Evaluation of the POSSUM, P-POSSUM and E-PASS scores in the surgical treatment of hilar cholangiocarcinoma

Abstract

BackgroundThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model, its Portsmouth (P-POSSUM) modification and the Estimation of physiologic ability and surgical stress (E-PASS) are three surgical risk scoring systems used extensively to predict postoperative morbidity and mortality in general surgery. The aim was to undertake the first study of the predictive value of these models in patients undergoing surgical treatment of hilar cholangiocarcinoma.MethodsA retrospective analysis was performed on data collected prospectively over a 10-year interval from January 2003 to December 2012. The morbidity and mortality risks were calculated using the POSSUM, P-POSSUM and E-PASS equations.ResultsOne hundred patients underwent surgical treatment of hilar cholangiocarcinoma. Complications were seen in 52 of 100 patients (52.0%). There were 10 postoperative in-hospital deaths (10.0%). Of 31 preoperative and intraoperative variables studied, operative type (P = 0.000), preoperative serum albumin (P = 0.003) and aspartate aminotransferase (P = 0.029) were found to be factors multivariate associated with postoperative complications. Intraoperative blood loss (P = 0.015), Bismuth-Corlette classification (P = 0.033) and preoperative hemoglobin (P = 0.041) were independent factors multivariate associated with in-hospital death. The POSSUM system predicted morbidity risk effectively with no significant lack of fit (P = 0.488) and an area under the ROC curve (AUC) of 0.843. POSSUM, P-POSSUM and E-PASS scores showed no significant lack of fit in calculating the mortality risk (P >0.05) and all yielded an AUC value exceeding 0.8. POSSUM had significantly more accuracy in predicting morbidity after major and major plus operations (O:E (observed/expected) ratio 0.98 and AUC 0.901) than after minor and moderate operations (O:E ratio 1.13 and AUC 0.759).ConclusionsPOSSUM, P-POSSUM and E-PASS scores effectively predict morbidity and mortality in surgical treatment of hilar cholangiocarcinoma. However, improvements are still needed in the future because none of these scoring systems yielded an AUC value exceeding 0.9 for operations with all different levels of severity. Only POSSUM had more accuracy in predicting postoperative morbidity after operations with higher severity.Trial registrationThis study was undertaken after obtaining approval from the ethics committee of School of Medicine, Shanghai Jiao Tong University with a trial registration number of http://09411960800.

Value of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder carcinoma

“…The ability of the E-PASS models was high to predict 16 These findings support the E-PASS models having a high predictive power in this field.…”

“…Another limitation is that this study was only performed in Japan. Although the high predictive power of E-PASS for hilar carcinoma was previously demonstrated in China, 16 validation studies are desirable in western countries.…”

“…15 Regarding proximal biliary carcinoma resection, Wang et al demonstrated that E-PASS accurately predicted postoperative mortality in the surgical treatment of hilar carcinoma. 16 No further study has been performed in this field. Preoperative risk tools are needed for liver and biliary surgery in proximal bile duct tumors as these procedures are associated with high risks of postoperative morbidity and mortality.…”

The applicability of POSSUM and P-POSSUM scores as predictors of morbidity and mortality in colorectal surgery

“…Postoperative morbidity and mortality rates are objective measures of outcomes that can be used to modify behavior and assess the quality of care. Previous studies have evidenced the important role of the POSSUM system as a predictor of postoperative morbidity and mortality 5,9,10 . A systematic review of the literature that evaluated POSSUM and its variants in patients undergoing surgery for colorectal cancer showed that the POSSUM score was able to predict morbidity in a reliable way and the P-POSSUM was the most accurate predictor of mortality, even when compared with CR-POSSUM 1 .…”

Real-time histology in liver disease using multiphoton microscopy with fluorescence lifetime imaging

“…Conventional histology relies on microscopic examination of a specimen obtained from biopsy or surgery, which is usually time consuming due to the complicated sample preparation procedures including fixation, sectioning and staining. The frozen sections of surgical margin are assessed during hepatocellular carcinoma or cholangiocarcinoma surgery to achieve a R0 resection (complete resection with microscopic examination of margins showing no tumor cells) [5]. Re-resection and/or re-anastomosis must be performed if the surgical margin is tumor positive, leading to the prolonged operation time.…”