Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the oesophagus

Background: The outcome after oesophagectomy depends not only on the surgical procedure itself but can be improved by the selection of patients based on a preoperative risk score. Methods: In order to compare the preoperative risk for different histological subtypes of oesophageal carcinoma, 221 patients with a squamous cell carcinoma (SCC) and 104 patients with an adenocarcinoma (AC) were enrolled in a prospective study. The preoperative assessment included socioeconomic status, alcohol and tobacco consumption, general and nutritional status, and pulmonary, cardiovascular, hepatic and renal function. Results: More patients with an SCC were 'blue collar' and with an AC were 'white collar' workers (P < 0.001). Alcohol and tobacco consumption was higher in patients with an SCC (P < 0.01 and P < 0.05 respectively). The preoperative forced expiratory volume, arterial partial pressure of oxygen and the aminopyrine breath test showed more severely compromised pulmonary and hepatic function in patients with an SCC (P < 0.05 for all variables). Some 50 per cent of patients with an AC mere overweight with a higher body mass index (P < 0.001). More patients with an AC had severely impaired cardiac function (P < 0.01). Conclusion: Patients with SCC and AC of the oesophagus differed regarding their socioeconomic and preoperative risk factors for surgery.