Predictive Value of the Estimation of Physiologic Ability and Surgical Stress Scoring System for Postoperative Lymphocele Formation in Patients with Endometrial Cancer

Background: The incidence of endometrial cancer is steadily rising worldwide. Although surgical interventions, particularly comprehensive lymphadenectomy, have improved survival rates, postoperative lymphoceles formation remains a significant clinical complication adversely affecting patient recovery and quality of life. In recent years, the estimation of physiologic ability and surgical stress (E-PASS) scoring system has emerged as a valuable tool in perioperative risk assessment. This system provides a comprehensive evaluation by quantifying patients’ physiological reserves and surgical stress. Although this scoring method has demonstrated value across various surgical disciplines, its potential utility in gynecological oncology remains to be thoroughly explored. Methods: In this retrospective cohort study conducted at Dongyang Hospital affiliated with Wenzhou Medical University, China, we analyzed 180 patients with endometrial cancer who underwent radical surgery between 2012 and 2023. We evaluated the predictive performance of E-PASS components: preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS). Results: Lymphocele developed in 62 patients (34.4%). The CRS demonstrated superior predictive performance (area under the curve [AUC] = 0.930; 95% confidence interval [CI]: 0.893–0.966) with 0.806 sensitivity and 0.915 specificity. Multivariate analysis identified CRS (odds ratio [OR] = 1.161; 95% CI: 1.110–1.214) and advanced International Federation of Gynecology and Obstetrics stage (OR = 3.211, 95% CI: 1.262–8.172) as independent risk factors. Conclusions: The E-PASS scoring system, particularly the CRS, effectively predicts postoperative lymphocele formation in patients with endometrial cancer undergoing radical surgery, potentially facilitating early risk assessment and guiding preventive interventions.