Avaliação do risco cirúrgico nos doentes com cancro colo-rectal : POSSUM ou ACPGBI?

Abstract

Diversos modelos têm sido desenvolvidos para prever o risco cirúrgico dos doentes submetidos a cirurgia por cancro colo- -rectal (CCR), contudo actualmente ainda não existe nenhum que responda satisfatoriamente a essa necessidade. Material e métodos: Foram analisados os processos de 345 doentes submetidos a tratamento cirúrgico por CCR no Serviço de Cirurgia Geral do Hospital de Braga e calculado o risco cirúrgico previsto pelas escalas Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), ColoRectal POSSUM (CR-POSSUM), Association of Coloproctology of Great Britain and Ireland (ACPGBI) e ACPGBI modificado. Para todas as escalas de risco foi comparada a mortalidade prevista com a observada e realizada a análise de curva Receiver Operating Characteristic (ROC). Resultados e conclusão: O estudo incluiu 345 doentes operados por CRC, 219 homens e 126 mulheres com média de idade de 68 anos. Na maioria dos doentes (69,0%) o cancro localizou-se no cólon tendo sido a maioria (86,4%) submetidos a cirurgia de forma electiva. A mortalidade pós-operatória global observada aos 30 dias foi de 3,768%. No nosso estudo, apesar de nenhum dos modelos mostrar ser estatisticamente superior a outro, o modelo ACPGBI foi o que apresentou melhor capacidade discriminativa, o que aliado à maior facilidade de aplicação o torna no modelo escolhido para avaliar o risco cirúrgico, na nossa população.

Introduction: Several models have been developed with the purpose of predicting surgical risk of patients submitted to colorectal cancer surgery. However, to date, there isn’t any model that fulfills this purpose in a satisfactory manner. Methods: We consulted the clinical processes of 345 patients, who were submitted to surgical colorectal cancer treatment at the General Surgery department in Hospital de Braga, and calculated surgical risk based on the following risk assessment scales: Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), Portsmouth POSSUM (P-POSSUM), ColoRectal POSSUM (CR-POSSUM), Association of Coloproctology of Great Britain and Ireland (ACPGBI) and modified ACPGBI. For all scales, we compared observed and previewed mortality and calculated Receiver Operating Characteristic (ROC) curve. Results and conclusion: The study included 345 patients submitted to colorectal cancer surgery of which 219 were male and 126 were female, with an average age of 68 years old. Most patients (69,0%) presented with colon cancer and 86,4% were submitted to elective surgery. Post-operatory mortality at 30 days was 3,768%. In the present study, despite no model being statistically better than the other, the ACPGBI model was the one that showed more discriminative properties which, along with easier applicability, makes it the best model for evaluating surgical risk in our population.