Esophageal Cancer Specific Risk Score Is Associated with Postoperative Complications Following Open Ivor-Lewis Esophagectomy for Adenocarcinoma

Abstract

Background/Aims: Surgery for esophageal cancer is associated with a high morbidity and mortality. With this study, we investigated if a validated preoperative risk score correlates with overall morbidity, mortality, anastomotic insufficiency, respiratory complications and with the severity of complications after open Ivor-Lewis esophagectomy. Methods: A total of 94 patients undergoing esophageal resection for adenocarcinoma between 2005 and 2009 were included. Patients were assigned using the preoperative risk score according to Schröder et al. [Langenbecks Arch Surg 2006;391:455-460] and the Dindo classification regarding the severity of complications. Results: Of all the patients, 12% had a ‘normal', 54% a ‘moderateʼ and 34% a ‘high' preoperative risk score. Postoperative complications occurred in 79%. Furthermore, 36 or 21 or 14 or 7% of patients experienced complications of category I/II or III or IV or V, respectively. There was a significant association between preoperative risk score and overall morbidity (p = 0.010), mortality (p = 0.035) and anastomotic insufficiency (p = 0.023). Furthermore, higher preoperative risk score was significant related to increasing severity of postoperative complications (grade IV according to the Dindo classification: p = 0.018, Dindo grade V: p = 0.035). Neoadjuvant therapy consisting of cisplatin and 5-fluorouracil had no influence. Conclusion: As we demonstrated, a significant association between preoperative risk score and occurrence and severity of postoperative complications after open Ivor-Lewis esophagectomy, standardized, organ-specific pre- and postoperative categorizations might be useful for individual clinical decision making in this group of patients.

Impact of preoperative risk factors on outcome after gastrectomy

“…This score was first described by Schroeder et al who demonstrated a correlation between the risk score and outcome of patients undergoing esophageal resection [16]. Our current results underline this hypothesis and are consistent with previous findings from our group for esophageal cancer surgery [25]. Also known as risk score for prediction of outcome following complex surgery is the POSSUM score, which was also considered in this study.…”

Prognostic Impact of Lymph Node Localization in Node-Positive Esophageal Cancer

“…Preoperative investigations included clinical examination, assessment of physical condition, American Society of Anesthesiologists physical status classification system (ASA-Score), Karnofsky-Index, body mass index, concomitant diseases (cardiac comorbidities such as hypertension, coronary heart disease, myocardial infarction in the past and pulmonary comorbidities as well as diabetes mellitus), weight loss during the last six months before surgery, consumption of alcohol and nicotine, blood tests including tumor markers, lung and cardiac function tests. The staging consisted of endoscopy with biopsy and histological examination, endosonography, and computed tomography of the thorax and abdomen as described previously [15].…”

Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer

“…Some scores share similar factors, like an increased risk with age, large tumor size, LN metastasis, inflammatory processes, malnutrition, and comorbidities [10, 11]. Some scores are based on physiological parameters, like the Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) score [12] and the National Cancer Database – Japan Risk Calculator (NCD) Surgery Risk Calculator, based on an extensive database from Japan.…”