Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 4/2009

01-04-2009 | original article

Risk Prediction Scores for Postoperative Mortality After Esophagectomy: Validation of Different Models

Authors: U. Zingg, C. Langton, B. Addison, B. P. L. Wijnhoven, J. Forberger, S. K. Thompson, A. J. Esterman, D. I. Watson

Published in: Journal of Gastrointestinal Surgery | Issue 4/2009

Login to get access

Abstract

Background

Different prediction models for operative mortality after esophagectomy have been developed. The aim of this study is to independently validate prediction models from Philadelphia, Rotterdam, Munich, and the ASA.

Methods

The scores were validated using logistic regression models in two cohorts of patients undergoing esophagectomy for cancer from Switzerland (n = 170) and Australia (n = 176).

Results

All scores except ASA were significantly higher in the Australian cohort. There was no significant difference in 30-day mortality or in-hospital death between groups. The Philadelphia and Rotterdam scores had a significant predictive value for 30-day mortality (p = 0.001) and in-hospital death (p = 0.003) in the pooled cohort, but only the Philadelphia score had a significant prediction value for 30-day mortality in both cohorts. Neither score showed any predictive value for in-hospital death in Australians but were highly significant in the Swiss cohort. ASA showed only a significant predictive value for 30-day mortality in the Swiss. For in-hospital death, ASA was a significant predictor in the pooled and Swiss cohorts. The Munich score did not have any significant predictive value whatsoever.

