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Estimation of physiologic ability and surgical stress (E-PASS) can assess short-term outcome after esophagectomy for esophageal cancer

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Abstract

Background

Postoperative morbidity after esophagectomy for esophageal cancer is still frequent. Tools for prediction of postoperative complications have been sought, with the estimation of physiologic ability and surgical stress (E-PASS) scoring system being one of the candidates. The aim of this study was to determine the usefulness of the E-PASS system for risk assessment of esophagectomy.

Methods

The clinical courses of 308 patients who underwent elective subtotal esophagectomy with lymph node dissection for esophageal cancer were analyzed. The incidence and severity of complication and influence of preoperative therapy were investigated using the E-PASS system.

Results

The incidence of any complication was as high as 42.2 %. The frequency of severe and critical complications was 13.0 and 6.8 %, respectively. The E-PASS system could estimate the incidence and severity of complications. Patients with a comprehensive risk score (CRS) >0.9 had a significantly higher probability of incidence of severe or critical complications. The incidence of complication and the CRS increased linearly according to preoperative treatment in the following order: no preoperative treatment < neoadjuvant chemotherapy < neoadjuvant chemoradiotherapy < definitive chemoradiotherapy. These were significantly higher after salvage esophagectomy.

Conclusion

The E-PASS scoring system was useful for risk assessment after esophagectomy. Patients with a CRS >0.9 and patients undergoing salvage esophagectomy should be treated carefully after surgery. Among two scoring systems of which the CRS consisted, the surgical stress score strongly correlated with postoperative complications after esophagectomy, but the preoperative risk score did not.

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Conflict of interest

Naoya Yoshida and the other co-authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan

    Naoya Yoshida, Masayuki Watanabe, Yoshifumi Baba, Shiro Iwagami, Takatsugu Ishimoto, Masaaki Iwatsuki, Yasuo Sakamoto, Yuji Miyamoto, Nobuyuki Ozaki & Hideo Baba

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  1. Naoya Yoshida
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  2. Masayuki Watanabe
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  3. Yoshifumi Baba
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  4. Shiro Iwagami
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  5. Takatsugu Ishimoto
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  6. Masaaki Iwatsuki
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  7. Yasuo Sakamoto
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  9. Nobuyuki Ozaki
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  10. Hideo Baba
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Correspondence to Hideo Baba.

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Yoshida, N., Watanabe, M., Baba, Y. et al. Estimation of physiologic ability and surgical stress (E-PASS) can assess short-term outcome after esophagectomy for esophageal cancer. Esophagus 10, 86–94 (2013). https://doi.org/10.1007/s10388-013-0369-5

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