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Analysis of preoperative patient variables can predict patients at increased risk for morbidity or mortality, or both, after bypass surgery. Increased morbidity results in higher costs. Different strategies for high and low risk patients should be used in cost reduction efforts.

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Preoperative plasma CEA levels were measured by radioimmunoassay for 149 patients with bronchogenic carcinoma. The data were used to determine the prognostic value of the CEA assay in these patients. The relationship of preoperative CEA levels with stage of disease, histology and resectability was also examined. All of the patients with CEA levels >6 ng/ml died in less than 3 years while all of the patients who survived 3 to 5 years had preoperative CEA levels 56 ng/ml. The CEA assay had no prognostic significance for patients with undifferentiated large or small cell carcinomas since all of the patients with undifferentiated large cell carcinoma had CEA levels 56.0 ng/ml and all of the patients with small cell carcinoma have died regardless of their initial preoperative plasma CEA value. The number of patients in these two histologic groups was small and perhaps the study of additional patients will show a critical CEA level for these patients as well. There was no correlation observed between CEA levels 56 ng/ml vs. >6 ng/ml and resectability of the primary tumor.The studies indicate, however, that preoperative CEA levels are of prognostic value in patients with epidermoid and adenocarcinoma who have values >6 ng/ml since all of these patients have died and all of the long term survivors had levels 1 6 ng/ml.

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