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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Defining Subclinical Acute Kidney Injury Within 72 Hours After Minimally Invasive Esophagectomy in Prone Position and

Seiji Ishikawa1,2, Junko Hirashima2, Makiko Hiroyama2

  • 1Department of Anesthesiology and Pain Medicine, Juntendo University, Tokyo, JPN.

Cureus
|March 11, 2026
PubMed
Abstract

Insights

Subclinical acute kidney injury (AKI), indicated by a 30% rise in serum creatinine post-surgery, impacts minimally invasive esophagectomy outcomes. Targeting subclinical AKI alongside AKI is crucial for preventing adverse events and improving patient recovery.

Area of Science:

  • Nephrology
  • Surgical Oncology
  • Critical Care Medicine

Background:

  • Minimally invasive esophagectomy (MIE) in the prone position can lead to postoperative changes in serum creatinine (sCr).
  • The clinical significance of sCr increases not meeting acute kidney injury (AKI) diagnostic criteria remains under investigation.
  • Identifying early indicators of kidney dysfunction is crucial for optimizing patient outcomes after major surgery.

Purpose of the Study:

  • To investigate the impact of minor postoperative sCr elevations, not meeting AKI criteria, on patient outcomes following MIE.
  • To compare outcomes between patients with AKI, subclinical AKI (defined as ΔsCr% ≥30%), and no significant sCr increase.
  • To determine if subclinical AKI is associated with adverse postoperative events.

Main Methods:

  • Retrospective cohort study of 933 patients undergoing MIE between January 2010 and December 2024.
  • Patients classified into AKI group (KDIGO criteria), subclinical AKI group (ΔsCr% ≥30%), and reference group (ΔsCr% <30%).
  • Comparison of postoperative outcomes including hospital stay duration and mechanical ventilation requirement among the three groups.

Main Results:

  • The incidence of subclinical AKI was 1.3%.
  • Patients in both the AKI and subclinical AKI groups experienced significantly longer postoperative hospital stays (≥25 days) and higher rates of mechanical ventilation compared to the reference group.
  • No significant difference in these outcomes was observed between the AKI and subclinical AKI groups.

Conclusions:

  • Subclinical AKI, defined by a 30% increase in sCr post-MIE, is associated with increased need for mechanical ventilation.
  • The findings suggest that subclinical AKI shares similar adverse outcome risks with overt AKI after MIE.
  • Preventive strategies should encompass both overt AKI and subclinical AKI to mitigate poor patient outcomes.
Keywords:
acute kidney injuryesophageal cancermechanical ventilationminimally invasive esophagectomypostoperative complication

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