Results of the use of an integrated risk scale for postoperative complications in patients with colorectal cancer

Inroduction. Polymorbidity significantly increases the risk of complications in the early postoperative period, especially in patients with colorectal cancer, taking into account the initial nutritional status disorder. At present, several scales of postoperative complications risk assessment (POSSUM, RCRI, MUST) are used, but they do not fully meet the needs of modern oncosurgery, so we consider it necessary to compare their effectiveness and propose a new integrated scale.

Aim. To establish the most significant factors influencing the outcome of surgical treatment and length of hospitalization in comorbid patients with colon cancer with the development of a surgical risk assessment scale that is most adapted for this group of patients.

Materials and methods. We analyzed the data of hospital charts of patients undergo surgery for colorectal cancer in the oncoproctologic department of the S. P. Botkin State Clinical Hospital of the Moscow Healthcare Department in the period from 2019 to 2022. Inclusion criteria: histologically verified colorectal adenocarcinoma; colorectal cancer in stage cT4, cN0, cM0 or cT1–4, cN1–2, cM0; presence of one or more concomitant diseases in the patient. Exclusion criteria: presence of distant metastases of colorectal cancer; absence of confirmed comorbidities; early forms of colorectal cancer (cT1–2, cN0). All patients were assessed for risk of perioperative complications using ASA, POSSUM, MUST, and RCRI scales. The study endpoints were number of days in intensive care, number of days of hospitalization, and 30-day mortality. An Excel database with POSSUM, RCRI, and MUST scale calculators was created for the study. The evaluation of parameters influencing the outcome of hospitalization was performed using ROC analysis and correlation analysis using Pearson’s criterion. To identify the most sensitive parameters affecting the outcome of hospitalization, commonly used calculators were studied in detail.

Results. 200 patient records were analyzed. The results of treatment were compared with the data obtained using the postoperative risk scales POSSUM, MUST, RCRI. A comparative analysis of the scales presented above with our proposed integral scale of postoperative complications risk assessment was carried out. It was found that the parameters of our proposed integral scale showed the highest sensitivity (Se >70 %) and specificity (Sp >70 %) to the risk of postoperative complications. Our proposed integral scale showed a moderate correlation with the age of patients (r = 0.475, p = 0.01) and preoperative weight loss (r = 0.592, p = 0.01), as well as a high correlation with POSSUM (r = 0.649, p = 0.01; r = 0.852, p = 0.01) and MUST (r = 0.655, p = 0.01).

Conclusion. The developed scale for assessment of surgical risk in comorbid patients with colorectal cancer showed a higher correlation with the outcome of surgical treatment than similar known scales, which indicates its effectiveness and possibility of application in clinical practice after its validation in prospective studies. 

1. Ganesh R., Kebede E., Mueller M. et al. Perioperative cardiac risk reduction in noncardiac surgery. Mayo Clin Proc 2021;96(8):2260– 76. DOI: 10.1016/j.mayocp.2021.03.014

2. Patel A.Y., Eagle K.A., Vaishnava P. Cardiac risk of noncardiac surgery. J Am Coll Cardiol 2015;66(19):2140–8. DOI: 10.1016/j.jacc.2015.09.026

3. Modha K., Whinney C. Preoperative evaluation for noncardiac surgery. Ann Intern Med 2022;175(11):Itc161–6. DOI: 10.7326/AITC202211150

4. Zabolotskikh I.B., Trembach N.V. High perioperative risk patients: two approaches to stratification. Vestnik intensivnoj terapii imeni A.I. Saltanova = Annals of critical care 2019;(4):34–46. (In Russ.). DOI: 10.21320/1818-474X-2019-4-34-46

5. Elia M. The ‘’MUST’’ report. Nutritional screening of adults: a multidisciplinary responsibility. BAPEN. 2003. ISBN: 189946770X

6. Stratton R.J., King C.L., Stroud M.A. et al. ‘’Malnutrition universal screening tool’’ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 2006;95(2):325–30. DOI: 10.1079/bjn20051622

7. Todorovic V., Russell C., Elia M. The ‘MUST’ explanatory booklet. A guide to the MUST for adults. Malnutrition Action Group (MAG) a standing committee of BAPEN. 2011. ISBN: 978-1- 899467-71-6

8. Snegoviy A.V., Saltanov A.I., Manzyuk L.V. et al. Nutritional deficiency and methods of its treatment in cancer patients. Prakticheskaya onkologiya = Practical Oncology 2009;10(1):49–57. (In Russ.).

9. Jones D., Copeland G., De Cossart L. Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high‐ dependency unit. Br J Surg 1992;79(12):1293–6. DOI: 10.1002/bjs.1800791216

10. Ford M.K., Beattie W.S., Wijeysundera D.N. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 2010;152(1): 26–35. DOI: 10.7326/0003-4819-152-1-201001050-00007

11. Sheikh-Wu S.F., Anglade D., Gattamorta K.A. et al. The relationship between colorectal cancer survivors’ positive psychology, symptom characteristics, and prior trauma during acute cancer survivorship. Oncol Nurs Forum 2022;50(1):115–27. DOI: 10.1188/23.ONF.115-127

12. Knaus W.A., Zimmerman J.E., Wagner D.P. et al. APACHE – acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981;9(8):591–7. DOI: 10.1097/00003246-198108000-00008

13. Clavien P.A., Barkun J., De Oliveira M.L. et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–96. DOI: 10.1097/SLA.0b013e3181b13ca2

14. Bergfeld A.Yu., Damaskina M.V., Ignatova E.S. Motivation to treatment and life values of the oncological patients. Obrazovatel’nyj vestnik soznanie = Educational Bulletin Consciousness 2018;20(6):65–70. (In Russ.).