PREOPERATIVE RISK ANALYSIS AND POSTOPERATIVE MORTALITY OF ESOPHAGECTOMY FOR RESECTABLE ESOPHAGEAL CANCER

Background Postoperative mortality after oesophagectomy for oesophagea l cancer depends largely on the preoperative physiological status of t he patient. Methods A composite scoring system to predict the risk of oesophagectomy based on objective preoperative parameters was develope d based on a retrospective review of patients operated on and evaluate d prospectively in two subsequent patient groups. Results An initial r etrospective multivariate analysis of 432 patients who had oesophagect omy identified a compromised general status (P < 0.001) and poor cardi ac (P < 0 001), hepatic (P < 0.05) and respiratory (P < 0.05) function as independent predictors of a fatal postoperative course. Based on t he relative risk associated with the individual impaired organ functio ns, a composite risk score was established. A prospective study in 121 patients confirmed that this composite scoring system provides a bett er identification of high-risk patients than any of the individual par ameters. Inclusion of the composite score into the process of patient selection and choice of the procedure resulted in a decrease of postop erative 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 oesophagect omy 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.