The Surgical Apgar Score Predicts Postoperative Complications in Elderly Patients After Surgery for Colorectal Cancer

2021 ◽  
pp. 000313482110385
Author(s):  
Atsushi Sugimoto ◽  
Tatsunari Fukuoka ◽  
Hisashi Nagahara ◽  
Masatsune Shiutani ◽  
Yasuhito Iseki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Apgar Score ◽  
Assessment Tool ◽  
Univariate Analysis ◽  
Operation Time ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

Objective The surgical Apgar score (SAS) has been validated as a risk assessment tool for postoperative complications. However, the utility of the SAS in elderly patients with colorectal cancer remains unclear. In this study, we evaluated the utility of the SAS for predicting the severe complications in elderly patients with colorectal cancer. Methods We retrospectively analyzed 295 patients underwent radical surgery for colorectal cancer in elderly patients ≥75 years old. The SAS was calculated based on 3 intraoperative parameters: estimated blood loss (EBL), lowest mean arterial pressure, and lowest heart rate. Severe complications were defined as Clavien-Dindo classification grade ≥ IIIa. We divided all patients into 2 groups according to with or without severe complications. The optimal cut-off value of SAS for severe complications has been determined by receiver operator characteristic curve. Predictors for severe complications were analyzed by logistic regression modeling. Results Severe complications were observed in 57 patients (19.3%). Male, rectal cancer, operation time (>240 minutes), EBL (≥120 mL), and a low SAS (≤6) were significantly associated with severe complications in univariate analysis. A multivariate analysis revealed that male, rectal cancer, and a low SAS (≤6) were independent predictors for severe complications. Conclusions A low SAS (≤6) was associated with severe complications after colorectal cancer surgery in elderly patients. The SAS is a valuable predictor for severe complications in elderly patients with colorectal cancer.

Colorectal Cancer Surgery Using the Da Vinci Xi and Si Systems: Comparison of Perioperative Outcomes

2018 ◽  
Vol 26 (2) ◽  
pp. 192-200 ◽  
Author(s):  
Yu-Min Huang ◽  
Yan Jiun Huang ◽  
Po-Li Wei
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Da Vinci ◽  
Operation Time ◽  
Robotic System ◽  
Cancer Surgery ◽  
Perioperative Outcomes ◽  
Da Vinci Xi ◽  
Colorectal Cancer Surgery ◽  
Estimated Blood Loss

Purpose. Robotic surgery for colorectal cancer is an emerging technique. Potential benefits as compared with the conventional laparoscopic surgery have been demonstrated. However, experience with the previous da Vinci Si robotic system revealed several unsolved problems. The novel features of the new da Vinci Xi increase operational flexibility and maneuverability and are expected to facilitate the performance of multiquadrant surgery. Methods. Between December 2011 and May 2015, 120 patients with colon or rectal cancer were operated on using the Si robotic system (the Si group). Between May 2015 and October 2017, 60 more patients with colon or rectal cancer were operated on using the Xi robotic system (the Xi group). The clinicopathological characteristics and perioperative outcomes of these 2 groups of patients were compared. Results. The 2 groups of patients were comparable with regard to baseline clinical characteristics, types of resection performed, and the proportion of patients undergoing neoadjuvant chemoradiation therapy. The statuses of resection margin, the numbers of lymph nodes harvested, and the rates of postoperative complications were also similar between the 2 groups. Nevertheless, a lower rate of diverting ileostomy, a shorter operation time, less estimated blood loss, and a faster postoperative recovery was observed in the Xi group. Conclusions. Colorectal cancer surgery using the Xi robotic system was associated with improved perioperative outcomes. These benefits may be attributed to its improved, more user-friendly design.

scholarly journals The Impact of the Surgical Apgar Score On Oncological Outcomes in Patients With Colorectal Cancer: A Single-Center Retrospective Cohort Study

2021 ◽  
Author(s):  
Atsushi Sugimoto ◽  
Tatsunari Fukuoka ◽  
Hisashi Nagahara ◽  
Masatsune Shibutani ◽  
Yasuhito Iseki ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Apgar Score ◽  
Tumor Type ◽  
Cancer Specific Survival ◽  
Receiver Operating Characteristic Curves ◽  
Oncological Outcomes ◽  
Estimated Blood Loss ◽  
Comorbidity Index ◽  
The Impact ◽  
Surgical Apgar Score

