title: POSSUM predicts survival in patients with unresectable pancreatic cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation.
  
  
  METHODS
  Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy.
  
  
  RESULTS
  Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis.
  
  
  CONCLUSIONS
  Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.
authors.affiliation: Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: S M M
authors.initials: SM
authors.lastname: de Castro
authors.forename: J T
authors.initials: JT
authors.lastname: Houwert
authors.forename: S M
authors.initials: SM
authors.lastname: Lagard
authors.forename: O R C
authors.initials: OR
authors.lastname: Busch
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016019:Survival Analysis