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26.07.2024 | Sarcoma

Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity

verfasst von: Michela Angelucci, MD, Marco Baia, MD, Marilù Garo, MD, Rossana Alloni, MD, Dario Callegaro, MD, Chiara Pagnoni, MD, Stefano Radaelli, MD, Chiara Colombo, MD, Sandro Pasquali, MD, PhD, Alessandro Gronchi, MD, Sergio Valeri, MD, Marco Fiore, MD, FACS, FEBS

Erschienen in: Annals of Surgical Oncology | Ausgabe 12/2024

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Abstract

Introduction

Retroperitoneal sarcoma often requires comprehensive resection, leading to severe postoperative morbidity. The lack of disease-procedure specific tools for morbidity risk and the questionable accuracy of existing tools (ACS-NSQIP and P-POSSUM) in RPS surgery drove this study to assess these calculators’ accuracy.

Methods

Retrospective analysis of primary RPS cases undergoing surgery at two sarcoma-referral centers was conducted. Predicted morbidity/mortality rates at 90 days postsurgery, classified by Clavien–Dindo (CD) and Comprehensive Complication Index (CCI), were compared with observed data. Accuracy was assessed by Brier Score and area under the curve (AUC). Inflammatory Biomarkers Prognostic Index (IBPI) also was tested.

Results

A total of 567 patients (median age 62 years; 53.6% male) with a median of four resected organs were included. 59% experienced surgical complications by 90 days postoperation, graded CD ≥ 3 in 30.5%, median CCI 20.9, with a mortality rate of 1.6% (8/567). Reoperation was required in 68 of 567 patients (12%). Thirty-day mortality was 1.1%. Severe complications occurred after 30th postoperative day in 3.5% cases. ACS-NSQIP predicted below-average complication for 65.1%, average for 16.9%, and above-average for 18% of patients. P-POSSUM predicted a 66% rate of morbidity and 4% mortality. None of the prediction tools were accurate, with Brier scores ranging 0.155–0.231 and no AUC ≥ 0.7. IBPI accuracy for predicting severe infective complication was low (AUC 0.58, Brier 0.161).

Conclusions

The significant morbidity burden after MVR necessitates reliable evaluation, especially in frail patients. Given the limitations of ACS-NSQIP and P-POSSUM, a dedicated prediction tool for perioperative events in RPS candidates for MVR needs urgent development.

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Titel: Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity
verfasst von: Michela Angelucci, MD
Marco Baia, MD
Marilù Garo, MD
Rossana Alloni, MD
Dario Callegaro, MD
Chiara Pagnoni, MD
Stefano Radaelli, MD
Chiara Colombo, MD
Sandro Pasquali, MD, PhD
Alessandro Gronchi, MD
Sergio Valeri, MD
Marco Fiore, MD, FACS, FEBS
Publikationsdatum: 26.07.2024
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe 12/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-15861-1

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Surgical Outcome in Retroperitoneal Sarcoma Surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) Risk-Calculators for Prediction of Severe and Overall Morbidity