Abstract Background: The surgical Apgar score (SAS) predicts postoperative complications (POCs) following gastrointestinal cancer surgery. Recently, the SAS was reported to be a predictor of not only POCs but also the prognosis. However, the impact of the SAS on oncological outcomes in patients with colorectal cancer (CRC) has not been fully examined. The present study therefore explored the oncological significance of the SAS in patients with CRC.Methods: We retrospectively analyzed 639 patients who underwent radical surgery for CRC. The SAS was calculated based on three intraoperative parameters: estimated blood loss, lowest mean arterial pressure and lowest heart rate. The optimal cut-off value of the SAS was determined by receiver operating characteristic curves. All patients were classified into 2 groups based on the SAS (≤6 and >6). The association of the SAS with the recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) was analyzed.Results: Univariate analyses revealed that a lower SAS (≤6) was significantly associated with a worse RFS, OS and CSS. A multivariate analysis revealed that age ≥75 years old, Charlson comorbidity index ≥1, ASA-Physical Status ≥3, SAS ≤6, histologically undifferentiated tumor type and an advanced pStage were independent factors for the OS, and an SAS ≤6 and advanced pStage were independent factors for the CSS.Conclusions: A lower SAS (≤6) was an independent prognostic factor for not only the OS but also the CSS in patients with CRC, suggesting that the SAS might be a useful biomarker predicting oncological outcomes in patients with CRC.

scholarly journals Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

2020 ◽  
Author(s):  
Masato Hayashi ◽  
Takaki Yoshikawa ◽  
Masahiro Yura ◽  
Sho Otsuki ◽  
Yukinori Yamagata ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Apgar Score ◽  
Predictive Value ◽  
Assessment System ◽  
Radical Gastrectomy ◽  
Predictive Values ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

Abstract Background: The surgical Apgar score (SAS) or modified SAS (mSAS) has been reported as a simple and easy risk assessment system to predict postoperative complications (PCs) in primary surgery for gastric cancer (GC). However, there are still few studies which revealed the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC). Methods: One hundred and fifteen patients who received NAC and R0 gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heat rate (LHR). The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for PCs were assessed with uni and multivariate analyses. Results: Among 115 patients, 41 (35.7%) developed PCs. According to analyses with receiver operating characteristic (ROC) curve of the SAS and mSAS for predicting PCs, the cutoff value of the mSAS was set at 8. The rates of anastomotic leakage, pancreatic fistula, and arrhythmia in patients with high mSAS ( > 8) values were higher, compared to those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis detected operation time, Body Mass Index (BMI), and Diabetes Mellitus (DM) were independent risk factors for PCs. The mSAS was not a significant predictor. Conclusions: Neither the SAS nor mSAS was a useful predictor of PCs in patients treated with NAC followed by radical gastrectomy. The predictive value of SAS/mSAS is limited in patients undergoing surgery after NAC.

scholarly journals Predictive Value of the Surgical Apgar Score on Postoperative Complications in Advanced Gastric Cancer Patients Treated with Neoadjuvant Chemotherapy Followed by Radical Gastrectomy: A Single Center Retrospective Study

2020 ◽  
Author(s):  
Masato Hayashi ◽  
Takaki Yoshikawa ◽  
Masahiro Yura ◽  
Sho Otsuki ◽  
Yukinori Yamagata ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Apgar Score ◽  
Predictive Value ◽  
Assessment System ◽  
Radical Gastrectomy ◽  
Predictive Values ◽  
Estimated Blood Loss ◽  
Surgical Apgar Score

Abstract Background: The surgical Apgar score (SAS) or modified SAS (mSAS) has been reported as a simple and easy risk assessment system to predict postoperative complications (PCs) in primary surgery for gastric cancer (GC). However, there are still few studies which revealed the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC). Methods: One hundred and fifteen patients who received NAC and R0 gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by estimated blood loss (EBL), lowest intraoperative mean arterial pressure (LMAP), and lowest heat rate (LHR). The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for PCs were assessed with uni and multivariate analyses. Results: Among 115 patients, 41 (35.7%) developed PCs. According to analyses with receiver operating characteristic (ROC) curve of the SAS and mSAS for predicting PCs, the cutoff value of the mSAS was set at 8. The rates of anastomotic leakage, pancreatic fistula, and arrhythmia in patients with high mSAS (>8) values were higher, compared to those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis detected operation time, Body Mass Index (BMI), and Diabetes Mellitus (DM) were independent risk factors for PCs. The mSAS was not a significant predictor. Conclusions: Neither the SAS nor mSAS was a useful predictor of PCs in patients treated with NAC followed by radical gastrectomy. The predictive value of SAS/mSAS is limited in patients undergoing surgery after NAC.

