title: The usefulness of P-POSSUM score in patients undergoing elective liver resection for benign disease, metastatic colorectal cancer and non-colorectal cancer.
abstract: OBJECTIVE
  P-POSSUM predicts operative risk and mortality, although few reports describe its use in elective liver resection. We analysed P-POSSUM scores in patients undergoing resection for colorectal liver metastases, non-colorectal cancer and benign liver dis-ease.
  
  
  METHODS
  Data for 664 elective liver resections were included between 1998 and 2009; 480 for colorectal metastases; 96 for benign and 88 for non-colorectal disease. Peri-operative management was standardised according to unit protocol.
  
  
  RESULTS
  P-POSSUM predicted mortality was 3.73%, 6.27% and 9.99% for benign, colorectal and non-colorectal can-cer patients. 60-day mortality was 1.04%, 1.88% and 6.81%, p<0.001. There was correlation between predicted and actual mortality in non-colorectal patients, p=0.029 and weak correlation between physiological score and mortality in each group. There were high-er physiological scores in patients with morbidity and higher predicted mortality in colorectal patients experiencing morbidity, p=0.014. There was correlation be-tween observed and expected operative mortality in benign and non-colorectal patients. Long-term survival was unaffected by various aspects of the P-POSSUM system.
  
  
  CONCLUSIONS
  Predicted mortality is over estimated in patients undergoing liver resection. Pre-operative,physiological score and predicted mortality may have a role predicting morbidity. P-POSSUM is ineffective in predicting prognosis following colorectal cancer metastases resection, although may be used to stratify risk in high risk cancer patients.
authors: Department of Hepatopancreaticobiliary Surgery, Royal Surrey County Hospital, Guildford, Surrey, UK.
authors: Rhys
authors: R
authors: Thomas
authors: Rana
authors: R
authors: Madani
authors: Tim
authors: T
authors: Worthington
authors: Nariman
authors: N
authors: Karanjia
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000473:pathology*; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome