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Esophagus

, Volume 16, Issue 2, pp 155–161 | Cite as

Novel prognostic score of postoperative complications after transthoracic minimally invasive esophagectomy for esophageal cancer: a retrospective cohort study of 90 consecutive patients

  • Takahiro Saito
  • Kimitaka TanakaEmail author
  • Yuma Ebihara
  • Yo Kurashima
  • Soichi Murakami
  • Toshiaki Shichinohe
  • Satoshi Hirano
Original Article

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

Our novel score may help to decide surgical intervention for esophagectomy and provide appropriate resources for perioperative management.

Keywords

Postoperative complications Minimally invasive surgical procedures Esophagectomy Esophageal neoplasms Retrospective studies 

Notes

Acknowledgements

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

Ethical statement

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.

Supplementary material

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Supplementary material 1 (TIFF 105476 kb)
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Supplementary material 2 (TIFF 105476 kb)
10388_2018_645_MOESM3_ESM.docx (14 kb)
Supplementary material 3 (DOCX 14 kb)
10388_2018_645_MOESM4_ESM.docx (12 kb)
Supplementary material 4 (DOCX 11 kb)

References

  1. 1.
    Jemal A, Center MM, DeSantis C, et al. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomark Prev. 2010;19:1893–907.CrossRefGoogle Scholar
  2. 2.
    Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60:1449–72.CrossRefGoogle Scholar
  3. 3.
    Hulscher JB, Tijssen JG, Obertop H, et al. Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg. 2001;72:306–13.CrossRefGoogle Scholar
  4. 4.
    Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;21:1662–9.CrossRefGoogle Scholar
  5. 5.
    Takeuchi H, Hiroaki M, Ozawa Soji, et al. Comparison of short-term outcomes between open and minimally invasive esophagectomy for esophageal cancer using a nationwide database in Japan. Ann Surg Oncol. 2017;24:1821–7.CrossRefGoogle Scholar
  6. 6.
    Takeuchi H, Hiroaki M, Mitsukazu G, et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014;260:259–66.CrossRefGoogle Scholar
  7. 7.
    Lagarde SM, Reitsma JB, Maris AK, et al. Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram. Ann Thorac Surg. 2008;85:1938–45.CrossRefGoogle Scholar
  8. 8.
    Ferguson MK, Celauro AD, Prachand V. Assessment of a scoring system for predicting complications after esophagectomy. Dis Esophagus. 2011;24:510–5.CrossRefGoogle Scholar
  9. 9.
    Noble F, Curtis N, Harris S, et al. Risk assessment using a novel score to predict anastomotic leak and major complications after oesophageal resection. J Gastrointest Surg. 2012;16:1083–95.CrossRefGoogle Scholar
  10. 10.
    Yoshida N, Baba Y, Watanabe M, et al. Original scoring system for predicting postoperative morbidity after esophagectomy for esophageal cancer. Surg Today. 2015;45:346–54.CrossRefGoogle Scholar
  11. 11.
    Lv L, Hu W, Ren Y, et al. Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. Onco Targets Ther. 2016;9:6751–62.CrossRefGoogle Scholar
  12. 12.
    Koyanagi K, Ozawa S, Tachimori Y. Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review. Surg Today. 2016;46:275–84.CrossRefGoogle Scholar
  13. 13.
    Fukuda N, Shichinohe T, Ebihara Y, et al. Thoracoscopic esophagectomy in the prone position versus the lateral position (hand-assisted thoracoscopic surgery): a retrospective cohort study of 127 consecutive esophageal cancer patients. Surg Laparosc Endosc Percutan Tech. 2017;27:179–82.CrossRefGoogle Scholar
  14. 14.
    Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.CrossRefGoogle Scholar
  15. 15.
    Chang AC, Lee JS. Resection for esophageal cancer in the elderly. Thorac Surg Clin. 2009;19:333–43.CrossRefGoogle Scholar
  16. 16.
    Viklund P, Linblad M, Lu M, et al. Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg. 2006;243:204–11.CrossRefGoogle Scholar
  17. 17.
    Shiraishi T, Kawahara K, Shirakusa T, et al. Risk analysis in resection of thoracic esophageal cancer in the era of endoscopic surgery. Ann Thorac Surg. 2006;81:1083–9.CrossRefGoogle Scholar
  18. 18.
    Tatematsu N, Park M, Tanaka E, et al. Association between physical activity and postoperative complications after esophagectomy for cancer: a prospective observational study. Asian Pac J Cancer Prev. 2013;14:47–51.CrossRefGoogle Scholar
  19. 19.
    Wichmann MW, Muller C, Hornung HM, et al. Colorectal Cancer Study Group. Gender differences in long-term survival of patients with colorectal cancer. Br J Surg. 2001;88:1092–8.CrossRefGoogle Scholar
  20. 20.
    Matsuoka K, Kuroda A, Kang A, et al. Surgical results of video-assisted thoracic surgery and risk factors for prolonged hospitalization for secondary pneumothorax in elderly patients. Ann Thorac Cardiovasc Surg. 2013;19:18–23.CrossRefGoogle Scholar
  21. 21.
    Weimann A, Braga M, Harsanyi L, et al. ESPEN Guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr. 2006;25:224–44.CrossRefGoogle Scholar
  22. 22.
    Groblewska M, Mroczko B, Sosnowska D, et al. Interleukin 6 and C-reactive protein in esophageal cancer. Clin Chim Acta. 2012;413:1583–90.CrossRefGoogle Scholar
  23. 23.
    Gockel I, Dirksen K, Messow CM, et al. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol. 2006;21:3746–50.CrossRefGoogle Scholar
  24. 24.
    Nozoe T, Korenaga D, Futatsugi M, et al. Immunohistochemical expression of C-reactive protein in squamous cell carcinoma of the esophagus—significance as a tumor marker. Cancer Lett. 2003;192:89–95.CrossRefGoogle Scholar
  25. 25.
    Ikeda M, Natsugoe S, Ueno S, et al. Significant host- and tumor-related factors for predicting prognosis in patients with esophageal carcinoma. Ann Surg. 2003;238:197–202.Google Scholar
  26. 26.
    Yoshida N, Harada K, Baba Y, et al. Preoperative controlling nutritional status (CONUT) is useful to estimate the prognosis after esophagectomy for esophageal cancer. Langenbecks Arch Surg. 2017;402:333–41.CrossRefGoogle Scholar
  27. 27.
    Dutta S, Al-Mrabt NM, Fullarton GM, et al. A comparison of POSSUM and GPS models in the prediction of post-operative outcome in patients undergoing oesophago-gastric cancer resection. Ann Surg Oncol. 2011;18:2808–17.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery IIHokkaido University Faculty of MedicineSapporoJapan

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