Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Eur J Surg. 1995 Mar;161(3):173-80.

Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas.

Author information

  • 1Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden.

Abstract

OBJECTIVE:

To define risk factors for postoperative morbidity and mortality in patients undergoing standardised laparotomy/gastrectomy or thoracoabdominal resection for carcinomas of the stomach, oesophagus, and oesophagogastric junction.

DESIGN:

Prospective open study.

SETTING:

University hospital, Sweden.

SUBJECTS:

All 213 patients operated on for carcinoma of the stomach, oesophagus, or oesophagogastric junction between January 1983 and June 1990.

INTERVENTIONS:

Laparotomy/gastrectomy (n = 132) or thoracoabdominal resection (n = 81).

MAIN OUTCOME MEASURES:

Postoperative morbidity and mortality.

RESULTS:

8 Patients died after laparotomy/gastrectomy, and 10 after thoracoabdominal resection. Complications were more common after thoracoabdominal resection (101 in 81 patients) than after laparotomy/gastrectomy (108 in 132 patients). The most common complication in both groups was pneumonia (29/132, 22%, compared with 22/81, 27%), but this could be predicted only in the group that underwent thoracoabdominal resection. Significant risk factors in this group were: an abnormal chest radiograph preoperatively (p = 0.0007), a high risk predicted by the anaesthetist (p = 0.005), and signs of obstruction on spirometry (p = 0.002). In the thoracoabdominal group a history of pulmonary disease, the patient's age, and general physical performance assessed by the exercise test significantly predicted a high risk of postoperative death. Risk profile curves for mortality were generated for patients aged 55, 65, or 75 years with and without pre-existing pulmonary disease and adjusted for working capacity (W) so that patients at high risk of dying after thoracoabdominal resection could easily be identified. Any patient with a history of pulmonary disease and a working capacity of less than 80 W whatever their age should be advised against thoracoabdominal resection, whereas in those without a history of pulmonary disease and a working capacity of more than 80 W, a good recovery may be anticipated. The cut off point for working capacity seems to be 80 W.

CONCLUSION:

With simple clinical guidelines it is possible to draw risk profiles for patients about to undergo thoracoabdominal resections for carcinoma of the oesophagus or oesophagogastric junction.

PMID:
7599295
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Loading ...
    Write to the Help Desk