Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
Gastrointernal Surgical Institute, Nanchang University, Nanchang, China.
Surg Endosc. 2024 Oct;38(10):5657-5667. doi: 10.1007/s00464-024-11089-y. Epub 2024 Aug 12.
The Surgical Apgar Score quantifies three intraoperative parameters: lowest heart rate, lowest mean arterial pressure, and estimated blood loss (EBL). This scoring system predicts postoperative complications based on these measured factors. The aim of this study was to investigate the value of modified Surgical Apgar Score (mSAS) in predicting postoperative complications in patients with rectal cancer treated with robotic surgery in order to improve the survival and quality of life of rectal cancer patients.
The study included patients with rectal cancer who underwent robotic surgery in the Department of Gastrointestinal Surgery at the First Affiliated Hospital of Nanchang University from January 2015 to December 2023. In minimally invasive surgery, we developed a modified Surgical Apgar Score (mSAS) tailored for robotic rectal cancer surgery, incorporating an adjusted threshold for EBL. This threshold was derived from quartile analysis of a cohort of 524 patients, with a median EBL of 100 mL (IQR 80-130 mL). We analyzed the association of postoperative complications with low mSAS.
This study included 524 patients, of which 91 (17.4%) experienced complications and 22 (4.2%) suffered severe complications. mSAS of 6 provided maximal Youden index and were determined as the cut-off values. The area under the ROC curve for predicting complications using the mSAS was 0.740. Univariate and multivariate analyses indicated that an older age, lower tumor localization, longer operation time, radiotherapy alone, combined chemoradiotherapy, and lower mSAS as independent risk factors for complications. The AUC of the prediction nomogram was 0.834 (95% CI 0.774-0.867). The calibration curve demonstrated excellent concordance with the nomogram, indicating the prediction curve ft the diagonal well.
This study suggests that mSAS might be a valuable predictive indicator for postoperative complications following robotic rectal cancer surgery, with potentially higher clinical utility.
手术 Apgar 评分量化了三个术中参数：最低心率、最低平均动脉压和估计失血量（EBL）。该评分系统基于这些测量因素预测术后并发症。本研究旨在探讨改良手术 Apgar 评分（mSAS）在预测接受机器人手术治疗的直肠癌患者术后并发症中的价值，以提高直肠癌患者的生存率和生活质量。
本研究纳入了 2015 年 1 月至 2023 年 12 月在南昌大学第一附属医院胃肠外科接受机器人手术治疗的直肠癌患者。在微创手术中，我们针对机器人直肠手术制定了改良的手术 Apgar 评分（mSAS），其中 EBL 的调整阈值来源于 524 例患者的四分位分析，中位 EBL 为 100 mL（IQR 80-130 mL）。我们分析了术后并发症与低 mSAS 的相关性。
本研究共纳入 524 例患者，其中 91 例（17.4%）发生并发症，22 例（4.2%）发生严重并发症。mSAS 为 6 时提供最大的 Youden 指数，并确定为截断值。mSAS 预测并发症的 ROC 曲线下面积为 0.740。单因素和多因素分析表明，年龄较大、肿瘤位置较低、手术时间较长、单独放疗、联合放化疗以及 mSAS 较低是并发症的独立危险因素。预测列线图的 AUC 为 0.834（95%CI 0.774-0.867）。校准曲线表明，列线图具有良好的一致性，表明预测曲线与对角线拟合良好。
本研究表明，mSAS 可能是机器人直肠手术后预测术后并发症的一个有价值的指标，具有更高的临床应用价值。
