Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer.

BACKGROUND

Postoperative mortality after oesophagectomy for oesophageal cancer depends largely on the preoperative physiological status of the patient.

METHODS

A composite scoring system to predict the risk of oesophagectomy based on objective preoperative parameters was developed based on a retrospective review of patients operated on and evaluated prospectively in two subsequent patient groups.

RESULTS

An initial retrospective multivariate analysis of 432 patients who had oesophagectomy identified a compromised general status (P < 0.001) and poor cardiac (P < 0.001), hepatic (P < 0.05) and respiratory (P < 0.05) function as independent predictors of a fatal postoperative course. Based on the relative risk associated with the individual impaired organ functions, a composite risk score was established. A prospective study in 121 patients confirmed that this composite scoring system provides a better identification of high-risk patients than any of the individual parameters. Inclusion of the composite score into the process of patient selection and choice of the procedure resulted in a decrease of postoperative mortality rate from 9.4 per cent (52 of 553) to 1.6 per cent (four of 252) (P < 0.001).

CONCLUSION

The risk of death after oesophagectomy for oesophageal cancer can be assessed objectively before surgery and quantified by a composite risk score. This score provides a useful tool for refining the criteria of patient selection for resection or the choice of procedure.