In this study, investigators from England evaluated risk factors for postoperative mortality and morbidity in patients undergoing major esophageal and gastric surgery.
They performed a multicenter cohort study, and included data on postoperative mortality and morbidity in hospital.
Using the ASCOT prospective database, the team evaluated 2087 patients with newly diagnosed esophageal and gastric cancer from 24 hospitals in England and Wales.
They used multivariate logistic regression analysis to calculate the risk of death and postoperative complications.
The investigators found that 955 of the patients underwent esophagectomy or gastrectomy.
Of these, 27% were graded ASA III or IV, and 20% had a high physiological POSSUM score.
They determined that operative mortality was 12%.
The team found that physiological POSSUM score, surgeon's assessment, type of operation, hospital case volume, and tumor stage were independent predictors of operative mortality.
They also found that medical complications were associated with higher physiological POSSUM scores and ASA grade, esophagectomy or total gastrectomy, thoracotomy, and radical nodal dissection.
|Operative mortality was 12%.|
|British Medical Journal|
Stage and additional organ resection predicted surgical complications.
Peter McCulloch's team concluded, "Many patients undergoing surgery for gastroesophageal cancer have major comorbid disease, which strongly influences their risk of postoperative death".
"Technical complications do not seem to be influenced by preoperative factors but reflect the extent of surgery and perhaps surgical judgment".
"Detailed prospective multicenter cooperative audit, with appropriate risk adjustment, is fundamental in the evaluation of cancer care and must be properly resourced".