Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Oct 2016
Improvement of the Surgical Apgar Score by Addition of Intraoperative Blood Transfusion Among Patients Undergoing Major Gastrointestinal Surgery.
The surgical Apgar score (SAS) has been shown to correlate with postoperative outcomes. A key component of the SAS is estimated blood loss (EBL), which has been shown to be inaccurate and discordant with intraoperative blood transfusion. Given this, the objective of the current study was to assess the added predictive value of the including receipt of intraoperative transfusion to the SAS. ⋯ The inclusion of intraoperative transfusion in a modified SAS significantly improves the risk-stratifying ability of the score with regard to postoperative morbidity and mortality. Given the variability of intraoperative transfusion, its discordance with EBL, and its strong negative impact on postoperative outcomes, we strongly support the inclusion of this factor in a modified SAS.
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J. Gastrointest. Surg. · Oct 2016
Comparative StudyA Comparison of Prognostic Schemes for Perihilar Cholangiocarcinoma.
Although widely used, the 7th edition American Joint Committee on Cancer (AJCC) staging system for perihilar cholangiocarcinoma (PHC) may be limited. Disease-specific nomograms have been proposed as a better means to predict long-term survival for individual patients. We sought to externally validate a recently proposed nomogram by Memorial Sloan Kettering Cancer Center (MSKCC) for PHC, as well as identify factors to improve the prediction of prognosis for patients with PHC. ⋯ The 7th edition AJCC staging system and the MSKCC nomogram had a poor ability to predict long-term survival for individual patients with PHC. A revised nomogram provided more accurate prediction of survival, but will need to be externally validated.