Conclusion

None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed.
Literature
1.
go back to reference McCulloch P, Ward J, Tekkis PP for the ASCOT group of surgeons. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BJM 2003;327:1192–7. doi:10.1136/bmj.327.7425.1192.CrossRef McCulloch P, Ward J, Tekkis PP for the ASCOT group of surgeons. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BJM 2003;327:1192–7. doi:10.​1136/​bmj.​327.​7425.​1192.CrossRef
2.
go back to reference Low DE, Kunz S, Schembre D, Otero H, Malpass T, His A et al. Esophagectomy—it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 2007;11:1395–402. doi:10.1007/s11605-007-0265-1.PubMedCrossRef Low DE, Kunz S, Schembre D, Otero H, Malpass T, His A et al. Esophagectomy—it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 2007;11:1395–402. doi:10.​1007/​s11605-007-0265-1.PubMedCrossRef
3.
go back to reference Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR et al. Minimally invasive esophagectomy. Outcomes in 222 patients. Ann Surg 2003;238:486–95.PubMed Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR et al. Minimally invasive esophagectomy. Outcomes in 222 patients. Ann Surg 2003;238:486–95.PubMed
5.
go back to reference Schroeder W, Bollschweiler E, Kossow C, Hoelscher AH. Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy. Langenbecks Arch Surg 2006;391:455–460. doi:10.1007/s00423-006-0067-z.CrossRef Schroeder W, Bollschweiler E, Kossow C, Hoelscher AH. Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy. Langenbecks Arch Surg 2006;391:455–460. doi:10.​1007/​s00423-006-0067-z.CrossRef
7.
go back to reference Tekkis PP, McCulloch P, Poloniecki JD, Prytherch DR, Kessaris N, Steger AC. Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM. Br J Surg 2004;91:288–295. doi:10.1002/bjs.4414.PubMedCrossRef Tekkis PP, McCulloch P, Poloniecki JD, Prytherch DR, Kessaris N, Steger AC. Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM. Br J Surg 2004;91:288–295. doi:10.​1002/​bjs.​4414.PubMedCrossRef
8.
go back to reference Lai F, Kwan TL, Yuen WC, Wai A, Siu YC, Shung E. Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma. Br J Surg 2007;94:1171–1178. doi:10.1002/bjs.5793.CrossRef Lai F, Kwan TL, Yuen WC, Wai A, Siu YC, Shung E. Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma. Br J Surg 2007;94:1171–1178. doi:10.​1002/​bjs.​5793.CrossRef
9.
go back to reference Lagarde SM, Maris AK, de Castro SM, Busch OR, Obertop H, van Lanschot JJ. Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg 2007;94:1521–1526. doi:10.1002/bjs.5850.PubMedCrossRef Lagarde SM, Maris AK, de Castro SM, Busch OR, Obertop H, van Lanschot JJ. Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg 2007;94:1521–1526. doi:10.​1002/​bjs.​5850.PubMedCrossRef
11.
go back to reference Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coeberg JW et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277–4284. doi:10.1200/JCO.2005.05.0658.PubMedCrossRef Steyerberg EW, Neville BA, Koppert LB, Lemmens VE, Tilanus HW, Coeberg JW et al. Surgical mortality in patients with esophageal cancer: development and validation of a simple risk score. J Clin Oncol 2006;24:4277–4284. doi:10.​1200/​JCO.​2005.​05.​0658.PubMedCrossRef
12.
go back to reference Ra J, Paulson EC, Kucharczuk J, Armstrong K, Wirtalla C, Rapaport-Kelz R et al. Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol 2008;15:1577–1584. doi:10.1245/s10434-008-9867-4.PubMedCrossRef Ra J, Paulson EC, Kucharczuk J, Armstrong K, Wirtalla C, Rapaport-Kelz R et al. Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol 2008;15:1577–1584. doi:10.​1245/​s10434-008-9867-4.PubMedCrossRef
20.
go back to reference Siewert RJ, Stein HJ, Feith M, Bruecher BLDM, Bartels H, Fink U. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1000 consecutive resections at a single center in the western world. Ann Surg 2001;234:360–369. doi:10.1097/00000658-200109000-00010.PubMedCrossRef Siewert RJ, Stein HJ, Feith M, Bruecher BLDM, Bartels H, Fink U. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1000 consecutive resections at a single center in the western world. Ann Surg 2001;234:360–369. doi:10.​1097/​00000658-200109000-00010.PubMedCrossRef
22.
23.
go back to reference Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662–1669. doi:10.1056/NEJMoa022343.PubMedCrossRef Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662–1669. doi:10.​1056/​NEJMoa022343.PubMedCrossRef
25.
go back to reference Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305–13.PubMed Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305–13.PubMed
26.
go back to reference Mariette C, Piessen G, Lamblin A, Mirabel X, Adenis A, Triboulet JP. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg 2006;93:1077–1083. doi:10.1002/bjs.5358.PubMedCrossRef Mariette C, Piessen G, Lamblin A, Mirabel X, Adenis A, Triboulet JP. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg 2006;93:1077–1083. doi:10.​1002/​bjs.​5358.PubMedCrossRef
30.
go back to reference Swisher SG, Deford L, Merriman KW, Walsh GL, Smythe R, Vaporicyan A et al. Effect of operative volume on morbidity, mortality and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 2000;119:1126–1132. doi:10.1067/mtc.2000.105644.PubMedCrossRef Swisher SG, Deford L, Merriman KW, Walsh GL, Smythe R, Vaporicyan A et al. Effect of operative volume on morbidity, mortality and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 2000;119:1126–1132. doi:10.​1067/​mtc.​2000.​105644.PubMedCrossRef
31.
go back to reference Santin B, Kulwicki A, Price P. Mortality rate associated with 56 consecutive esophagectomies performed at a low-volume hospital: is procedure volume as important as we are trying to make it. J Gastrointest Surg 2008;12:1346–1350. doi:10.1007/s11605-008-0550-7.PubMedCrossRef Santin B, Kulwicki A, Price P. Mortality rate associated with 56 consecutive esophagectomies performed at a low-volume hospital: is procedure volume as important as we are trying to make it. J Gastrointest Surg 2008;12:1346–1350. doi:10.​1007/​s11605-008-0550-7.PubMedCrossRef
Metadata
Title
Risk Prediction Scores for Postoperative Mortality After Esophagectomy: Validation of Different Models
Authors
U. Zingg
C. Langton
B. Addison
B. P. L. Wijnhoven
J. Forberger
S. K. Thompson
A. J. Esterman
D. I. Watson
Publication date
01-04-2009
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 4/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-008-0761-y

Other articles of this Issue 4/2009

Journal of Gastrointestinal Surgery 4/2009 Go to the issue