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.