Skip to main content

Advertisement

SpringerLink
Log in

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The Physiological and Operative Severity Score for the enUmeration of Mortality andmorbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM) have been used to predictmorbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations needsome adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group ofpatients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables.

Methods

between January 1995 and December 2004, 273 consecutive patients underwent surgery forrectal cancer. Information was gathered about the patients, tumour and therapy. To assess the predictioncapacity of POSSUM, subgroups for analysis were created according to variables related to operativemorbidity and mortality.

Results

The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7%(6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUMpredictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for thosereceiving neoadjuvant therapy.

Conclusion

POSSUM is a good instrument to make results between different institutions and publicationcomparable. We found prediction errors for some variables related to morbidity. Modifications of surgicalvariables and specifications for neoadjuvant therapy as well as physiological variables including life stylemay improve future prediction of surgical risk. More research is needed to identify further potential riskfactors for surgical complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ (1998) POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and operative severity score for the enumeration of mortality and morbidity. Br J Surg 85(9):1217–1220

    Article  PubMed  CAS  Google Scholar 

  2. Oomen JL, Engel AF, Cuesta MA (2006) Mortality after acute surgery for complications of diverticular disease of the sigmoid colon is almost exclusively due to patient related factors. Colorectal Dis 8(2):112–119

    Article  PubMed  CAS  Google Scholar 

  3. Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78(3):355–360 Mar

    Article  PubMed  CAS  Google Scholar 

  4. Neary WD, Heather BP, Earnshaw JJ (2003) The physiological and operative severity score for enumeration of mortality and morbidity (POSSUM). Br J Surg 90:157–165

    Article  PubMed  CAS  Google Scholar 

  5. Copeland GP (2002) The POSSUM system of surgical audit. Arch Surg 137:15–19

    Article  PubMed  Google Scholar 

  6. Tekkis PP, Kessaris N, Kocher HM, Poloniecki JD, Lyttle J, Windsor AC (2003) Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery. Br J Surg 90(3):340–345

    Article  PubMed  CAS  Google Scholar 

  7. Whitely MS (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815

    Article  Google Scholar 

  8. Wijesinghe LD, Mahmood T, Sacott DJ, Berridge DC, Kent PJ, Kester RC (1998) Comparison of POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery. Br J Surg 85:209–212

    Article  PubMed  CAS  Google Scholar 

  9. Poon JT, Chan B, Law WL (2005) Evaluation of P-POSSUM in surgery for obstructing colorectal cancer and correlation of the predicted mortality with different surgical options. Dis Colon Rectum 48(3):493–498

    Article  PubMed  Google Scholar 

  10. Menon KV, Farouk R (2002) An analysis of the accuracy of P-POSSUM scoring for mortality risk assessment after surgery for colorectal cancer. Colorectal Dis 4(3):197–200

    Article  PubMed  Google Scholar 

  11. Khoury G (2003) Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery (Br J Surg 2003; 90: 340–345). Br J Surg 90(8):1021 author reply, Aug

    Article  PubMed  CAS  Google Scholar 

  12. Brooks MJ, Sutton R, Sarin S (2005) Comparison of surgical risk score, POSSUM and p-POSSUM in higher-risk surgical patients. Br J Surg 92(10):1288–1292

    Article  PubMed  CAS  Google Scholar 

  13. Tekkis PP, Kinsman R, Thompson MD, Stamatakis JD (2004) The association of coloproctology of Great Britain and Ireland study of large bowel obstruction caused by colorectal cancer. Ann Surg 240:76–81

    Article  PubMed  Google Scholar 

  14. Law WL, Lam CM, Lee YM (2006) Evaluation of outcome of laparoscopic colorectal resection with POSSUM, Portsmouth POSSUM and colorectal POSSUM. Br J Surg 93(1):94–99

    Article  PubMed  CAS  Google Scholar 

  15. Ramkumar T, Ng V, Fowler L, Farouk R (2006) A comparison of POSSUM, P-POSSUM and colorectal POSSUM for the prediction of postoperative mortality in patients undergoing colorectal resection. Dis Colon Rectum 49(3):330–335

    Article  PubMed  Google Scholar 

  16. Senagore AJ, Warmuth AJ, Delaney CP, Tekkis PP, Fazio VW (2004) POSSUM, p-POSSUM, and Cr-POSSUM: implementation issues in a United States health care system for prediction of outcome for colon cancer resection. Dis Colon Rectum 47(9):1435–1441

    PubMed  Google Scholar 

  17. American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:111

    Google Scholar 

  18. AJCC (2002) Cancer staging handbook: TNM classification of malignant tumors. 6th edn. Sixth ed. Springer, New York

    Google Scholar 

  19. International Commission on Radiation Units and Measurements Report 50 (1993) Prescribing, recording, and reporting photon beam therapy. International Commission on Radiation Units

  20. Molina GO, Garrido LO, Manterola CD (2005) Evaluación de resultados quirúrgicos. Validación inicial del escore POSSUM. Rev Chilena de Cirugía 57(4):291–296

    Google Scholar 

  21. Isbister WH (2000) Study populations and case mix: influence on analysis of postoperative outcomes. Aust NZ J Surg 70:279–284

    Article  CAS  Google Scholar 

  22. Murray GHC, Fowler S, Dunn DC (1995) Presentation of comparative audit data. Br J Surg 82:329–332

    Article  PubMed  CAS  Google Scholar 

  23. Jones HJS, de Cossart L (1999) Risk scoring in surgical patients. Br J Surg 86:149–157

    Article  PubMed  CAS  Google Scholar 

  24. Dripps RD, Lamont A, Eckenhoff JE (1961) The role of anesthesia in surgical mortality. J Am Med Assoc 178:261–266

    CAS  Google Scholar 

  25. Hall JC, Hall JL (1996) ASA status and age predict adverse events after abdominal surgery. Journal for Quality in Clinical Practice 16(2):103–108

    CAS  Google Scholar 

  26. Bufalari A, Giustozzi G, Burattini MF, Servili S, Bussotti C, Lucaroni E et al (2006) Rectal cancer surgery in the elderly: a multivariate analysis of outcome risk factors. J Surg Oncol 93(3):173–180 Mar 1

    Article  PubMed  Google Scholar 

  27. Bold RJ (2006) Re: Rectal cancer surgery in the elderly: A multivariate analysis of outcome risk factors, by Bufalari A, Giustozzi G, Burattini MF, et al. J Surg Oncol 93(3):167–168

    Article  PubMed  Google Scholar 

  28. Puig la Calle J, Quayle J, Thaler HT, Shi W, Paty P, Quan SH et al (2000) Favorable short-term and long-term outcome after elective radical rectal cancer resection in patients 75 years of age or older. Dis Col Rectum 43(12):1704–1709

    Article  Google Scholar 

  29. Kuzu MA, Koksoy C, Akyol F, Uzal D, Kale T (1998) Effects of preoperative fractionated irradiation on left colonic anastomoses in the rat. Dis Colon Rectum 41:370–376

    Article  PubMed  CAS  Google Scholar 

  30. Dominuez J, Jakate S, Speziale S, Savin M, Altringer WE, Saclarides TJ (1996) Intestinal anastomotic healing at varying times after irradiation. J Surg Res 61:293–299

    Article  Google Scholar 

  31. Pucciarelli S, Toppan P, Friso ML, Fornasiero A, Vieceli G, Marchiori E et al (1999) Preoperative combined radiotherapy and chemotherapy for rectal cancer does not affect early postoperative morbidity and mortality in low anterior resection. Dis Colon Rectum 42(10):1276–1283 discussion 83–84

    Article  PubMed  CAS  Google Scholar 

  32. Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T et al (2002) Acute effects and complications after short term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825

