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Ann Thorac Surg 1992;53:493-497
© 1992 The Society of Thoracic Surgeons

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Articles

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

Departments of Surgery and Medicine, University of Toronto, Toronto, Canada

Accepted for publication October 9, 1991.

^_* Address reprint requests to Dr Olak, Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Virginia, MCV Station, PO Box 68, Richmond, VA 23298-0068 USA.

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 807, when its specificity was 100%, and would require a higher sensitivity as the specificity fell below 100%.

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