title: Preoperative risk analysis--a reliable predictor of postoperative outcome after transthoracic esophagectomy?
abstract: OBJECTIVE
  In patients with esophageal carcinoma, transthoracic esophagectomy is associated with high postoperative morbidity and mortality rates. The question of this study was whether an individualized preoperative risk analysis is able to predict postoperative outcome.
  
  
  METHODS
  Based on prospectively accumulated data of 126 patients with a malignant esophageal tumor, a preoperative composite risk score using objective parameters was evaluated. All patients underwent a transthoracic en bloc esophagectomy with two-field lymphadenectomy. The risk score was correlated to the postoperative course which was classified according to the days of intensive care unit (ICU) treatment, hours of mechanical ventilation, and reoperation and readmission to the ICU. A multivariate analysis was performed to identify single risk factors.
  
  
  RESULTS
  The overall morbidity rate was 55%, while the mortality rate was 5.6%. According to the composite risk score, 22.8% of the patients had a "low" risk, 53.2% had a "moderate" risk, and in 19% the preoperative risk was classified as "high". There was a significant correlation of the preoperative risk and the postoperative course (p<0.001). Multivariate analysis identified age, general status, and preoperative pulmonary function as independent risk factors of the postoperative outcome.
  
  
  CONCLUSIONS
  Preoperative risk analysis in particular pulmonary function and general status helps to select patients for transthoracic esophagectomy to reduce postoperative morbidity.
authors.affiliation: Department of Visceral and Vascular Surgery, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany. Wolfgang.Schroeder@uni-koeln.de
authors.forename: W
authors.initials: W
authors.lastname: Schröder
authors.forename: E
authors.initials: E
authors.lastname: Bollschweiler
authors.forename: C
authors.initials: C
authors.lastname: Kossow
authors.forename: A H
authors.initials: AH
authors.lastname: Hölscher
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment