Skip to main content
Top
Published in: World Journal of Surgery 9/2010

01-09-2010

POSSUM and Its Related Models as Predictors of Postoperative Mortality and Morbidity in Patients Undergoing Surgery for Gastro-oesophageal Cancer: A Systematic Review

Authors: Sumanta Dutta, Paul G. Horgan, Donald C. McMillan

Published in: World Journal of Surgery | Issue 9/2010

Login to get access

Abstract

Background

Gastro-oesophageal surgery is associated with appreciable postoperative morbidity and mortality. POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity) and its related models P-POSSUM and O-POSSUM have been developed to predict such events in general surgery. The aim was to undertake the first systematic review of the use of these models in gastro-oesophageal surgery patients.

Methods

An online database search was carried out from 1991 to December 2008.

Results

Twenty-two published studies in gastro-oesophageal cancer surgery were identified. Twelve studies were found not to address the above aim, leaving ten relevant publications for analysis. Pooled data from these studies showed the weighted observed-to-expected ratio (O/E) for postoperative mortality using POSSUM (n = 1189), P-POSSUM (n = 2314), and O-POSSUM (n = 1755) was 0.37, 0.83, and 0.51, respectively. The weighted O/E for morbidity using POSSUM (n = 1038) was 0.86.

Conclusion

POSSUM and O-POSSUM most significantly overestimated postoperative mortality in gastro-oesophageal cancer patients. In contrast, P-POSSUM had the least overestimation and may be the most useful predictor of likely postoperative mortality in these patients.
Literature
1.
go back to reference Koshy M, Esiashvilli N, Landry JC et al (2004) Multiple management modalities in esophageal cancer: epidemiology, presentation and progression, work-up, and surgical approaches. Oncologist 9:137–146CrossRefPubMed Koshy M, Esiashvilli N, Landry JC et al (2004) Multiple management modalities in esophageal cancer: epidemiology, presentation and progression, work-up, and surgical approaches. Oncologist 9:137–146CrossRefPubMed
2.
go back to reference Jamieson GG, Mathew G, Ludemann R et al (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 91:943–947CrossRefPubMed Jamieson GG, Mathew G, Ludemann R et al (2004) Postoperative mortality following oesophagectomy and problems in reporting its rate. Br J Surg 91:943–947CrossRefPubMed
3.
go back to reference Nagabhushan JS, Srinath S, Weir F et al (2007) Comparison of P-POSSUM and O-POSSUM in predicting mortality after oesophagogastric resections. Postgrad Med J 83:355–358CrossRefPubMed Nagabhushan JS, Srinath S, Weir F et al (2007) Comparison of P-POSSUM and O-POSSUM in predicting mortality after oesophagogastric resections. Postgrad Med J 83:355–358CrossRefPubMed
4.
go back to reference Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360CrossRefPubMed Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360CrossRefPubMed
5.
go back to reference Whiteley MS, Prytherch DR, Higgins B et al (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815CrossRefPubMed Whiteley MS, Prytherch DR, Higgins B et al (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815CrossRefPubMed
6.
go back to reference Prytherch DR, Ridler BM, Beard JD et al (2001) A model for national outcome audit in vascular surgery. Eur J Vasc Endovasc Surg 21:477–483CrossRefPubMed Prytherch DR, Ridler BM, Beard JD et al (2001) A model for national outcome audit in vascular surgery. Eur J Vasc Endovasc Surg 21:477–483CrossRefPubMed
7.
go back to reference Prytherch DR, Sutton GL, Boyle JR (2001) Portsmouth POSSUM models for abdominal aortic aneurysm surgery. Br J Surg 88:958–963CrossRefPubMed Prytherch DR, Sutton GL, Boyle JR (2001) Portsmouth POSSUM models for abdominal aortic aneurysm surgery. Br J Surg 88:958–963CrossRefPubMed
8.
go back to reference Tekkis PP, Prytherch DR, Kocher HM et al (2004) Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182CrossRefPubMed Tekkis PP, Prytherch DR, Kocher HM et al (2004) Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182CrossRefPubMed
9.
go back to reference Jones DR, Copeland GP, de Cossart L (1992) Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit. Br J Surg 79:1293–1296CrossRefPubMed Jones DR, Copeland GP, de Cossart L (1992) Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit. Br J Surg 79:1293–1296CrossRefPubMed
10.
go back to reference Tekkis PP, McCulloch P, Poloniecki JD et al (2004) Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM. Br J Surg 91:288–295CrossRefPubMed Tekkis PP, McCulloch P, Poloniecki JD et al (2004) Risk-adjusted prediction of operative mortality in oesophagogastric surgery with O-POSSUM. Br J Surg 91:288–295CrossRefPubMed
11.
go back to reference Zafirellis KD, Fountoulakis A, Dolan K et al (2002) Evaluation of POSSUM in patients with oesophageal cancer undergoing resection. Br J Surg 89:1150–1155CrossRefPubMed Zafirellis KD, Fountoulakis A, Dolan K et al (2002) Evaluation of POSSUM in patients with oesophageal cancer undergoing resection. Br J Surg 89:1150–1155CrossRefPubMed
12.
go back to reference Bollschweiler E, Lubke T, Monig SP et al (2005) Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy. BMC Surg 5:8CrossRefPubMed Bollschweiler E, Lubke T, Monig SP et al (2005) Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy. BMC Surg 5:8CrossRefPubMed
13.
go back to reference Lai F, Kwan TL, Yuen WC et al (2007) Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma. Br J Surg 94:1172–1178CrossRefPubMed Lai F, Kwan TL, Yuen WC et al (2007) Evaluation of various POSSUM models for predicting mortality in patients undergoing elective oesophagectomy for carcinoma. Br J Surg 94:1172–1178CrossRefPubMed
14.
go back to reference Otsuka Y, Kunisaki C, Ono H et al (2007) Modified POSSUM to predict postoperative morbidity following gastrectomy. Hepatogastroenterology 54:1142–1145PubMed Otsuka Y, Kunisaki C, Ono H et al (2007) Modified POSSUM to predict postoperative morbidity following gastrectomy. Hepatogastroenterology 54:1142–1145PubMed
15.
go back to reference Lamb P, Sivashanmugam T, White M et al (2008) Gastric cancer surgery—a balance of risk and radicality. Ann R Coll Surg Engl 90:235–242CrossRefPubMed Lamb P, Sivashanmugam T, White M et al (2008) Gastric cancer surgery—a balance of risk and radicality. Ann R Coll Surg Engl 90:235–242CrossRefPubMed
16.
go back to reference Gocmen E, Koc M, Tez M et al (2004) Evaluation of P-POSSUM and O-POSSUM scores in patients with gastric cancer undergoing resection. Hepatogastroenterology 51:1864–1866PubMed Gocmen E, Koc M, Tez M et al (2004) Evaluation of P-POSSUM and O-POSSUM scores in patients with gastric cancer undergoing resection. Hepatogastroenterology 51:1864–1866PubMed
17.
go back to reference Internullo E, Moons J, Nafteux P et al (2008) Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg 33:1096–1104CrossRefPubMed Internullo E, Moons J, Nafteux P et al (2008) Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg 33:1096–1104CrossRefPubMed
18.
go back to reference Lagarde SM, Maris AK, de Castro SM et al (2007) Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg 94:1521–1526CrossRefPubMed Lagarde SM, Maris AK, de Castro SM et al (2007) Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer. Br J Surg 94:1521–1526CrossRefPubMed
19.
go back to reference Sah BK, Min CM, Yan WX et al (2008) Risk adjusted auditing of postop complications in gastric cancer patients by POSSUM. Int J Surg 6:311–316CrossRefPubMed Sah BK, Min CM, Yan WX et al (2008) Risk adjusted auditing of postop complications in gastric cancer patients by POSSUM. Int J Surg 6:311–316CrossRefPubMed
20.
go back to reference McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67:257–262CrossRefPubMed McMillan DC (2008) An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc 67:257–262CrossRefPubMed
21.
go back to reference McMillan DC (2009) Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 12:223–226CrossRefPubMed McMillan DC (2009) Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care 12:223–226CrossRefPubMed
22.
go back to reference Brosens RP, Oomen JL, Glas AS et al (2006) POSSUM predicts decreased overall survival in curative resection for colorectal cancer. Dis Colon Rectum 49:825–832CrossRefPubMed Brosens RP, Oomen JL, Glas AS et al (2006) POSSUM predicts decreased overall survival in curative resection for colorectal cancer. Dis Colon Rectum 49:825–832CrossRefPubMed
23.
go back to reference Jenkins JT, O’Neill G, Morran CG (2007) The relationship between patient physiology and cancer-specific survival following curative resection of colorectal cancer. Br J Cancer 96:213–217CrossRefPubMed Jenkins JT, O’Neill G, Morran CG (2007) The relationship between patient physiology and cancer-specific survival following curative resection of colorectal cancer. Br J Cancer 96:213–217CrossRefPubMed
24.
go back to reference de Castro SM, Houwert JT, Lagard SM et al (2009) POSSUM predicts survival in patients with unresectable pancreatic cancer. Dig Surg 26:75–79CrossRefPubMed de Castro SM, Houwert JT, Lagard SM et al (2009) POSSUM predicts survival in patients with unresectable pancreatic cancer. Dig Surg 26:75–79CrossRefPubMed
25.
go back to reference Moyes LH, Leitch EF, McKee RF et al (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100:1236–1239CrossRefPubMed Moyes LH, Leitch EF, McKee RF et al (2009) Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer. Br J Cancer 100:1236–1239CrossRefPubMed
Metadata
Title
POSSUM and Its Related Models as Predictors of Postoperative Mortality and Morbidity in Patients Undergoing Surgery for Gastro-oesophageal Cancer: A Systematic Review
Authors
Sumanta Dutta
Paul G. Horgan
Donald C. McMillan
Publication date
01-09-2010
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 9/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-010-0685-z

Other articles of this Issue 9/2010

World Journal of Surgery 9/2010 Go to the issue