SURGICAL DECISION-ANALYSIS - ESOPHAGECTOMY ESOPHAGOGASTRECTOMY WITH OR WITHOUT DRAINAGE

Decision analysis was used to compare three management strategies for patients undergoing esophagogastrectomy for carcinoma of the esophagus or gastric cardia: drain all patients with either pyloromyotomy or pyloroplasty, drain no patient, or perform a test that stratifies patients into high-risk and low-risk groups for development of gastric outlet obstruction and drain the high-risk group. Results indicate that a "drain all" approach is appropriate in clinical settings where the risk of gastric outlet obstruction is greater than 10%, as long as the drainage procedure is 95% effective. If a test were developed to stratify patients, it would have to have a sensitivity of 80% when its specificity was 100%, and would require a higher sensitivity as the specificity fell below 100%.