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Su P, Huang C, Lv H, Zhang Z, Tian Z. Prediction model using risk factors associated with anastomotic leakage after minimally invasive esophagectomy. Pak J Med Sci 2023; 39:1345-1349. [PMID: 37680807 PMCID: PMC10480737 DOI: 10.12669/pjms.39.5.8050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/24/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
Objective To explore the risk factors of anastomotic leakage after minimally invasive esophagectomy (MIE) and to build a prediction model of the probability of postoperative anastomotic leakage. Methods Clinical data of patients undergoing MIE, admitted in the Fourth Hospital of Hebei Medical University from March 2018 to March 2022, were retrospectively selected, and risk factors of anastomotic leakage after MIE were analyzed by univariate and multivariate logistic regression. A prediction nomogram model was established based on the independent risk factors, and its prediction effect was evaluated. Results A total of 308 patients were included. Thirty patients had postoperative anastomotic leakage, with an incidence of 9.74%. Logistic regression analysis showed that age, postoperative delirium, pleural adhesion, postoperative pulmonary complications, high postoperative white blood cell count and low lymphocyte count were risk factors for postoperative anastomotic leakage. A nomograph prediction model was constructed based on these risk factors. The predicted probability of occurrence of the nomograph model was consistent with the actual probability of occurrence. The calculated C-index value (Bootstrap method) was 0.9609, indicating that the nomograph prediction model had a good discrimination ability. By drawing the receiver operating characteristic (ROC) curve, we showed that the area under the curve (AUC) of the nomograph prediction model was 0.9609 (95%CI: 0.937-0.985), which indicated a good prediction efficiency of the model. Conclusions The nomograph prediction model based on the independent risk factors of anastomotic leakage after MIE can accurately predict the probability of postoperative anastomotic leakage.
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Affiliation(s)
- Peng Su
- Peng Su, Department of Thoracic Fifth, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, P.R. China
| | - Chao Huang
- Chao Huang, Department of Thoracic Fifth, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, P.R. China
| | - Huilai Lv
- Huilai Lv, Department of Thoracic Fifth, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, P.R. China
| | - Zhen Zhang
- Zhen Zhang, Department of Thoracic Fifth, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, P.R. China
| | - Ziqiang Tian
- Ziqiang Tian, Department of Thoracic Fifth, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, P.R. China
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Okamoto K, Inaki N, Saito H, Shimada M, Yamaguchi T, Tsuji T, Moriyama H, Kinoshita J, Makino I, Nakamura K, Takamura H, Ninomiya I. Analysis of factors associated with operative difficulty in thoracoscopic esophageal cancer surgery in the left-decubitus position: a single-center retrospective study. BMC Surg 2023; 23:242. [PMID: 37596560 PMCID: PMC10439606 DOI: 10.1186/s12893-023-02131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/29/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The degree of difficulty in the overall procedure and forceps handling encountered by surgeons is greatly influenced by the positional relationship of intrathoracic organs in minimally invasive esophagectomy. This study aimed to identify the anatomical factors associated with the difficulty of minimally invasive esophagectomy assessed by intraoperative injuries and postoperative outcomes. METHODS Minimally invasive esophagectomy in the left-decubitus position was performed in 258 patients. We defined α (mm) as the anteroposterior distance between the front of the vertebral body and aorta, β (mm) as the distance between the center of the vertebral body and center of the aorta, and γ (degree) as the angle formed at surgeon's right-hand port site by insertion of lines from the front of aorta and from the front of vertebrae in the computed tomography slice at the operator's right-hand forceps hole level. We retrospectively analyzed the correlations among clinico-anatomical factors, surgeon- or assistant-caused intraoperative organ injuries, and postoperative complications. RESULTS Intraoperative injuries significantly correlated with shorter α (0.2 vs. 3.9), longer β (33.0 vs. 30.5), smaller γ (3.0 vs. 4.3), R1 resection (18.5% vs. 8.3%), and the presence of intrathoracic adhesion (46% vs. 26%) compared with the non-injured group. Division of the median values into two groups showed that shorter α and smaller γ were significantly associated with organ injury. Longer β was significantly associated with postoperative tachycardia onset, respiratory complications, and mediastinal recurrence. Furthermore, the occurrence of intraoperative injuries was significantly associated with the onset of postoperative pulmonary complications. CONCLUSIONS Intrathoracic anatomical features greatly affected the procedural difficulty of minimally invasive esophagectomy, suggesting that preoperative computed tomography simulation and appropriate port settings may improve surgical outcomes.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan.
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku, 920-0293, Ishikawa, Japan.
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Hiroto Saito
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Mari Shimada
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, 920-8530, Ishikawa, Japan
| | - Toshikatsu Tsuji
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Hideki Moriyama
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Jun Kinoshita
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Isamu Makino
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medical Science, Kanazawa University, 13- 1 Takara-machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Keishi Nakamura
- Department of Gastrointestinal Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara- machi, Kanazawa, 920-8641, Ishikawa, Japan
| | - Hiroyuki Takamura
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku, 920-0293, Ishikawa, Japan
| | - Itasu Ninomiya
- Department of Surgery, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui, 910-0846, Japan
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