Assessment of Different Prognostic Scores for Early Postoperative Outcomes after Esophagectomy
B. Filip, I. Hutanu, I. Radu, M.G. Anitei, V. ScripcariuOriginal article, no. 4, 2014
Objective: Surgery remains the best curative option foroesophageal cancer. This demanding intervention performedon a high risk patient is accompanied by high morbidity andmortality rates. The aim of this study was to analyse the preoperativerisk assessment using different comorbidity models inpatients operated for esophageal cancer in a tertiary unit.Methods: A retrospective study was conducted on aprospectively collected database. The performance of severalprognostic scores (POSSUM, P-POSSUM, O-POSSUM,Charlson and age adjusted Charlson, ASA score) was assessedin terms of early postoperative outcomes.Results: Out of 137 patients diagnosed with oesophagealcancer, esophagectomy was performed in 43 cases.Postoperative mortality (11.62%) was best predicted byPOSSUM score (10.48; 95% CI 9.37 -11.66). The observedmorbidity was 58.13%, higher than that expected byPOSSUM (48.24%; 95%CI, 44.82-51.66) with a morbidityratio O E of 1.2. The area under the ROC curve for thephysiological score of POSSUM and age adjusted Charlsonindex showed a good discriminatory power. The bestperformance was obtained for POSSUM equation, whoshowed to have the highest area under the ROC curve (0.826;95%CI, 0.67-0.92).Conclusions: A thoroughly assessment of comorbidities andthe surgeon’s clinical assessment remain the best tool forpatient selection for surgery.
