Sauvanet et al identified risk factors associated with complications following surgical management of an adenocarcinoma arising at the gastroesophageal junction. These can help identify patients who may require more aggressive management or a change in operative strategy. The authors are from multiple hospitals in France.
Parameters:
(1) ASA class (American Society of Anesthesiologists, see Chapter 31)
(2) age of the patient
(3) gender
(4) location of anastomosis
(5) method of achieving the anastomosis
(6) anastomotic leakage
(7) abdominal complications (bleeding, bowel obstruction, etc.)
|
Parameter |
Findings |
Points |
|
ASA class |
I or II (healthy or well-controlled disorder of 1 organ system) |
0 |
|
|
III or IV (1 major organ impaired, more than 1 comorbid condition, impaired) |
1 |
|
age of the patient |
<= 60 years of age |
0 |
|
|
> 60 years of age |
1 |
|
gender |
female |
0 |
|
|
male |
1 |
|
location of anastomosis |
abdomen or thorax |
0 |
|
|
cervical |
1 |
|
method of anastomosis |
mechanical stapler |
0 |
|
|
manual |
1 |
|
anatomic leakage |
none |
0 |
|
|
present |
1 |
|
abdominal complications |
none |
0 |
|
|
present |
1 |
where:
• Mortality was also affected by the period of study from 1985 to 2000, but this would have no prospective meaning today.
• The ASA classes go from I to V, with V moribund.
|
Adverse Event |
Rate in Study |
|
post-operative death |
6% |
|
morbidity |
35% |
|
anastomosis leakage |
9% |
|
major pulmonary complications |
23% |
The risk of post-operative mortality increased with ASA class of III or IV.
number of risk factors for morbidity =
= (points for ASA class) + (points for age) + (points for gender) + (points for location of anastomosis)
number of risk factors for anastomosis leakage =
= (points for ASA class) + (points for method of anastomosis)
number of risk factors for major pulmonary complications (respiratory failure, pneumonia, bronchoscopy required for sputum or atelectasis) =
= (points for ASA class) + (points for age) + (points for anastomotic leakage) + (points for abdominal complications)
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
