Skip to main content

Advertisement

Log in

Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy?

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background and aims

In patients with esophageal carcinoma, transthoracic esophagectomy is associated with high postoperative morbidity and mortality rates. The question of this study was whether an individualized preoperative risk analysis is able to predict postoperative outcome.

Materials and methods

Based on prospectively accumulated data of 126 patients with a malignant esophageal tumor, a preoperative composite risk score using objective parameters was evaluated. All patients underwent a transthoracic en bloc esophagectomy with two-field lymphadenectomy. The risk score was correlated to the postoperative course which was classified according to the days of intensive care unit (ICU) treatment, hours of mechanical ventilation, and reoperation and readmission to the ICU. A multivariate analysis was performed to identify single risk factors.

Results

The overall morbidity rate was 55%, while the mortality rate was 5.6%. According to the composite risk score, 22.8% of the patients had a “low” risk, 53.2% had a “moderate” risk, and in 19% the preoperative risk was classified as “high”. There was a significant correlation of the preoperative risk and the postoperative course (p<0.001). Multivariate analysis identified age, general status, and preoperative pulmonary function as independent risk factors of the postoperative outcome.

Conclusion

Preoperative risk analysis in particular pulmonary function and general status helps to select patients for transthoracic esophagectomy to reduce postoperative morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Law SYK, Wong KH, Kwok KF, Chu KM, Wong J (2004) Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg 240:791–800

    Article  PubMed  Google Scholar 

  2. Lerut T, Nafteux P, Moons J, Coosemanns W, Decker P, de Leyn P, van Raemdonck D, Ectors N (2004) Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease free survival, and outcome. Ann Surg 240:962–974

    Article  PubMed  CAS  Google Scholar 

  3. Jamiesson GG, Mathew G, Ludemann R, Waymann J, Myers JC, Devitt PG (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 91:943–947

    Article  Google Scholar 

  4. Hulscher JBF, Tijssen JGP, Obertop H, Lanschot JB (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a metaanalysis. Ann Thorac Surg 72:306–313

    Article  PubMed  CAS  Google Scholar 

  5. Hulscher JBF, van Sandick JW, de Boer AGEM (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669

    Article  PubMed  Google Scholar 

  6. Igaki H, Tachimori Y, Kato H (2004) Improved survival for patients with upper and/or middle mediastinal lymph node metastasis of squamous cell carcinoma of the lower thoracic esophagus treated with 3-field dissection. Ann Surg 239:483–490

    Article  PubMed  Google Scholar 

  7. Bollschweiler E, Schröder W, Hölscher AH, Siewert JR (2000) Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the esophagus. Br J Surg 87:1106–1110

    Article  PubMed  CAS  Google Scholar 

  8. Bartels H, Stein HJ, Siewert JR (1998) Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg 85:840–844

    Article  PubMed  CAS  Google Scholar 

  9. Hölscher AH, Schröder W, Bollschweiler E, Beckurts KTE, Schneider PM (2003) How safe is high intrathoracic esophagogastrostomy? Chirurg 74:726–733

    Article  PubMed  Google Scholar 

  10. Van Lanschot JJB, Hulscher JBF, Buskens CJ, Tilanus HW, ten Kate FJW, Obertop H (2001) Hospital volume and hospital mortality for esophagectomy. Cancer 91:1574–1578

    Article  PubMed  Google Scholar 

  11. Hölscher AH, Metzger R, Brabender J, Vallböhmer D, Bollschweiler E (2004) High-volume centers—effect of case load on outcome in cancer surgery. Onkologie 27:412–416

    Article  PubMed  Google Scholar 

  12. Mariette C, Taillier G, Van S, Triboulet JP (2004) Factors affecting postoperative course and survival after en bloc resection for esophageal carcinoma. Ann Thorac Surg 78:1177–1183

    Article  PubMed  Google Scholar 

  13. Schröder W, Stippel D, Beckurts KTE, Lacher M, Gutchow C, Hölscher AH (2001) Intraoperative changes of mucosal pCO2 during gastric tube formation. Langenbeck’s Arch Surg 386:324–327

    Article  Google Scholar 

  14. Matsuzaki Y, Edagawa M, Maeda M, Shimizu T, Sekiya R, Nakamura K, Onitsuka T (1999) Beneficial effect of prostaglandin E1 on blood flow to the gastric tube after esophagectomy. Ann Thorac Surg 67:908–910

    Article  PubMed  CAS  Google Scholar 

  15. Reavis KM, Chang EY, Hunter JG, Jobe BA (2005) Utilization of the delay phenomenon improves blood flow and reduces collagen deposition in esophagogastric anastomoses. Ann Surg 241:736–747

    Article  PubMed  Google Scholar 

  16. McCulloch P, Ward J, Tekkis PP (2003) Mortality and morbidity in gastro-oesophageal surgery: initial results of ASCOT multicentre prospective cohort study. BMJ 327:1192–1197

    Article  PubMed  Google Scholar 

  17. Zafirellis KD, Fountoulakis A, Dolan K, Dexter SPL, Martin IG, Sue-Ling HM (2002) Evaluation of POSSUM in patients with oesophageal cancer undergoing resection. Br J Surg 89:1150–1155

    Article  PubMed  CAS  Google Scholar 

  18. Gockel I, Exner C, Junginger T (2005) Morbidity and mortality after esophagectomy for esophageal carcinoma: a risk analysis. World J Surg Oncol 3:37

    Article  PubMed  Google Scholar 

  19. Law SYK, Folk M, Wong J (1994) Risk analysis in resection of squamous cell carcinoma of the esophagus. World J Surg 18:339–346

    Article  PubMed  CAS  Google Scholar 

  20. Abunasra H, Lewis S, Beggs L, Duffy J, Beggs D, Morgan E (2005) Predictors of operative death after esophagectomy for carcinoma. Br J Surg 92:1029–1033

    Article  PubMed  CAS  Google Scholar 

  21. Ferguson MK, Durkin AE (2002) Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 123:661–669

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to W. Schröder.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schröder, W., Bollschweiler, E., Kossow, C. et al. Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy?. Langenbecks Arch Surg 391, 455–460 (2006). https://doi.org/10.1007/s00423-006-0067-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-006-0067-z

Keywords

Navigation