title: Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors.
abstract: BACKGROUND
  Resection for adenocarcinoma of the gastroesophageal junction (AGEJ) is associated with severe mortality and morbidity. This retrospective study aimed to evaluate mortality and morbidity after resection for AGEJ and to determine their predictive factors.
  
  
  METHODS
  Data from 1,192 patients (mean age 65 +/- 11 years) who underwent resection for AGEJ by members of French Association of Surgery from 1985 to 2000 were collected. A stepwise logistic regression model was built to identify by multivariate analysis the variables independently associated with mortality, morbidity, anastomotic leakage, and major pulmonary complications.
  
  
  RESULTS
  Distribution of Siewert's type was: I = 480 (40%), II = 500 (42%), and III = 212 (18%). Most type I and II tumors were treated by esophagectomy and proximal gastrectomy (93% and 58%, respectively), using an approach including a thoracotomy (82% and 64%, respectively); type III tumors were treated mainly by total gastrectomy and distal esophagectomy (83%), through an exclusive transabdominal approach (69%). Seventy-six (6%) patients died postoperatively. Only American Society of Anesthesiologists (ASA) scores III and IV (p < 0.001) and period of study (p = 0.025) were predictive of mortality. Predictive factors of overall morbidity (overall rate = 35%) were high ASA score (p < 0.001), age more than 60 years (p = 0.020), male gender (p = 0.039), and cervical anastomosis (p = 0.001). Factors predictive of anastomotic leakage (overall rate = 9%) were high ASA score (p = 0.006) and manual anastomosis (p = 0.010). Factors predictive of major pulmonary complications (overall rate = 23%) were high ASA score (p = 0.015), age more than 60 years (p < 0.001), anastomotic leakage (p < 0.001), and abdominal complications (p = 0.003).
  
  
  CONCLUSIONS
  ASA score is a reliable predictive factor of operative mortality and morbidity after resection of AGEJ.
authors.affiliation: Department of Digestive Surgery, Hôpital Beaujon, Clichy.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Patrick
authors.initials: P
authors.lastname: Lozac'h
authors.forename: Philippe
authors.initials: P
authors.lastname: Segol
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.forename: Joël
authors.initials: J
authors.lastname: Leborgne
authors.forename: Bernard
authors.initials: B
authors.lastname: Pradère
authors.forename: André
authors.initials: A
authors.lastname: Bourgeon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Triboulet
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D004943:Esophagogastric Junction; D005260:Female; D005602:France / Q000453:epidemiology; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016019:Survival Analysis