Evaluation of Modified Estimation of Physiologic Ability and Surgical Stress in Colorectal Carcinoma Surgery

Haga, Yoshio; Wada, Yasuo; Ikenaga, Masakazu; Takeuchi, Hitoshi; Izutsu, Koji

doi:10.1097/dcr.0b013e3182271a54

Cited by 14 publications

(17 citation statements)

References 26 publications

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“…Haga et al, therefore, developed modified E-PASS (mE-PASS) which assess surgical risk according to the type of surgical procedure rather than the concrete factors during the operation. [ 19 ] The mE-PASS showed a similar predicting ability with E-PASS in some researches, [ 12 , 13 ] but it also had limitations in clinical use. In the mE-PASS system, only routine surgical procedure can be assessed, whereas procedures such as emergency surgery or multiple organ resections cannot be assessed.…”

Section: Discussionmentioning

confidence: 99%

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Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Zhang

Liu²,

Zheng³

et al. 2017

Medicine

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Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status.In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status.E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries.The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk.

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Section: Discussionmentioning

confidence: 99%

“…Estimation of physiologic ability and surgical stress (E-PASS) system is a more recent predicting system developed by Haga et al [ 10 ] According to his following examination studies, E-PASS was reported to have a good death predicting ability in various surgeries including colorectal cancer surgery. [ 11 – 13 ]…”

Section: Introductionmentioning

confidence: 99%

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Zhang

Liu²,

Zheng³

et al. 2017

Medicine

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“…In Japan, a mortality prediction risk score was developed termed Estimation of Physiological Ability and Surgical Stress (E-PASS) [ 10 ] using parameters to assess the health status of the patient (ASA score, co-morbidities, performance status) and the stress of surgery (blood loss, operation time, open or laparoscopic surgery). E-PASS has been validated for patients undergoing elective general surgery [ 11 , 12 ] and colorectal surgery [ 13 ]. E-PASS has not been validated in a UK-based population.…”

Section: Introductionmentioning

confidence: 99%

Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon

Bagnall

Pring

Malietzis

et al. 2018

Int J Colorectal Dis

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PurposeThis study aims to determine whether traditional risk models can accurately predict morbidity and mortality in patients undergoing major surgery by colorectal surgeons within an enhanced recovery program.MethodsOne thousand three hundred eighty patients undergoing surgery performed by colorectal surgeons in a single UK hospital (2008–2013) were included. Six risk models were evaluated: (1) Physiology and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), (2) Portsmouth POSSUM (P-POSSUM), (3) ColoRectal (CR-POSSUM), (4) Elderly POSSUM (E-POSSUM), (5) the Association of Great Britain and Ireland (ACPGBI) score, and (6) modified Estimation of Physiologic Ability and Surgical Stress Score (E-PASS). Model accuracy was assessed by observed to expected (O:E) ratios and area under Receiver Operating Characteristic curve (AUC).ResultsEleven patients (0.8%) died and 143 patients (10.4%) had a major complication within 30 days of surgery. All models overpredicted mortality and had poor discrimination: POSSUM 8.5% (O:E 0.09, AUC 0.56), P-POSSUM 2.2% (O:E 0.37, AUC 0.56), CR-POSSUM 7.1% (O:E 0.11, AUC 0.61), and E-PASS 3.0% (O:E 0.27, AUC 0.46). ACPGBI overestimated mortality in patients undergoing surgery for cancer 4.4% (O:E = 0.28, AUC = 0.41). Predicted morbidity was also overestimated by POSSUM 32.7% (O:E = 0.32, AUC = 0.51). E-POSSUM overestimated mortality (3.25%, O:E 0.57 AUC = 0.54) and morbidity (37.4%, O:E 0.30 AUC = 0.53) in patients aged ≥ 70 years and over.ConclusionAll models overestimated mortality and morbidity. New models are required to accurately predict the risk of adverse outcome in patients undergoing major abdominal surgery taking into account the reduced physiological and operative insult of laparoscopic surgery and enhanced recovery care.Electronic supplementary materialThe online version of this article (10.1007/s00384-018-3141-4) contains supplementary material, which is available to authorized users.

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“…We recently modified this model, termed mE-PASS, to maintain the discrimination power with a reduced number of variables [8]. We also demonstrated its efficacy in a specialty field of surgery for colorectal carcinoma [9], gastric carcinoma [10], liver carcinoma [11], and choledochocystolithiasis [12].…”

Section: Introductionmentioning

confidence: 99%

Preliminary study of surgical audit for overall survival following gastric cancer resection

et al. 2014

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Evaluation of Modified Estimation of Physiologic Ability and Surgical Stress in Colorectal Carcinoma Surgery

Cited by 14 publications

References 26 publications

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Perioperative risk prediction in the era of enhanced recovery: a comparison of POSSUM, ACPGBI, and E-PASS scoring systems in major surgical procedures of the colorectal surgeon

Preliminary study of surgical audit for overall survival following gastric cancer resection

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