The Surgical Apgar Score Is an Independent Prognostic Factor in Patients with Pancreatic Cancer Undergoing Pancreatoduodenectomy Followed by Adjuvant Chemotherapy

Background: We investigated the impact of the surgical Apgar score (SAS) on survival in patients with pancreatic cancer and recurrence after curative surgery followed by adjuvant chemotherapy. Patients and Methods: This study included 103 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. Patients with a SAS of 0-4 were classified into the low SAS group, while those with a SAS of 5-10 were classified into the high SAS group. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. Results: The OS rates at 3 and 5 years after surgery were 23.0% and 14.4%, respectively, in the low-SAS group and 32.3% and 21.4%, respectively, in the high-SAS group, which was a statistically significant difference (p=0.039). The RFS rates at 3 and 5 years after surgery were 13.1% and 13.1%, respectively, in the low-SAS group and 21.4% and 19.2%, respectively, in the high-SAS group, which was a marginally significant difference (p=0.100). Multivariate analysis demonstrated that the SAS was a significant independent risk factor for OS and a marginally significant risk factor for RFS. Conclusion: The SAS was a risk factor for OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned to improve survival.