Annals of Surgical Oncology

, Volume 21, Issue 8, pp 2601–2607 | Cite as

Perioperative Risk Assessment for Gastrectomy by Surgical Apgar Score

  • Yuichiro Miki
  • Masanori Tokunaga
  • Yutaka Tanizawa
  • Etsuro Bando
  • Taiichi Kawamura
  • Masanori Terashima
Gastrointestinal Oncology



Recently, a simple and easy complication prediction system, the surgical apgar score (SAS) calculated by three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. In this study, we evaluated the predictability of the original SAS (oSAS) for severe complications after gastrectomy. In addition, the predictability of a modified SAS (mSAS) was evaluated, in which the cutoff value for blood loss was slightly modified.


We investigated 328 patients who underwent gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. Patients with postoperative morbidities classified as Clavien–Dindo grade IIIa or more were defined as having severe complications. Univariate and multivariate analyses were performed to elucidate factors that affected the development of severe complications.


Thirty-six patients (11.0 %) had severe complications postoperatively. Univariate analyses showed that the oSAS (p = 0.007) and mSAS (p < 0.001), as well as sex, preoperative chemotherapy, cStage, type of operation, thoracotomy, surgical approach, operation time, and extent of lymph node dissection, were associated with severe complications. Multivariate analysis showed that an mSAS ≤6 was found to be an independent risk factor for severe complication, while an oSAS ≤6 was not.


The oSAS was not found to be a predictive factor for severe complications following gastrectomy in Japanese patients. A slightly modified SAS (i.e. the mSAS) is considered to be a useful predictor for the development of severe complications in elective surgery.


Gastric Cancer Severe Complication Pancreatic Fistula Estimate Blood Loss Electronic Supplementary Table 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflicts of Interest

Yuichiro Miki, Masanori Tokunaga, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, and Masanori Terashima declare that they have no conflicts of interest.

Supplementary material

10434_2014_3653_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Yuichiro Miki
    • 1
  • Masanori Tokunaga
    • 1
  • Yutaka Tanizawa
    • 1
  • Etsuro Bando
    • 1
  • Taiichi Kawamura
    • 1
  • Masanori Terashima
    • 1
  1. 1.Division of Gastric SurgeryShizuoka Cancer CenterShizuokaJapan

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