Abstract
Aim To analyze whether the change of laboratory tests (postoperative day 1 (POD1) minus pre-operation) could be predictive factors for postoperative infection in patients who have undergone McKeown esophagogastrectomy. Methods We retrospectively investigated the clinical data of 358 patients who have undergone McKeown esophagogastrectomy, and divided them into infection and noninfection groups. SPSS 22.0 software was performed for data analysis. Results In the two groups, smoking status (66.7% vs. 42.3%; P = 0.014), male gender (86.1% vs. 72.0%; P < 0.001), hoarseness (23.6% vs. 8.7%; P < 0.001), poor coughing ability (51.4% vs. 9.1%; P < 0.001), the change of WBC count (5.59 ± 4.75 × 109/L vs. 4.51 ± 4.11 × 109/L; P = 0.05), the change of glucose (6.03 ± 3.97 g/L vs. 3.78 ± 3.18 g/L), the change of ALB (−12.83 ± 3.45 g/L vs. −10.69 ± 3.86 g/L), the change of CRE (0.17 ± 19.94 umol/L vs. −4.02 ± 15.40 umol/L, P = 0.047) were significantly different. These factors were assessed using logistic regression analysis, and factors with P ≤ 0.05 in the univariate analysis were entered into multivariate analysis based on the forward stepwise (conditional) method. Poor coughing ability (odds ratio [OR], 11.034, 95% confidence interval [CI], 5.358–22.724), smoking status (OR, 4.218; 95% CI, 2.110–8.431), the change of WBC count (OR, 1.079; 95% CI, 1.000–1.164), the change of serum ALB level (OR, 0.849; 95% CI, 0.772–0.935), and the change of blood glucose levels (OR, 1.237; 95% CI, 1.117–1.371) were determined as independent risk factors for postoperative infection. We established a scoring system based on these 5 factors, and the area under the curve for this predictive model was 0.843 (range, 0.793–0.894); the sensitivity, specificity, and cut-off score were 70.8%, 85.3%, and 2.500, respectively. Conclusion Poor coughing ability, smoking habit, the high change of WBC and blood glucose levels, and low change of serum ALB levels can be used to predict the occurrence of postoperative infections among patients who have undergone McKeown esophagogastrectomy.
Highlights
Up to now, Esophageal cancer is the sixth-most common cause of cancer-related death all around the world, and in developing countries, it is the h most frequent cause of deaths [1]
We collected clinical data from 358 esophageal cancer patients who were admitted for McKeown esophagogastrectomy between July 2014 and October 2016 at Sun Yat-Sen University Cancer Center (SYSUCC). e RDD number for this study is RDDA2019001127. e average age of the patients was 60.55 ± 7.87 years
We compared the patients’ baseline characteristics and clinical disease features between groups, and identi ed signi cant di erences in smoking habits and gender between the two groups. e smoking habit frequency (66.7% vs. 42.3%; < 0.001) and proportion of males
Summary
Esophageal cancer is the sixth-most common cause of cancer-related death all around the world, and in developing countries, it is the h most frequent cause of deaths [1]. The incidence and mortality of patients with esophageal cancer in China were the highest globally in 2009 [2]. Surgery remains the standard treatment for resectable esophageal cancer. Esophagogastrectomy is a complex procedure, with morbidity and mortality rates of 23%– 50% and 2%–8%, respectively [3, 4]. Patients undergoing McKeown esophagogastrectomy are exposed to a higher risk of infection compared with those receiving other types of surgery. Patients with esophageal cancer are at a greater risk of antimicrobial exposure due to their impaired immunological functions and are at an increased risk of infection with multidrug-resistant bacteria
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