Estimation of Physiologic Ability and Surgical Stress Score Does Not Predict Immediate Outcome After Pancreatic Surgery

Deyle, Simone; Banz, Vanessa; Wagner, Markus; Becker, Karin; Inderbitzin, Daniel; Gloor, Beat; Candinas, Daniel

doi:10.1097/mpa.0b013e318212c02c

Cited by 15 publications

(16 citation statements)

References 36 publications

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“…Accurate identification of patients at high risk of perioperative morbidity can guide patient-physician discussions prior to surgery, as well as identify appropriate patients for “pre-habiliation.” 11 Several studies have demonstrated that active alcoholism, coagulopathy, jaundice, acute renal failure, heart disease, and obesity are associated with increased postoperative morbidity and mortality after pancreatic resection. 12–14 More recently, there has been interest in identifying more general parameters of “health” to risk stratify patients.…”

Section: Introductionmentioning

confidence: 99%

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini

Spolverato

Gupta

et al. 2015

Journal of Gastrointestinal Surgery

215

219

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Background While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV. Method Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis. Result Median TPA and TPV were both lower in women versus men (both P<0.001). TPA identified 192 (25.1 %) patients as sarcopenic, while TPV identified 152 patients (19.9 %). Three hundred sixty-nine (48.4 %) patients experienced a postoperative complication. While TPA-sarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P=0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P=0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P=0.006), as well as long-term survival (HR 1.46; P=0.006). Conclusion The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image.

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Section: Introductionmentioning

confidence: 99%

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Amini

Spolverato

Gupta

et al. 2015

Journal of Gastrointestinal Surgery

215

219

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“…While several scoring systems have been proposed, their prognostic accuracy in quantifying the risk associated with patient-level physiological/performance status has been questioned. 15-17 Frailty has been proposed as a more global metric of patient physiological reserve and overall health status. 32 Frailty can be assessed utilizing patient questionnaires or varied clinical measurements of weakness or physical activity.…”

Section: Discussionmentioning

confidence: 99%

“…Several groups have suggested the Estimation of Physiologic Ability and Surgical Stress Scoring (E-PASS) system as a more comprehensive physiologic estimation; however, results have been mixed. 15-17 Frailty, a measure believed to estimate a patient’s physiologic reserves, has recently been proposed as a more robust predictor of outcomes following surgery. 18,19 Initial assessments of frailty have been criticized for relying on scales dependent on subjective evaluations of weakness, exhaustion, and physical activity.…”

Section: Introductionmentioning

confidence: 99%

Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma

Peng

Hyder

Firoozmand

et al. 2012

Journal of Gastrointestinal Surgery

476

419

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Introduction Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia—the measurement of muscle wasting—may be a more objective and comprehensive patient-specific factor associated with long-term survival. Methods Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors. Results Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm2/m2) was greater than among women (454 mm2/m2). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49.9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR=1.68; P<0.001). Tumor-specific factors such as poor differentiation on histology (HR=1.75), margin status (HR=1.66), and lymph node metastasis (HR=2.06) were associated with risk of death at 3-years (all P<0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR=1.63; P<0.001). Conclusions Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.

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“…In contrast, Deyle et al. analyzed 304 patients undergoing pancreatic resection and revealed no significant differences in E‐PASS scores between patients with and without postoperative complications. They concluded that E‐PASS is an ineffective predictor of complications after pancreatic resections.…”

Section: Discussionmentioning

confidence: 95%

“…In contrast, Deyle et al. reported that E‐PASS was an ineffective predictor of complications following pancreatic resection. Similar contradictive results have been reported on the accuracy of POSSUM models in pancreatic resections .…”

Section: Introductionmentioning

confidence: 92%

Value of general surgical risk models for predicting postoperative morbidity and mortality in pancreatic resections for pancreatobiliary carcinomas

Haga

Wada

Saitoh

et al. 2014

J Hepato Biliary Pancreat

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Estimation of Physiologic Ability and Surgical Stress Score Does Not Predict Immediate Outcome After Pancreatic Surgery

Cited by 15 publications

References 36 publications

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia

Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma

Value of general surgical risk models for predicting postoperative morbidity and mortality in pancreatic resections for pancreatobiliary carcinomas

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