Utility of the Surgical Apgar Score in pancreatic cancer and modification

Abstract

Objectives: The Surgical Apgar Score (SAS) can predict the incidence of complications in different surgical fields. However, it is rarely studied in pancreatic cancer. The aim of the present study was to assess the predictive value of the SAS in pancreatic ductal adenocarcinoma (PDAC), and then propose a modified SAS which was more suitable for pancreatic cancer patients. Materials and methods: A prospective cohort study of 160 PDAC patients was concluded. The primary endpoint was 30-day major complications. The SAS was calculated as described. The overall discriminatory power of the score was analyzed using receiver operating characteristic curves and the area under the curve (AUC) with respect to major complications or death. Results: It showed a significant predictive value of SAS in major complications or death in PDAC (p = 0.020, AUC = 0.606), especially in complication of pneumonia (p = 0.022) and pleural effusion (p = 0.023). In addition, the SAS exert significant predictive value in distal pancreatectomy group, but it has a weak predictive value for pancreaticoduodenectomy group. On multivariable analyses, occurrence of major postoperative complications was associated with lowest mean arterial pressure, estimated blood loss and operative time. Interestingly, as a characteristic of SAS, lowest heart rate was not involved. The modified SAS we proposed including lowest mean arterial pressure, estimated blood loss and operative time increased AUC from 0.606 to 0.743. Conclusions: The SAS can be a simple, rapid scoring system that effectively predicts major postoperative complications. Besides, the modified SAS we proposed in this study, which included lowest mean arterial pressure, estimated blood loss and operative time, exert a better predictive value in PDAC patients. Keywords: Surgical Apgar Score, Pancreatic cancer, Prognosis