How does Surgical Apgar Score predict the short-term complications and long-term prognosis after esophagectomy?

The incidence of esophageal cancer is increasing steadily, which is now the eighth most common malignancy, and its annual amounts have reached nearly half a million (1). Surgical treatment is the cornerstone of curative therapy for esophageal cancer, while this procedure is associated with significant severe complications, whose mortality rate would be the highest among all gastrointestinal surgeries (2). To better the treatment outcomes of esophageal malignancy, Akio Nakagawa and his colleagues provided evidence that the Surgical Apgar Score (SAS) predicts short-term complications and long-term prognosis after an esophagectomy (3). In this study, the sum of the scores of estimated blood loss, lowest mean arterial pressure, and lowest heart rate defined the SAS. A total of 400 patients received surgical treatment were taken into account. Complications achieved the grade-3 level according to the Clavien-Dindo classification, which had occurred in 145 of the cases (36%), which contained 8 cases of surgical mortality, 2 cases of pneumonia, 1 case of an anastomotic leak and 1 case of bronchial fistula. The occurrences of complications were significantly associated with hypertension, thoracotomy, a SAS of less than 5, age (older than 65 years), diabetes, and reconstruction route. Multivariate analysis showed that a SAS of ≤5 was significantly associated with pulmonary and gastrointestinal complication