Clinical Significance of Pretreatment Red Blood Cell Distribution Width as a Predictive Marker for Postoperative Morbidity After Esophagectomy for Esophageal Cancer: A Retrospective Study

Yoshida, Naoya; Horinouchi, Tomo; Toihata, Tasuku; Harada, Kazuto; Eto, Kojiro; Sawayama, Hiroshi; Iwatsuki, Masaaki; Nagai, Yohei; Ishimoto, Takatsugu; Baba, Yoshifumi; Miyamoto, Yuji; Baba, Hideo

BACKGROUND: Clinical significance of red blood cell distribution (RDW) as a predictive marker for the incidence of postoperative morbidity after esophagectomy for esophageal cancer has not been established. METHODS: This study included 634 consecutive patients who underwent three-incisional esophagectomy with lymphadenectomy for esophageal cancer between April 2005 and November 2020. Correlation between pretreatment RDW and patient background, cancer background, and short-term outcome after esophagectomy were retrospectively investigated. RESULTS: Eighty patients (12.6%) had a high pretreatment RDW (> 14.2), which correlated with malnutrition estimated by body mass index, hemoglobin, total lymphocyte count, albumin, and total cholesterol. High pretreatment RDW was an independent risk factor for postoperative severe morbidity of grade IIIb or higher based on the Clavien–Dindo classification (hazard ratio [HR] 3.90, 95% confidence interval [CI] 1.707–8.887; p = 0.0012) and reoperation (HR 4.39, 95% CI 1.552–12.390; p = 0.0053) after open esophagectomy (OE). However, RDW was not associated with postoperative morbidity incidence after minimally invasive esophagectomy (MIE). CONCLUSIONS: Pretreatment RDW may be a surrogate marker for nutritional status and could be a predictive marker for postoperative severe morbidity, reoperation, and possibly pneumonia after OE. On the contrary, the lower invasiveness of MIE may have reduced the effect of pretreatment malnutrition on morbidity incidence, which could explain the insignificant relationship between RDW and poor short-term outcomes in MIE. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10719-2.