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Estimation of Physiologic Ability and Surgical Stress (E-PASS) versus modified E-PASS for prediction of postoperative complications in elderly patients who undergo gastrectomy for gastric cancer

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Abstract

Background

Improvements in operative technique and perioperative management have resulted in increasing numbers of elderly patients undergoing gastrectomy for gastric cancer (GC). We evaluated the accuracy of Estimation of Physiologic Ability and Surgical Stress (E-PASS) and modified (m)E-PASS scores in predicting postoperative complications in elderly patients with GC.

Methods

We retrospectively analyzed short-term outcomes in 413 patients who underwent gastrectomy for GC between 2005 and 2014. They were divided into two groups: Group N comprised 341 non-elderly patients <80 years of age and Group E comprised 72 elderly patients ≥80 years of age. We calculated the E-PASS and mE-PASS scores and evaluated the correlation between the comprehensive risk score (CRS) and occurrence of postoperative complications.

Results

Morbidity rates were 25.5 % in Group N and 31.9 % in Group E. In Group N, the CRS values of both the E-PASS (P < 0.0001) and mE-PASS (P < 0.0001) scores were significantly higher in patients with complications than in those without complications. In Group E, although the E-PASS CRS was significantly higher in patients with complications than in patients without complications (P = 0.01), the mE-PASS CRS fixed (CRSf) score was not significantly correlated with the occurrence of postoperative complications (P = 0.08).

Conclusion

Both E-PASS and mE-PASS can be used to predict the occurrence of postoperative complications in GC patients undergoing gastrectomy. However, the E-PASS CRS is more accurate for elderly patients because variations in intraoperative parameters such as operation time, blood loss, and extent of skin incision have a strong influence on the occurrence of postoperative complications.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Yuki Kitano, Masaaki Iwatsuki, Junji Kurashige, Daisuke Kuroda, Keisuke Kosumi, Yoshifumi Baba, Yasuo Sakamoto, Yuji Miyamoto, Naoya Yoshida & Hideo Baba

  2. National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan

    Yoshio Haga

Authors
  1. Yuki Kitano
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  2. Masaaki Iwatsuki
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  3. Junji Kurashige
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  4. Daisuke Kuroda
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  5. Keisuke Kosumi
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  6. Yoshifumi Baba
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  7. Yasuo Sakamoto
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  8. Yuji Miyamoto
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  9. Naoya Yoshida
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  10. Yoshio Haga
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  11. Hideo Baba
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Corresponding author

Correspondence to Hideo Baba.

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Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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We declare that there is no grant support and any other conflict of interest.

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Kitano, Y., Iwatsuki, M., Kurashige, J. et al. Estimation of Physiologic Ability and Surgical Stress (E-PASS) versus modified E-PASS for prediction of postoperative complications in elderly patients who undergo gastrectomy for gastric cancer. Int J Clin Oncol 22, 80–87 (2017). https://doi.org/10.1007/s10147-016-1028-3

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  • DOI: https://doi.org/10.1007/s10147-016-1028-3

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