    Article  PubMed  CAS  Google Scholar 

  33. Hyams DM, Mamounas EP, Petrelli N, Rockette H, Jones J, Wieand S et al (1997) A clinical trial to evaluate the worth of preoperative multimodality therapy in patients with operable carcinoma of the rectum. A progress report of national surgical adjuvant breast and bowel project protocol R.03. Dis Col Rectum 40(2):131–139

    Article  CAS  Google Scholar 

  34. Shumate C, Rich T, Skibber J, Ajani J, Ota D (1993) Preoperative chemotherapy and radiation therapy for locally advanced primary and recurrent rectal carcinoma. A report of surgical morbidity. Cancer 71:3690–3696

    Article  PubMed  CAS  Google Scholar 

  35. Stryker SJ, Kiel KD, Rademaker A, Shaw J, Ujiki G, Poticha S (1996) Preoperative “chemoradiation” for stages II and III rectal cancer. Arch Surg 131:514–518

    PubMed  CAS  Google Scholar 

  36. Zaheer S, Pemberton JH, Farouk R, Dozois RR, Wolff BG, Ilstrup D (1998) Surgical treatment of adenocarcinoma of the rectum. Ann Surg 227(6):800–811

    Article  PubMed  CAS  Google Scholar 

  37. Rosen L, Veidenheimer MC, Coller JA, Corman ML (1982) Mortality, morbidity, and patterns of recurrence after abdominoperineal resection for cancer of the rectum. Dis Colon Rectum 25:202

    Article  PubMed  CAS  Google Scholar 

  38. Isbister WH, Naser S (2002) POSSUM: A re-evaluation in patients undergoing surgery for rectal cancer. Aust NZ J Surg 72:421–425

    Article  Google Scholar 

  39. Menon KV, Whiteley MS, Burden P, Galland RB (1999) Surgical patients with methicillin resistant staphylococcus aureus infection: An analysis of outcome using P-POSSUM. J R Coll Surg Edinb 44:161–163

    PubMed  CAS  Google Scholar 

  40. Parinkh D, Johnson M, Chagla L, Lowe D (1996) Lessons from a prospective audit of the learning curve. Br J Surg 83:1595–1599

    Article  Google Scholar 

  41. Sagar PM, Hartley MN, Mancey-Jones B, Sedman PC, May J, Macfie J (1994) Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg 81:1492–1494

    Article  PubMed  CAS  Google Scholar 

  42. Jones HJS, Foster GE, de Cossart L (1999) Colorectal surgery: does POSSUM predict outcome? Dis Col Rectum 42:A18

    Google Scholar 

  43. Cagigas JC, Escalante CF, Ingelmo A et al (1999) Application of POSSUM system to bariatric surgery. Obesity Surg 9:279–281

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Clinica Universitaria de Navarra, University of Navarra, Avda Pio XII, 36., 31080, Pamplona, Spain

    V. Valenti, J. L. Hernandez-Lizoain, J. Baixauli, C. Pastor, F. Martinez-Regueira, J. J. Beunza, J. J. Aristu & J. Alvarez Cienfuegos

  2. Internal Medicine, Clinica Universitaria de Navarra, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain

    J. J. Beunza

  3. Radiotherapy, Clinica Universitaria de Navarra, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain

    J. J. Aristu

  4. Clinica Universitaria de Navarra, University of Navarra, Avda Pio XII, 36, 31080, Pamplona, Spain

    J. Alvarez Cienfuegos

Authors
  1. V. Valenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. L. Hernandez-Lizoain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Baixauli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Martinez-Regueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. J. Beunza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. J. Aristu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Alvarez Cienfuegos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Valenti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Valenti, V., Hernandez-Lizoain, J.L., Baixauli, J. et al. Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery. Langenbecks Arch Surg 394, 55–63 (2009). https://doi.org/10.1007/s00423-008-0314-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-008-0314-6

Keywords

Search

Navigation