The PER (Preoperative Esophagectomy Risk) Score

Abstract

Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection.In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score.The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001).The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score.

Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy

“…27 A number of attempts have been made to develop esophagectomy-specific prediction calculators using both retrospective institutional samples and large database-derived cohorts, largely without success. [28][29][30][31][32] It is not clear why risk-prediction is so limited in this particular cohort, but there are a number of factors that contribute variability, including technical factors (2-field vs 3-field approaches, hybrid or complete minimally invasive approaches, the well-described impact of institutional volume on outcomes), 33 variability of preoperative therapy and nutritional fitness, and oncologic factors such as extent of disease. Additionally, one of the limitations of the more general NSQIP SRC is its absence of procedure-specific risk factors and complications.…”

A New Score to Assess the Perioperative Period of the Cancer Patient Undergoing Non-Palliative Elective Surgery: A Retrospective Evaluation of a Case Report by PERIDIA Score

“…In the first step of our study, some scores already in use in clinical practice were selected for the peri-operatory evaluation process. Edmonton Frail Scale, Mini Nutritional Assessment Short Form, Charlson Age Morbidity Index, Assess Respiratory Risk in Surgical Patients in Catalogna (ARISCAT Index), Lee's Revised Cardiac Risk Index, Preoperative Esophagectomy Risk, Clavien Dindo Classification, Child Pugh Score, Model for End Stage Liver Disease, Simple Risk Score for Pancreatectomy Surgical Outcomes Analysis and Research, Hacor Score, and World Society of Emergency Surgery Sepsis Score were deeply analyzed and synthetized by the team to extract the most s i g n ifi can t it ems to b uild our n ew sc ore, name d PERIDIAphragmatic surgery score or PERIDIA score (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”