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Kong J, Odisho T, Alhajahjeh A, Maqsood HA, Al-Share BA, Shahait M, Abubaker A, Kim S, Shahait A. Long-term survival following adrenalectomy for secondary adrenal tumors: A systematic review and meta-analysis. Am J Surg 2024; 237:115809. [PMID: 38945726 DOI: 10.1016/j.amjsurg.2024.115809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/04/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Secondary adrenal tumors (SATs) are uncommon, and the benefits of adrenalectomy for SATs have not been well-established. A systematic review and meta-analysis were conducted to assess the survival benefits of adrenalectomy for SATs. METHOD ology: A systematic literature search was performed (1990-2022). The inclusion criteria included a known primary tumor with confirmed adrenal metastasis in patients who underwent adrenalectomy. The primary outcome was the overall survival (OS). RESULTS A total of 26 studies were included, with 2279 patients. The average age at the time of diagnosis was 61.1 years. Lung cancer was the most common primary tumor. The average time from primary tumor diagnosis to identification of adrenal metastasis was 17 months. The median OS was 35.2 months. One, three, and five-year OS were 79.7 %, 49.1 %, and 37.9 %, respectively. CONCLUSION The results of this review provide insight into the long-term survival of patients with SATs who underwent adrenalectomy. The study highlights the need for further research to identify the risk factors that play a role in the outcome of adrenalectomy in patients with SATs.
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Affiliation(s)
- Joshua Kong
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Tanya Odisho
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
| | | | | | - Bayan A Al-Share
- Monument Health Cancer Care Institute, Monument Health Rapid City Hospital, SD, USA
| | - Mohammed Shahait
- Urology and Robotic Surgery Consultant, Dubai, United Arab Emirates
| | - Ali Abubaker
- Department of Surgery, Detroit Medical Center, Detroit, MI, USA
| | - Steve Kim
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Awni Shahait
- Southern Illinois University School of Medicine, Carbondale, IL, USA.
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Wang Z, Shi K, Mo S, Liu Z, Yao J. A meta-analysis of Lactate Ringer's solution versus Normal Saline in the treatment of acute pancreatitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2024; 47:876-887. [PMID: 38101616 DOI: 10.1016/j.gastrohep.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/22/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
Fluid resuscitation is an important way in the treatment of acute pancreatitis (AP). This meta-analysis aimed to compare the safety and efficacy of Lactate Ringer's solution (LR) and Normal Saline (NS) in the treatment of patients with acute pancreatitis. Searched in PubMed, Web of Science Core Collection (Clarivate), Embase, Cochrane Library, CNKI, China Wanfang, and China VIP database. All randomized controlled clinical trials (RCTs) were identified. Six studies with 431 patients were included. Compared with NS, LR can significantly reduce the incidence of SIRS at 24h, reduce the length of hospitalization, moderate-severe AP, ICU admission and local complications, especially pancreatic necrosis. It is safe and effective to choose LR for fluid resuscitation in AP, but due to the small number of included studies, multi-center and large-sample RCTs are still needed for further verification. PROSPERO registration number: CRD42022322788.
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Affiliation(s)
- Zhengwang Wang
- Yangzhou University Medical College, Yangzhou, Jiangsu, China
| | - Keru Shi
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Shaojian Mo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ziang Liu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan 030032, China
| | - Jie Yao
- Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.
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Jacobs CS, Vitello DJ, Chawla A. Surgical Palliation for Advanced Pancreas Cancer. Surg Clin North Am 2024; 104:1121-1135. [PMID: 39237168 PMCID: PMC11377866 DOI: 10.1016/j.suc.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
To provide optimal care in pancreatic ductal adenocarcinoma, involvement of palliative medicine and nutritional support is recommended. Advances in endoscopy have resulted in robust options for biliary and gastrointestinal stenting for relief of obstruction. Notwithstanding, surgical hepaticojejunostomy and gastrojejunostomy remain incontrovertible considerations for biliary obstruction and gastric outlet obstruction, respectively. For PDAC-associated pain, opioid therapy continues to be the mainstay. However, refractory pain may be treated with interventional procedures such as celiac or splanchnic nerve blocks or neurolysis. In patients with PDAC, enteral nutrition can be further complicated by exocrine pancreatic insufficiency, which should be treated with oral pancreatic enzyme supplementation.
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Affiliation(s)
- Caitlin S Jacobs
- Department of Surgery, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Suite 9-900, Chicago, IL 60611, USA
| | - Dominic J Vitello
- Department of Surgery, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Suite 9-900, Chicago, IL 60611, USA
| | - Akhil Chawla
- Department of Surgery, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Suite 9-900, Chicago, IL 60611, USA; Arkes Family Pavilion, 676 North Saint Clair Street, Suite 6-096, Chicago, IL 60611, USA.
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Martinino A, Ladowski JM, Schilirò D, Hartwig MG, Moris D, Barbas AS. Textbook Outcomes in Solid Transplantation: A Systematic Review. Transplant Direct 2024; 10:e1694. [PMID: 39301557 PMCID: PMC11410326 DOI: 10.1097/txd.0000000000001694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/17/2024] [Accepted: 07/05/2024] [Indexed: 09/22/2024] Open
Abstract
Background The concept of TO is expanding across various surgical disciplines to establish a standardized, comprehensive quality benchmark. Traditional metrics such as 1-y patient and graft survival have been key for evaluating transplant program performance but are now deemed inadequate because of significant field advancements. This systematic review aims to provide a comprehensive understanding of the applicability and validity of textbook outcome (TO) in the setting of solid organ transplantation. Methods A structured search, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, was conducted across PubMed, Embase, and Scopus databases on March 10, 2024. Results Fourteen articles were identified for inclusion in this review. Of these, 2 studies addressed TO in heart transplantation, 3 in lung transplantation, 2 in kidney transplantation, and 7 in liver transplantation. A subgroup analysis was conducted to categorize the different definitions of TOs and identify the most common reasons for TO failure. Conclusions Our systematic review highlights the ongoing efforts in the field of solid organ transplantation to define TO and emphasizes the importance of developing a universally recognized set of TO criteria for each type of transplant. TO provides a valuable framework for transplant centers to benchmark their performance against similar institutions on a risk-adjusted basis and to pinpoint specific areas for enhancing patient outcomes. Even the most successful programs may discover aspects within the composite outcome with scope for improvement.
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Affiliation(s)
| | | | - Davide Schilirò
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Andrew S Barbas
- Department of Surgery, Duke University Medical Center, Durham, NC
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Ichida H, Imamura H, Takahashi A, Yoshioka R, Mise Y, Inoue Y, Takahashi Y, Saiura A. Evaluation of pancreatic morphometric parameters, exocrine function, and nutritional status and their causal relationships in long-term survivors following pancreatectomy. Surgery 2024; 176:1189-1197. [PMID: 39003090 DOI: 10.1016/j.surg.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Patients undergoing pancreatectomy are at risk for pancreatic exocrine insufficiency and malnutrition. However, the incidence of these complications and the associated risk factors have not been sufficiently examined. This study aimed to investigate the changes in pancreatic morphology, pancreatic exocrine function, and long-term nutritional status after pancreatectomy. METHODS We assessed the nutritional status, pancreatic morphologic parameters, and pancreatic exocrine function in patients undergoing pancreaticoduodenectomy and distal pancreatectomy. Nutritional status was evaluated on the basis of body weight change, body mass index, and skeletal muscle mass. Pancreatic parenchymal texture at the time of surgery, remnant volume of the pancreatic parenchyma, and diameter of the pancreatic duct were measured. Exocrine function was measured using the N-benzoyl-L-tyrosyl-p-aminobenzoic acid excretion test and the clinical signs of steatorrhea and nonalcoholic steatohepatitis. We then investigated potential causal relationships. RESULTS Seventy patients were included in the study. Moderate and severe malnutrition were diagnosed in 19 (27%) and 15 patients (21%), respectively. Most patients with malnutrition before surgery were also found to be malnourished postoperatively. Body weight and skeletal muscle mass decreased after pancreatectomy in most patients, even in the longer term. Subclinical and clinical pancreatic exocrine insufficiency was found in 36 (51%) and 25 patients (36%), respectively, and pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, dilated pancreatic duct, low preoperative body mass index, and pancreatic exocrine insufficiency grade were found to contribute to postoperative malnutrition. CONCLUSION Pancreatic ductal adenocarcinoma, dilated pancreatic duct, pancreaticoduodenectomy, low preoperative body mass index, and pancreatic exocrine insufficiency were risk factors for postoperative malnutrition.
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Affiliation(s)
- Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Imamura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Ryuji Yoshioka
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshihiro Mise
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yosuke Inoue
- Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Takahashi
- Department of Hepatobiliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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Busquets J, Secanella L, Carnaval T, Sorribas M, Serrano-Navidad M, Alba E, Escalante E, Ruiz-Osuna S, Peláez N, Fabregat J. Embolize, supercharge, resect: Embolization to enhance hepatic vascularization prior to en-bloc pancreas and arterial resection. Cir Esp 2024:S2173-5077(24)00199-6. [PMID: 39304131 DOI: 10.1016/j.cireng.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 08/03/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Embolization could increase the resectability of pancreatic tumors by supercharging visceral arterial perfusion prior to pancreatic surgery with arterial en-bloc resection. Its indications, however, are controversial. METHODS We retrospectively analyzed the results of a single-center database of patients undergoing pancreatic surgery with arterial resection (AR) after preoperative arterial embolization (PAE) to increase hepatic vascular flow and spare arterial reconstruction. RESULTS PAE was planned in 15 patients with arterial involvement due to pancreatic tumors. Three patients were excluded due to the finding of irresectable disease during surgery. Twelve cases were resected because of pancreatic cancer (10), distal cholangiocarcinoma (1), and pancreatic neuroendocrine tumor (1). Arterial involvement in these cases required embolization of the substitute right hepatic artery (RHA) (5), left hepatic artery (1), and common hepatic artery (CHA) (6) to enhance liver vascularization. Two patients presented migration of the vascular plug after PAE. Six pancreatoduodenectomies and 6 distal pancreatectomies were performed, the latter associated with en-bloc celiac trunk and CHA resection. R0 was achieved in 7 out of 12 patients, and pathological vascular involvement was confirmed in 8. Postoperative complications included one patient who developed gastric ischemia and underwent gastrectomy, and one patient who underwent reoperation for acute cholecystitis with liver abscesses. CONCLUSION Preoperative arterial embolization before pancreatic surgery with hepatic arterial resection enables surgeons to precondition hepatic vascularization and prevent hepatic ischemia. In addition, this avoids having to perform arterial anastomosis in the presence of pancreatic suture.
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Affiliation(s)
- Juli Busquets
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament de Ciències Clíniques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Luis Secanella
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Departament d'Infermeria Fonamental i Medicoquirúrgica, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Thiago Carnaval
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, Bellvitge Campus, L'Hospitalet de Llobregat, Barcelona, Spain; Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Maria Sorribas
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica Serrano-Navidad
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Alba
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elena Escalante
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra Ruiz-Osuna
- Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Peláez
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Fabregat
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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Zhang J, Weng X. Development of a Nomogram to Predict the Risk for Acute Necrotizing Pancreatitis. Gut Liver 2024; 18:915-923. [PMID: 38384201 PMCID: PMC11391142 DOI: 10.5009/gnl230403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 02/23/2024] Open
Abstract
Background/Aims Necrotizing pancreatitis (NP) presents a more severe clinical trajectory and increased mortality compared to edematous pancreatitis. Prompt identification of NP is vital for patient prognosis. A risk prediction model for NP among Chinese patients has been developed and validated to aid in early detection. Methods A retrospective analysis was performed on 218 patients with acute pancreatitis (AP) to examine the association of various clinical variables with NP. The least absolute shrinkage and selection operator (LASSO) regression was utilized to refine variables and select predictors. Subsequently, a multivariate logistic regression was employed to construct a predictive nomogram. The model's accuracy was validated using bootstrap resampling (n=500) and its calibration assessed via a calibration curve. The model's clinical utility was evaluated through decision curve analysis. Results Of the 28 potential predictors analyzed in 218 AP patients, the incidence of NP was 25.2%. LASSO regression identified 14 variables, with procalcitonin, triglyceride, white blood cell count at 48 hours post-admission, calcium at 48 hours post-admission, and hematocrit at 48 hours post-admission emerging as independent risk factors for NP. The resulting nomogram accurately predicted NP risk with an area under the curve of 0.822, sensitivity of 82.8%, and specificity of 76.4%. The bootstrap-validated area under the curve remained at 0.822 (95% confidence interval, 0.737 to 0.892). This model exhibited excellent calibration and demonstrated greater predictive efficacy and clinical utility for NP than APACHE II, Ranson, and BISAP. Conclusions We have developed a prediction nomogram of NP that is of great value in guiding clinical decision.
