Clinical Benefits of Predicting Surgical Risk by E-PASS in Colorectal Cancer Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Zongli ^1,2 , HUANG Rui ^1,2 , MENG Yue ^1,2 , CHEN Qi ^1,2 , WANG Xiaodong ^2,3 ,  LI Li ^2,3

1.West China School of Medicine/West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.MCQ of Gastrointestinal Surgery Department, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
3.Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

LI Li, Email: drlili116@126.com

Keywords：

Colorectal cancer; Estimation of physiologic ability and surgical stress; Evaluation; Complication

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ObjectiveTo evaluate the usefulness of estimation of physiologic ability and surgical stress (E-PASS) for predicting postoperative complications in patients undergoing elective colorectal cancer surgery. MethodsPatients underwent colorectal cancer surgery between August 2009 and October 2010 were analyzed retrospectively. E-PASS equations were applied to those patients for estimation of operative risk. The preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) of the E-PASS were compared with actual postoperative complications. The relationship between E-PASS variables and morbidity after colorectal cancer surgery was identified. ResultsOf the 313 patients, 22 (7.0%) had postoperative complications. Of all the E-PASS variables between complicative group and noncomplicative group, the morbidity was significantly correlated to age (P=0.003), weight (P=0.019), tumor histologic types (P=0.033), Dukes stage (P=0.001), severe heart disease (P=0.019), severe pulmonary disease (P=0.000), performance status (P=0.000), loss of blood volume/body weight (P=0.007), loss of blood volume (P=0.001) and operation time (P=0.001). Differentiation degree of tumor (P=0.503), diabetes (P=0.745), ASA grade (P=0.085), and size of surgical incision (P=0.726) were not significantly associated with postoperative complications. The PRS and CRS were higher in complicative group than those in noncomplicative group (P lt;0.001). But the difference of SSS between the two groups was not statistically significant (P=0.059). ConclusionThe E-PASS scoring system is a relatively simple, fast, and operable tool that can be used to predict short-term postoperative morbidity accurately for clinical decision-making in colorectal cancer surgery.

Citation： HU Zongli ,HUANG Rui,MENG Yue,CHEN Qi,WANG Xiaodong,LI Li. Clinical Benefits of Predicting Surgical Risk by E-PASS in Colorectal Cancer Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(1): 43-47. doi: Copy

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3.	Kulkarni SV, Naik AS, Subramanian N Jr. APACHEⅡ scoring system in erforative peritonitis [J]. Am J Surg, 2007， 194(4): 549552.
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5.	Haga Y, Ikei S, Wada Y, et al. Evaluation of an Estimation of Physiologic Ability and Surgical Stress (EPASS) scoring system to predict postoperative risk: a multicenter prospective study [J]. Surg Today, 2001， 31(7): 569574.
6.	Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system: estimation of physiologic ability and surgical stress [J]. Arch Surg, 2002， 137(4): 481485.
7.	Haga Y, Wada Y, Takeuchi H, et al. Estimation of physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery [J]. Surgery, 2004， 135(6): 586594.
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9.	Tang T， Walsh SR， Fanshawe TR, et al. Estimation of physiologic ability and surgical stress (EPASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery [J]. Am J Surg, 2007， 194(2): 176182.
10.	吕东昊, 汪晓东, 阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007， 14(6): 713715.
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12.	Russell SD, Saval MA, Robbins JL, et al. New York Heart Association functional class predicts exercise parameters in the current era [J]. Am Heart J, 2009， 158(4 Suppl): S24S30.
13.	Lonit D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008， 57(2): 7074.
14.	Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study [J]. Cancer, 1995, 76(10): 17311736.
15.	Hirose J， Mizuta H， Ide J, et al. EPASS for predicting postoperative risk with hip fracture: a multicenter study [J]. Clin Orthop Relat Res, 2008， 466(11): 28332841.
16.	Tang TY, Walsh SR, Fanshawe TR, et al. Comparison of riskscoring methods in predicting the immediate outcome after elective open abdominal aortic aneurysm surgery [J]. Eur J Vasc Endovasc Surg， 2007， 34(5): 505513.
17.	Oka Y， Nishijima J， Oku K, et al. Usefulness of an estimation of physiologic ability and surgical stress (EPASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery [J]. World J Surg, 2005， 29(8): 10291033.
18.	Dukes CE. The classification of cancer of the rectum [J]. Dis Colon Rectum, 1980， 23(8): 605611.
19.	Sakurai Y， Uyama I. Neoadjuvant and postoperative adjuvant anticancer chemotherapy in gastric cancer [J]. Ann Surg Oncol, 2009， 16(5): 14441445.
20.	汪晓东, 谭嘉熙，杨文旭，等. 多学科协作诊治模式下新辅助化疗联合手术治疗直肠癌的随机对照研究 [J]. 中国普外基础与临床杂志， 2008， 15(12): 937940.
21.	汪晓东, 邱萌, 李亚伦, 等. 多学科协作诊治模式下结直肠癌不同周期新辅助化疗联合手术的方案研究 [J]. 中国普外基础与临床杂志， 2008， 15(3): 210214, 217.
22.	Wilmore DW， Kehlet H. Recent advances： management of patients in fast track surgery [J]. BMJ， 2001， 322(7284)： 473476．.
23.	汪晓东, 谢尧, 肖军，等. 快速流程在结直肠外科手术后管理中的应用 [J]. 中国普通外科杂志, 2008， 17(4): 394396.

1. Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortalityin patients with colorectal cancer: a prospective study [J]. Lancet Oncol, 2007， 8(4): 317322.
2. Alves A, Panis Y, Mantion G, et al. The AFC score: validation of a 4item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1 049 patients [J]. Ann Surg, 2007， 246(1): 9196.
3. Kulkarni SV, Naik AS, Subramanian N Jr. APACHEⅡ scoring system in erforative peritonitis [J]. Am J Surg, 2007， 194(4): 549552.
4. 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 gastrointestinal surgery [J]. Surg Today, 1999， 29(3): 219225.
5. Haga Y, Ikei S, Wada Y, et al. Evaluation of an Estimation of Physiologic Ability and Surgical Stress (EPASS) scoring system to predict postoperative risk: a multicenter prospective study [J]. Surg Today, 2001， 31(7): 569574.
6. Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system: estimation of physiologic ability and surgical stress [J]. Arch Surg, 2002， 137(4): 481485.
7. Haga Y, Wada Y, Takeuchi H, et al. Estimation of physiologic ability and surgical stress (EPASS) for a surgical audit in elective digestive surgery [J]. Surgery, 2004， 135(6): 586594.
8. Hirose J， Mizuta H， Ide J, et al. Evaluation of estimation of physiologic ability and surgical stress (EPASS) to predict the postoperative risk for hip fracture in elder patients [J]. Arch Orthop Trauma Surg, 2008， 128(12): 14471452.
9. Tang T， Walsh SR， Fanshawe TR, et al. Estimation of physiologic ability and surgical stress (EPASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery [J]. Am J Surg, 2007， 194(2): 176182.
10. 吕东昊, 汪晓东, 阳川华，等. 结直肠肿瘤多学科协作诊治模式的数据库初期建设现状 [J]. 中国普外基础与临床杂志, 2007， 14(6): 713715.
11. 汪晓东, 冯硕, 游小林，等. 结直肠肿瘤多学科协作诊治模式下的随访体系建设 [J]. 中国普外基础与临床杂志, 2007， 14(6): 709712.
12. Russell SD, Saval MA, Robbins JL, et al. New York Heart Association functional class predicts exercise parameters in the current era [J]. Am Heart J, 2009， 158(4 Suppl): S24S30.
13. Lonit D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008， 57(2): 7074.
14. Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study [J]. Cancer, 1995, 76(10): 17311736.
15. Hirose J， Mizuta H， Ide J, et al. EPASS for predicting postoperative risk with hip fracture: a multicenter study [J]. Clin Orthop Relat Res, 2008， 466(11): 28332841.
16. Tang TY, Walsh SR, Fanshawe TR, et al. Comparison of riskscoring methods in predicting the immediate outcome after elective open abdominal aortic aneurysm surgery [J]. Eur J Vasc Endovasc Surg， 2007， 34(5): 505513.
17. Oka Y， Nishijima J， Oku K, et al. Usefulness of an estimation of physiologic ability and surgical stress (EPASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery [J]. World J Surg, 2005， 29(8): 10291033.
18. Dukes CE. The classification of cancer of the rectum [J]. Dis Colon Rectum, 1980， 23(8): 605611.
19. Sakurai Y， Uyama I. Neoadjuvant and postoperative adjuvant anticancer chemotherapy in gastric cancer [J]. Ann Surg Oncol, 2009， 16(5): 14441445.
20. 汪晓东, 谭嘉熙，杨文旭，等. 多学科协作诊治模式下新辅助化疗联合手术治疗直肠癌的随机对照研究 [J]. 中国普外基础与临床杂志， 2008， 15(12): 937940.
21. 汪晓东, 邱萌, 李亚伦, 等. 多学科协作诊治模式下结直肠癌不同周期新辅助化疗联合手术的方案研究 [J]. 中国普外基础与临床杂志， 2008， 15(3): 210214, 217.
22. Wilmore DW， Kehlet H. Recent advances： management of patients in fast track surgery [J]. BMJ， 2001， 322(7284)： 473476．.
23. 汪晓东, 谢尧, 肖军，等. 快速流程在结直肠外科手术后管理中的应用 [J]. 中国普通外科杂志, 2008， 17(4): 394396.

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