Risk Factors Analysis Of Complications After Radical Resection Of Esophageal Cancer With Clavien-Dindo Grade ≥Ⅲ

Background:The latest epidemiological results show that the global incidence of esophageal cancer ranks eighth,and the overall mortality ranks sixth.Globally,there are estimated to be 604,100 new cases and544,100 deaths of esophageal cancer in 52020.As a region with a high incidence of esophageal cancer,the number of new cases of esophageal cancer in China in 2020 is as high as 324,000.Although there are a variety of treatments for esophageal cancer,including radiotherapy,chemotherapy,targeting and immunotherapy,and the concept of multidisciplinary integrated treatment is advocated.However,surgery is still the first choice for the best treatment of esophageal cancer.Despite the continuous improvement of surgical methods and surgical techniques,radical resection of esophageal cancer is still one of the highly invasive and complicated surgical operations.The risk of perioperative complications and death is still high.Meanwhile,at home and abroad,more attention is paid to the analysis of risk factors of a particular complication.There are few studies on the comprehensive evaluation of all postoperative complications of esophageal cancer,and there is a long-term lack of unified evaluation standards for postoperative complications in China,which is not conducive to the comparison of data from different centers and the improvement of medical quality.As an internationally common complication grading system,Clavien-Dindo grading can be used to grade the severity of postoperative complications of esophageal cancer,which is an objective,holistic and comprehensive postoperative complication grading system.This study will be guided by the treatment methods of postoperative complications of esophageal cancer,with reference to the Clavien-Dindo grading system.To quantitatively grade postoperative complications,to explore the risk factors of complications after radical resection of esophageal cancer with Clavien-Dindo grade ≥Ⅲ.Objective:The purpose of this study was to investigate the risk factors of complications with Clavien-Dindo grading ≥Ⅲ after radical resection of esophageal cancer through the Clavien-Dindo grading system,so as to carry out individualized intervention in the perioperative period for patients with esophageal cancer surgery,and reduce the incidence and severity of perioperative complications in patients with esophageal cancer.Methods:Clinical data of 121 patients undergoing radical resection of esophageal cancer admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Henan University from January 2018 to December 2022 were collected,including 84 male patients and 37 female patients,respectively.The Clavien-Dindo grading system was used to guide the treatment of postoperative complications of patients with esophageal cancer.Postoperative complications of esophageal cancer were quantitatively graded.Patients were divided into two groups according to the severity of complications(Clavien-Dindo grade <Ⅲ and ≥Ⅲ).Relevant data of patients before,during and after surgery were taken as potential risk factors.Univariate analysis was performed on the factors that may affect the occurrence of postoperative complications ≥Ⅲ in Clavien-Dindo grade,and multivariate analysis was performed on the risk factors that were significant in single factor to explore the independent risk factors leading to the occurrence of complications ≥Ⅲ.Results:The results of univariate analysis suggest that Gender(P=0.504),age(P=0.218),long-term heavy smoking(smoking index ≥400 cigarettes × years)(P=0.6),history of alcohol consumption(P=0.577),BMI(P=0.712),history of cardiovascular disease(P=0.808),history of diabetes(P=0.358),and tumor site(P=0.362),clinical stage(P=0.656),preoperative neoadjuvant therapy(P=0.302),Charlson index(P=0.885),NRS-2002 nutritional risk screening score(P=0.94),NLR(P=0.081)and SII(P=0.198).There was no significant difference in Clavien-Dindo classification of complications between group < Ⅲ and group ≥Ⅲ(P> 0.05).2.Cerebrovascular disease history(P=0.02),PNI(P=0.002),ASA classification(P=0.017),operation time(P=0.001)and intraoperative blood loss(P=0.005)were significantly different between Clavien-Dindo classification < Ⅲ and ≥Ⅲ(P < 0.05)).3.Multi-factor Logistics regression analysis hints: ASA classification > Grade Ⅱ(OR=3.730,95%CI 1.211-11.492,P=0.022),low PNI(OR=0.867,95%CI 0.780-0.964,P=0.008),operation time(OR=1.018,95%CI 1.003-1.034,P=0.016)was an independent risk factor for the occurrence of Clavien-Dindo grade ≥Ⅲ.Conclusion:The longer the operation time,the ASA grade > Ⅱ,and the low preoperative PNI will increase the incidence of postoperative complications of esophageal cancer patients with Clavien-Dindo grade ≥Ⅲ,among which medium-large pleural effusion is common.