Supplementary Material for: Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma

<br><strong><em>Background/Aims:</em></strong> Surgery for esophageal cancer is associated with a high morbidity and mortality. With this study, we investigated if a validated preoperative risk score correlates with overall morbidity, mortality, anastomotic insufficiency, respiratory complications and with the severity of complications after open Ivor-Lewis esophagectomy. <b><i>Methods:</i></b> A total of 94 patients undergoing esophageal resection for adenocarcinoma between 2005 and 2009 were included. Patients were assigned using the preoperative risk score according to Schröder et al. [Langenbecks Arch Surg 2006;391:455-460] and the Dindo classification regarding the severity of complications. <b><i>Results:</i></b> Of all the patients, 12% had a ‘normal', 54% a ‘moderateʼ and 34% a ‘high' preoperative risk score. Postoperative complications occurred in 79%. Furthermore, 36 or 21 or 14 or 7% of patients experienced complications of category I/II or III or IV or V, respectively. There was a significant association between preoperative risk score and overall morbidity (p = 0.010), mortality (p = 0.035) and anastomotic insufficiency (p = 0.023). Furthermore, higher preoperative risk score was significant related to increasing severity of postoperative complications (grade IV according to the Dindo classification: p = 0.018, Dindo grade V: p = 0.035). Neoadjuvant therapy consisting of cisplatin and 5-fluorouracil had no influence. <b><i>Conclusion:</i></b> As we demonstrated, a significant association between preoperative risk score and occurrence and severity of postoperative complications after open Ivor-Lewis esophagectomy, standardized, organ-specific pre- and postoperative categorizations might be useful for individual clinical decision making in this group of patients.

**背景与研究目的**：食管癌手术伴随较高的并发症发生率与死亡率。本研究旨在探讨经验证的术前风险评分（preoperative risk score）是否与开放Ivor-Lewis食管切除术（open Ivor-Lewis esophagectomy）后的总体并发症发生率、死亡率、吻合口漏（anastomotic insufficiency）、呼吸系统并发症以及并发症严重程度相关。

**研究方法**：本研究纳入2005年至2009年间共94例因食管腺癌接受食管切除术的患者。依据Schröder等发表于《Langenbecks Arch Surg》（《兰根贝克外科学文献》）2006年；391卷：455-460页的术前风险评分体系对患者进行分组，并采用Dindo分级（Dindo classification）评估并发症严重程度。

**研究结果**：所有患者中，12%的术前风险评分为"正常"，54%为"中度"，34%为"高度"。术后并发症总发生率为79%。其中，分别有36%、21%、14%、7%的患者出现I/II级、III级、IV级、V级并发症。术前风险评分与总体并发症发生率（p = 0.010）、死亡率（p = 0.035）及吻合口漏发生率（p = 0.023）均存在显著相关性。此外，术前风险评分越高，术后并发症的严重程度越高（依据Dindo分级的IV级并发症：p = 0.018；V级并发症：p = 0.035）。以顺铂（cisplatin）联合5-氟尿嘧啶（5-fluorouracil）实施的新辅助治疗（neoadjuvant therapy）对上述结果无显著影响。

**研究结论**：本研究证实，开放Ivor-Lewis食管切除术后的术前风险评分与术后并发症的发生及严重程度存在显著相关性。采用标准化、器官特异性的术前及术后分类体系，或可为此类患者的个体化临床决策提供有效参考依据。