Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer

Authors

  • Dr H. Bartels,

    Corresponding author
    1. Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
    • Chirurgische Klinik und Poliklink, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstrasse 22, D-81 675 München, Germany
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  • H. J. Stein,

    1. Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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  • J. R. Siewert

    1. Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Abstract

Background

Postoperative mortality after oesophagectomy for oesophageal cancer depends largely on the preoperative physiological status of the patient.

Methods

A composite scoring system to predict the risk of oesophagectomy based on objective preoperative parameters was developed based on a retrospective review of patients operated on and evaluated prospectively in two subsequent patient groups.

Results

An initial retrospective multivariate analysis of 432 patients who had oesophagectomy identified a compromised general status (P<0·001) and poor cardiac (P<0·001), hepatic (P<0·05) and respiratory (P<0·05) function as independent predictors of a fatal postoperative course. Based on the relative risk associated with the individual impaired organ functions, a composite risk score was established. A prospective study in 121 patients confirmed that this composite scoring system provides a better identification of high-risk patients than any of the individual parameters. Inclusion of the composite score into the process of patient selection and choice of the procedure resulted in a decrease of postoperative mortality rate from 9·4 per cent (52 of 553) to 1·6 per cent (four of 252) (P<0·001).

Conclusion

The risk of death after oesophagectomy for oesophageal cancer can be assessed objectively before surgery and quantified by a composite risk score. This score provides a useful tool for refining the criteria of patient selection for resection or the choice of procedure. © 1998 British Journal of Surgery Society Ltd

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