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Development and validation of a novel nomogram for postoperative pulmonary complications following minimally invasive esophageal cancer surgery


Postoperative pulmonary complications (PPCs) are the most common complications following minimally invasive esophagectomy (MIE) and can be associated with adverse outcomes. This study aims to construct a nomogram based on clinical factors to predict PPCs and investigate related early outcomes. Clinical data of 969 consecutive patients receiving MIE were retrospectively collected. Univariate and multivariate analysis were performed to select independent predictors. Using independent predictors to develop a nomogram and using a bootstrap-resampling approach to conduct internal verification. Early outcomes of PPCs were analyzed. The incidence of PPCs following MIE was 39.6% (384 out of 969). In multivariate analysis, older age (Odds ratio (OR) 1.034, P < 0.001), higher body mass index (OR 0.993, P = 0.003), heavy smoking (OR 1.396, P = 0.027), FEV1/FVC < 105% (OR 1.958, P < 0.001), chemoradiotherapy (OR 0.653, P = 0.039), estimated blood loss ≥ 400 mL (OR 2.582, P = 0.018), general anesthesia (vs Combined thoracic paravertebral blockade, OR 1.578, P = 0.014), operative time ≥ 240 min (OR 1.388, P = 0.027), squamous cell carcinoma (OR 2.099, P = 0.036) and conversion to thoracotomy (OR 2.820, P = 0.026) were independent predictors for PPCs. These ten independent predictors were used to develop a nomogram, with concordance index (C index) value of 0.662 and good calibration. After internal validation, similarly good calibration and discrimination (C index, 0.654; 95% CI 0.614–0.690) were observed. Patients developing PPCs had higher rates of anastomotic leakage, reoperation, ICU and 30-day readmissions, and prolonged ICU and hospital stays (P < 0.05). Our study identified ten predictors for PPCs, which were associated with poor early outcomes. The proposed nomogram can be a useful tool to identify patients at high risk of PPCs after MIE.

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Our research team would like to thank Dr. Zhigang Li and Dr. Bin Li thoracic surgeons in Shanghai Chest Hospital, Shanghai, China, for their involvement and support.


This work was supported by National Natural Science Foundation of China (82071233).

Author information




Study conception and design: JW and CT; acquisition of data: JW and CT; analysis and interpretation of data JW, CT and YL; drafting of manuscript: JW, CT and YL; critical revision of manuscript: all authors; approval of the final version of manuscript: all authors.

Corresponding author

Correspondence to Jingxiang Wu.

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All authors have no conflicts of interest to declare.

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This study was approved by the Institutional Review Board at Shanghai Chest Hospital (ChiCTR1900022257), and the informed consent was waived because of the retrospective nature of the study.

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Tong, C., Liu, Y. & Wu, J. Development and validation of a novel nomogram for postoperative pulmonary complications following minimally invasive esophageal cancer surgery. Updates Surg (2021).

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  • Esophageal cancer
  • Minimally invasive esophagectomy
  • Postoperative pulmonary complications
  • Nomogram