| Hilar cholangiocarcinoma was firstly published as s special tumor by Klatskin in 1965. So it is also called Klatskin's tumor. Hilar cholangiocarcinoma grew very slowly and seculdedly. And there was often no special sense for patients. So the diagnosis is difficult in early. In forepart the ratio of resection for hilar cholangiocarcinoma was low. It was difficult for surgical treatment. With more than forty year's research, the surgical treatment made a great progress for operation of hilar cholangiocarcinoma. The ratio of radical resection and 5 year's survival were increasing. With the progress in medical sciences and operative technology, operative indications for many medical conditions were being expanded, the range of the operation was growing, with operative complications increased accordingly. In the last ten years, the published articles for hilar cholangiocarcinoma indicated that the operative risk was also high. The morbidity was from 25.0% to 65.0%. And the average mortality was about 4.0%. These results were not satisfied with doctors and patients. Since the concept of'damage control operation'published in 1993, surgical treatment progressively emphasized radical resection, safety, and function. And now there was few research about the risk assessment of hilar cholangiocarcinoma operation. So we found a good risk assessment tool was very important for hilar cholangiocarcinoma.There were a number of risk assessment scores that could be used to preoperatively stratify risk in surgical patients. Every score had advantage and disadvantage. Now the ASA, POSSUM and APACHE were used frequently in clinical practice. 1. the ASA classification: It was published by American Society of Anethesiologists and usually used in assessment risk of anesthesia undergoing operative patients. The classification was simple, and being used freely. But Its'conclusion was not accuracy because of few parameters. 2. POSSUM score: The score was firstly published by Copeland et al in 1991.It was a assessment score for enumeration morbidity and mortality for surgical patients. Some studies confirmed the result. But Whiteley and his partners assessed the surgical patients operative risk with POSSUM scores at Portsmouth strict in 1996. They found that the expected mortality was higher than the actual mortality. And the differentia was statistical significant. They analyzed the reason of this result. They found that the POSSUM regression equation for mortality was not suitable for the data. Then they rebuilt a new regression equation with the original data. And they got a exact result. This regression equation is called Portsmouth-POSSUM equation. 3. APACHE score: This score was built by Knaus in 1981.It was used to assess the severity for severe patients in intensive care unit. But it was too inconvenient to use. Then Knaus simplified the score's parameters in 1985. He saved 12 original parameters, and joined 2 new parameters. One was age point, the other was the chronic health point. This new score was called APACHE-Ⅱ.This study was a retrospective study. Three hundred forty eight medical records of patients with hilar cholangiocarcinoma admitted to Easten Hepatobiliary Hospital from January 1, 2002, to December 31, 2007, were reviewed. All patients underwent operation. We predicted perioperative morbidity and mortality(<30days after operation) with POSSUM, P-POSSUM, and APACHE-Ⅱscores. We objectively evaluated the predictive capability of every score, and hoped to find a effective risk assessment score for hilar cholangiocarcinoma.Objective: To assess the value of POSSUM, P-POSSUM, and APACHE-Ⅱscore in prediction of complications and perioperative death in patients with hilar cholangiocarcinoma underwent operation. And found a effective risk assessment score for operation of hilar cholangiocarcinoma.Methods: Three hundred forty eight patients with hilar cholangiocarcinoma admitted to Easten Hepatobiliary Hospital from January 1,2002, to December 31,2007, who underwent surgical operation were evaluated using POSSUM, P-POSSUM. And APACHE-Ⅱscore. The outcome meaures were complications and perioperative death within 30 days. All data analyzed by SPSS15.0 and Medcalc9.2.10 for windows. Continuous variables were assessed as medians with t-test ,χ2-test for qualitative variables, significance level for P=0.05. ROC curve and O:E ratio used to estimate the predictive ability of the scoring system. Z-test for the area under ROC curve, significance level for P=0.05.Results: The overall complication rate was 44.8%(156 cases).Expected complication rate was 39.7%(138 cases) for POSSUM score. The differentia between actual morbidity and predictive morbidity was non-significant(χ2=1.91,df=1,P>0.05). The overall mortality was 1.7%( 6cases). Expected mortality was 9.3%(33 cases) for POSSUM score. The differentia between actual morbidity and predictive mortality was significant(χ2=19.80,df=1,P<0.05). The area under ROC curve was 0.722 for morbidity. Expected mortality was 2.8%(10 cases) for P-POSSUM score. The differentia between actual mortality and predictive mortality was non-significant(χ2=1.02,df=1,P>0.05). Expected mortality was 9.2%(32 cases) for APACHE-Ⅱscore. The differentia between actual mortality and predictive mortality was significant(χ2=18.82,df=1, P<0.01).The area under ROC curve was 0.759 for POSSUM (P<0.05), 0.741 for P-POSSUM(P<0.05), and 0.608 for APACHE-Ⅱ(P>0.05).Conclusions: The POSSUM score was useful in predicting perioperative morbidity for patients with hilar cholangiocarcinoma. P-POSSUM score was useful in predicting perioperative mortality for patients with hilar cholangiocarcinoma. POSSUM and APACHE-Ⅱscores were unuseful in predicting perioperative mortality, and overrated the mortality. And POSSUM and P-POSSUM score could help guide in disease stratification and subsequent management, particularly in severe ill surgical patients. Twenty eight points of POSSUM was a reference for morbidity in clinical work. Thirty one points of P-POSSUM was a reference for mortality in clinical work. |
PDF Full Text Request