title: Postoperative outcome after oesophagectomy for cancer: Nutritional status is the missing ring in the current prognostic scores.
abstract: BACKGROUND
  Several prognostic scores were designed in order to estimate the risk of postoperative adverse events. None of them includes a component directly associated to the nutritional status. The aims of the study were the evaluation of performance of risk-adjusted models for early outcomes after oesophagectomy and to develop a score for severe complication prediction with special consideration regarding nutritional status.
  
  
  METHODS
  A comparison of POSSUM and Charlson score and their derivates, ASA, Lagarde score and nutritional index (PNI) was performed on 167 patients undergoing oesophagectomy for cancer. A logistic regression model was also estimated to obtain a new prognostic score for severe morbidity prediction.
  
  
  RESULTS
  Overall morbidity was 35.3% (59 cases), severe complications (grade III-V of Clavien-Dindo classification) occurred in 20 cases. Discrimination was poor for all the scores. Multivariable analysis identified pulse, connective tissue disease, PNI and potassium as independent predictors of severe morbidity. This model showed good discrimination and calibration. Internal validation using standard bootstrapping techniques confirmed the good performance.
  
  
  CONCLUSIONS
  Nutrition could be an independent risk factor for major complications and a nutritional status coefficient could be included in current prognostic scores to improve risk estimation of major postoperative complications after oesophagectomy for cancer.
authors.affiliation: Department of Surgery, University of Medicine and Pharmacy, Iasi, Romania; Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Filip
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy. Electronic address: marcoscarpa73@yahoo.it.
authors.forename: M
authors.initials: M
authors.lastname: Scarpa
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cagol
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Alfieri
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Saadeh
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ancona
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Castoro
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery*; D000368:Aged; D003240:Connective Tissue Diseases / Q000150:complications; D004938:Esophageal Neoplasms / Q000097:blood / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology; D011188:Potassium / Q000097:blood; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin; D011188:Potassium
keywords: Oesophageal cancer; Oesophagectomy; Postoperative complications; Prognostic scores