Assessment of a scoring system for predicting complications after esophagectomy

Abstract

Complications occur frequently after esophagectomy. Identifying the risk of complications preoperatively may help in patient selection and postoperative management. We performed a retrospective review of patients who underwent esophagectomy between 1980 and 2009. A previously reported scoring system was used to estimate risk, and its ability to predict complications was assessed. A total of 514 patients (382 men; 74%) with a mean age of 59.0 ± 12.5 years underwent esophagectomy for cancer (398; 77%) or benign disease. Minor complications occurred in 224 patients (44%) and severe complications occurred in 134 patients (26%). The calculated risk score was based on weighted values for age, coronary artery disease, cerebrovascular disease, type of operation, and forced expiratory volume in the first second expressed as a percent of predicted (FEV1%). Increasing risk score was associated with a linear increase in the incidence of complications (P < 0.001 for either severe complications or any complications). The scoring system predicted severe complications with an accuracy of 65.3% (P < 0.001). Score groups identified an incremental risk of severe complications (0 to 6 = 12%; 7 to 13 = 18%; 14 to 20 = 28%; 21 to 27 = 36%; >27 = 52%; P < 0.001). Complications are frequent after esophagectomy and can be predicted using a previously reported scoring system. This scoring system may assist in patient selection for esophagectomy and in providing appropriate resources for postoperative management of higher risk patients.

An esophagectomy Surgical Apgar Score (eSAS)-based nomogram for predicting major morbidity in patients with esophageal carcinoma

“…It is difficult to predict the risk of complications after esophagectomy for malignancy accurately. In recent studies, risk assessments incorporating preoperative risk factors into models to predict the probability of postoperative complications in esophageal carcinoma were used ( 6 - 7 , 21 ). however, these reported risk models did not include intraoperative factors and concluded limited clinical applicability.…”

Preoperative Nutritional Assessment by Controlling Nutritional Status (CONUT) is Useful to estimate Postoperative Morbidity After Esophagectomy for Esophageal Cancer

“…Esophagectomy is the most invasive of these gastrointestinal surgeries. Despite advances in perioperative management, esophagectomy remains correlated with a high incidence of postoperative morbidity [8][9][10][11][12]. Several studies demonstrated that preoperative malnutrition predisposed to complications after esophagectomy [8,[13][14][15], and several markers related to nutrition, such as low body mass index (BMI), weight loss, hypoalbuminemia, and sarcopenia could be independent predictors of postoperative complications [1,[15][16][17].…”

Influence of Neoadjuvant Chemotherapy on Short-term Outcomes After Minimally Invasive Esophagectomy for Esophageal Cancer

“…Previous study suggested that patients who are current smokers at surgery are more likely to have complications after MIE (19). Impaired respiratory function and worse performance status is also associated with increased postoperative morbidities (20,21). Such patients may have anemia and malnutrition more frequently, which can be risks of postoperative morbidity, so they must be closely monitored.…”