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Invited Commentary
June 23, 2021

Predicting Mortality Rates After Esophagectomy for Cancer

Author Affiliations
  • 1None
  • 2Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
JAMA Surg. 2021;156(9):845-846. doi:10.1001/jamasurg.2021.2377

During the last decade, the mortality rate for esophagectomy for cancer has decreased considerably.1 However, this is still a complex procedure with the highest morbidity and mortality rates among gastrointestinal operations. Patient selection is therefore of paramount importance in guiding treatment.

In this issue of JAMA Surgery, D’Journo et al2 used the database of the International Esodata Study Group, a large prospective and multicenter database collecting complications after esophagectomy, to create a preoperative prognostic score to predict 90-day mortality. They analyzed the information of 8403 patients from 39 institutions (mostly academic centers) in 19 countries. Using multiple logistic regression analysis, they were able to identify 10 variables that played a role in the creation of the scoring system: age; sex; body mass index (calculated as weight in kilograms divided by height in meters squared); World Health Organization/Eastern Cooperative Oncology Group status; presence of myocardial infarction and connective tissue, peripheral vascular, or liver disease; neoadjuvant treatment; and hospital procedure volume. Depending on the value, each variable could have either a negatively, neutrally, or positively weighted point (as per eTable 5 in their Supplement2): for instance, a body mass index less than 18.5 was valued as −3, but values between 25 and 29.9 or more than 30 were valued positively as 1. The prognostic scores ranged from −10 to 5 and were categorized into 5 risk groups, from low risk (≥1), with a predicted mortality rate of 1.8%, to very high risk (≤−5), with a predicted mortality rate of 18.2%.

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