BackgroundAfter esophagectomy, anastomotic strictures disturb food passage and increase the incidence of aspiration pneumonia. Multiple endoscopic balloon dilatations are required to treat strictures. As a result, long-term quality of life and nutritional status might be adversely affected. The aim of this study was to identify risk factors for strictures after cervical triangular anastomosis using gastric conduit among patients who underwent minimally invasive esophagectomy (MIE). Materials and MethodsIn total, 188 patients who underwent MIE for esophageal cancer between 2010 and 2020 at Kobe University Hospital were retrospectively examined. The incidence of strictures, number of dilatations for stricture, and time to stricture diagnosis were evaluated. Next, potential independent risk factor for refractory strictures requiring more than five endoscopic balloon dilatations was clarified. ResultsThe study included 188 patients who satisfied the inclusion criteria. Anastomotic strictures were observed in 44 patients (23%). Neoadjuvant chemotherapy was significantly more common in patients with stricture than in patients without stricture (75% vs. 58%, p = 0.041). The median number of endoscopic balloon dilations was 5 (range, 1–31); 30 patients (68%) underwent their first dilatation within 3 months after MIE. In univariate and multivariate analysis, less than 69 days from surgery to first endoscopic balloon dilatation was an independent risk factor for stricture requiring more than five endoscopic balloon dilatations after cervical triangular anastomosis in MIE (hazard ratio, 9.483; 95% confidence interval, 2.220–54.274; p = 0.002). ConclusionsIt is necessary to consider that early postoperative anastomotic stricture might become refractory and develop an appropriate treatment plan.