Surgical decision analysis: esophagectomy/esophagogastrectomy with or without drainage?
Decision analysis was used to compare three management strategies for patients undergoing esophagogastrectomy for carcinoma of the esophagus or gastric cardia: drain all patients with either pyloromyotomy or pyloroplasty, drain no patient, or perform a test that stratifies patients into high-risk and low-risk groups for development of gastric outlet obstruction and drain the high-risk group. Results indicate that a "drain all" approach is appropriate in clinical settings where the risk of gastric outlet obstruction is greater than 10%, as long as the drainage procedure is 95% effective. If a test were developed to stratify patients, it would have to have a sensitivity of 80% when its specificity was 100%, and would require a higher sensitivity as the specificity fell below 100%.
Olak
J
J
Department of Surgery, University of Toronto, Canada.
Detsky
A
A
D003661:Decision Support Techniques; D004322:Drainage; D004938:Esophageal Neoplasms / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D006801:Humans; D008722:Methods; D011183:Postoperative Complications; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012984:Software; D013270:Stomach / Q000601:surgery*