Risk factors for postoperative intensive care unit admission after minimally invasive esophagectomy following neoadjuvant chemoimmunotherapy in patients with esophageal squamous cell carcinoma: a retrospective cohort study

Cancer research · Esophageal cancer

Lower preoperative prognostic nutritional index (PNI) and American Society of Anesthesiologists (ASA) physical status class III are independently associated with postoperative intensive care unit (ICU) admission in patients with esophageal squamous cell carcinoma undergoing neoadjuvant chemoimmunotherapy followed by minimally invasive esophagectomy.

Introduction: Patients with esophageal squamous cell carcinoma (ESCC) who undergo minimally invasive esophagectomy (MIE) after neoadjuvant chemoimmunotherapy (nCIT) and subsequently require postoperative intensive care unit (ICU) admission may experience a greater economic burden and poorer clinical outcomes. This study aimed to identify perioperative factors independently associated with postoperative ICU admission in patients with ESCC treated with nCIT followed by MIE. Methods: A retrospective cohort study of patients with ESCC who underwent MIE after nCIT. Baseline demographic characteristics, perioperative variables, postoperative complications, and details of postoperative ICU admission were collected. Univariable and multivariable logistic regression analyses identified factors associated with postoperative ICU admission. A nomogram was constructed to provide individualized risk estimates. Results: Among 115 eligible patients, 25 (21.7%) required postoperative ICU admission. Compared with patients who did not require ICU admission, those admitted had higher rates of pulmonary infection (60.0% vs. 11.1%) and respiratory failure (80.0% vs. 41.1%), a longer postoperative hospital stay (26.1 ±17.1 vs. 18.5 ±9.1 days), and higher total hospital costs (¥59,519 ±40,754 vs. ¥63,426 ±16,895). In multivariable analysis, each unit increase in preoperative prognostic nutritional index (PNI) was associated with lower odds of ICU admission (OR = 0.84, 95% CI 0.74‑0.94, p = 0.002), whereas ASA physical status class III was associated with higher odds than class I/II (OR = 7.57, 95% CI 2.10‑27.20, p = 0.002). Operative duration was associated with ICU admission in univariable analysis (p = 0.024) but not in multivariable analysis (p = 0.102). The PNI‑ASA nomogram had acceptable discrimination (apparent AUC = 0.810; optimism‑corrected AUC = 0.781). Conclusion: Lower preoperative PNI and ASA class III were independently associated with postoperative ICU admission in patients with ESCC undergoing nCIT followed by MIE. The PNI‑ASA nomogram may support preoperative risk stratification. The dichotomized PNI cutoff derived from subgroup analyses requires external validation and should not be used as a standalone clinical threshold.

Postoperative ICU admission represents an important adverse clinical event with substantial clinical and economic consequences, leading to increased in‑hospital mortality, prolonged hospitalization, and higher healthcare expenditures.

Evidence level: Állatkísérletes. Állatmodellben vizsgálták.

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