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©The Author(s) 2023.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1485-1500
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1485
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1485
Table 1 Development studies of combined and intraoperative multivariate models
Ref. | Period + number | Sample region | Operation | Characteristics | Source of data | Models tested | Outcomes tested |
Janowak et al[26], 2015 | 2009-2013 (168) | United States | TT/TH/Hybrid/MIE | N: 93/168; H: N/A | Single centre | eSAS | Major morbidity |
Yoshida et al[28], 2015 | 2005-2013 (365) | Japan | TT | N: 113/250; H: N/A | Single centre | Yoshida score | Morbidity +; Major morbidity |
Stroyer et al[27], 2017 | 2011-2014 (234) | Denmark | TT | N: 188/234; H: N/A | Single centre | Modified eSAS, SAS, eSAS | Major morbidity |
Xi et al[30], 2019 | 2015-2018 (194) | China | TT/Hybrid/MIE | N: 48/194; H: N/A | Single centre | eSAS nomogram | Major morbidity |
Xi et al[29], 2020 | 2015-2017 (251) | China | TT/Hybrid/MIE | N: 56/251; H: N/A | Single centre | IPF nomogram | Major morbidity |
Huang et al[31], 2020 | 2016-2018 (330) | China | TT/Hybrid/MIE | N: 41/330; H: 321SCC/9AC | Single centre | Huang nomogram | Anastomotic leak |
Table 2 Validation studies of combined and intraoperative models
Ref. | Period + number | Sample region | Operation | Characteristics | Source of data | Models tested | Outcomes tested |
Zafirellis et al[36], 2002 | 1990-1999 (204) | United Kingdom | TT/TH | N: 39/204; H: 156AC/45SCC | Single centre | POSSUM | Major morbidity + Mortality |
Lai et al[37], 2007 | 2001-2005 (545) | China | TT | N: N/A; H: 545SCC/0AC | Hong Kong (All) | POSSUM; O-POSSUM; P-POSSUM | Mortality |
Lagarde et al[38], 2007 | 1993-2005 (663) | Netherlands | TT/TH | N: N/A; H: 476AC/187SCC | Single centre | O-POSSUM | Mortality |
Baba et al[39], 2008 | 2000-2007 (142) | Japan | TT | N: 15/142; H: 142SCC/0AC | Single centre | E-PASS | Morbidity |
Bosch et al[33], 2011 | 1991-2007 (278) | Netherlands | TT | N: 10/278; H: 235AC/43SCC | Single centre | ACCI; CCI; O-POSSUM; P-POSSUM | Mortality |
Yoshida et al[40], 2013 | 2005-2012 (308) | Japan | TT | N: N/A; H: N/A | Single centre | E-PASS | Morbidity |
Filip et al[34], 2014 | 2004-2013 (43) | Romania | TT/TH | N: 22/43; H: 33SCC/9AC | Single centre | ACCI; CCI; POSSUM; O-POSSUM; P-POSSUM | Mortality |
Filip et al[32], 2015 | 2008-2012 (167) | Italy | TT/TH/MIE | N: 131/167; H: 105 AC/62SCC | Single centre | PNI-multivariate PNI; CCI; ACCI; O-POSSUM; P-POSSUM; Amsterdam score | Morbidity |
Yamana et al[35], 2015 | 2005-2013 (251) | Japan | TT/MIE | N: 150/251; H: N/A | Single centre | GNRI; PNI; E-PASS; POSSUM | Respiratory complications |
Xing et al[41], 2016 | 2008-2010 (189) | China | TT/TH | N: 7/189; H: 141SCC/45AC | Single centre | E-SAS | Major morbidity |
Eto et al[42], 2016 | 2007-2015 (399) | Japan | Hybrid | N: 176/399; H: N/A | Single centre | SAS | Major morbidity |
Nakagawa et al[43], 2017 | 2007-2017 (379) | Japan | TT/Hybrid/MIE | N: 129/379; H: 367SCC/12AC | Single centre | SAS | Major morbidity |
Aoki et al[44], 2019 | 2011-2015 (246) | Japan | TT/Hybrid/MIE | N: 152/246; H: N/A | Single centre | E-SAS; Modified E-SAS | Major morbidity |
Hayashi et al[45], 2019 | 2012-2016 (190) | Japan | TT | N: 115/190; H: N/A | Single centre | SAS | Major morbidity |
Table 3 Clinical credibility of combined and intraoperative models
Model | Ref. | Oesophageal specific | No thresholds | Timely data | Reliable data | Easy to generate | Understandable | Useful range | Total |
POSSUM | Copeland et al[46], 1991 | No | No | No | Yes | Yes | Yes | Yes | 4 |
O-POSSUM | Tekkis et al[48], 2004 | Partly | No | No | Yes | Yes | Yes | Yes | 4.5 |
P-POSSUM | Prytherch et al[47], 1998 | No | No | No | Yes | Yes | Yes | Yes | 4 |
E-PASS | Haga et al[49], 1999 | No | Yes | No | Partly | No | Partly | Yes | 3 |
Yoshida score | Yoshida et al[28], 2014 | Yes | No | No | Yes | Yes | Yes | No | 4 |
Xi SAS nomogram | Xi et al[29], 2020 | Yes | No | No | Partly | Yes | Yes | Yes | 4.5 |
Xi IPF nomogram | Xi et al[30], 2019 | Yes | No | No | Partly | Yes | Yes | Yes | 4.5 |
Huang Model | Huang et al[31], 2020 | Yes | No | No | Yes | Yes | Yes | Yes | 5 |
SAS | Gawande et al[50], 2007 | No | No | No | Partly | Yes | Yes | Yes | 3.5 |
eSAS | Janowak et al[26], 2015 | Yes | No | No | Partly | Yes | Yes | Yes | 4.5 |
Modified eSAS | Stroyer et al[27], 2017 | Yes | No | No | Partly | Yes | Yes | Yes | 4.5 |
Table 4 Methodological quality (overall performance) for combined and intraoperative models
Model | Study participation (out of 8) | Measurements (out of 4) | Analysis (out of 8) | Total (out of 20) |
POSSUM | 7 | 3 | 5.5 | 15.5 |
O-POSSUM | 8 | 4 | 8 | 20 |
P-POSSUM | 7 | 3 | 7 | 17 |
E-PASS | 7.5 | 3 | 6 | 16.5 |
Yoshida score | 6 | 4 | 6 | 16.5 |
Xi SAS nomogram | 8 | 4 | 7 | 19 |
Xi IPF nomogram | 8 | 4 | 6 | 18 |
Huang model | 7.5 | 4 | 6 | 16.5 |
SAS | 8 | 4 | 7 | 19 |
eSAS | 8 | 4 | 4 | 16 |
Modified eSAS | 8 | 4 | 6 | 17.5 |
Table 5 Summary of the performance for each of the combined and intraoperative models
Predictive model (n) | Ref. | Discrimination | Calibration/other statistics | Outcome |
POSSUM (5) | Zafirellis et al[36], 2002 | 0.55, 0.62 | HL P < 0.001, 0.002 | Morbidity + Mortality |
Lai et al[37], 2007 | AUC = 0.776 | O:E 0.367 (P = 0.001) | Mortality | |
Filip et al[34], 2014 | AUC = 0.826 | O:E 1.11 | Mortality | |
Filip et al[32], 2015 | AUC = 0.59 | HL P value (0.08) | Morbidity | |
Yamana et al[35], 2015 | AUC = 0.601 | Not reported | Resp complications | |
O-POSSUM (4) | Lai et al[37], 2007 | AUC = 0.676 | O:E 0.505 (P = 0.002) | Mortality |
Lagarde et al[38], 2007 | AUC = 0.60 | O:E 0.29 (P < 0.001) | Mortality | |
Bosch et al[33], 2011 | AUC = 0.756 | HL P value (0.035) | Mortality | |
Filip et al[34], 2014 | AUC = 0.740 | O:E 1.70 | Mortality | |
P-POSSUM (3) | Lai et al[37], 2007 | AUC = 0.776 | O:E (P = 0.814) | Mortality |
Bosch et al[33], 2011 | AUC = 0.766 | HL P value (0.529) | Mortality | |
Filip et al[34], 2014 | AUC = 0.607 | O:E 4.28 | Mortality | |
E-PASS (3) | Baba et al[39], 2008 | CRS > 1 (P < 0.001) | N/A | Morbidity |
Yoshida et al[40], 2013 | CRS > 0.9 (P 0.029) | N/A | Morbidity | |
Yamana et al[35], 2015 | AUC = 0.659 | N/A | Resp complications | |
Yoshida (1) | Yoshida et al[28], 2015 | P value = < 0.001, 0.037 | Not reported | Morbidity + Major morbidity |
Xi SAS nomogram (1) | Xi et al[30], 2019 | AUC = 0.903, 0.967 | “Good” | Major morbidity |
Xi IPF nomogram (1) | Xi et al[29], 2020 | AUC = 0.921 | “Sufficient” | Major morbidity |
Huang (1) | Huang et al[31], 2020 | AUC = 0.69 | “Good” | Anastomotic leak |
SAS (4) | Eto et al[42], 2016 | AUC = 0.68 | Cut off = 6 Pulm, SSI, AL | Major morbidity |
Stroyer et al[27], 2017 | AUC = 0.561 | All comp P = 0.148 | Major morbidity | |
Nakagawa et al[43], 2017 | Not reported | Cut off > 5, P < 0.0001 | Major morbidity | |
Hayashi et al[45], 2019 | Not reported | Cut off ≥ 6, P = 0.032 | Major morbidity | |
eSAS (4) | Janowak et al[26], 2015 | AUC = 0.614 | Cut off = 6, Com P = 0.01 | Major morbidity |
Xing et al[41], 2016 | AUC = 0.62 | Cut off > 7 LOS | Major morbidity | |
Stroyer et al[27], 2017 | AUC = 0.572 | All comp P = 0.460 | Major morbidity | |
Aoki et al[44], 2019 | Optimal cut-off 4 (Youden’s index = 0.069) | Major morbidity (P = 0.29) | Major morbidity | |
Modified eSAS (2) | Stroyer et al[27], 2017 | AUC = 0.532 | All comp P = 0.096 | Major morbidity |
Aoki et al[44], 2019 | Optimal cut-off 4 (Youden’s index = 0.180) | Major morbidity (P = 0.004) | Major morbidity |
Table 6 Summary of the combination and intraoperative models across the five categories
Model | Ref. | Clinical credibility (out of 7) | Methodological quality (out of 20) | Model performance (overall utility) | External validation | Clinical effectiveness |
POSSUM | Copeland et al[46], 1991 | 4 | 15.5 | Mortality | Yes | No |
O-POSSUM | Tekkis et al[48], 2004 | 4.5 | 20 | No | Yes | No |
P-POSSUM | Prytherch et al[47], 1998 | 4 | 17 | Mortality | Yes | No |
E-PASS | Haga et al[49], 1999 | 3 | 16.5 | No | Yes | No |
SAS | Gawande et al[50], 2007 | 4 | 16.5 | No | Yes | No |
eSAS | Janowak et al[26], 2015 | 4.5 | 19 | No | Yes | No |
Modified eSAS | Stroyer et al[27], 2017 | 4.5 | 18 | No | Yes | No |
Yoshida score | Yoshida et al[28], 2015 | 5 | 16.5 | No | No | No |
Xi SAS nomogram | Xi et al[29], 2020 | 3.5 | 19 | Major morbidity | No | No |
Xi IPF nomogram | Xi et al[30], 2019 | 4.5 | 16 | Major morbidity | No | No |
Huang | Huang et al[31], 2020 | 4.5 | 17.5 | No | No | No |
- Citation: Grantham JP, Hii A, Shenfine J. Combined and intraoperative risk modelling for oesophagectomy: A systematic review. World J Gastrointest Surg 2023; 15(7): 1485-1500
- URL: https://www.wjgnet.com/1948-9366/full/v15/i7/1485.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v15.i7.1485