Why the study?
Does the POSSUM score predict morbidity and survival in patients with unresectable pancreatic cancer undergoing double bypass surgery?
Does the POSSUM score predict morbidity and survival in patients with unresectable pancreatic cancer undergoing double bypass surgery?
The POSSUM score is an independent predictor of survival, though it overpredicts morbidity, in patients with unresectable pancreatic cancer undergoing palliative bypass.
Caution advised for morbidity risk stratification with POSSUM; leaves open its independent survival association pending validation in palliative bypass.
BACKGROUND: The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation. METHODS: Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy. RESULTS: Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis. CONCLUSIONS: Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.
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Castro et al. (2009) studied this question.
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