| Objective: To investigate the predictive value of four commonly used preoperative nutritional risk screening methods,including prognostic nutritional index(PNI),nutritional risk index(NRI),geriatric nutritional risk index(GNRI)and body mass index(BMI),in complications after McKeown robotic esophagectomy for esophageal cancer.The above four preoperative nutritional risk screening methods were compared to find the most suitable preoperative nutritional risk screening method to predict the occurrence of postoperative complications after McKeown robotic esophagectomy for esophageal cancer.So as to prevent or treat the postoperative complications of esophageal cancer in advance.Methods: The clinical data of 120 patients with esophageal cancer who underwent McKeown robotic esophagectomy for esophageal cancer at the Department of Thoracic Surgery,the First Hospital of Lanzhou University from January 2019 to June 2022 were retrospectively collected.There were 95 males and 25 females,with an average age of62.82 years.The optimal cut-off values of the four preoperative nutritional risk screening methods for predicting postoperative complications were determined according to the receiver operating characteristic curve(ROC),and the corresponding area under the curve(AUC)of the four preoperative nutritional risk screening methods was compared.To study the effect of PNI on postoperative complications of McKeown robotic esophagectomy,patients were divided into high PNI group and low PNI group according to the cut-off value of PNI.The basic characteristics,surgery-related indicators and postoperative complications between the two groups were analyzed.The methods of NRI,GNRI and BMI were the same as PNI.According to the occurrence of postoperative complications,the patients were divided into the complication group and the non-complication group.Univariate and multivariate analysis were used to explore the influence of related indicators on the occurrence of postoperative complications of McKeown robotic esophagectomy.Results: By comparing the area under the curve of the four preoperative nutritional risk screening methods,PNI had the highest predictive value for postoperative complications.There were significant differences in preoperative hemoglobin,preoperative lymphocyte count,preoperative albumin and preoperative total cholesterol between the high PNI group and the low PNI group(P < 0.05),and the above indicators in the high PNI group were higher than those in the low PNI group.There were significant differences in preoperative hemoglobin,preoperative albumin and preoperative total cholesterol between the high NRI group and the low NRI group(P < 0.05),and the above indicators in the high NRI group were higher than those in the low NRI group.There were significant differences in preoperative hemoglobin,preoperative albumin,preoperative total cholesterol and body weight between the high GNRI group and the low GNRI group(P < 0.05),and the above indicators in the high GNRI group were higher than those in the low GNRI group.The preoperative serum albumin level and body weight of the high BMI group were significantly different from those of the low BMI group(P < 0.05).The preoperative serum albumin level and body weight of the high BMI group were higher than those of the low BMI group.There were significant differences in the incidence of overall postoperative complications,pulmonary infection,pleural effusion,and poor wound healing between the high PNI group and the low PNI group(P < 0.05),and the incidence of the above complications in the high PNI group was lower than that in the low PNI group.There were significant differences in the incidence of overall postoperative complications and arrhythmia between the high NRI group and the low NRI group(P < 0.05),and the incidence of the above complications in the high NRI group was lower than that in the low NRI group.There were significant differences in the incidence of overall postoperative complications and pulmonary infection between the high GNRI group and the low GNRI group(P < 0.05),and the incidence of the above complications in the high GNRI group was lower than that in the low GNRI group.There was no significant difference in the incidence of postoperative complications between the high BMI group and the low BMI group(P > 0.05).The related indicators that may cause postoperative complications were included in the univariate analysis.The results suggest that age,operation time,intraoperative blood loss,preoperative blood lymphocyte count,preoperative blood hemoglobin,preoperative blood monocyte count,preoperative blood albumin,preoperative total cholesterol,NRI,GNRI and PNI are the possible influencing factors of postoperative complications of McKeown robotic esophagectomy.When the above indicators with P < 0.1 were included in the multivariate analysis,the results showed that age,PNI,operation time and intraoperative blood loss were independent risk factors for postoperative complications.Conclusions: Among the four preoperative nutritional risk screening methods,PNI has the highest predictive value for postoperative complications of McKeown robotic esophagectomy.Age,PNI,operation time and intraoperative blood loss are independent risk factors for postoperative complications.The nomogram based on the above indicators has a good predictive efficiency,which can be applied to clinical practice.For those pre-operative esophageal cancer patients with a high incidence of postoperative complications,the nutritional and immune status should be improved before surgery,and the postoperative monitoring and nursing should be strengthened to actively prevent the occurrence of postoperative complications. |
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