Oesophagectomy for cancer is associated with a significant incidence of post-operative complications and death, and so this study sought to determine objective criteria which could better predict operative risk. Clinical risk factors for oesophagectomy and the results of objective investigations were assessed prospectively by independent surgical and intensive care specialists and a multivariate analysis was used to develop a scoring system for predicting operative risk. From September 1994 to June 1997, 32 patients from an overall experience of 70 oesophagectomy procedures for cancer at the Royal Adelaide Hospital were entered into this study. Hypertension, a history of previous cigarette smoking and FEV1/FVC were identified as independent predictors of the post-operative outcome. Age and FEV1/FVC were also significantly associated with the occurrence of cardiovascular and pulmonary complications respectively. The average risk score was 4.8 ± 4.5 (mean ± SD) for patients who died, 2.9 ± 2.9 for patients who developed post-operative complications and 2.6 ± 2.1 for patients who had an uncomplicated recovery. The likelihood of post-operative mortality and morbidity was highest in patients with a score of 5 or more. Mortality rates of different patient groups undergoing oesophagectomy by the same surgeons during the same time period were also compared, showing greatly different mortality rates. Important risk factors can be identified preoperatively, and a scoring system can be used to provide objective criteria which can be used to identify patients at an increased risk of post-operative complications and death. A prospective study of this scoring system is now needed to determine whether it proves useful in rejecting patients for surgery who would otherwise have undergone oesophagectomy.