Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1485
Peer-review started: November 26, 2022
First decision: February 20, 2023
Revised: March 13, 2023
Accepted: May 22, 2023
Article in press: May 22, 2023
Published online: July 27, 2023
Processing time: 237 Days and 13 Hours
Oesophageal cancer is the eighth most common malignancy worldwide and is associated with a poor prognosis. Oesophagectomy remains the best prospect for a cure if diagnosed in the early disease stages. However, the procedure is asso
To evaluate which multivariate risk models, using intraoperative information with or without preoperative information, best predict perioperative oeso
A systematic review of the MEDLINE, EMBASE and Cochrane databases was undertaken from 2000-2020. The search terms used were [(Oesophagectomy) AND (Model OR Predict OR Risk OR score) AND (Mortality OR morbidity OR complications OR outcomes OR anastomotic leak OR length of stay)]. Articles were included if they assessed multivariate based tools incorporating pre
Twenty published studies were identified which examined eleven multivariate risk models. Eight of these combined preoperative and intraoperative data and the remaining three used only intraoperative values. Only two risk models were identified as promising in predicting mortality, namely the Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and POSSUM scores. A further two studies, the intraoperative factors and Esophagectomy surgical Apgar score based nomograms, adequately forecasted major morbidity. The latter two models are yet to have external validation and none have been tested for clinical effectiveness.
Despite the presence of some promising models in forecasting perioperative oesophagectomy outcomes, there is more research required to externally validate these models and demonstrate clinical benefit with the adoption of these models guiding postoperative care and allocating resources.
Core Tip: Performing an oesophagectomy is a technically demanding procedure for the surgeon and a physiologically demanding undertaking for the patient. Aspects relating to the operation, as well as preoperative patient characteristics both have a significant impact on perioperative outcomes. These factors have been harnessed in the construction of numerous multivariate models aimed at identifying individuals at heightened risk. Given the plethora of options available, it is important to determine which of these models is most accurate in doing this and thereby most effective in guiding resource allocation.