Validation of the surgical Apgar score in a neurosurgical patient population

2013 ◽  
Vol 118 (2) ◽  
pp. 270-279 ◽  
Author(s):  
John E. Ziewacz ◽  
Matthew C. Davis ◽  
Darryl Lau ◽  
Abdulrahman M. El-Sayed ◽  
Scott E. Regenbogen ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Hospital Stay ◽  
Apgar Score ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Neurosurgical Procedures ◽  
Complication Rates ◽  
Risk Of Death ◽  
Neurosurgical Patient ◽  
Surgical Apgar Score

Object The surgical Apgar score (SAS) reliably predicts postoperative death and complications and has been validated in a large cohort of general and vascular surgery patients. However, there has been limited study of the utility of the score in the neurosurgical population. The authors tested the hypothesis that the SAS would predict postoperative complications and length of stay after neurosurgical procedures. Methods A cohort of 918 intracranial and spine surgery patients treated over a 3-year period were retrospectively evaluated. The 10-point SAS was calculated and postoperative 30-day mortality and complications rates, intensive care unit (ICU) stay, and hospital stay were assessed by 2 independent raters. Univariate analysis and multivariate logistic regression were performed. Results There were 145 patients (15.8%) with at least 1 complication and 24 patients (2.6%) who died within 30 days of surgery. Surgical Apgar scores were significantly associated with the likelihood of postoperative complications (p < 0.001) and death (p = 0.002); scores varied inversely with postoperative complication and mortality risk in a multivariate analysis. Low SASs also predicted prolonged ICU and hospital stay. Patients with scores of 0–2 stayed a mean of 18.9 days (p < 0.001) and patients with scores of 3–4 stayed an average of 14.3 days (p < 0.001) compared with 4.1 days in patients with scores of 9–10. Conclusions The application of the surgical Apgar score to a neurosurgical cohort predicted 30-day postoperative mortality and complication rates as well as extended ICU and hospital stay. This readily calculated score may help neurosurgical teams efficiently direct postoperative care to those at highest risk of death and complications.

Lymphocyte C-reactive protein ratio: A new biomarker to predict early complications after gastrointestinal oncologic surgery

2021 ◽  
pp. 1-9
Author(s):  
Murat Yildirim ◽  
Bulent Koca
Keyword(s):  
Colorectal Cancer ◽  
Postoperative Complications ◽  
Inflammatory Markers ◽  
Operation Time ◽  
C Reactive Protein ◽  
Oncologic Surgery ◽  
Protein Ratio ◽  
Colorectal Cancer Surgery ◽  
Neutrophil Lymphocyte Ratio ◽  
Reactive Protein

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS: Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS: Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9–94.8) sensitivity, and 85.7% (73.6–95.4) selectivity. CONCLUSION: Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.

Clinical and demographical factors associated with fertility counseling in colorectal cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24047-e24047
Author(s):  
Chengwei Peng ◽  
Lena Masri ◽  
Stefanie Roman ◽  
Scott Sherman ◽  
Daniel Jacob Becker
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Univariate Analysis ◽  
Cancer Center ◽  
Survivorship Care ◽  
Demographic Shift ◽  
Curative Intent ◽  
Younger Patients ◽  
Future Fertility ◽  
Fertility Counseling

e24047 Background: The incidence of colorectal cancer in patients younger than 50 has been increasing over the past 2 decades. This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility especially in light of USPSTF’s recommendation for colorectal cancer screening to begin at 45. Although ASCO has longstanding recommendations for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown. Methods: Records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2012 and 2019 were queried for patient demographics, disease characteristics, and documentation of fertility counseling. Associations between demographic/clinical characteristics and fertility counseling were explored. Univariate and multivariable logistical regression analyses were performed using SAS v9.4. Results: Among 194 patients who met inclusion criteria, 39.2% of patients were female, 10.4% were African American, 31.4% had rectal cancer, and 69.6% were treated with curative intent. Approximately 14.5% of patients had Medicaid insurance. Age ranged from 22-55. The overall rate of fertility counseling among all patients was 15.5%. Of these patients, 43.3% were male. In univariate analysis, age less than or equal to 40 (p < 0.01), female gender (p = 0.03) and curative intent therapy (p = 0.03) were associated with fertility counseling. These factors were again statistically significant in multivariate analysis: age < 40, female, and curative intent therapy (Table). Race, stage of cancer, insurance status, prior exposure to chemotherapy, year of diagnosis and colon vs rectal cancer were not associated with counseling. Conclusions: The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men. Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made in fertility counseling. Increases in fertility counseling were not seen in more recent years despite recognition of increasing incidence in younger patients. Additional studies to identify barriers to counseling and strategies to improve survivorship care are urgently needed.[Table: see text]

Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

2017 ◽  
Vol 83 (7) ◽  
pp. 786-792
Author(s):  
Nathan Belkin ◽  
Liliana G. Bordeianou ◽  
Paul C. Shellito ◽  
Alexander T. Hawkins
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Anterior Resection ◽  
Massachusetts General Hospital ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Operation Time ◽  
Emergency Department Visits ◽  
Rectosigmoid Resection ◽  
Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

Sign in / Sign up

Export Citation Format

Share Document