Morbidity and mortality after esophagectomy for esophageal carcinoma: A risk analysis
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Morbidity and mortality after esophagectomy for esophageal carcinoma: A risk analysis Ines Gockel*, Christoph Exner and Theodor Junginger Address: Department of General and Abdominal Surgery, Johannes Gutenberg University of Mainz, Germany Email: Ines Gockel* - [email protected]; Christoph Exner - [email protected]; Theodor Junginger - [email protected] * Corresponding author
Published: 21 June 2005 World Journal of Surgical Oncology 2005, 3:37 37
doi:10.1186/1477-7819-3-
Received: 01 June 2005 Accepted: 21 June 2005
This article is available from: http://www.wjso.com/content/3/1/37 © 2005 Gockel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: The study was aimed to identify pre- and intraoperative risk factors that potentially influence morbidity and mortality after esophagectomy for esophageal carcinoma with particular emphasis on the predominant tumor types. Patients and methods: Between September 1985 and March 2004, 424 patients underwent esophagectomy for esophageal carcinoma. Of these, 186 (43.9%) patients had a transhiatal, and 231 (54.5%) patients underwent a transthoracic procedure with two-field lymphadenectomy. Pre-, intraoperative risk factors and tumor characteristics were included in the risk analysis to assess their influence on postoperative morbidity and mortality. Results: Multivariate analysis (logistic regression model) identified the surgical procedure as the most important risk factor for postoperative morbidity and mortality with the transthoracic technique associated with a significant higher risk. The comparison of the risk profile between the different histological tumor types, a significantly higher nutritional risk, poorer preoperative lung function and a higher prevalence of hepatopathy was observed in patients with squamous cell carcinoma (n = 229) compared to adenocarcinoma (n = 150) (p < 0.05). Although there was no significant difference in surgical complications between the two groups, the rate of general complications, length of postoperative intensive care unit-stay and mortality rate was significantly higher in patients with squamous cell carcinoma (p < 0.05). Conclusion: The present risk analysis shows that the selection and the type of the surgical procedure are crucial factors for both the incidence of postoperative complications and the mortality rate. The higher risk of the transthoracic procedure is justified with a view to a better long term prognosis.
Background Despite the standardization of the operative technique, improvement of preoperative risk assessment, and postoperative intensive care management, surgical therapy for esophageal carcinoma continues to be associated with a
high incidence of operative complications, and a high morta
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