long-term survival and complications in patients post-esophagectomy.

• Out of 2905 patients, 425 (14.6%) developed an anastomotic leak, leading to nearly double the rate of pulmonary complications (46.8% vs. 26.7%; p<0.001).
• Type III leaks (requiring surgical reintervention) were linked to increased 30-day and 90-day mortality (7.3% vs. 2.7% and 12.3% vs. 4%; p<0.001) and significantly reduced median overall survival (33.9 vs. 69.3 months; p<0.001).

Type III leaks represent a high-risk group, emphasizing the need for enhanced management strategies to mitigate these risks.