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Annals of Surgical Oncology

, Volume 23, Supplement 5, pp 757–763 | Cite as

Usefulness of Surgical Apgar Score on Predicting Survival After Surgery for Gastric Cancer

  • Takanobu Yamada
  • Akira Tsuburaya
  • Tsutomu Hayashi
  • Toru Aoyama
  • Hirohito Fujikawa
  • Junya Shirai
  • Haruhiko Cho
  • Toshio Sasaki
  • Yasushi Rino
  • Munetaka Masuda
  • Takaki Yoshikawa
Gastrointestinal Oncology

Abstract

Background

Complete surgical resection is essential for a cure for most gastric cancer. Recently it was reported that surgical Apgar score (SAS) can predict postoperative complication and that postoperative complication is associated with poor long-term survival. The aim of this study is to assess whether SAS can predict overall survival (OS) after surgery for gastric cancer.

Methods

We retrospectively compared clinicopathological characteristics and survival between high and low SAS score groups in patients who underwent gastrectomy for gastric cancer.

Results

Low-scored SAS group (group L) was significantly more common among ASA-PS 2, open approach, total gastrectomy, D2 lymph node dissection, postoperative complication grade 2–4, deep tumor invasion, lymph node metastases, and advanced pathological TNM stage than high-scored SAS group (group H). The 5-year OS of group H and group L were 81.6 and 55.9 %, respectively (p < .001); OS of group L tended to be poorer than that of group H in stage III patients (p = .060) and in stage IV patients (p < .001). In multivariate analysis, pathological stage and SAS were identified as independent predictors for OS.

Conclusions

SAS is useful for predicting survival after surgery for gastric cancer.

Keywords

Gastric Cancer Overall Survival Anesthetic Management Japanese Gastric Cancer Treatment Guideline Severe Diabetes Mellitus 
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.

Notes

Acknowledgment

None.

Disclosure

None.

References

  1. 1.
    Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available at: http://globocan.iarc.fr, accessed March 25, 2016.
  2. 2.
    Bonenkamp JJ, Hermans J, Sasako M, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1990;340:908–14.CrossRefGoogle Scholar
  3. 3.
    Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.PubMedGoogle Scholar
  4. 4.
    Sasako M, Sano T, Yamamoto S, et al. D2 lymphadenectomy alone or with para-aortic nodal dissection for gastric cancer. N Engl J Med. 2008;359:453–62.CrossRefPubMedGoogle Scholar
  5. 5.
    Kim HH, Hyung WJ, Cho GS, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report–a phase III multicenter, prospective, randomized trial (KLASS Trial). Ann Surg. 2010;51:417–20.CrossRefGoogle Scholar
  6. 6.
    Katai H, Sasako M, Fukuda H, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13:238–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007;204:201–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Bang YJ, Kim YW, Yang HK, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379:315–21.CrossRefPubMedGoogle Scholar
  9. 9.
    Regenbogen SE, Lancaster RT, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA. Does the Surgical Apgar Score measure intraoperative performance? Ann Surg. 2008; 248:320–328.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Prasad SM, Ferreria M, Berry AM, Lipsitz SR, Richie JP, Gawande AA, Hu JC. Surgical Apgar outcome score: perioperative risk assessment for radical cystectomy. J Urol. 2009;181:1046–52.CrossRefPubMedGoogle Scholar
  11. 11.
    Haynes AB, Regenbogen SE, Weiser TG, et al. Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries. Surgery. 2011;149:519–24.CrossRefPubMedGoogle Scholar
  12. 12.
    Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA. Utility of the surgical apgar score: validation in 4119 patients. Arch Surg. 2009;144:30–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Zighelboim I, Kizer N, Taylor NP, et al. “Surgical Apgar Score” predicts postoperative complications after cytoreduction for advanced ovarian cancer. Gynecol Oncol. 2010;116:370–3.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Yamada T, Tsuburaya A, Hayashi T, et al. Surgical Apgar score predicts postoperative complications after surgery for gastric cancer. Glob Surg. 2015;1:48–51.CrossRefGoogle Scholar
  16. 16.
    Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2014;20:1575–83.CrossRefGoogle Scholar
  17. 17.
    Hayashi T, Yoshikawa T, Aoyama T, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer. 2015;18:368–74.CrossRefPubMedGoogle Scholar
  18. 18.
    Li QG, Li P, Tang D, Chen J, Wang DR. Impact of postoperative complications on long-term survival after radical resection for gastric cancer. World J Gastroenterol. 2013;19:4060–5.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sobin LH, Gospodarowicz MK, Witterkind CH. International Union Against Cancer (UICC) TNM Classification of Malignant Tumors. 7th ed. Oxford, UK: Wiley-Blackwell. 2009.Google Scholar
  20. 20.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.CrossRefGoogle Scholar
  21. 21.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Fujitani K, Yang HK, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18.CrossRefPubMedGoogle Scholar
  23. 23.
    Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100:4–10.CrossRefPubMedGoogle Scholar
  24. 24.
    Kawasaki T, Ogata M, Kawasaki C, Okamoto K, Sata T. Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery. Br J Anaesth. 2007;98:196–203.CrossRefPubMedGoogle Scholar
  25. 25.
    Zhao J, Mo H. The impact of different anesthesia methods on stress reaction and immune function of the patients with gastric cancer during peri-operative period. J Med Assoc Thai. 2015;98:568–73.PubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Takanobu Yamada
    • 1
    • 2
  • Akira Tsuburaya
    • 2
  • Tsutomu Hayashi
    • 1
  • Toru Aoyama
    • 1
  • Hirohito Fujikawa
    • 1
  • Junya Shirai
    • 1
  • Haruhiko Cho
    • 1
  • Toshio Sasaki
    • 3
  • Yasushi Rino
    • 2
  • Munetaka Masuda
    • 2
  • Takaki Yoshikawa
    • 1
    • 2
  1. 1.Department of Gastrointestinal SurgeryKanagawa Cancer CenterYokohamaJapan
  2. 2.Department of SurgeryYokohama City UniversityYokohamaJapan
  3. 3.Department of AnesthesiologyKanagawa Cancer CenterYokohamaJapan

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