The value of esophagectomy surgical apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy

Xing, Xue; Wang, Hai Jun; Qu, Shi Ning; Huang, Chu Lin; Zhang, Hao; Wang, Hao; Yang, Quan Hui; Gao, Yong

doi:10.21037/jtd.2016.06.28

Cited by 83 publications

(15 citation statements)

References 28 publications

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“…Thus far, some previous studies have demonstrated the SAS's utility in predicting complications (9,10,20), other studies reported the usefulness of the mSAS but not the SAS (12,14,15). The utility of the SAS seems to depend on the type of surgery or the characteristics of the cohort.…”

Section: Discussionmentioning

confidence: 95%

“…SAS is determined by the following intraoperative factors: estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heat rate (LHR). Moreover, the modified SAS (mSAS) using a cut off value of EBL has previously been proposed in assessing the PC risk in several types of surgery as well (12)(13)(14)(15). However, previous studies investigating the SAS or mSAS only examined GC patients received primary surgery with or without adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

Hayashi

Yoshikawa²,

Yura

et al. 2020

Preprint

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KEYWORDS 2 gastrectomy, neoadjuvant chemotherapy, surgical Apgar score 3 Abstract Background: The surgical Apgar score (SAS) or modified SAS (mSAS) has been reported as a simple and easy risk assessment system to predict postoperative complications (PCs) in primary surgery for gastric cancer (GC). However, there are still few studies which revealed the SAS's utility in gastric surgery after neoadjuvant chemotherapy (NAC). Methods: One hundred and fifteen patients who received NAC and R0 gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heat rate (LHR). The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for PCs were assessed with uni and multivariate analyses. Results: Among 115 patients, 41 (35.7%) developed PCs. According to analyses with receiver operating characteristic (ROC) curve of the SAS and mSAS for predicting PCs, the cutoff value of the mSAS was set at 8. The rates of anastomotic leakage, pancreatic fistula, and arrhythmia in patients with high mSAS (>8) values were higher, compared to those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis detected operation time, Body Mass Index (BMI), and Diabetes Mellitus (DM) were independent risk factors for PCs. The mSAS was not a significant predictor.Conclusions: Neither the SAS nor mSAS was a useful predictor of PCs in patients treated with NAC followed by radical gastrectomy. The predictive value of SAS/mSAS is limited in patients undergoing surgery after NAC.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

Hayashi

Yoshikawa²,

Yura

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Several previous studies have demonstrated the utility of SAS for predicting complications (9, 10), although other studies have described the usefulness of the mSAS but not the SAS (12,14). The utility of the SAS seems to depend on the type of surgery or the characteristics of the cohort.…”

Section: Discussionmentioning

confidence: 97%

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single-center Retrospective Study

Hayashi

Yoshikawa²,

Yura

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The surgical Apgar score (SAS) or modified SAS (mSAS) has been reported as a simple and easy risk assessment system for predicting postoperative complications in primary surgery for gastric cancer. However, few studies have described the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC).Methods One hundred and fifteen patients who received NAC and radical gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by the estimated blood loss (EBL), lowest intraoperative mean arterial pressure, and lowest heart rate. The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for postoperative complications were assessed with univariate and multiple logistic regression analyses.Results Among the 115 patients, 41 (35.7%) developed postoperative complications. According to analyses with receiver operating characteristic curves of the SAS and mSAS for predicting postoperative complications, the cut-off value of the mSAS was set at 8. The rates of anastomotic leakage, pancreatic fistula, and arrhythmia in patients with high mSAS (>8) values were higher than in those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis showed that the operation time, body mass index, and diabetes mellitus were independent risk factors for postoperative complications. The mSAS was not a significant predictor.Conclusion The predictive value of SAS or mSAS for morbidity may be limited in patients who undergo gastric cancer surgery after NAC. Future prospective studies with a large sample size will be needed to confirm the present results.

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“…Total MIME was associated with less intraoperative blood loss and shorter hospital stay compared with DIE in our study. Recently, Xing et al reported that esophagectomy Surgical Apgar Score (eSAS) was strongly associated with 30‐day major morbidity after esophagectomy, and the eSAS is based on the intraoperative lowest heart rate, lowest mean arterial pressure, and estimated blood loss intraoperatively . From this point of view, less intraoperative blood loss during MIE may decrease the postoperative morbidity rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of short‐term outcomes and three yearsurvival between total minimally invasiveMcKeown and dual‐incision esophagectomy

Gao

Xue

et al. 2017

Thoracic Cancer

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BackgroundThe aim of this study was to compare the short‐term outcomes and three‐year survival between dual‐incision esophagectomy (DIE) and total minimally invasive McKeown esophagectomy (MIME) for esophageal cancer patients with negative upper mediastinal lymph nodes requiring esophagectomy and neck anastomosis.MethodsOne hundred and fifty patients underwent DIE, while 361 patients received total MIME. Perioperative outcomes and three‐year survival were compared in unmatched and propensity score matched data between two groups.ResultsBoth unmatched and matched analysis demonstrated that there were no significant differences in the number of lymph nodes harvested, or major or minor complication rates between the DIE and MIME groups. Compared with patients who underwent DIE, patients who underwent total MIME had longer operation duration (310 minutes vs. 345 minutes; P = 0.002). However, there was significantly less intraoperative blood loss in the total MIME compared with the DIE group (191 mL vs. 287 mL, respectively; P < 0.001). Kaplan‐Meier analysis demonstrated a trend that patients who underwent MIME had longer overall (79.5% vs. 64.1%; P = 0.063) and disease‐free three‐year survival (65.3% vs. 82.8%; P = 0.058) compared with patients who underwent DIE.ConclusionsBoth total MIME and DIE are feasible for the surgical treatment of esophageal cancer patients with negative upper mediastinal lymph nodes requiring esophagectomy and neck anastomosis. However, MIME was associated with better overall and disease‐free three‐year survival compared with DIE.

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The value of esophagectomy surgical apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy

Cited by 83 publications

References 28 publications

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single-center Retrospective Study

Comparison of short‐term outcomes and three yearsurvival between total minimally invasiveMcKeown and dual‐incision esophagectomy

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