Annals of Surgical Oncology

, Volume 18, Issue 13, pp 3680–3685 | Cite as

The Revised ACPGBI Model is a Simple and Accurate Predictor of Operative Mortality After Potentially Curative Resection of Colorectal Cancer

  • Colin H. Richards
  • E. Fiona Leitch
  • John H. Anderson
  • Ruth F. McKee
  • Donald C. McMillan
  • Paul G. Horgan
Colorectal Cancer

Abstract

Background

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) risk-adjustment model for colorectal cancer surgery has been recently revised. The aim of the present study was to compare the performance of the revised ACPGBI model, the original ACPGBI model, P-POSSUM, and CR-POSSUM, in the prediction of operative mortality after resection of colorectal cancer.

Methods

A total of 423 patients who underwent potentially curative resection of colorectal cancer at a single institution (1997–2007) were included. Data used in the construction of the ACPGBI model was collected prospectively. The models were compared by examining observed to expected (O:E) ratios, the Hosmer-Lemeshow (H-L) goodness-of-fit test, and area under the receiver operator characteristic curve (AUC) analysis.

Results

The 30-day mortality rate was 4%. The performance of the models was as follows: revised ACPGBI model (O:E ratio = 1.05, AUC = 0.73, H-L = 11.02), original ACPGBI model (O:E ratio = 0.58, AUC = 0.76, H-L = 14.23), P-POSSUM (O:E ratio = 0.87, AUC = 0.79, H-L = 10.63), and CR-POSSUM (O:E ratio = 0.63, AUC = 0.84, H-L = 15.84). In subgroup analysis, the revised ACPGBI model performed well in both elective cases (O:E ratio = 1.06) and emergency cases (O:E ratio = 0.91).

Conclusions

The revised ACPGBI model is simple to construct and accurately predicts operative mortality after potentially curative resection of colorectal cancer.

Keywords

Colorectal Cancer Curative Resection Operative Mortality Laparoscopic Resection Colorectal Cancer Resection 

Notes

Conflict of interest

None.

References

  1. 1.
    Cancer Research UK. http://www.cancerresearchuk.org. Accessed September 2010.
  2. 2.
    Russell EM, Bruce J, Krukowski ZH. Systematic review of the quality of surgical mortality monitoring. Br J Surg. 2003;90:527–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Sagar PM, Hartley MN, Mancey-Jones B, Sedman PC, May J, Macfie J. Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg. 1994;81:1492–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Jones HJ, de Cossart L. Risk scoring in surgical patients. Br J Surg. 1999;86:149–57.PubMedCrossRefGoogle Scholar
  5. 5.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system. Br J Surg. 1996;83:812–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and operative severity score for the enumeration of mortality and morbidity. Br J Surg. 1998;85:1217–20.PubMedCrossRefGoogle Scholar
  8. 8.
    Tekkis PP, Prytherch DR, Kocher HM, et al. Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg. 2004;91:1174–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW. POSSUM, P-POSSUM, and CR-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum. 2004;47:1435–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Slim K, Panis Y, Alves A, Kwiatkowski F, Mathieu P, Mantion G, Association Française de Chirurgie. Predicting postoperative mortality in patients undergoing colorectal surgery. World J Surg. 2006;30:100–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Ren L, Upadhyay AM, Wang L, Li L, Lu J, Fu W. Mortality rate prediction by physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM), Portsmouth POSSUM and colorectal POSSUM and the development of new scoring systems in Chinese colorectal cancer patients. Am J Surg. 2009;198:31–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Leung E, Ferjani AM, Stellard N, Wong LS. Predicting post-operative mortality in patients undergoing colorectal surgery using P-POSSUM and CR-POSSUM scores: a prospective study. Int J Colorectal Dis. 2009;24:1459–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Tekkis PP, Poloniecki JD, Thompson MR, Stamatakis JD. Operative mortality in colorectal cancer: prospective national study. BMJ. 2003;327(7425):1196–201.PubMedCrossRefGoogle Scholar
  14. 14.
    Risk prediction in surgery. http://www.riskprediction.org.uk. Accessed September 2010.
  15. 15.
    Metcalfe MS, Norwood MG, Miller AS, Hemingway D. Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis. 2005;7:275–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Ferjani AM, Griffin D, Stallard N, Wong LS. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study. Lancet Oncol. 2007;8:317–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum. 2003;46:1461–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000;18:2327–40.PubMedGoogle Scholar
  19. 19.
    de Leon MP, Pezzi A, Benatti P, et al. Survival, surgical management and perioperative mortality of colorectal cancer in the 21-year experience of a specialised registry. Int J Colorectal Dis. 2009;24:777–88.PubMedCrossRefGoogle Scholar
  20. 20.
    Richards CH, Leitch FE, Horgan PG, McMillan DC. A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer. J Gastrointest Surg. 2010;14:1511–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg. 2006;93:921–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Ravitch MM. Subjectivity in decision making: common problems and limitations. World J Surg. 1989;13:281–6.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Colin H. Richards
    • 1
  • E. Fiona Leitch
    • 1
  • John H. Anderson
    • 1
  • Ruth F. McKee
    • 1
  • Donald C. McMillan
    • 1
  • Paul G. Horgan
    • 1
  1. 1.Glasgow University Department of SurgeryGlasgow Royal InfirmaryGlasgowUK

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