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Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas
B L Liedman1, K Bennegård, L C Olbe
1Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden.
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.