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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2017

01-12-2017 | Gastrointestinal Oncology

The Surgical Apgar Score Predicts Not Only Short-Term Complications But Also Long-Term Prognosis After Esophagectomy

Authors: Akio Nakagawa, MD, Tetsu Nakamura, MD, PhD, Taro Oshikiri, MD, PhD, Hiroshi Hasegawa, MD, PhD, Masashi Yamamoto, MD, PhD, Shingo Kanaji, MD, PhD, Yoshiko Matsuda, MD, PhD, Kimihiro Yamashita, MD, PhD, Takeru Matsuda, MD, PhD, Yasuo Sumi, MD, PhD, Satoshi Suzuki, MD, PhD, Yoshihiro Kakeji, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2017

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Abstract

Background

The surgical Apgar score (SAS) quantifies three intraoperative factors and predicts postoperative complications, but few reports describe its usefulness in esophagectomy, and no studies to date show its correlation with long-term prognosis after esophagectomy.

Methods

This study investigated 400 cases in which esophagectomy was performed on esophageal malignant tumors at the authors’ hospital from January 2007 to January 2017. In this study, SAS was defined as the sum of the scores of three parameters, namely, estimated blood loss, lowest mean arterial pressure, and lowest heart rate, with values extracted from medical records. Postoperative complications classified as Clavien–Dindo grade 3 or higher were also extracted. The study retrospectively compared the relationship of SAS to postoperative complications and survival.

Results

Univariate analysis showed that postoperative complications were significantly associated with hypertension (p = 0.017), thoracotomy (p = 0.012), and SAS ≤ 5 (p < 0.0001), and multivariate analysis showed that hypertension (p = 0.049) and SAS ≤ 5 (p < 0.0001) were significant predictive factors for complications. In the prognostic analysis, log-rank analysis showed that patients with an SAS ≤ 5 had a significantly poorer prognosis than those with a SAS > 5 (p = 0.043), especially for complications classified as clinical stage 2 or higher (p = 0.027). In the multivariate analysis, SAS ≤ 5 was identified as a significantly poor prognostic factor for complications classified as clinical stage 2 or higher (p = 0.029).

