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.

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 ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Apgar Score ◽  
Predictive Value ◽  
Assessment System ◽  
Radical Gastrectomy ◽  
Multiple Logistic Regression ◽  
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 for predicting postoperative complications in primary surgery for gastric cancer. However, few studies have described the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC). Methods One hundred and fifteen patients who received NAC and radical gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by the estimated blood loss (EBL), lowest intraoperative mean arterial pressure, and lowest heart rate. The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for postoperative complications were assessed with univariate and multiple logistic regression analyses. Results Among the 115 patients, 41 (35.7%) developed postoperative complications. According to analyses with receiver operating characteristic curves of the SAS and mSAS for predicting postoperative complications, the cut-off 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 than in those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis showed that the operation time, body mass index, and diabetes mellitus were independent risk factors for postoperative complications. The mSAS was not a significant predictor. Conclusions The predictive value of SAS or mSAS for morbidity may be limited in patients who undergo gastric cancer surgery after NAC. Future prospective studies with a large sample size will be needed to confirm the present results.

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 ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Neoadjuvant Chemotherapy ◽  
Apgar Score ◽  
Predictive Value ◽  
Assessment System ◽  
Radical Gastrectomy ◽  
Multiple Logistic Regression ◽  
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 for predicting postoperative complications in primary surgery for gastric cancer. However, few studies have described the SAS’s utility in gastric surgery after neoadjuvant chemotherapy (NAC).Methods One hundred and fifteen patients who received NAC and radical gastrectomy from 2008 and 2015 were included in this study. The SAS was determined by the estimated blood loss (EBL), lowest intraoperative mean arterial pressure, and lowest heart rate. The mSAS was determined by the EBL reassessed using the interquartile values. The predictive values of the SAS/mSAS for postoperative complications were assessed with univariate and multiple logistic regression analyses.Results Among the 115 patients, 41 (35.7%) developed postoperative complications. According to analyses with receiver operating characteristic curves of the SAS and mSAS for predicting postoperative complications, the cut-off 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 than in those with low (0-3) and moderate (4-7) mSAS values. A multiple logistic regression analysis showed that the operation time, body mass index, and diabetes mellitus were independent risk factors for postoperative complications. The mSAS was not a significant predictor.Conclusion The predictive value of SAS or mSAS for morbidity may be limited in patients who undergo gastric cancer surgery after NAC. Future prospective studies with a large sample size will be needed to confirm the present results.

Predictive value of Surgical Apgar Score for long-term outcome in patients with gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 178-178
Author(s):  
Masanori Tokunaga ◽  
Tomoyuki Irino ◽  
Rie Makuuchi ◽  
Yutaka Tanizawa ◽  
Etsuro Bando ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Apgar Score ◽  
Cancer Center ◽  
Curative Gastrectomy ◽  
Term Survival ◽  
Long Term Outcome ◽  
Estimated Blood Loss ◽  
The Impact ◽  
Surgical Apgar Score

178 Background: Recently, a simple and easy complication prediction system, the surgical Apgar score (SAS) calculated according to three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. We previously reported on the predictive power of SAS for severe complications after gastrectomy. However, the impact of SAS on long-term survival is still unclear. The aim of the present study was to clarify the relationship between SAS and survival outcome in patients with gastric cancer undergoing curative gastrectomy. Methods: This study included 302 patients who underwent curative gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. When the SAS score was ≤ 6, patients were classified into an L-SAS group (n = 82), otherwise, they were classified into an H-SAS group (n = 220). Clinicopathological characteristics and survival outcomes were compared between the groups. Results: There was no difference in demographic data including sex and age between the groups. Total gastrectomy was more frequently performed in the L-SAS group (43%) than in the H-SAS group (21%; P < 0.001). The L-SAS group included patients with higher pT and pN stage. Five-year overall survival rate was worse in the L-SAS group (65.4%) than in the H-SAS group (82.7%; P < 0.001). Multivariate analysis, which included age, sex, histology, pT, pN, type of surgery and SAS as covariates, identified lower SAS (HR, 1.71, 95% C.I., 1.04-2.80) as well as age (HR, 1.62, 95% C.I., 1.10-2.40) and pN (HR, 2.05, 95% C.I., 1.19-3.52) as independent prognostic factors. Conclusions: The SAS was found to be a predictive factor for survival. Intraoperative bleeding and vital signs may affect survival of patients, and therefore warrant special attention from surgeons and anesthesiologists.

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.

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