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01-01-2009 | Original Article

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Authors: V. Valenti, J. L. Hernandez-Lizoain, J. Baixauli, C. Pastor, F. Martinez-Regueira, J. J. Beunza, J. J. Aristu, J. Alvarez Cienfuegos

Published in: Langenbeck's Archives of Surgery | Issue 1/2009

Abstract

Background

The Physiological and Operative Severity Score for the enUmeration of Mortality andmorbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM) have been used to predictmorbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations needsome adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group ofpatients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables.

Methods

between January 1995 and December 2004, 273 consecutive patients underwent surgery forrectal cancer. Information was gathered about the patients, tumour and therapy. To assess the predictioncapacity of POSSUM, subgroups for analysis were created according to variables related to operativemorbidity and mortality.

Results

The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7%(6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUMpredictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for thosereceiving neoadjuvant therapy.

Conclusion

POSSUM is a good instrument to make results between different institutions and publicationcomparable. We found prediction errors for some variables related to morbidity. Modifications of surgicalvariables and specifications for neoadjuvant therapy as well as physiological variables including life stylemay improve future prediction of surgical risk. More research is needed to identify further potential riskfactors for surgical complications.

Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ (1998) POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and operative severity score for the enumeration of mortality and morbidity. Br J Surg 85(9):1217–1220PubMedCrossRef

Oomen JL, Engel AF, Cuesta MA (2006) Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis 8(2):112–119PubMedCrossRef

Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78(3):355–360 MarPubMedCrossRef

Neary WD, Heather BP, Earnshaw JJ (2003) The physiological and operative severity score for enumeration of mortality and morbidity (POSSUM). Br J Surg 90:157–165PubMedCrossRef

Copeland GP (2002) The POSSUM system of surgical audit. Arch Surg 137:15–19PubMedCrossRef

Tekkis PP, Kessaris N, Kocher HM, Poloniecki JD, Lyttle J, Windsor AC (2003) Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery. Br J Surg 90(3):340–345PubMedCrossRef

Whitely MS (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815CrossRef

Wijesinghe LD, Mahmood T, Sacott DJ, Berridge DC, Kent PJ, Kester RC (1998) Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery. Br J Surg 85:209–212PubMedCrossRef

Poon JT, Chan B, Law WL (2005) Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 48(3):493–498PubMedCrossRef

10.

Menon KV, Farouk R (2002) An analysis of the accuracy of P-POSSUM scoring for mortality risk assessment after surgery for colorectal cancer. Colorectal Dis 4(3):197–200PubMedCrossRef

11.

Khoury G (2003) Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery (Br J Surg 2003; 90: 340–345). Br J Surg 90(8):1021 author reply, AugPubMedCrossRef

12.

Brooks MJ, Sutton R, Sarin S (2005) Comparison of surgical risk score, POSSUM and p-POSSUM in higher-risk surgical patients. Br J Surg 92(10):1288–1292PubMedCrossRef

13.

Tekkis PP, Kinsman R, Thompson MD, Stamatakis JD (2004) The association of coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81PubMedCrossRef

14.

Law WL, Lam CM, Lee YM (2006) Evaluation of outcome of laparoscopic colorectal resection with POSSUM, Portsmouth POSSUM and colorectal POSSUM. Br J Surg 93(1):94–99PubMedCrossRef

15.

Ramkumar T, Ng V, Fowler L, Farouk R (2006) A comparison of POSSUM, P-POSSUM and colorectal POSSUM for the prediction of postoperative mortality in patients undergoing colorectal resection. Dis Colon Rectum 49(3):330–335PubMedCrossRef

16.

Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW (2004) POSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum 47(9):1435–1441PubMed

17.

American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:111

18.

AJCC (2002) Cancer staging handbook: TNM classification of malignant tumors. 6th edn. Sixth ed. Springer, New York

19.

International Commission on Radiation Units and Measurements Report 50 (1993) Prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units

20.

Molina GO, Garrido LO, Manterola CD (2005) Evaluación de resultados quirúrgicos. Validación inicial del escore POSSUM. Rev Chilena de Cirugía 57(4):291–296

21.

Isbister WH (2000) Study populations and case mix: influence on analysis of postoperative outcomes. Aust NZ J Surg 70:279–284CrossRef

22.

