Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma

Lai, Fan-Cai; Kwan, Tze-Hoi; Yuen, Wai–Cheung; Wai, Abraham Ka Chung; Siu, Y. C.; Shung, E.

doi:10.1002/bjs.5793

Cited by 26 publications

(16 citation statements)

References 26 publications

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“…A number of predictive models for postoperative morbidity and mortality after esophagectomy have been developed, focusing primarily on fixed, preoperative risk factors [23][24][25][26][27][28][29] ; however, attempts to validate these risk stratification tools externally have demonstrated limited clinical applicability. 7,30-32 A recent systematic review of 20 clinical prediction models for mortality after esophagectomy concluded that these models were unreliable because of poor discrimination and inadequate validation.…”

Section: Discussionmentioning

confidence: 99%

The Surgical Apgar Score in esophagectomy

Janowak

Blasberg

Taylor

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Section: Discussionmentioning

confidence: 99%

The Surgical Apgar Score in esophagectomy

Janowak

Blasberg

Taylor

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…In particular, POSSUM has been proposed as a predictor equation taking into account differences in case-mix [6][7][8][9]. However, POSSUM requires up to 19 perioperative physiological parameters, including some parameters that are not routinely examined before surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Predicting postoperative mortality and risk assessment before surgery continues to be challenging [6,7]. In patients undergoing elective esophagectomy for esophageal cancer, the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) has been reported to predict mortality accurately [8,9]. However, POSSUM requires up to 19 perioperative physiological variables, which are not necessarily collected as a part of routine clinical care [6,7].…”

Section: Introductionmentioning

confidence: 99%

Estimation of Physiologic Ability and Surgical Stress (E-PASS system) in patients with esophageal squamous cell carcinoma undergoing resection

et al. 2008

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Background. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system was designed on the hypothesis that the balance between the patient's physiological reverse capacity and the surgical stress of operation was important in the development of postoperative complications. The aim of this study was to evaluate whether the E-PASS scoring system could predict the occurrence of complications after elective esophagectomy for esophageal cancer, including salvage esophagectomy.Methods. E-PASS predictor equations were applied retrospectively to 142 patients who had undergone esophagectomy for esophageal squamous cell carcinoma [110 patients without preoperative chemoradiotherapy (CRT), 15 patients with neoadjuvant CRT followed by planned esophagectomy, and 17 patients with defi nitive CRT followed by salvage esophagectomy]. The incidence rates of postoperative complications were compared with the preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) of the E-PASS scoring system. Results. Of the 142 patients, 43 (30%) had postoperative complications. The incidence of postoperative complications increased as the CRS score increased. Patients with a CRS > 1.0 were at a particularly high risk of postoperative complications. Defi nitive CRT increased the incidence of postoperative complications, and the SSS and CRS of patients with defi nitive CRT were signifi cantly higher than those of patients without preoperative CRT or with neoadjuvant CRT.Conclusions. The E-PASS scoring system was useful in predicting complications after elective esophagectomy for esophageal cancer. The SSS of the E-PASS scoring system could also refl ect the maximum invasiveness of salvage esophagectomy.

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“…In a study of 545 patients who underwent esophagectomy in public hospitals in Hong Kong, the observed in-hospital mortality rate was 5.5%, whereas that predicted by Portsmouth (P)-POSSUM score was 4.7%. P-POSSUM also showed no lack of fi t, and the area under the receiver operator characteristic curve (ROC) was 0.776, demonstrating good discriminatory power [9]. It is uncertain if patient selection based on a strict mathematical scoring system is better than one based on surgeons and anesthesiologists' assessments alone.…”

Section: Short-term Prognosticationmentioning

confidence: 97%

Prognostication for patients with esophageal cancer

Law

2009

Esophagus

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The ability to predict both short-term and longterm outcome after esophagectomy for cancer is invaluable. It helps us to select the appropriate patients for esophagectomy, to modify surgical procedures or perioperative care to lessen the chance of adverse events, and to decide if neoadjuvant or adjuvant therapies are of value. Predictors of morbidity and mortality after esophagectomy can include many individual factors or their combinations in the form of mathematical scores. Long-term prognosis depends to a large extent on disease stage, but the surgeon can play a major role as well, by minimizing postoperative complications and by performing a R0 resection with extended lymphadenectomy. The accuracy of prediction is improving as technology advances and understanding of the disease becomes more thorough. Information gained should be used for better individualized patient care.

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Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma

Abstract: P-POSSUM provided the most accurate prediction of in-hospital mortality in this group of patients who had elective oesophagectomy.

Cited by 26 publications

References 26 publications

The Surgical Apgar Score in esophagectomy

The Surgical Apgar Score in esophagectomy

Estimation of Physiologic Ability and Surgical Stress (E-PASS system) in patients with esophageal squamous cell carcinoma undergoing resection

Prognostication for patients with esophageal cancer

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