Surgical Risk Scores as Morbidity and Mortality Predictors in Periampullary Cancer

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.