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The Annals of Thoracic Surgery, Vol 53, 493-497, Copyright © 1992 by The Society of Thoracic Surgeons

ARTICLES

Surgical decision analysis: esophagectomy/esophagogastrectomy with or without drainage?

J Olak and A Detsky
Department of Surgery, University of Toronto, Canada.

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%.

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				M. Junemann-Ramirez, M.Y. Awan, Z.M. Khan, and J.S. Rahamim Anastomotic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre Eur. J. Cardiothorac. Surg., January 1, 2005; 27(1): 3 - 7. [Abstract] [Full Text] [PDF]

				A. S. Detsky, G. Naglie, M. D. Krahn, D. Naimark, and D. A. Redelmeier Primer on Medical Decision Analysis: Part 1--Getting Started Med Decis Making, April 1, 1997; 17(2): 123 - 125. [Abstract] [PDF]