Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas.

Autor:	Liedman BL; Department of Surgery, Sahlgren's Hospital, University of Gothenburg, Sweden., Bennegård K, Olbe LC, Lundell LR
Jazyk:	angličtina
Zdroj:	The European journal of surgery = Acta chirurgica [Eur J Surg] 1995 Mar; Vol. 161 (3), pp. 173-80.
Abstrakt:	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.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu