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

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

Chao Chen  1   2   3 , Shao-Jun Xu  1   2   3 , Zhi-Fan Zhang  1   2   3 , Cheng-Xiong You  1   2   3 , Yun-Fan Luo  1   2   3 , Rui-Qin Chen  1   2   3 , Shu-Chen Chen  1   2   3
Affiliations

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

Chao Chen et al. Ann Med. 2025 Dec.

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.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves for OS (A) and DFS (B) in locally advanced ESCC patients with SPCs and non-SPCs.
Figure 2.
Figure 2.
Kaplan–Meier survival curves for patients with SPCs and non-SPCs. OS (A) and DFS (B) in low-PNI; OS (C) and DFS (D) in high-PNI.
Figure 3.
Figure 3.
Nomogram for predicting OS (A) and DFS (B) in high-PNI.
Figure 4.
Figure 4.
Calibration curves for 3-and 5-year OS and DFS based on nomogram in high-PNI.
Figure 5.
Figure 5.
OS (A) and DFS (B) survival curves for low, intermediate, and high-risk patients stratified by nomogram score.
See this image and copyright information in PMC

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