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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Gastric Cancer Severe Complication Pancreatic Fistula Estimate Blood Loss Electronic Supplementary Table 

Notes

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)

References

  1. 1.
    Sasako M. Principles of surgical treatment for curable gastric cancer. J Clin Oncol. 2003;21(23 Suppl):274-5s.CrossRefGoogle Scholar
  2. 2.
    Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215-21.PubMedCrossRefGoogle Scholar
  3. 3.
    Kang YK, Kang WK, Shin DB, et al. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol. 2009;20:666-73.PubMedCrossRefGoogle Scholar
  4. 4.
    Imamura H, Kurokawa Y, Kawada J, et al. Influence of bursectomy on operative morbidity and mortality after radical gastrectomy for gastric cancer: results of a randomized controlled trial. World J Surg. 2011;35:625-30.PubMedCrossRefGoogle Scholar
  5. 5.
    Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767-73.PubMedCrossRefGoogle Scholar
  6. 6.
    Sasako M, Sano T, Yamamoto S, et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia: a randomised controlled trial. Lancet Oncol. 2006;7:644-51.PubMedCrossRefGoogle Scholar
  7. 7.
    Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355-60.PubMedCrossRefGoogle Scholar
  8. 8.
    Fink AS, Campbell DA Jr, Mentzer RM Jr, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg. 2002;236:344-53;discussion 353-4.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Khuri SF, Daley J, Henderson W, et al. The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491-507.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Haga Y, Ikei S, Ogawa M. Estimation of Physiologic Ability and Surgical Stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery. Surg Today. 1999;29:219-25.PubMedCrossRefGoogle Scholar
  11. 11.
    Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007;204:201-8.PubMedCrossRefGoogle Scholar
  12. 12.
    Ziewacz JE, Davis MC, Lau D, El-Sayed AM, Regenbogen SE, Sullivan SE, et al. Validation of the surgical Apgar score in a neurosurgical patient population. J Neurosurg. 2013;118:270-9.PubMedCrossRefGoogle Scholar
  13. 13.
    Thorn CC, Chan M, Sinha N, Harrison RA. Utility of the Surgical Apgar Score in a district general hospital. World J Surg. 2012;36:1066-1073.PubMedCrossRefGoogle Scholar
  14. 14.
    Prasad SM, Ferreria M, Berry AM, et al. Surgical apgar outcome score: perioperative risk assessment for radical cystectomy. J Urol. 2009;181:1046-52;discussion 1052-3.PubMedCrossRefGoogle Scholar
  15. 15.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101-12.CrossRefGoogle Scholar
  16. 16.
    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-96.PubMedCrossRefGoogle Scholar
  17. 17.
    Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg. 1953;32:260-7.PubMedCrossRefGoogle Scholar
  18. 18.
    Regenbogen SE, Bordeianou L, Hutter MM, Gawande AA. The intraoperative Surgical Apgar Score predicts postdischarge complications after colon and rectal resection. Surgery. 2010;148:559-66.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Regenbogen SE, Lancaster RT, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA. Does the Surgical Apgar Score measure intraoperative performance? Ann Surg. 2008;248:320-8.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg. 2002;95:273-7.PubMedGoogle Scholar
  21. 21.
    Wolters U, Wolf T, Stutzer H, Schroder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217-22.PubMedCrossRefGoogle Scholar
  22. 22.
    Ives CL, Harrison DK, Stansby GS. Tissue oxygen saturation, measured by near-infrared spectroscopy, and its relationship to surgical-site infections. Br J Surg. 2007;94:87-91.PubMedCrossRefGoogle Scholar
  23. 23.
    Meyhoff CS, Wetterslev J, Jorgensen LN, et al. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery: the PROXI randomized clinical trial. JAMA 2009;302:1543-50.PubMedCrossRefGoogle Scholar
  24. 24.
    Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15:250-9;discussion 259.PubMedCrossRefGoogle Scholar
  25. 25.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439-49.PubMedCrossRefGoogle Scholar
  26. 26.
    Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745-8.PubMedCrossRefGoogle Scholar
  27. 27.
    Waddell T, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D. Gastric cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi57-63.PubMedCrossRefGoogle Scholar

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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