title: Impact of preoperative risk factors on morbidity after esophagectomy: is there room for improvement?
abstract: BACKGROUND
  Despite progress in multidisciplinary treatment of esophageal cancer, oncologic esophagectomy is still the cornerstone of therapeutic strategies. Several scoring systems are used to predict postoperative morbidity, but in most cases they identify nonmodifiable parameters. The aim of this study was to identify potentially modifiable risk factors associated with complications after oncologic esophagectomy.
  
  
  METHODS
  All consecutive patients with complete data sets undergoing oncologic esophagectomy in our department during 2001-2011 were included in this study. As potentially modifiable risk factors we assessed nutritional status depicted by body mass index (BMI) and preoperative serum albumin levels, excessive alcohol consumption, and active smoking. Postoperative complications were graded according to a validated 5-grade system. Univariate and multivariate analyses were used to identify preoperative risk factors associated with the occurrence and severity of complications.
  
  
  RESULTS
  Our series included 93 patients. Overall morbidity rate was 81 % (n = 75), with 56 % (n = 52) minor complications and 18 % (n = 17) major complications. Active smoking and excessive alcohol consumption were associated with the occurrence of severe complications, whereas BMI and low preoperative albumin levels were not. The simultaneous presence of two or more of these risk factors significantly increased the risk of postoperative complications.
  
  
  CONCLUSIONS
  A combination of malnutrition, active smoking and alcohol consumption were found to have a negative impact on postoperative morbidity rates. Therefore, preoperative smoking and alcohol cessation counseling and monitoring and improving the nutritional status are strongly recommended.
authors.affiliation: Department of Visceral Surgery, University Hospital CHUV, 46 Rue du Bugnon, Lausanne, 1011, Switzerland, styliani.mantziari@chuv.ch.
authors.forename: Styliani
authors.initials: S
authors.lastname: Mantziari
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology; D012372:ROC Curve; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology