Miki Yuichiro, Tokunaga Masanori, Tanizawa Yutaka, Bando Etsuro, Kawamura Taiichi, Terashima Masanori
Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Ann Surg Oncol. 2014 Aug;21(8):2601-7. doi: 10.1245/s10434-014-3653-2. Epub 2014 Mar 25.
Recently, a simple and easy complication prediction system, the surgical apgar score (SAS) calculated by three intraoperative parameters (estimated blood loss, lowest mean arterial pressure, and lowest heart rate), has been proposed for general surgery. In this study, we evaluated the predictability of the original SAS (oSAS) for severe complications after gastrectomy. In addition, the predictability of a modified SAS (mSAS) was evaluated, in which the cutoff value for blood loss was slightly modified.
We investigated 328 patients who underwent gastrectomy at the Shizuoka Cancer Center in 2010. Clinical data, including intraoperative parameters, were collected retrospectively. Patients with postoperative morbidities classified as Clavien-Dindo grade IIIa or more were defined as having severe complications. Univariate and multivariate analyses were performed to elucidate factors that affected the development of severe complications.
Thirty-six patients (11.0 %) had severe complications postoperatively. Univariate analyses showed that the oSAS (p = 0.007) and mSAS (p < 0.001), as well as sex, preoperative chemotherapy, cStage, type of operation, thoracotomy, surgical approach, operation time, and extent of lymph node dissection, were associated with severe complications. Multivariate analysis showed that an mSAS ≤6 was found to be an independent risk factor for severe complication, while an oSAS ≤6 was not.
The oSAS was not found to be a predictive factor for severe complications following gastrectomy in Japanese patients. A slightly modified SAS (i.e. the mSAS) is considered to be a useful predictor for the development of severe complications in elective surgery.
最近，一种简单易行的并发症预测系统——手术阿氏评分（SAS）被提出用于普通外科手术，该评分由三个术中参数（估计失血量、最低平均动脉压和最低心率）计算得出。在本研究中，我们评估了原始SAS（oSAS）对胃癌切除术后严重并发症的预测能力。此外，还评估了改良SAS（mSAS）的预测能力，其中对失血量的临界值进行了轻微修改。
我们调查了2010年在静冈癌症中心接受胃癌切除术的328例患者。回顾性收集包括术中参数在内的临床资料。术后并发症分级为Clavien-Dindo IIIa级或更高的患者被定义为发生严重并发症。进行单因素和多因素分析以阐明影响严重并发症发生的因素。
36例患者（11.0%）术后发生严重并发症。单因素分析显示，oSAS（p = 0.007）和mSAS（p < 0.001），以及性别、术前化疗、cStage、手术类型、开胸手术、手术入路、手术时间和淋巴结清扫范围，均与严重并发症相关。多因素分析显示，mSAS≤6是严重并发症的独立危险因素，而oSAS≤6则不是。
在日本患者中，oSAS未被发现是胃癌切除术后严重并发症的预测因素。一种轻微改良的SAS（即mSAS）被认为是择期手术中严重并发症发生的有用预测指标。
