The Role of Pre-Assessment in Oesophageal Cancer Surgery
National figures for oesophagectomy mortality in the United Kingdom have been
steadily dropping (12% to 9%) since the late 1990’s.
More recently, these figures have improved significantly as shown
in the 2016 annual report of the UK National Oesophago-Gastric Cancer Audit,
revealing a post-oesophagectomy 90-day mortality rate of 3.2%.2
Despite this, surgical treatment for oesophageal cancer still carries significant morbidity,
often quoted up to 64%.
While centres of excellence maintain high standards of surgery and improved surgical techniques, with minimally invasive techniques potentially reducing physiological stresses on patients,
we are perhaps being less conservative in our selection of patients for surgery;
all having varying influences on the overall risks.
Pre-assessment of patients over the last 2 decades has dramatically changed.
We have moved from pre-assessment being performed by the most junior members
of the surgical team in the past, to the current system with dedicated consultants and nurse
specialists, specializing in peri-operative medicine.
This has been shown to decrease cancellations of surgery, reduce length of stay
in a number of surgical specialities and potentially improve the outcome.
The primary aim is to balance the impact of the stress
of surgery and the overall physiological reserve of the patient, to
provide some idea of the individual’s risk of morbidity and mortality.
Based on this initial assessment, any specific risks would be highlighted and strategies
to mitigate these would be implemented, thus, attempting to tip the balance to lower those risks.
Gastro Open J. 2017; 3(1): e1-e3. doi: 10.17140/GOJ-3-e004
