title: Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma.
abstract: OBJECTIVE
  Surgery for esophageal cancer is associated with a high morbidity and mortality. With this study, we investigated if a validated preoperative risk score correlates with overall morbidity, mortality, anastomotic insufficiency, respiratory complications and with the severity of complications after open Ivor-Lewis esophagectomy.
  
  
  METHODS
  A total of 94 patients undergoing esophageal resection for adenocarcinoma between 2005 and 2009 were included. Patients were assigned using the preoperative risk score according to Schröder et al. [Langenbecks Arch Surg 2006;391:455-460] and the Dindo classification regarding the severity of complications.
  
  
  RESULTS
  Of all the patients, 12% had a 'normal', 54% a 'moderate' and 34% a 'high' preoperative risk score. Postoperative complications occurred in 79%. Furthermore, 36 or 21 or 14 or 7% of patients experienced complications of category I/II or III or IV or V, respectively. There was a significant association between preoperative risk score and overall morbidity (p = 0.010), mortality (p = 0.035) and anastomotic insufficiency (p = 0.023). Furthermore, higher preoperative risk score was significant related to increasing severity of postoperative complications (grade IV according to the Dindo classification: p = 0.018, Dindo grade V: p = 0.035). Neoadjuvant therapy consisting of cisplatin and 5-fluorouracil had no influence.
  
  
  CONCLUSIONS
  As we demonstrated, a significant association between preoperative risk score and occurrence and severity of postoperative complications after open Ivor-Lewis esophagectomy, standardized, organ-specific pre- and postoperative categorizations might be useful for individual clinical decision making in this group of patients.
authors.affiliation: Department of General and Visceral Surgery, Muenster University Hospital, Mx00FC;nster, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Lindner
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Amelie
authors.initials: A
authors.lastname: Grübener
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Jörg
authors.initials: J
authors.lastname: Haier
authors.forename: Richard
authors.initials: R
authors.lastname: Hummel
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000379:methods; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome