Mortality risk scales in esophagectomy for cancer: their usefulness in preoperative patient selection.
OBJECTIVE
To improve esophagectomy outcome, preoperative identification of high-risk patients should allow the surgical approach to be modified or alternative treatment methods to be employed.


METHODS
Preoperative risk assessment of 114 patients with resected esophageal cancer. One half of the cases affected the middle third of the esophagus. The tumor stage was III (33.3%) or IV (29.8%). The combined thoracoabdominal approach was the preferred route for resection (88.6%). We analyzed the influence of different variables (epidemiological, clinicopathological and surgical) affecting postoperative mortality.


RESULTS
Sixty-six (57.9%) patients developed postoperative complications, mainly pulmonary. The mortality rate was 12.3% (14 patients). Multivariate analysis of preoperative variables found significant association between postoperative death and previous neoplasm (p=0.01), liver cirrhosis (p=0.001), abnormal functional respiratory test (p=0.01) and low serum cholesterol (p=0.005) and albumin (p=0.01). Using those variables, we created a composite scoring system that provides a separation of patients into three postoperative death risk groups. If this knowledge was used, we could avoid 50% of postoperative mortality via improved patient selection.


CONCLUSIONS
The development of risk scales based on preoperative mortality risk factors may be useful in the selection and preparation of patients suitable for esophageal resection in order to diminish postoperative mortality.
Sanz
Lourdes
L
Department of General Surgery I, Hospital Universitario Central de Asturias, Oviedo, Spain. lousanz@telecable.es
Ovejero
Victor J
VJ
González
Juan J
JJ
Laso
Carlos A
CA
Azcano
Enedina
E
Navarrete
Francisco
F
Martínez
Enrique
E
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 / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods