Severe postoperative complications after minimally invasive esophagectomy reduce the long-term prognosis of well-immunonutrition patients with locally advanced esophageal squamous cell carcinoma

Ann Med. 2025 Dec;57(1):2440622. doi: 10.1080/07853890.2024.2440622. Epub 2024 Dec 13.

Abstract

Background: While severe postoperative complications (SPCs) impact cancer prognosis, their effect on locally advanced esophageal squamous cell carcinoma (ESCC) patients with varying immunonutritional statuses after minimally invasive esophagectomy (MIE) is unclear.

Methods: This retrospective study analyzed 442 patients with locally advanced ESCC who underwent MIE, investigating the relationship between SPCs and survival based on preoperative immunonutritional status, determined by the prognostic nutritional index (PNI). Nomograms were developed for patients with preserved immunonutritional status using Cox regression, and their performance was assessed.

Results: Of the patients, 102 (23.1%) experienced SPCs after MIE. Five-year overall survival (OS) and disease-free survival (DFS) were significantly different between SPCs and non-SPCs groups (p < 0.001). In the preserved immunonutritional group, SPCs significantly reduced 5-year OS (p = 0.008) and DFS (p = 0.011), but not in the poor immunonutritional group (OS p = 0.152, DFS p = 0.098). Multivariate Cox regression identified SPCs as an independent risk factor for OS (HR = 1.653, p = 0.013) and DFS (HR = 1.476, p = 0.039). A nomogram for predicting OS and DFS in preserved immunonutritional patients demonstrated excellent performance.

Conclusions: SPCs significantly affect prognosis in ESCC patients with preserved immunonutritional status after MIE. Nomograms based on SPCs can predict OS and DFS in these patients.

Keywords: Minimally invasive esophagectomy; esophageal squamous cell carcinoma; prognostic nutritional index; severe postoperative complications.

MeSH terms

  • Aged
  • Disease-Free Survival
  • Esophageal Neoplasms* / immunology
  • Esophageal Neoplasms* / mortality
  • Esophageal Neoplasms* / surgery
  • Esophageal Squamous Cell Carcinoma* / immunology
  • Esophageal Squamous Cell Carcinoma* / surgery
  • Esophagectomy* / adverse effects
  • Female
  • Humans
  • Immunonutrition Diet
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Nomograms
  • Nutrition Assessment
  • Nutritional Status*
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / prevention & control
  • Prognosis
  • Retrospective Studies
  • Risk Factors

Grants and funding

This study was supported by grants from the Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University (No. 0713304); the Natural Science Foundation in Fujian Province (No. 2020J011004); the Fujian provincial health technology project (No. 2020CXA028); the cohort study of the School of Public Health, Fujian Medical University (No. 2021HX003); the Joint Funds for the innovation of science and Technology, Fujian province (No. 2020Y9076); and the National Nature Science Foundation of China (No. 82273415).