Liu J F, Watson D I, Devitt P G, Mathew G, Myburgh J, Jamieson G G
University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Dis Esophagus. 2000;13(2):130-5. doi: 10.1046/j.1442-2050.2000.00099.x.
Oesophagectomy for cancer is associated with a significant incidence of post-operative complications and death, and so this study sought to determine objective criteria which could better predict operative risk. Clinical risk factors for oesophagectomy and the results of objective investigations were assessed prospectively by independent surgical and intensive care specialists and a multivariate analysis was used to develop a scoring system for predicting operative risk. From September 1994 to June 1997, 32 patients from an overall experience of 70 oesophagectomy procedures for cancer at the Royal Adelaide Hospital were entered into this study. Hypertension, a history of previous cigarette smoking and FEV1/FVC were identified as independent predictors of the post-operative outcome. Age and FEV1/FVC were also significantly associated with the occurrence of cardiovascular and pulmonary complications respectively. The average risk score was 4.8 +/- 4.5 (mean +/- SD) for patients who died, 2.9 +/- 2.9 for patients who developed post-operative complications and 2.6 +/- 2.1 for patients who had an uncomplicated recovery. The likelihood of post-operative mortality and morbidity was highest in patients with a score of 5 or more. Mortality rates of different patient groups undergoing oesophagectomy by the same surgeons during the same time period were also compared, showing greatly different mortality rates. Important risk factors can be identified preoperatively, and a scoring system can be used to provide objective criteria which can be used to identify patients at an increased risk of post-operative complications and death. A prospective study of this scoring system is now needed to determine whether it proves useful in rejecting patients for surgery who would otherwise have undergone oesophagectomy.
食管癌切除术与术后并发症及死亡的高发生率相关，因此本研究旨在确定能更好预测手术风险的客观标准。独立的外科和重症监护专家对食管癌切除术的临床风险因素及客观检查结果进行了前瞻性评估，并采用多变量分析来制定预测手术风险的评分系统。从1994年9月至1997年6月，皇家阿德莱德医院共进行了70例食管癌切除术，其中32例患者纳入本研究。高血压、既往吸烟史以及第一秒用力呼气容积/用力肺活量被确定为术后结局的独立预测因素。年龄和第一秒用力呼气容积/用力肺活量也分别与心血管和肺部并发症的发生显著相关。死亡患者的平均风险评分为4.8±4.5（均值±标准差），发生术后并发症的患者为2.9±2.9，恢复顺利的患者为2.6±2.1。评分5分及以上的患者术后死亡率和发病率最高。同时还比较了同一时期同一外科医生进行食管癌切除术的不同患者组的死亡率，结果显示死亡率差异很大。术前可识别重要风险因素，评分系统可用于提供客观标准，以识别术后并发症和死亡风险增加的患者。目前需要对该评分系统进行前瞻性研究，以确定其是否有助于拒绝那些原本会接受食管癌切除术的患者进行手术。
