Prediction of morbidity and mortality after thoracoabdominal esophageal surgery

Abstract

Background Complications after esophagectomy result in higher morbidity and mortality, longer hospital stays and lower quality of life. Unfortunately, we have insufficient knowledge of which patients will tolerate the combination of strenuous oncological therapy and major surgery. This study was designed to evaluate whether additional physical tests, apart from standard preoperative workups, could help identify high-risk patients regarding esophageal cancer surgery.Methods A total of 88 patients due to undergo esophagectomy for esophageal cancer were enrolled. In addition to the mandatory physical examinations, seven additional physical therapy tests were carried out within 10 days prior to surgery. CT scans were examined by an experienced radiologist to determine whether patients suffered from sarcopenia. Perioperative data and times of death were gathered from a national register. The primary outcome was the presence of any severe postoperative complication, classified as Clavien-Dindo ≥3, with specific complications as secondary outcomes, and associations between preoperative test performance and complications were examined.Results Patients with severe complications had preoperatively performed significantly worse on peak expiratory flow tests (p = 0.013). Patients suffering from anastomotic leakage had shown significantly worse performance on cardiopulmonary exercise testing, whereas the results from shoulder abduction tests were significantly lower in patients who later suffered from pneumonia (p = 0.034 and p = 0.043, respectively).Conclusion More extensive preoperative physical examination tests could potentially aid in identifying patients with an increased risk of postoperative complications. Further studies are needed on the subject to corroborate these findings and evaluate their clinical use.