Preoperative CRP–Albumin–Lymphocyte (CALLY) Index Is Associated with Survival but Does Not Predict Anastomotic Leak or Major Morbidity After Minimally Invasive Esophagectomy

Background/Objectives: The CRP–albumin–lymphocyte (CALLY) index is promoted both as a marker of postoperative morbidity and as a prognostic factor for survival. These claims are rarely tested together, thresholds usually come from the dataset in which they are then tested, and the index is seldom compared against its components. We examined both in one minimally invasive esophagectomy cohort. Methods: Consecutive esophagectomies with a thoracoscopic or robotic thoracic phase at one centre were reviewed. The index was derived from the preoperative albumin, C-reactive protein, and lymphocyte count. Short-term endpoints were major morbidity (Clavien–Dindo grade ≥ 3) and anastomotic leak; survival was analysed by Kaplan–Meier and Cox methods, with internal cut-points stress-tested by bootstrapping. Results: Of 154 esophagectomies screened, 22 open or transhiatal procedures and one exploration without resection were excluded, leaving 131 patients. Major morbidity occurred in 39 (29.8%), and leak in 21 (16.0%). The index discriminated neither: area under the curve 0.556 (95% CI: 0.450–0.663) and 0.481 (95% CI: 0.339–0.623). Over a median follow-up of 31.0 months, there were 39 deaths, and median survival was 62.1 months. Here, the index behaved differently: each unit of log-CALLY carried a hazard ratio of 0.776 (95% CI: 0.643–0.936, p = 0.008), and three-year survival rose from 48.5% in the lowest tertile to 77.1% in the highest (trend p = 0.020). The association held after adjustment for stage and nodal status (0.749, 95% CI: 0.609–0.922, p = 0.006), lifting the concordance index of a stage-based model from 0.699 to 0.741. However, entered with CRP, the index lost significance. Conclusions: The index said nothing useful about early surgical morbidity yet was independently associated with survival, although that signal did not survive adjustment for CRP alone. It belongs with prognostic markers rather than perioperative risk scores.