title: Evaluation of the POSSUM score in surgical treatment of cholangiocarcinoma.
abstract: OBJECTIVE
  The surgical treatment for cholangiocarcinoma (CCC) is still a challenge. The aim of this study was to evaluate the POSSUM scoring system for preoperative physiological risk adjustment and for the operative risk of postoperative morbidity and mortality.
  
  
  METHODS
  The operative notes and hospital files of 171 patients with CCC were analyzed retrospectively. The POSSUM scoring system was used to predict morbidity and mortality rates after surgery. The physiological sub score and the operative sub score of the POSSUM score were analyzed with regard to their ability to predict major postoperative complications.
  
  
  RESULTS
  The overall complication rate was 40.9% and the mortality was 11.2%. The morbidity predicted by POSSUM was 63.5% and the prediction for postoperative mortality was 23.7%. Both rates are much higher than the observed morbidity and mortality. High operative severity sub scores correlate with the occurrence of major complications.
  
  
  CONCLUSIONS
  The POSSUM scoring system over predicts morbidity and mortality in surgery for CCC. Operative severity and intraoperative parameters have a greater influence on postoperative mortality and morbidity rates than the physiological parameters represented in the POSSUM physiological score. Prospective studies will have to show whether POSSUM can be modified or whether it is necessary to develop a new score for assessing morbidity and mortality in surgery for CCC.
authors.affiliation: Department of General Surgery and Thoracic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105 Kiel, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Hellmann
authors.forename: Clemens
authors.initials: C
authors.lastname: Schafmayer
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hinz
authors.forename: Bodo
authors.initials: B
authors.lastname: Schniewind
authors.forename: Juergen
authors.initials: J
authors.lastname: Tepel
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Broering
authors.forename: Jan-Hendrik
authors.initials: JH
authors.lastname: Egberts
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index