Takuya Kudo1, Taro Oshikiri2, Hironobu Goto1, Hitoshi Harada1, Naoki Urakawa1, Hiroshi Hasegawa1, Shingo Kanaji1, Kimihiro Yamashita1, Takeru Matsuda3, Yoshihiro Kakeji1. 1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. 2. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. oshikiri@med.kobe-u.ac.jp. 3. Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Abstract
BACKGROUND: Postoperative complications affect long-term prognosis in patients with esophageal squamous cell carcinoma (ESCC). Although a comprehensive estimator can predict long-term prognosis, the Clavien-Dindo classification system, a widely used approach to evaluate complications, assesses each complication individually. We aimed to clarify the utility of the comprehensive complication index (CCI) on predicting the overall survival (OS) of patients with ESCC following minimally invasive esophagectomy (MIE). METHODS: This was a retrospective study of patients undergoing MIE for ESCC in the prone position between January 2011 and December 2018. Multivariate analyses using the Cox proportional hazards model were performed to determine independent risk factors for OS. RESULTS: The study cohort included 229 patients who were categorized into patients with CCI values of ≥ 33.7 (CCI high) and < 33.7 (CCI low) by receiver-operating characteristic (ROC) curve analysis. There were no significant differences between the two groups according to clinicopathological factors, such as sex, age, tumor location, tumor depth, lymph node metastasis, and neoadjuvant chemotherapy. The intraoperative transfusion rate in the CCI high group was significantly higher than in the CCI low group. The 5 year OS rate was significantly lower in the CCI high group than in the CCI low group (49.5% vs. 65.7%, p = 0.030). By multivariate analyses, age, tumor depth, lymph node metastasis, and the CCI were independent predictors of OS. CONCLUSIONS: Comprehensive assessment of postoperative complications using the CCI was useful in predicting OS of patients undergoing MIE for the ESCC.
BACKGROUND: Postoperative complications affect long-term prognosis in patients with esophageal squamous cell carcinoma (ESCC). Although a comprehensive estimator can predict long-term prognosis, the Clavien-Dindo classification system, a widely used approach to evaluate complications, assesses each complication individually. We aimed to clarify the utility of the comprehensive complication index (CCI) on predicting the overall survival (OS) of patients with ESCC following minimally invasive esophagectomy (MIE). METHODS: This was a retrospective study of patients undergoing MIE for ESCC in the prone position between January 2011 and December 2018. Multivariate analyses using the Cox proportional hazards model were performed to determine independent risk factors for OS. RESULTS: The study cohort included 229 patients who were categorized into patients with CCI values of ≥ 33.7 (CCI high) and < 33.7 (CCI low) by receiver-operating characteristic (ROC) curve analysis. There were no significant differences between the two groups according to clinicopathological factors, such as sex, age, tumor location, tumor depth, lymph node metastasis, and neoadjuvant chemotherapy. The intraoperative transfusion rate in the CCI high group was significantly higher than in the CCI low group. The 5 year OS rate was significantly lower in the CCI high group than in the CCI low group (49.5% vs. 65.7%, p = 0.030). By multivariate analyses, age, tumor depth, lymph node metastasis, and the CCI were independent predictors of OS. CONCLUSIONS: Comprehensive assessment of postoperative complications using the CCI was useful in predicting OS of patients undergoing MIE for the ESCC.