title: Prognostic factors influencing morbidity and mortality in esophageal carcinoma.
abstract: OBJECTIVE
  In 1980, operative mortality for esophageal resection was 29%. Over the last 15 years, technical and critical care improvements contributed to the reduction of postoperative mortality rate to 8%. The aim of this study is to analyze retrospectively the role of different factors (surgical procedure, stage of the disease, and anesthetic risk) on the postoperative mortality of 63 patients that underwent esophagectomy with gastric interposition for cancer.
  
  
  METHODS
  Seventy-two patients underwent esophagectomy. The stomach was the esophageal substitute in 63 cases. Surgical procedures included transthoracic esophagectomy in 49 patients and transhiatal esophagectomy in 14 cases. Among the 49 transthoracic esophagectomy patients, there were 18 patients with a high anesthetic risk (ASA III). Among the patients that underwent transhiatal esophagectomy, there were 10 patients with a high anesthetic risk (ASA III).
  
  
  RESULTS
  The operative mortality rate was 14% (2/14) in transhiatal esophagectomy group and 22% (1(1/4)9) in transthoracic esophagectomy group (P = ns). The postoperative mortality of patients with a high anesthetic risk (ASA III) was 47% (8/17) after transthoracic esophagectomy and 10% (1/10) after transhiatal esophagectomy (P <0.05).
  
  
  CONCLUSIONS
  In our experience, the operative mortality was nearly 18% (16.6% after transhiatal esophagectomy and 20.8% after transthoracic esophagectomy). Among the patients with a high anesthetic risk (ASA III) that underwent surgery, the postoperative mortality was significantly lower after transhiatal esophagectomy (10%) compared to transthoracic esophagectomy (47%) (P <0.05).
authors.affiliation: Institute of Surgical Clinic, Genoa University.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cariati
authors.forename: Alessandro
authors.initials: A
authors.lastname: Casano
authors.forename: Antonello
authors.initials: A
authors.lastname: Campagna
authors.forename: Erminio
authors.initials: E
authors.lastname: Cariati
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Pescio
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate