{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:51:42Z","timestamp":1760057502716,"version":"build-2065373602"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gastrointestinal Disorders"],"abstract":"<jats:p>Background: Surgery in periampullary cancers (PAC) is associated with high morbimortality rates. There are multiple scores used to predict surgical risk. This study aims to identify a possible correlation between POSSUM, P-POSSUM, E-PASS, and mE-PASS scores and morbimortality in patients operated on for PAC. Methods: POSSUM, P-POSSUM, E-PASS, and mE-PASS were calculated for patients operated for PAC in Hospital de Braga between 1 January 2011 and 31 August 2021. The calibration and discrimination of scores were analyzed by comparing the predicted mortality and morbidity with the observed one and by evaluating the Receiver Operating Characteristic (ROC) curve, respectively. Results: The study included 58 patients. The most frequent location was the ampulla of Vater (AVC) (43.10%), and the most frequent stage was IIb (48.28%). The postoperative mortality and morbidity observed at 30 days were 3.45% and 37.93%, respectively. P-POSSUM (O:E 0.45), POSSUM (O:E 0.16), and E-PASS (O:E 0.03) overestimated mortality, and mE-PASS underestimated it (O:E 1.89). In most subgroups, both POSSUM scores showed the best calibration. CRS and E-PASS showed the highest discriminative ability for mortality (AUC 0.982). In the pancreatic head carcinoma subgroup, the SSS showed better calibration for morbidity. The operative score had the best discrimination for the CAV subgroup (AUC 0.767) and for stage IIb (AUC 0.900). No scale showed discriminative ability in overall morbidity. Conclusions: POSSUM and P-POSSUM obtained the best calibration regarding subgroup mortality. E-PASS and CRS showed the highest discrimination for mortality, and the operative score showed the greatest discrimination for morbidity in the subgroups.<\/jats:p>","DOI":"10.3390\/gidisord7010013","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T04:03:35Z","timestamp":1739419415000},"page":"13","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Risk Scores as Morbidity and Mortality Predictors in Periampullary Cancer"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0047-4517","authenticated-orcid":false,"given":"Elisa","family":"Perestrelo","sequence":"first","affiliation":[{"name":"General Surgery at Funchal Central Hospital, 9000-177 Funchal, Portugal"}]},{"given":"Jo\u00e3o Pedro","family":"Dinis","sequence":"additional","affiliation":[{"name":"Anesthesiology at Funchal Central Hospital, 9000-177 Funchal, Portugal"}]},{"given":"Ana","family":"Pereira","sequence":"additional","affiliation":[{"name":"Hepatobiliary Unit, Department of General Surgery at Braga\u2019s Hospital, 4710-243 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3526-3199","authenticated-orcid":false,"given":"Sandra F.","family":"Martins","sequence":"additional","affiliation":[{"name":"Life and Health Science Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal"},{"name":"Life and Health Sciences Research Institute (ICVS)\/3B\u2019s-PT Government Associate Laboratory, 4806-909 Guimar\u00e3es, Portugal"},{"name":"Coloproctology Unit, Department of General Surgery at Braga\u2019s Hospital, 4710-243 Braga, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1158\/1055-9965.EPI-15-0578","article-title":"Global cancer incidence and mortality rates and trends\u2014An update","volume":"25","author":"Torre","year":"2016","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S0039-6109(05)70142-0","article-title":"Periampullary cancers: Are there differences?","volume":"81","author":"Sarmiento","year":"2001","journal-title":"Surg. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1007\/s12094-018-1832-5","article-title":"Pancreaticoduodenectomy for periampullary tumours: A review article based on Surveillance, End Results and Epidemiology (SEER) database","volume":"20","author":"Kamarajah","year":"2018","journal-title":"Clin. Transl. Oncol."},{"key":"ref_4","first-page":"CD006053","article-title":"Pancreaticoduodenectomy (classic Whipple) versus pylorus-preserving pancreaticoduodenectomy (pp Whipple) for surgical treatment of periampullary and pancreatic carcinoma","volume":"2","author":"Diener","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.hpb.2020.09.023","article-title":"Long-term survival after minimally invasive resection versus open pancreaticoduodenectomy for periampullary cancers: A systematic review, meta-analysis and meta-regression","volume":"23","author":"Kamarajah","year":"2021","journal-title":"HPB"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.ejso.2020.11.146","article-title":"A systematic review into patient reported outcomes following pancreaticoduodenectomy for malignancy","volume":"47","author":"Patel","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1159\/000073701","article-title":"Evaluation of the POSSUM scoring system for comparative audit in pancreatic surgery","volume":"20","author":"Khan","year":"2003","journal-title":"Dig. Surg."},{"key":"ref_8","first-page":"9","article-title":"Avalia\u00e7\u00e3o da performance cir\u00fargica pelo P-POSSUM em doentes com cancro g\u00e1strico\u2014Revis\u00e3o de 5 anos","volume":"36","author":"Bernardo","year":"2016","journal-title":"Port. J. Surg."},{"key":"ref_9","first-page":"10","article-title":"The possum scoring system and complete blood count in the prediction of complications after pancreato-duodenal area resections","volume":"83","author":"Osiniak","year":"2011","journal-title":"Pol. Przegl. Chir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1477-7819-6-39","article-title":"Application of Portsmouth modification of physiological and operative severity scoring system for enumeration of morbidity and mortality (P-POSSUM) in pancreatic surgery","volume":"6","author":"Tamijmarane","year":"2008","journal-title":"World J. Surg. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5517","DOI":"10.21037\/tcr-20-828","article-title":"A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy","volume":"9","author":"Zhang","year":"2020","journal-title":"Transl. Cancer Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e13969","DOI":"10.1097\/MD.0000000000013969","article-title":"A simplified scoring system for the prediction of pancreatoduodenectomy\u2019s complications: An observational study","volume":"98","author":"Chen","year":"2019","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"399","DOI":"10.21614\/chirurgia.113.3.399","article-title":"Evaluation of P-POSSUM Risk Scoring System in Prediction of Morbidity and Mortality after Pancreaticoduodenectomy","volume":"113","author":"Bodea","year":"2018","journal-title":"Chirurgia"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/SLA.0b013e3181f66199","article-title":"A multicenter prospective study of surgical audit systems","volume":"253","author":"Haga","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.hpb.2015.09.001","article-title":"Value of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder carcinoma","volume":"18","author":"Haga","year":"2016","journal-title":"HPB"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.amjsurg.2011.04.003","article-title":"Comparison of different risk-adjustment models in assessing short-term surgical outcome after transthoracic esophagectomy in patients with esophageal cancer","volume":"202","author":"Bosch","year":"2011","journal-title":"Am. J. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/BF02483010","article-title":"Estimation of Physiologic Ability and Surgical Stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery","volume":"29","author":"Haga","year":"1999","journal-title":"Surg. Today"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1001\/jamasurg.2016.2305","article-title":"External Validation of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) Risk Model to Predict Operative Risk in Perihilar Cholangiocarcinoma","volume":"151","author":"Coelen","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_20","unstructured":"Goulart, A., and Martins, S. (2013). Assessment of surgical risk in colo-rectal cancer patients: POSSUM or ACPGBI?. Port. J. Surg., 19\u201328."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1002\/jhbp.105","article-title":"Value of general surgical risk models for predicting postoperative morbidity and mortality in pancreatic resections for pancreatobiliary carcinomas","volume":"21","author":"Haga","year":"2014","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1007\/s00534-009-0116-4","article-title":"Is an estimation of physiologic ability and surgical stress able to predict operative morbidity after pancreaticoduodenectomy?","volume":"17","author":"Hashimoto","year":"2010","journal-title":"J. Hepato-Biliary-Pancreat. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/hpb.12071","article-title":"Longterm survival after pancreaticoduodenectomy for periampullary adenocarcinomas","volume":"15","author":"Chen","year":"2013","journal-title":"HPB"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1097\/00000658-200209000-00012","article-title":"Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: Randomized controlled trial evaluating survival, morbidity, and mortality","volume":"236","author":"Yeo","year":"2002","journal-title":"Ann. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1111\/hpb.12078","article-title":"2564 resected periampullary adenocarcinomas at a single institution: Trends over three decades","volume":"16","author":"He","year":"2014","journal-title":"HPB"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/00000658-199806000-00005","article-title":"Periampullary adenocarcinoma: Analysis of 5-year survivors","volume":"227","author":"Yeo","year":"1998","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/j.suc.2016.07.001","article-title":"Surgical Therapy for Pancreatic and Periampullary Cancer","volume":"96","author":"Ammori","year":"2016","journal-title":"Surg. Clin. N. Am."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1097\/JTO.0b013e3181ec173d","article-title":"Receiver operating characteristic curve in diagnostic test assessment","volume":"5","author":"Mandrekar","year":"2010","journal-title":"J. Thorac. Oncol."},{"key":"ref_29","first-page":"1","article-title":"New score for prediction of morbidity in patients undergoing open pancreaticoduodenectomy","volume":"49","author":"Chen","year":"2021","journal-title":"J. Int. Med. Res."}],"container-title":["Gastrointestinal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2624-5647\/7\/1\/13\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:32:33Z","timestamp":1760027553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2624-5647\/7\/1\/13"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["gidisord7010013"],"URL":"https:\/\/doi.org\/10.3390\/gidisord7010013","relation":{},"ISSN":["2624-5647"],"issn-type":[{"type":"electronic","value":"2624-5647"}],"subject":[],"published":{"date-parts":[[2025,2,13]]}}}