Abstract
BackgroundPostoperative anastomotic leakage (AL) is associated with not only prolonged hospital stay and increased medical costs, but also poor prognosis in esophageal cancer. Several studies have addressed the utility of various inflammation-based and/or nutritional markers as predictors for postoperative complications. However, none have been documented as specific predictors for AL in esophageal cancer. We aimed to identify predictors of AL after esophagectomy for thoracic esophageal cancer, focusing on preoperative inflammation-based and/or nutritional markers.MethodsWe retrospectively analyzed 295 patients who underwent radical esophagectomy for thoracic esophageal squamous cell carcinoma between June 2007 and July 2020. As inflammation-based and/or nutritional markers, Onodera prognostic nutritional index, C-reactive protein (CRP)-to-albumin ratio (CAR) and modified Glasgow prognostic score were investigated. Optimal cut-off values of inflammation-based and/or nutritional markers for AL were determined by receiver operating characteristic curves. Predictors for AL were analyzed by logistic regression modeling.ResultsAL was observed in 34 patients (11.5%). In univariate analyses, preoperative body mass index (≥ 22.1 kg/m2), serum albumin level (≤ 3.8 g/dL), serum CRP level (≥ 0.06 mg/dL), CAR (≥ 0.0139), operation time (> 565 min) and blood loss (≥ 480 mL) were identified as predictors of AL. Multivariate analyses revealed higher preoperative CAR (≥ 0.0139) as an independent predictor of AL (p = 0.048, odds ratio = 3.02, 95% confidence interval 1.01–9.06).ConclusionPreoperative CAR may provide a useful predictor of AL after esophagectomy for thoracic esophageal squamous cell carcinoma.
Highlights
Postoperative anastomotic leakage (AL) is associated with prolonged hospital stay and increased medical costs, and poor prognosis in esophageal cancer
All clinical and surgical data were collected from electronic medical records as follows: age, sex, body mass index (BMI), habitual tobacco use, habitual alcohol use, comorbidities according to the Charlson comorbidity index (CCI) [12], serum albumin level, serum C-reactive protein (CRP) level, prognostic nutritional index (PNI), CRP-toalbumin ratio (CAR), modified Glasgow prognostic score (mGPS), the American Society of Anesthesiologists classification of physical status (ASA-PS), tumor location, clinical T stage, clinical N stage, clinical stage, preoperative treatment, thoracic procedure, abdominal procedure, lymph node dissection, anastomosis method, reconstruction route, operation time, blood loss, and the timing of surgery (2007–2014 or 2015–2020)
Among the patients with AL, 2 patients were categorized to Clavien-Dindo classification (CDC) class I, 6 patients to CDC class II, 23 patients to CDC class IIIa, and 3 patients to CDC class IIIb, respectively
Summary
Postoperative anastomotic leakage (AL) is associated with prolonged hospital stay and increased medical costs, and poor prognosis in esophageal cancer. Several studies have addressed the utility of various inflammation-based and/or nutritional markers as predictors for postoperative complications. We aimed to identify predictors of AL after esophagectomy for thoracic esophageal cancer, focusing on preoperative inflammation-based and/or nutritional markers. Postoperative AL is reportedly associated with prolonged postoperative hospital stays and increased medical costs, but Sugimoto et al BMC Surg (2021) 21:348 poor prognosis for esophageal cancer [1]. The Japanese National Clinical Database (NCD) of digestive surgery demonstrated an incidence of 12.6% for AL after esophagectomy for esophageal cancer [3]. Perioperative management and surgical techniques have been improved, the incidence of AL after esophagectomy for esophageal cancer remains unsatisfactory. To reduce AL after esophagectomy, identifying preoperative and surgical predictors of AL is important
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