Journal of Gastric Cancer

  • 제20권3호
  • /
  • Pages.267-276
  • /
  • 2020
  • /
  • 2093-582X(pISSN)
  • /
  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
권호 표지
DOI QR코드

DOI QR Code

Validation of the ACS NSQIP Surgical Risk Calculator for Patients with Early Gastric Cancer Treated with Laparoscopic Gastrectomy

  • Alzahrani, Saleh M (Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ko, Chang Seok (Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoo, Moon-Won (Division of Stomach Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 투고 : 2020.04.11
  • 심사 : 2020.07.22
  • 발행 : 2020.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator is useful in predicting postoperative adverse events. However, its accuracy in specific disorders is unclear. We validated the ACS NSQIP risk calculator in patients with gastric cancer undergoing curative laparoscopic surgery. Materials and Methods: We included 207 consecutive early gastric cancer patients who underwent laparoscopic gastrectomy between January 2018 and January 2019. The preoperative characteristics and risks of the patients were reviewed and entered into the ACS NSQIP calculator. The estimated risks of postoperative outcomes were compared with the observed outcomes using C-statistics and Brier scores. Results: Most of the patients underwent distal gastrectomy with Roux-en-Y reconstruction (74.4%). We did not observe any cases of mortality, venous thromboembolism, urinary tract infection, renal failure, or cardiac complications. The other outcomes assessed were complications such as pneumonia, surgical site infections, any complications requiring re-operation or hospital readmission, the rates of discharge to nursing homes/rehabilitation centers, and the length of stay. All C-statistics were <0 and the highest was for pneumonia (0.65; 95% confidence interval: 0.58-0.71). Brier scores ranged from 0.01 for pneumonia to 0.155 for other complications. Overall, the risk calculator was inconsistent in predicting the outcomes. Conclusions: The ACS NSQIP surgical risk calculator showed low predictive ability for postoperative adverse events after laparoscopic gastrectomy for patients with early gastric cancer. Further research to adjust the risk calculator for these patients may improve its predictive ability.

키워드

참고문헌

  1. Rugge M, Fassan M, Graham DY. Epidemiology of gastric cancer. In: Strong VE, ed. Gastric Cancer. Cham: Springer International Publishing, 2015:23-34.
  2. Ferro A, Peleteiro B, Malvezzi M, Bosetti C, Bertuccio P, Levi F, et al. Worldwide trends in gastric cancer mortality (1980-2011), with predictions to 2015, and incidence by subtype. Eur J Cancer 2014;50:1330-1344. https://doi.org/10.1016/j.ejca.2014.01.029
  3. Nagini S. Carcinoma of the stomach: a review of epidemiology, pathogenesis, molecular genetics and chemoprevention. World J Gastrointest Oncol 2012;4:156-169. https://doi.org/10.4251/wjgo.v4.i7.156
  4. Bertuccio P, Chatenoud L, Levi F, Praud D, Ferlay J, Negri E, et al. Recent patterns in gastric cancer: a global overview. Int J Cancer 2009;125:666-673. https://doi.org/10.1002/ijc.24290
  5. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev 2014;23:700-713. https://doi.org/10.1158/1055-9965.EPI-13-1057
  6. Kweon SS. Updates on cancer epidemiology in Korea, 2018. Chonnam Med J 2018;54:90-100. https://doi.org/10.4068/cmj.2018.54.2.90
  7. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007;10:1-11. https://doi.org/10.1007/s10120-006-0408-1
  8. Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 1992;79:241-244. https://doi.org/10.1002/bjs.1800790319
  9. Lee HJ, Yang HK, Ahn YO. Gastric cancer in Korea. Gastric Cancer 2002;5:177-182. https://doi.org/10.1007/s101200200031
  10. Kim YW, Bae JM, Lee JH, Ryu KW, Choi IJ, Kim CG, et al. The role of hand-assisted laparoscopic distal gastrectomy for distal gastric cancer. Surg Endosc 2005;19:29-33. https://doi.org/10.1007/s00464-004-8119-3
  11. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833-842.e1-3. https://doi.org/10.1016/j.jamcollsurg.2013.07.385
  12. Ingraham AM, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Adv Surg 2010;44:251-267. https://doi.org/10.1016/j.yasu.2010.05.003
  13. Hall BL, Hamilton BH, Richards K, Bilimoria KY, Cohen ME, Ko CY. Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 2009;250:363-376. https://doi.org/10.1097/SLA.0b013e3181b4148f
  14. Beal EW, Saunders ND, Kearney JF, Lyon E, Wei L, Squires MH, et al. Accuracy of the ACS NSQIP online risk calculator depends on how you look at it: results from the United States Gastric Cancer Collaborative. Am Surg 2018;84:358-364. https://doi.org/10.1177/000313481808400318
  15. Bickenbach K, Strong VE. Comparisons of gastric cancer treatments: east vs. west. J Gastric Cancer 2012;12:55-62. https://doi.org/10.5230/jgc.2012.12.2.55
  16. Xia J, Broadhurst DI, Wilson M, Wishart DS. Translational biomarker discovery in clinical metabolomics: an introductory tutorial. Metabolomics 2013;9:280-299. https://doi.org/10.1007/s11306-012-0482-9
  17. Cohen ME, Ko CY, Bilimoria KY, Zhou L, Huffman K, Wang X, et al. Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 2013;217:336-346.e1. https://doi.org/10.1016/j.jamcollsurg.2013.02.027
  18. StataCorp. Stata Statistical Software: Release 12. College Station (TX): StataCorp LP, 2011.
  19. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146-148.
  20. Hayashi H, Ochiai T, Shimada H, Gunji Y. Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 2005;19:1172-1176. https://doi.org/10.1007/s00464-004-8207-4
  21. Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 2005;241:232-237. https://doi.org/10.1097/01.sla.0000151892.35922.f2
  22. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report--a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg 2010;251:417-420. https://doi.org/10.1097/SLA.0b013e3181cc8f6b
  23. Son T, Hyung WJ. Laparoscopic gastric cancer surgery: current evidence and future perspectives. World J Gastroenterol 2016;22:727-735. https://doi.org/10.3748/wjg.v22.i2.727
  24. Merkow RP, Hall BL, Cohen ME, Dimick JB, Wang E, Chow WB, et al. Relevance of the C-statistic when evaluating risk-adjustment models in surgery. J Am Coll Surg 2012;214:822-830. https://doi.org/10.1016/j.jamcollsurg.2011.12.041
  25. Wu YC, Lee WC. Alternative performance measures for prediction models. PLoS One 2014;9:e91249. https://doi.org/10.1371/journal.pone.0091249
  26. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N; Japanese Laparoscopic Surgery Study Group. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007;245:68-72. https://doi.org/10.1097/01.sla.0000225364.03133.f8
  27. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, 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. https://doi.org/10.1097/SLA.0000000000001346
  28. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
  29. Luna A, Rebasa P, Navarro S, Montmany S, Coroleu D, Cabrol J, et al. An evaluation of morbidity and mortality in oncologic gastric surgery with the application of POSSUM, P-POSSUM, and O-POSSUM. World J Surg 2009;33:1889-1894. https://doi.org/10.1007/s00268-009-0118-z
  30. Hong S, Wang S, Xu G, Liu J. Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients. Asian J Surg 2017;40:89-94. https://doi.org/10.1016/j.asjsur.2015.07.004
  31. McMillan MT, Allegrini V, Asbun HJ, Ball CG, Bassi C, Beane JD, et al. Incorporation of procedure-specific risk into the ACS-NSQIP surgical risk calculator improves the prediction of morbidity and mortality after pancreatoduodenectomy. Ann Surg 2017;265:978-986. https://doi.org/10.1097/SLA.0000000000001796
  32. Hu WH, Chen HH, Lee KC, Liu L, Eisenstein S, Parry L, et al. Assessment of the addition of hypoalbuminemia to ACS-NSQIP surgical risk calculator in colorectal cancer. Medicine (Baltimore) 2016;95:e2999. https://doi.org/10.1097/MD.0000000000002999

피인용 문헌

  1. What is the Accuracy of the ACS-NSQIP Surgical Risk Calculator in Emergency Abdominal Surgery? A Meta-Analysis vol.268, 2021, https://doi.org/10.1016/j.jss.2021.07.009