Murray GHC, Fowler S, Dunn DC (1995) Presentation of comparative audit data. Br J Surg 82:329–332PubMedCrossRef

23.

Jones HJS, de Cossart L (1999) Risk scoring in surgical patients. Br J Surg 86:149–157PubMedCrossRef

24.

Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. J Am Med Assoc 178:261–266

25.

Hall JC, Hall JL (1996) ASA status and age predict adverse events after abdominal surgery. Journal for Quality in Clinical Practice 16(2):103–108

26.

Bufalari A, Giustozzi G, Burattini MF, Servili S, Bussotti C, Lucaroni E et al (2006) Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors. J Surg Oncol 93(3):173–180 Mar 1PubMedCrossRef

27.

Bold RJ (2006) Re: Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors, by Bufalari A, Giustozzi G, Burattini MF, et al. J Surg Oncol 93(3):167–168PubMedCrossRef

28.

Puig la Calle J, Quayle J, Thaler HT, Shi W, Paty P, Quan SH et al (2000) Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Col Rectum 43(12):1704–1709CrossRef

29.

Kuzu MA, Koksoy C, Akyol F, Uzal D, Kale T (1998) Effects of preoperative fractionated irradiation on left colonic anastomoses in the rat. Dis Colon Rectum 41:370–376PubMedCrossRef

30.

Dominuez J, Jakate S, Speziale S, Savin M, Altringer WE, Saclarides TJ (1996) Intestinal anastomotic healing at varying times after irradiation. J Surg Res 61:293–299CrossRef

31.

Pucciarelli S, Toppan P, Friso ML, Fornasiero A, Vieceli G, Marchiori E et al (1999) Preoperative combined radiotherapy and chemotherapy for rectal cancer does not affect early postoperative morbidity and mortality in low anterior resection. Dis Colon Rectum 42(10):1276–1283 discussion 83–84PubMedCrossRef

32.

Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T et al (2002) Acute effects and complications after short term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825PubMedCrossRef

33.

Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand S et al (1997) A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum. A progress report of national surgical adjuvant breast and bowel project protocol R.03. Dis Col Rectum 40(2):131–139CrossRef

34.

Shumate C, Rich T, Skibber J, Ajani J, Ota D (1993) Preoperative chemotherapy and radiation therapy for locally advanced primary and recurrent rectal carcinoma. A report of surgical morbidity. Cancer 71:3690–3696PubMedCrossRef

35.

Stryker SJ, Kiel KD, Rademaker A, Shaw J, Ujiki G, Poticha S (1996) Preoperative “chemoradiation” for stages II and III rectal cancer. Arch Surg 131:514–518PubMed

36.

Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227(6):800–811PubMedCrossRef

37.

Rosen L, Veidenheimer MC, Coller JA, Corman ML (1982) Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum 25:202PubMedCrossRef

38.

Isbister WH, Naser S (2002) POSSUM: A re-evaluation in patients undergoing surgery for rectal cancer. Aust NZ J Surg 72:421–425CrossRef

39.

Menon KV, Whiteley MS, Burden P, Galland RB (1999) Surgical patients with methicillin resistant staphylococcus aureus infection: An analysis of outcome using P-POSSUM. J R Coll Surg Edinb 44:161–163PubMed

40.

Parinkh D, Johnson M, Chagla L, Lowe D (1996) Lessons from a prospective audit of the learning curve. Br J Surg 83:1595–1599CrossRef

41.

Sagar PM, Hartley MN, Mancey-Jones B, Sedman PC, May J, Macfie J (1994) Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg 81:1492–1494PubMedCrossRef

42.

Jones HJS, Foster GE, de Cossart L (1999) Colorectal surgery: does POSSUM predict outcome? Dis Col Rectum 42:A18

43.

Cagigas JC, Escalante CF, Ingelmo A et al (1999) Application of POSSUM system to bariatric surgery. Obesity Surg 9:279–281CrossRef

Title: Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery
Authors: V. Valenti
J. L. Hernandez-Lizoain
J. Baixauli
C. Pastor
F. Martinez-Regueira
J. J. Beunza
J. J. Aristu
J. Alvarez Cienfuegos
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 1/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0314-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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