Research Article
Volume 7 Issue 10 - 2020
POSSUM, P-POSSUM and O-POSSUM in Patients Undergoing Gastrectomy due to Gastric Cancer
Jéssica Chaves1, Ana Pereira2, Pedro Costa3, Adhemar Longatto1,4,5,6 and Sandra F Martins1,4,7*
1Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
22General Surgery Resident, Hospital de Braga, Portugal
3Departement of Surgery, Trás-os-Montes e Alto Douro Hospital Center, Vila Real, Portugal
4ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
5Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
6Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of São Paulo, Brazil
7Coloproctology Unit - Hospital de Braga, Portugal
*Corresponding Author: Sandra F Martins, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
Received: August 10, 2020; Published: September 15, 2020


Background: Gastric cancer is one of the most incident and deadliest worldwide, with surgery being the only curative treatment. Despite the existing models for surgical risk assessment, the ability to predict morbidity and mortality associated with gastric surgery in gastric cancer remains uncertain. The aim of this study is to assess the acuity in predicting mortality and morbidity of the scales POSSUM, P-POSSUM and O-POSSUM in patients undergoing gastrectomy due to gastric cancer.

Methods: Data from 146 patients submitted to curative gastrectomy between December of 2012 and December of 2016 were included. The predictive capacity of the scales was tested through the calibration, comparing the observed mortality to the expected one (O: E ratio) and discrimination, by accessing the analysis of the Receiver Operating Characteristic curve.

Results: This study included 86 men and 60 women, with a median age of 67 years. Mortality and morbidity observed at 30 days postoperative was 4.79% and 27.4%, respectively. In mortality, P-POSSUM presented the best calibration (O: E ratio = 1.41), underestimating mortality and the operative score was the only one that presented discriminative power, although reasonable (AUC = 0.763). In morbidity, POSSUM presented an O: E ratio of 0.496, overestimating the morbidity, especially in the higher risk groups (> 60%) and no scale/score presented discriminative capacity.

Conclusion: Therefore, no model predicted morbidity and mortality correctly, however, the P-POSSUM equation for mortality and POSSUM for morbidity may have potential in the Portuguese population, but further studies are needed.

Keywords: Gastric Cancer; Morbidity; Mortality; POSSUM


  1. Ferlay J., et al. “Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012”. International Journal of Cancer5 (2015).
  2. Miranda N., et al. “Portugal Doenças Oncológicas em números, 2015”. Portugal Doenças Oncológicas Em Números (2016) 7-65.
  3. Smyth EC., et al. “Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”. Annals of Oncology5 (2016): v38-v49.
  4. Healthcare Quality Improvement Partnership Ltd. National Oesophago-Gastric Cancer Audit (2015).
  5. Nagabhushan JS., et al. “Comparison of P-POSSUM and O-POSSUM in predicting mortality after oesophagogastric resections”. Postgraduate Medical Journal979 (2007): 355-358.
  6. Scott S., et al. “An evaluation of POSSUM and P-POSSUM scoring in predicting post-operative mortality in a level 1 critical care setting”. BMC Anesthesiology1 (2014): 104.
  7. Bernardo AT., et al. “Avaliação da performance cirúrgica pelo P-POSSUM em doentes com cancro gástrico: revisão de 5 anos”. Revista Portuguesa de Cirurgia 36 (2016): 9-18.
  8. Smith J and Tekkis P. “Risk Prediction in surgery”. Consulted (2015).
  9. Copeland G and Kim J. “POSSUM for operative Mobility and Mortality Risk”. Consulted (2013).
  10. Lee HJ., et al. “Korean Laparoscopic Gastrointestinal Surgery Study (KLASS) Group. The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer”. Surgical Endoscopy11 (2009): 2473.
  11. Zheng L., et al. “The survival and the long-term trends of patients with gastric cancer in Shanghai, China”. BMC Cancer1 (2014): 300.
  12. Goulart A and Martins S. “Avaliação do risco cirúrgico nos doentes com cancro colo-rectal: POSSUM ou ACPGI?” Revista Portuguesa de Cirurgia 24 (2013) .
  13. Karimi P., et al. “Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention”. Cancer Epidemiology and Prevention Biomarkers5 (2014): 700-713.
  14. Healthcare Quality Improvement Partnership Ltd. National Oesophago-Gastric Cancer Audit (2016).
  15. Chen W., et al. “Cancer statistics in China, 2015. CA: a cancer”. Journal for Clinicians2 (2016): 115-132.
  16. Hong S., et al. “Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients”. Asian Journal of Surgery2 (2017): 89-94.
  17. Tekkis PP., et al. “Risk‐adjusted prediction of operative mortality in oesophagogastric surgery with O‐POSSUM”. British Journal of Surgery3 (2004): 288-295.
  18. Zheng L., et al. “The survival and the long-term trends of patients with gastric cancer in Shanghai, China”. BMC Cancer1 (2014): 300.
  19. Vather R., et al. “Comparison Of The Possum, P‐Possum And Cr‐Possum Scoring Systems As Predictors Of Postoperative Mortality In Patients Undergoing Major Colorectal Surgery”. ANZ Journal of Surgery9 (2006): 812-816.
  20. Yadav K., et al. “Evaluation of POSSUM and P-POSSUM as a tool for prediction of surgical outcomes in the Indian population”. The Australasian Medical Journal 7 (2011): 366.
  21. Gocmen E., et al. “Evaluation of P-POSSUM and O-POSSUM scores in patients with gastric cancer undergoing resection”. Hepato-gastroenterology60 (2004): 1864-1866.
  22. Luna A., et al. “An evaluation of morbidity and mortality in oncologic gastric surgery with the application of POSSUM, P-POSSUM, and O-POSSUM”. World Journal of Surgery 9 (2009): 1889-1894.
  23. Bollschweiler E., et al. “Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy”. BMC Surgery1 (2005): 8.
  24. Sohail I., et al. “Physiological POSSUM as an indicator for long-term survival in vascular surgery”. European Journal of Vascular and Endovascular Surgery2 (2013): 223-226.
Citation: Sandra F Martins., et al. “POSSUM, P-POSSUM and O-POSSUM in Patients Undergoing Gastrectomy due to Gastric Cancer”. EC Gastroenterology and Digestive System 7.10 (2020): 33-43.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 09, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.