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Affiliation(s)
- Junchao Zhang
- Department of Gastroenterology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
| | - Xiaxia Weng
- Department of Gastroenterology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen, China
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Hamidi O, Miljanic M, Tumyan G, Christie A, Mirfakhraee S, Ali S, Dohopolski M, Gottumukkala S, Brugarolas J, Timmerman R, Hannan R. Adrenal Insufficiency following Stereotactic Ablative Radiotherapy (SAbR) of Adrenal Gland Metastases. Cancers (Basel) 2024; 16:3140. [PMID: 39335112 PMCID: PMC11429775 DOI: 10.3390/cancers16183140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Adrenal metastases are often treated with stereotactic ablative radiation (SAbR). We aimed to assess the incidence, timing, and factors associated with the development of primary adrenal insufficiency (PAI) following SAbR. METHODS A retrospective cohort study comprised 66 consecutive patients (73% men, median age 61 years) who underwent SAbR for adrenal metastasis. RESULTS The series encompassed metastases from renal cell carcinoma (41%), lung tumors (38%), colorectal adenocarcinoma (9%), melanoma (5%), and others (7%). Median follow-up was 17 months from SAbR. Nine (14%) patients developed PAI at a median of 4.3 months (range, 0.7-20.2). The incidence of PAI was 44% in patients with prior adrenalectomy receiving unilateral SAbR, 44% with bilateral SAbR, 2% with unaffected contralateral gland, and 0% with bilateral metastases treated with unilateral SAbR. PAI was associated with prior adrenalectomy (odds ratio [OR] 32) and bilateral SAbR (OR 8.2), but not age, sex, metastasis size, or biological effective dose. Post-SAbR 6-month and 1-year local control rates were 82% and 75%, respectively. CONCLUSIONS Patients undergoing SAbR for adrenal metastasis are at high risk of developing PAI. PAI is associated with bilateral SAbR and contralateral adrenalectomy. PAI is unlikely with a remaining unaffected adrenal gland or in the setting of bilateral adrenal metastases with unilateral SAbR.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (O.H.); (G.T.); (S.M.); (S.A.)
| | - Mihailo Miljanic
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.M.); (R.T.)
| | - Gayane Tumyan
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (O.H.); (G.T.); (S.M.); (S.A.)
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.C.); (M.D.); (S.G.); (J.B.)
| | - Sasan Mirfakhraee
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (O.H.); (G.T.); (S.M.); (S.A.)
| | - Sadia Ali
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (O.H.); (G.T.); (S.M.); (S.A.)
| | - Michael Dohopolski
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.C.); (M.D.); (S.G.); (J.B.)
| | - Sujana Gottumukkala
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.C.); (M.D.); (S.G.); (J.B.)
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (A.C.); (M.D.); (S.G.); (J.B.)
- Department of Internal Medicine, Hematology-Oncology Division, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.M.); (R.T.)
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.M.); (R.T.)
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Ding H, Xu B, Wang Y, Xu B, Qiu W, Zhang W, Wang Y, Li G. Sigmoid colon cancer presenting as a large abdominal mass accompanied by abscess and rupture: a case report and literature review. Ann Med Surg (Lond) 2024; 86:5604-5610. [PMID: 39238955 PMCID: PMC11374294 DOI: 10.1097/ms9.0000000000002425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/25/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction and Importance Colon cancer presenting as a large abdominal mass accompanied by abscess and rupture is rare and prone to be misdiagnosed and delayed. In addition, the treatment plan is not clear when combined with abdominal wall metastasis. Case Presentation A 79-year-old woman presented with a large abdominal mass accompanied by abscess and rupture. It was misdiagnosed as a soft tissue infection in a local hospital, and after a comprehensive examination, it was diagnosed as sigmoid colon cancer with abdominal wall metastasis and abscess formation. The patient underwent a one-stage surgery, including en bloc resection of the tumor and invaded abdominal wall, as well as autologous tissue abdominal wall reconstruction, with a good clinical prognosis. Clinical Discussion For the diagnosis of large abdominal masses, abdominal CT, and pus culture are more valuable than ultrasound. For colon cancer with abdominal wall metastasis, one-stage surgery to completely remove the tumor and full-thickness of the abdominal wall, and the use of autologous tissue abdominal wall reconstruction technology to repair defects is feasible. Conclusion This case highlights the importance of using colon cancer as one of the differential diagnoses for the diagnosis for large abdominal mass accompanied by abscess and rupture in elderly patients, as well as the possibility of one-stage surgical resection of the tumor and invasion of the abdominal wall and reconstruction of the abdominal wall with autologous tissue when there is abdominal wall metastasis.
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Affiliation(s)
- Haibo Ding
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Baiying Xu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Yueming Wang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Bin Xu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wei Qiu
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Wenzhong Zhang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Yongbing Wang
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
| | - Gang Li
- Department of General Surgery, Pudong New Area People's Hospital, Shanghai, People's Republic of China
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Ramia JM, Alcázar-López CF, Villodre-Tudela C, Rubio-García JJ, Hernández B, Aparicio-López D, Serradilla-Martín M. Benchmark Outcomes for Distal Pancreatectomy: A Multicenter Prospective Snapshot Study from the Spanish Distal Pancreatectomy Project (SPANDISPAN). J Am Coll Surg 2024; 239:288-297. [PMID: 38533997 DOI: 10.1097/xcs.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a 1-country prospective study of distal pancreatectomies (DPs) and determined BM. STUDY DESIGN Prospective, multicenter, observational snapshot study of DP carried out at Spanish hepatopancreatobiliary centers for a year (February 1, 2022, to January 31, 2023). Hepatopancreatobiliary centers were defined as high volume if they performed more than 10 DPs per year. Inclusion criteria include any scheduled DP for any diagnosis and age older than 18 years. The low-risk group was defined following the criteria given by Durin and colleagues and major complications as Clavien-Dindo ≥III. RESULTS A total of 313 patients from 42 centers and 46.6% from high-volume centers were included. Median DP by center was 7 (interquartile range 5 to 10), median age was 65 years (interquartile range 55 to 74), and 53.4% were female. The surgical approach was minimally invasive in 69.3%. Major complications were 21.1%. Postoperative pancreatic fistula grade B/C rate was 20.1%, and 90-day mortality was 1.6%. One hundred forty-three patients were in low-risk group (43.8%). Compared with previous BM data, an increasing MIS rate and fewer hospital stay were obtained. CONCLUSIONS We present the first determination of DP-BM in a prospective series, obtaining similar results to the previous ones, but our BM values include a shorter hospital stay and a higher percentage of minimally invasive surgery probably related to Enhanced Recovery after Surgery protocols and prospective data collection. BM is a multiparameter valuable tool for reporting outcomes, comparing centers, and identifying the points to improve surgical care.
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Affiliation(s)
- José M Ramia
- From the Department of Surgery, Hospital General Universitario Dr Balmis, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- ISABIAL, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- Miguel Hernández University, Alicante, Spain (Ramia, Villodre-Tudela)
| | - Cándido F Alcázar-López
- From the Department of Surgery, Hospital General Universitario Dr Balmis, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- ISABIAL, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
| | - Celia Villodre-Tudela
- From the Department of Surgery, Hospital General Universitario Dr Balmis, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- ISABIAL, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- Miguel Hernández University, Alicante, Spain (Ramia, Villodre-Tudela)
| | - Juan J Rubio-García
- From the Department of Surgery, Hospital General Universitario Dr Balmis, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
- ISABIAL, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García)
| | - Belén Hernández
- Department of Surgery, Hospital General Universitario de Elda, Alicante, Spain (Hernández)
| | - Daniel Aparicio-López
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain (Aparicio-López, Serradilla-Martín)
| | - Mario Serradilla-Martín
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain (Aparicio-López, Serradilla-Martín)
- Department of Surgery, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria ibs.GRANADA, School of Medicine, University of Granada, Granada, Spain (Serradilla-Martín)
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11
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Jayaratnam S, Tandup C, Sakaray YR, Kurdia KC, Gupta A, Kaman L. Efficacy of the omental roll-up technique in pancreaticojejunostomy to prevent postoperative pancreatic fistula after pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg 2024; 28:358-363. [PMID: 38834539 PMCID: PMC11341888 DOI: 10.14701/ahbps.24-016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/27/2024] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
Backgrounds/Aims Pancreaticoduodenectomy (PD) is being performed more frequently. A pancreaticojejunostomy (PJ) leak is the major determinant of patient outcomes. An omental flap around PJ might improve postoperative outcomes. Methods A prospective randomized controlled trial was planned at PGIMER, Chandigarh. Fifty-eight patients meeting the criteria were included in the study. Group A underwent PD with omental roll-up and group B underwent standard PD. Results The mean age of patients in group A was 57.1 ± 14.3 years and 51.2 ± 10.7 in group B. Jaundice (p = 0.667), abdominal pain (p = 0.69), and co-morbidities were equal among the groups. The body mass index of patients in group B was higher at 24.3 ± 5.4 kg/m2 (p = 0.03). The common bile duct diameter (12.6 ± 5.3 mm vs. 17.2 ± 10.3 mm, p = 0.13) and the pancreatic duct diameter (4.06 ± 2.01 mm vs. 4.60 ± 2.43 mm, p = 0.91) were comparable. The intraoperative blood loss (mL) was significantly higher in group B (233.33 ± 9.57 vs. 343.33 ± 177.14, p = 0.04). Drain fluid amylase levels on postoperative day (POD) 1 (p = 0.97) and POD3 (p = 0.92) were comparable. The rate of postoperative pancreatic fistula (POPF) grade A (p ≥ 0.99) and grade B (p = 0.54) were comparable. The mean postoperative length of stay among was similar (p = 0.89). Conclusions An omental wrap can be performed without increase in complexity of the procedure. However, its utility in preventing POPFs and morbidity remains unclear.
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Affiliation(s)
| | | | | | | | - Ashish Gupta
- Department of General Surgery, AIMS, Mohali, India
| | - Lileswar Kaman
- Department of General Surgery, PGIMER, Chandigarh, India
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12
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Vilas-Boas F, Rizzo GEM, De Ponthaud C, Robinson S, Gaujoux S, Capurso G, Vanella G, Bozkırlı B. Unveiling hidden outcomes in malignant gastric outlet obstruction research - insights from a "Pancreas 2000" review. World J Gastrointest Endosc 2024; 16:451-461. [PMID: 39155997 PMCID: PMC11325868 DOI: 10.4253/wjge.v16.i8.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 08/01/2024] Open
Abstract
Malignant gastric outlet obstruction (mGOO) is a major condition affecting patients with periampullary tumors, including pancreatic cancer. The current treatment options include surgical gastroenterostomy, endoscopic stenting and more recently EUS-guided gastroenterostomy. Most studies comparing the outcomes of the three procedures focus on technical success, clinical success and safety. Several "occult" outcomes relevant to the patient's viewpoints and perspective may ultimately impact on cancer-related and overall survival, such as body mass composition, nutritional biomarkers, chemotherapy tolerance and patient-reported quality of life. The aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.
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Affiliation(s)
- Filipe Vilas-Boas
- Department of Gastroenterology, São João University Hospital, Porto 4200, Portugal
| | - Giacomo Emanuele Maria Rizzo
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, Scientific Institute for Research, Hospitalization and Healthcare - The Mediterranean Institute for Transplantation and Highly Specialized Therapies, Palermo 90127, Sicilia, Italy
| | - Charles De Ponthaud
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Paris 75013, Île-de-France, France
| | - Stuart Robinson
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle NE7 7DN, Newcastle upon Tyne, United Kingdom
| | - Sebastien Gaujoux
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Sorbonne Université, Paris 75013, Île-de-France, France
| | - Gabriele Capurso
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Giuseppe Vanella
- Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano 20132, Italy
| | - Bahadır Bozkırlı
- Department of General Surgery, HPB-Unit, Acıbadem Maslak Hospital, Istanbul 34398, Türkiye
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13
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Aji A, Abulizi A, Ma H, Ahan A, Jiang T, Zhang R, Guo Q, Shao Y, Aji T, Shalayiadang P. Efficiency of Anatomical Hepatectomy in the Treatment of Hepatic Cystic Echinococcosis. Surg Infect (Larchmt) 2024. [PMID: 39137061 DOI: 10.1089/sur.2024.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Introduction: Total cystectomy and hepatectomy are the main radical surgical procedures for hepatic cystic echinococcosis (CE). When CE lesions severely invade intrahepatic biliary ducts and vessels or single or multiple lesions occupy one hepatic lobe, performing total cystectomy is not indicated. This study aimed to analyze the clinical efficiency of anatomical hepatectomy in the treatment of patients with hepatic CE. Methods: Clinical data of 74 patients with hepatic CE who received anatomical hepatectomy were retrospectively analyzed from January 2005 to January 2022. The patients were classified into the intrahepatic biliary duct invasion group (group A), the intrahepatic vessel invasion group (group B), and the hepatic lobe occupation group (group C). Results: Among these 74 patients who received anatomical hepatectomy, right hepatectomy was performed in 20 cases (27.03%), left hepatectomy in 26 cases (35.13%), right posterior lobectomy in nine cases (12.16%), and left lateral sectionectomy in 19 cases (25.68%). Short-term post-operative complications occurred in seven cases (9.50%), including abdominal abscess in one case, pleural effusion in three cases, intestinal obstruction in one case, incision infection in one case, and ascites in one case. Long-term post-operative complications occurred in four cases (5.4%), including recurrences of CE in two cases and incisional hernias in another two cases. There were no statistical differences in the concentrations of total bilirubin, alanine aminotransferase, and aspartic transaminase before and after surgery between groups (p > 0.05). However, differences in operative time, short-term post-operative complications, average hospital stay, and number of open hepatectomy cases were statistically significant between groups (p < 0.05). The differences in cases receiving hepatic portal occlusion, intra-operative blood loss, and intra-operative blood transfusion were not statistically significant between groups (p > 0.05). Conclusions: Anatomical hepatectomy is an effective and feasible surgical procedure for patients with hepatic CE with severe invasion of intrahepatic biliary ducts and vessels or patients with huge lesions occupying one hepatic lobe, which effectively avoids residual cavity-related complications.
