PREDICTION OF HOSPITAL MORTALITY AFTER SURGICAL-TREATMENT FOR ESOPHAGEAL CANCER

A series of 100 patients with thoracic esophageal cancer who underwent subtotal esophagectomy through a right thoracotomy between 1986 and 1 989, were statistically analyzed to assess the risk factors predicting hospital mortality from complications. Hospital mortality was termed as ''complication death'', and the analyzed factors were age, pulmonar y function [% vital capacity (%VC) or % forced expiratory volume(1.0) (%FEV(1.0))], cardiac function [ECG and Master test], renal function [ creatinine clearance (C-CR)], hepatic function [15' indocyanine green test (R(15).ICG)], diabetes mellitus [75g oral glucose tolerance test (750GTT)], depth of tumor invasion [T-factor], and the type of operati ve procedure [operation]. Each patient was scored according to risk se verity on a scale from 0-3, with the higher numbers representing highe r risk. Patients not succumbing to complication death had less than 8 points in the total score, while those who suffered a complication dea th had 8 or more points. Through stepwise logistic regression analysis , we produced a prediction formula. In cases where eight or more point s are scored by the semi-quantitative analysis, or 0 or more, by the p rediction formula, the operative procedure should be changed to a less radical one for improved prognosis. The introduction of this semi-qua ntitative analysis for postoperative risk reduced the incidence of com plication death from 6% to 3%, and of hospital mortality from 13% to 3 %.