Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus.
BACKGROUND
The outcome after oesophagectomy depends not only on the surgical procedure itself but can be improved by the selection of patients based on a preoperative risk score.


METHODS
In order to compare the preoperative risk for different histological subtypes of oesophageal carcinoma, 221 patients with a squamous cell carcinoma (SCC) and 104 patients with an adenocarcinoma (AC) were enrolled in a prospective study. The preoperative assessment included socioeconomic status, alcohol and tobacco consumption, general and nutritional status, and pulmonary, cardiovascular, hepatic and renal function.


RESULTS
More patients with an SCC were 'blue collar' and with an AC were 'white collar' workers (P < 0.001). Alcohol and tobacco consumption was higher in patients with an SCC (P < 0.01 and P < 0.05 respectively). The preoperative forced expiratory volume, arterial partial pressure of oxygen and the aminopyrine breath test showed more severely compromised pulmonary and hepatic function in patients with an SCC (P < 0.05 for all variables). Some 50 per cent of patients with an AC were overweight with a higher body mass index (P < 0.001). More patients with an AC had severely impaired cardiac function (P < 0.01).


CONCLUSIONS
Patients with SCC and AC of the oesophagus differed regarding their socioeconomic and preoperative risk factors for surgery.
Bollschweiler
E
E
Department of Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
Schröder
W
W
Hölscher
A H
AH
Siewert
J R
JR
D000230:Adenocarcinoma / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000209:etiology* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors