Nomographic predictive models for complications after minimally invasive esophagectomy: Current status and future perspectives

Table 4 Risk factors found associated with morbidity in minimally invasive esophagectomy

Category	Risk factor	Association with higher morbidity
Patient related	Age	> 65 years[83]
	Gender	Male gender associated with more pulmonary and overall morbidity[48]
	Body habitus and BMI	Underweight/sarcopenic or morbid obesity[84]
	Performance status	ASA and ECOG score more than 1
	Nutritional status	Malnutrition (low albumin, hemoglobin level), weight loss, sarcopenia[48,84]
	Addictions	Smoking has higher risk[85-87]
	Pre-existing co-morbidities	Diabetes, COPD, cardiac disease and higher Charlson index[83,88]
Disease related	Tumor size	Tumour size > 4 cm[4]
	Tumor stage	T3 and higher tumours[4]
	Tumor location	Cervical and upper thoracic tumours[4]
Treatment related	Neo-adjuvant CRT	Standard of care but mixed evidence regarding slightly higher morbidity with CRT[89]
	Surgical approach (MIE/hybrid/open)	Open approach[5,15,16]
	Patient position (prone/semi-prone)	Semi-prone is associated with inferior outcomes in terms of pulmonary morbidity[17,81]
	Lymphadenectomy (standard or total two field/three field)	Three field and total two field have higher morbidity rates[82]
	Conduit type	Non gastric > gastric conduit[90]
	Anastomotic level	Cervical > intrathoracic anastomosis[91]
	Anastomotic technique	Overall similar for stapled and hand sewn technique. Semi-mechanical has better reported outcomes

BMI: Body mass index; ASA: American Society of Anesthesia; ECOG: Eastern Cooperative Oncology Group; COPD: Chronic obstructive pulmonary disease; CRT: Chemoradiotherapy; MIE: Minimally invasive esophagectomy.