Association Between Liver Fibrosis Assessed by the Aspartate Aminotransferase-To-Platelet Ratio Index and Outcomes of Esophageal Cancer Surgery.

Background: Although liver cirrhosis is widely recognized as a risk factor for postoperative complications following esophagectomy, the impact of liver fibrosis other than overt cirrhosis on surgical outcomes remains unclear. We investigated the association between the preoperative aspartate aminotransferase-to-platelet ratio index (APRI), a useful indicator of liver fibrosis, and surgical outcomes following esophagectomy.

Methods: A total of 516 patients who underwent esophagectomy for esophageal cancer were retrospectively reviewed and divided into high (≥ 0.40) and low (< 0.40) APRI groups. We compared short- and long-term outcomes following esophagectomy between the groups.

Results: The low and high APRI groups included 392 (76.0%) and 124 (24.0%) patients, respectively. The high APRI group had a higher proportion of male patients and patients with higher body mass index, diabetes mellitus, and adenocarcinoma than the low APRI group. Estimated blood loss was greater, and the incidence of anastomotic leakage and surgical site infection was higher in the high APRI group than in the low APRI group. Multivariable analysis revealed that high APRI was independently associated with an increased risk of anastomotic leakage (odds ratio, 1.88; 95% confidence interval, 1.02-3.46) and greater blood loss (standardized regression coefficient = 0.140). High APRI was also associated with a higher risk of surgical site infection (odds ratio, 1.95; 95% confidence interval, 0.98-3.89). Overall survival was comparable between the two groups (p = 0.387).

Conclusions: High APRI, indicative of liver fibrosis, is associated with an increased risk of anastomotic leakage and greater blood loss following esophagectomy.