title: Original scoring system for predicting postoperative morbidity after esophagectomy for esophageal cancer.
abstract: OBJECTIVE
  Postoperative morbidity remains common after esophagectomy. There are currently few tools that can be used to estimate the incidence of complications. This study aimed to create a novel scoring system for predicting postoperative morbidity.
  
  
  METHODS
  A total of 365 patients who underwent elective esophagectomy with two- or three-field lymphadenectomy for esophageal cancer were retrospectively analyzed. Patients were divided into development (n = 250) and validation datasets (n = 115). A scoring system was established by specifying the expected morbidity incidence values for all independent predictors in the development dataset, after which, the reproducibility was confirmed in the validation dataset.
  
  
  RESULTS
  The incidence of any morbidity was 44.7 %. Male sex, severe emaciation (body mass index <18), a lower performance status (grade 1 or 2), operation ≥540 min and massive bleeding (blood loss/body weight ≥20) were independent predictors of postoperative morbidity. The total of all predictive scores was calculated. The incidence of any morbidity and of severe morbidity (Clavien-Dindo classification ≥IIIb) significantly correlated with the score after dividing the scores into three groups (≤8, 10 and 11 and ≥13). This finding was also confirmed in the validation dataset.
  
  
  CONCLUSIONS
  The current scoring system is considered to be useful for predicting postoperative morbidity after esophagectomy.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuoku, Kumamoto, 860-8556, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Baba
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ida
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Ishimoto
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Karashima
authors.forename: Shiro
authors.initials: S
authors.lastname: Iwagami
authors.forename: Yu
authors.initials: Y
authors.lastname: Imamura
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*