Predictive factors for major postoperative complications related to gastric conduit reconstruction in thoracoscopic esophagectomy for esophageal cancer: a case control study

Shinichiro Kobayashi, Kengo Kanetaka, Yasuhiro Nagata, Masahiko Nakayama, Ryo Matsumoto, Mitsuhisa Takatsuki, Susumu Eguchi, Shinichiro Kobayashi, Kengo Kanetaka, Yasuhiro Nagata, Masahiko Nakayama, Ryo Matsumoto, Mitsuhisa Takatsuki, Susumu Eguchi

Abstract

Background: Regardless of developments in thoracoscopic esophagectomy (TE), postoperative complications relative to gastric conduit reconstruction are common after esophagectomy. The aim of the present study was to evaluate the predictive factors of major complications related to gastric conduit after TE.

Methods: From 2006 to 2015, 75 patients with esophageal cancer who underwent TE were evaluated to explore the predictive factors of major postoperative complications related to gastric conduit.

Results: Patients with major complications related to gastric conduit had a significantly longer postoperative hospital stay than patients without these complications (P < 0.01). Multivariate analysis demonstrated that three-field lymph node dissection (3FLND) and high serum levels of creatine phosphokinase (CPK) and C-reactive protein (CRP) at 1 postoperative day (1POD) after TE were significant predictive factors of major complications related to gastric conduit [odds ratio (OR) 5.37, 95% confidence interval (CI) 1.41-24.33, P = 0.02; OR 5.40, 95% CI 1.60-20.20, P < 0.01; OR 5.07, 95% CI 1.47-20.25, P = 0.01, respectively]. The incidence rates of major complications related to gastric conduit for 0, 1, 2, and 3 predictive factors were 5.3%, 18.8%, 58.8%, and 85.7%, respectively (P < 0.01).

Conclusions: Two or more factors in 3FLND and the high levels of CPK and CRP at 1POD after TE were identified as the risk model for major complications related to gastric conduit after TE.

Trial registration: UMIN Clinical Trials Registry, ID: UMIN000024436 , Registered date: Oct/17/2016.

Keywords: Esophageal cancer; Esophagectomy; Thoracoscopic surgery.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of Nagasaki University Hospital (16082215). The written informed consent from the patients was waved from the Ethics Committee because the information on the opportunity to opt out was presented on the web site (http://www.mh.nagasaki-u.ac.jp/research/rinsho/patients/open_surgery2.html).

Consent for publication

Not applicable. Individual identifying data were not included in this manuscript.

Competing interests

Shinichiro Kobayashi, Kengo Kanetaka, Yasuhiro Nagata, Masahiko Nakayama, Ryo Matsumoto, Mitsuhisa Takatsuki, and Susumu Eguchi do not have any financial relationships relevant to this publication to disclose.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Major complications related to gastric conduit reconstruction in 75 patients who underwent thoracoscopic esophagectomy. Seventeen patients developed anastomotic leakage. Refractory esophageal strictures were defined as more than 5 sessions of balloon dilation 6 months after the operation. Six patients developed refractory esophageal strictures. Two patients who had developed anastomotic leakage developed refractory esophageal strictures
Fig. 2
Fig. 2
ROC curve analysis of CRP (a) and CPK (b) at the first postoperative day after thoracoscopic esophagectomy. At a threshold of 9.6 x 104μg/L CRP at 1POD, the optimal sensitivity and specificity were 73.9% and 65.4%, respectively, in patients developing major postoperative complications related to gastric conduit reconstruction. At a threshold of 1164 IU/L CPK at 1POD, the sensitivity and the specificity were 69.6% and 75.0%, respectively, in patients developing major postoperative complications related to gastric conduit reconstruction. ROC, receiver operating characteristic; CRP, C-reactive protein; POD, postoperative days; CPK, creatine phosphokinase. AUC, area under the ROC curve; CI, confidence interval
Fig. 3
Fig. 3
Prevalence of major complications related to gastric conduit reconstruction compared according to the number of predictive factors after thoracoscopic esophagectomy. P-value based on the Cochrane-Armitage trend test

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