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The modified Surgical Apgar Score predictive value for postoperative complications after robotic surgery for rectal
Ju Houqiong1,2, Yuan Yuli3,4, Guo Fujia5
1Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China. juhouqiong@email.ncu.edu.cn.
Objective:
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.
Methods:
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.
Results:
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.
Conclusion:
This study suggests that mSAS might be a valuable predictive indicator for postoperative complications following robotic rectal cancer surgery, with potentially higher clinical utility.
Insights
The modified Surgical Apgar Score (mSAS) effectively predicts postoperative complications in robotic rectal cancer surgery. This tool aids in improving patient outcomes and quality of life after this minimally invasive procedure.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Informatics
Background:
- The Surgical Apgar Score (SAS) uses intraoperative data to predict postoperative complications.
- Rectal cancer treatment involves complex surgical procedures, including robotic-assisted minimally invasive surgery.
- Predictive tools are crucial for optimizing patient care and outcomes in rectal cancer surgery.
Purpose of the Study:
- To evaluate the efficacy of a modified Surgical Apgar Score (mSAS) in predicting postoperative complications.
- To assess the clinical utility of mSAS for patients undergoing robotic rectal cancer surgery.
- To enhance survival and quality of life for rectal cancer patients through improved risk stratification.
Main Methods:
- A cohort of 524 patients with rectal cancer who underwent robotic surgery was analyzed.
- A modified Surgical Apgar Score (mSAS) was developed, incorporating an adjusted threshold for estimated blood loss (EBL).
- The association between low mSAS and postoperative complications was investigated using statistical analyses.
Main Results:
- The study identified 91 (17.4%) patients with complications and 22 (4.2%) with severe complications.
- An mSAS cut-off value of 6 demonstrated optimal predictive accuracy (AUC 0.740) for complications.
- Older age, lower tumor site, longer operation time, and lower mSAS were independent risk factors for complications.
Conclusions:
- The modified Surgical Apgar Score (mSAS) shows promise as a valuable predictive tool for postoperative complications after robotic rectal cancer surgery.
- mSAS may offer enhanced clinical utility in risk assessment and patient management.
- Further validation could integrate mSAS into routine clinical practice for improved rectal cancer care.
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