Department of Surgery, Dentistry, Gynaecology and Paediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, P. le L.A. Scuro, 37134, Verona, Italy.
Surgical Clinic, University Hospital of Trieste (Azienda Sanitaria Giuliano-Isontina), 34149, Trieste, Italy.
J Gastrointest Surg. 2023 Oct;27(10):2114-2125. doi: 10.1007/s11605-023-05784-9. Epub 2023 Aug 14.
The American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC) has been designed to predict morbidity and mortality and help stratify surgical patients. This study evaluates the performance of the SRC for patients undergoing surgery for colorectal liver metastases (CRLM).
SRC was retrospectively computed for patients undergoing liver or simultaneous colon and liver surgery for colorectal cancer (CRC) in two high tertiary referral centres from 2011 to 2020. C-statistics and Brier score were calculated as a mean of discrimination and calibration respectively, for both group and for every level of surgeon adjustment score (SAS) for liver resections in case of simultaneous liver-colon surgery. An AUC ≥ 0.7 shows acceptable discrimination; a Brier score next to 0 means the prediction tool has good calibration.
Four hundred ten patients were included, 153 underwent simultaneous resection, and 257 underwent liver-only resections. For simultaneous surgery, the ACS-NSQIP SRC showed good calibration and discrimination only for cardiac complication (AUC = 0.720, 0.740, and 0.702 for liver resection unadjusted, SAS-2, and SAS-3 respectively; 0.714 for colon resection; and Brier score = 0.04 in every case). For liver-only surgery, it only showed good calibration for cardiac complications (Brier score = 0.03). The SRC underestimated the incidence of overall complications, pneumonia, cardiac complications, and the length of hospital stay.
ACS-NSQIP SRC showed good predicting capabilities only for 1 out of 5 evaluated outcomes; therefore, it is not a reliable tool for patients undergoing liver surgery for CRLM, both in the simultaneous and staged resections.
美国外科医师学院国家外科质量改进计划手术风险计算器（ACS-NSQIP SRC）旨在预测发病率和死亡率，并帮助对手术患者进行分层。本研究评估了 SRC 在结直肠癌肝转移（CRLM）患者接受手术治疗中的表现。
回顾性计算了 2011 年至 2020 年在两个高等级转诊中心接受肝或同时结肠和肝手术治疗结直肠癌（CRC）的患者的 SRC。分别计算了 C 统计量和 Brier 评分作为组内和每个肝切除术外科医生调整评分（SAS）水平的平均区分度和校准度，用于同时行肝结肠手术。AUC≥0.7 表示可接受的区分度；Brier 评分接近 0 表示预测工具具有良好的校准度。
共纳入 410 例患者，其中 153 例行同期切除术，257 例行单纯肝切除术。对于同期手术，ACS-NSQIP SRC 仅在心脏并发症方面显示出良好的校准度和区分度（未调整肝切除术、SAS-2 和 SAS-3 的 AUC 分别为 0.720、0.740 和 0.702；结肠切除术的 AUC 为 0.714；并且在每种情况下，Brier 评分均为 0.04）。对于单纯肝切除术，仅在心脏并发症方面显示出良好的校准度（Brier 评分=0.03）。SRC 低估了总并发症、肺炎、心脏并发症和住院时间的发生率。
ACS-NSQIP SRC 仅对 5 个评估结果中的 1 个显示出良好的预测能力；因此，它不是同时行和分期切除术治疗 CRLM 患者行肝切除术的可靠工具。
