Novel prognostic score of postoperative complications after transthoracic minimally invasive esophagectomy for esophageal cancer: a retrospective cohort study of 90 consecutive patients
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Esophagectomy is the standard treatment for esophageal cancer, but has a high rate of postoperative complications. Some studies reported the various scoring system to estimate the postoperative complications. However, there were according to various surgical methods and included intra- and post-operative factors. Recently, minimally invasive esophagectomy (MIE) is becoming the first-line treatment for esophageal cancer. The aim of this study was to investigate the risk factors of postoperative complications and to establish a useful system for predicting postoperative complications after transthoracic MIE.
From 2007 to 2015, 90 patients who underwent transthoracic MIE at our department were enrolled. Patients were divided into two groups according to postoperative complication: patients with major complications (n = 32) and without major complications (n = 58). Major complication was defined as ≥ IIIa in the Clavien–Dindo classification.
Multivariate analysis identified four independent risk factors for predicting postoperative complications: age [≥ 70 years; odd ratio (OR) 6.88; p = 0.001]; sex (male; OR 5.24; p = 0.031); total protein level (< 6.7 mg/dl; OR 6.51; p = 0.002), and C-reactive protein level (≥ 0.15; OR, 6.58; p = 0.001). These four factors were used to establish a score. The complication rate for scores 0–4 were 0, 11, 36, 71, 100%, respectively. The frequency of major complications was significantly associated with the score (p < 0.001). Receiver operator characteristic curves to predict the score with regard to major complications showed an area under the curve value of 0.798 (95% confidence interval: 0.696–0.871, P < 0.001).
Our novel score may help to decide surgical intervention for esophagectomy and provide appropriate resources for perioperative management.
KeywordsPostoperative complications Minimally invasive surgical procedures Esophagectomy Esophageal neoplasms Retrospective studies
We thank Hiroaki Iijima, MPH, MSc, of Hokkaido University Hospital, Department of Biostatistics, Sr. Biostatistician, Hokkaido, Japan, for the statistical advice.
Compliance with ethical standards
This study was approved by the Hokkaido University Ethics Committee (No. 017-0016). Comprehensive informed consent to use patient information for this study was obtained from all individual participants before surgery.
Conflict of interest
Drs. Takahiro Saito, Kimitaka Tanaka, Yuma Ebihara, Yo Kurashima, Soichi Murakami, Toshiaki Shichinohe, and Satoshi Hirano have no conflicts of interest or financial ties to disclose.
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