Conclusion

In this study, SAS was useful not only for predicting short-term complications, but also as a long-term prognostic factor after esophagectomy.
Literature
1.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379:1887–92.CrossRefPubMed
2.
Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage i gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.CrossRefPubMed
3.
Ng SS, Lee JF, Yiu RY, et al. Laparoscopic-assisted versus open total mesorectal excision with anal sphincter preservation for mid and low rectal cancer: a prospective, randomized trial. Surg Endosc. 2014;28:297–306.CrossRefPubMed
4.
Markar SR, Karthikesalingam A, Thrumurthy S, Low DE. Volume–outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000–2011. J Gastrointest Surg. 2012;16:1055–63.CrossRefPubMed
5.
6.
Baba Y, Yoshida N, Shigaki H, et al. Prognostic impact of postoperative complications in 502 patients with surgically resected esophageal squamous cell carcinoma: a retrospective single-institution study. Ann Surg. 2016;264:305–11.CrossRefPubMed
7.
Rutegard M, Lagergren P, Rouvelas I, Mason R, Lagergren J. Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study. Eur J Surg Oncol. 2012;38:555–61.CrossRefPubMed
8.
Kinugasa S, Tachibana M, Yoshimura H, et al. Postoperative pulmonary complications are associated with worse short- and long-term outcomes after extended esophagectomy. J Surg Oncol. 2004;88:71–7.CrossRefPubMed
9.
Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Med Baltim. 2015;94:e1369.CrossRefPubMedPubMedCentral
10.
Haga Y, Ikei S, Ogawa M. Estimation of physiologic ability and surgical stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery. Surg Today. 1999;29:219–25.CrossRefPubMed
11.
Vaid S. Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data. Perm J. 2012:10–7.
12.
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–60.CrossRefPubMed
13.
Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007;204:201–8.CrossRefPubMed
14.
Masi A, Amodeo S, Hatzaras I, et al. Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery. Am J Surg. 2017;213:696–705.CrossRefPubMed
15.
Assifi MM, Lindenmeyer J, Leiby BE, et al. Surgical Apgar score predicts perioperative morbidity in patients undergoing pancreaticoduodenectomy at a high-volume center. J Gastrointest Surg. 2012;16:275–81.CrossRefPubMed
16.
Urrutia J, Valdes M, Zamora T, Canessa V, Briceno J. An assessment of the surgical Apgar score in spine surgery. Spine J. 2015;15:105–9.CrossRefPubMed
17.
Melis M, Pinna A, Okochi S, et al. Validation of the surgical Apgar score in a veteran population undergoing general surgery. J Am Coll Surg. 2014;218:218–25.CrossRefPubMed
18.
Regenbogen SE, Ehrenfeld JM, Lipsitz SR, Greenberg CC, Hutter MM, Gawande AA. Utility of the surgical Apgar score: validation in 4119 patients. Arch Surg. 2009;144:30–6.CrossRefPubMed
19.
Haynes AB, Regenbogen SE, Weiser TG, Lipsitz SR, Dziekan G, Berry WR, Gawande AA. Surgical outcome measurement for a global patient population: validation of the surgical Apgar score in 8 countries. Surgery. 2011;149:519–24.CrossRefPubMed
20.
Xing XZ, Wang HJ, Qu SN, et al. The value of esophagectomy surgical Apgar score (eSAS) in predicting the risk of major morbidity after open esophagectomy. J Thorac Dis. 2016;8:1780–7.CrossRefPubMedPubMedCentral
21.
Janowak CF, Blasberg JD, Taylor L, Maloney JD, Macke RA. The surgical Apgar score in esophagectomy. J Thorac Cardiovasc Surg. 2015;150:806–12.CrossRefPubMed
22.
Eto K, Yoshida N, Iwatsuki M, et al. surgical Apgar score predicted postoperative morbidity after esophagectomy for esophageal cancer. World J Surg. 2016;40:1145–51.CrossRefPubMed
23.
Strøyer S, Mantoni T, Svendsen LB. Evaluation of the surgical Apgar score in patients undergoing Ivor–Lewis esophagectomy. J Surg Oncol. 2017.
24.
Owens WD, Felts JA, Spitznagel E Jr. ASA physical status classifications: a study of consistency of ratings. Anesthesiology. 1978;49:239–43.CrossRefPubMed
25.
26.
Katayama H, Kurokawa Y, Nakamura K, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.CrossRefPubMed
27.
Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefPubMed
28.
Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.CrossRefPubMed
29.
Otowa Y, Nakamura T, Takiguchi G, et al. Changes in modified Glasgow prognostic score after neoadjuvant chemotherapy is a prognostic factor in clinical stage II/III esophageal cancer. Dis Esophagus. 2016;29:146–51.CrossRefPubMed
30.
Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay: a randomised, controlled trial [ISRCTN38797445]. Crit Care. 2005;9:R687–93.CrossRefPubMedPubMedCentral
31.
Salzwedel C, Puig J, Carstens A, et al. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care. 2013;17:R191.CrossRefPubMedPubMedCentral
32.
Post IL, Verheijen PM, Pronk A, Siccama I, Houweling PL. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2012;27:765–72.CrossRefPubMedPubMedCentral
33.
Reich DL, Bennett-Guerrero E, Bodian CA, Hossain S, Winfree W, Krol M. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration. Anesth Analg. 2002;95:273–7.PubMed
34.
Law S, Wong K-H, Kwok K-F, Chu K-M, Wong J. Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004;240:791–800.CrossRefPubMedPubMedCentral
35.
Avendano CE, Flume PA, Silvestri GA, King LB, Reed CE. Pulmonary complications after esophagectomy. Ann Thorac Surg. 2002;73:922–6.CrossRefPubMed
36.
Zingg U, Forberger J, Rajcic B, Langton C, Jamieson GG. Association of C-reactive protein levels and long-term survival after neoadjuvant therapy and esophagectomy for esophageal cancer. J Gastrointest Surg. 2010;14:462–9.CrossRefPubMed
37.
Lindenmann J, Fink-Neuboeck N, Avian A, Pichler M, Habitzrruther M, Maier A, Smolle-Juettner F.M. Preoperative Glasgow Prognostic Score as additional independent prognostic parameter for patients with esophageal cancer after curative esophagectomy. Eur J Surg Oncol. 2017;43:445–53.CrossRefPubMed
38.
Nakamura K, Yoshida N, Baba Y, et al. Elevated preoperative neutrophil-to-lymphocytes ratio predicts poor prognosis after esophagectomy in T1 esophageal cancer. Int J Clin Oncol. 2017.
Metadata
Title
The Surgical Apgar Score Predicts Not Only Short-Term Complications But Also Long-Term Prognosis After Esophagectomy
Authors
Akio Nakagawa, MD
Tetsu Nakamura, MD, PhD
Taro Oshikiri, MD, PhD
Hiroshi Hasegawa, MD, PhD
Masashi Yamamoto, MD, PhD
Shingo Kanaji, MD, PhD
Yoshiko Matsuda, MD, PhD
Kimihiro Yamashita, MD, PhD
Takeru Matsuda, MD, PhD
Yasuo Sumi, MD, PhD
Satoshi Suzuki, MD, PhD
Yoshihiro Kakeji, MD, PhD
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 13/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-6103-0

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