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Affiliation(s)
- Adureheman Aji
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Abuduaini Abulizi
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Hairui Ma
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Tiemin Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Ruiqing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Qiang Guo
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Yingmei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Paizula Shalayiadang
- Department of Hepatobiliary and Echinococcosis Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
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14
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Di Martino M, Nicolazzi M, Baroffio P, Polidoro MA, Colombo Mainini C, Pocorobba A, Bottini E, Donadon M. A critical analysis of surgical outcomes indicators in hepato-pancreato-biliary surgery: From crude mortality to composite outcomes. World J Surg 2024. [PMID: 39129054 DOI: 10.1002/wjs.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/24/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Indicators of surgical outcomes are designed to objectively evaluate surgical performance, enabling comparisons among surgeons and institutions. In recent years, there has been a surge in complex indicators of perioperative short-term and long-term outcomes. The aim of this narrative review is to provide an overview and a critical analysis of surgical outcomes indicators, with a special emphasis on hepato-pancreato-biliary (HPB) surgery. METHODS A narrative review of outcome measures was conducted using a combined text and MeSH search strategy to identify relevant articles focused on perioperative outcomes, specifically within HPB surgery. RESULTS The literature search yielded 624 records, and 94 studies were included in the analysis. Included papers were classified depending on whether they assessed intraoperative or postoperative specific or composite outcomes, and whether they assessed purely clinical or combined clinical and socio-economic indicators. Specific indicators included in composite outcomes were categorized into three main domains: intraoperative metrics, postoperative outcomes, and oncological outcomes. While postoperative mortality, complications, hospital stay and readmission were the indicators most frequently included in composite outcomes, oncological outcomes were rarely considered. CONCLUSIONS The evolution of surgical outcomes has shifted from the simplistic assessment of crude mortality rates to complex composite outcomes. Whether the recent explosion of publications on these topics has a clinical impact in real life is questionable. Outcomes from the patient perspective, integrating social and financial indicators, are not yet integrated into most of these composite analytical tools but should not be underestimated.
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Affiliation(s)
- Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy
| | - Marco Nicolazzi
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy
| | - Paolo Baroffio
- Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy
| | - Michela Anna Polidoro
- Hepatobiliary Immunopathology Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Amanda Pocorobba
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Eleonora Bottini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy
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15
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Fu Y, Wang S, Tan L, Liu Y. Celiac Axis Stenosis as an Independent Risk Factor for Bile Leakage in Laparoscopic Pancreaticoduodenectomy: A Retrospective Study. J Laparoendosc Adv Surg Tech A 2024; 34:682-690. [PMID: 39110618 DOI: 10.1089/lap.2024.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
Background: Celiac axis stenosis can potentially lead to insufficient blood supply to vital organs, such as the liver, spleen, pancreas, and stomach. This condition result in the development of collateral circulation between the superior mesenteric artery and the hepatic artery. However, these collateral circulations are often disrupted during pancreaticoduodenectomy (PD), which may increase the risk of postoperative complications. Methods: A retrospective analysis was conducted on patients who underwent laparoscopic pancreaticoduodenectomy (LPD) from April 2015 to April 2023. Celiac trunk stenosis is classified according to the degree of stenosis: no stenosis (<30%), grade A (30%-<50%), grade B (50%-≤80%), and grade C (>80%). The incidence of postoperative complications was evaluated, and both univariate and multivariate risk analyses were conducted. Results: A total of 997 patients were included in the study, with mild celiac axis stenosis present in 23 (2.3%) patients, moderate stenosis in 18 (1.8%) patients, and severe stenosis in 10 (1.0%) patients. Independent risk factors for the development of bile leakage, as identified by both univariate and multivariate analyses, included body mass index (BMI) (HR = 1.108, 95% CI = 1.008-1.218, P = .033), intra-abdominal infection (HR = 2.607, 95% CI = 1.308-5.196, P = .006), postoperative hemorrhage (HR = 4.510, 95% CI = 2.048-9.930, P = <0.001), and celiac axis stenosis (50%-≤80%, HR = 4.235, 95% CI = 1.153-15.558, P = .030), and (>80%, HR = 4.728, 95% CI = .882-25.341, P = .047). Celiac axis stenosis, however, was not determined to be an independent risk factor for pancreatic fistula (P > 0.05). Additionally, the presence of an aberrant hepatic artery did not significantly increase the risk of postoperative complications when compared with celiac axis stenosis alone. Conclusion: Severe celiac axis stenosis is an independent risk factor for postoperative bile leakage following LPD.
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Affiliation(s)
- Yu Fu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Shupeng Wang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Ludong Tan
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
| | - Yahui Liu
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China
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16
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Sommier L, Lim C, Jeune F, Goumard C, Turco C, Salloum C, Llado L, Savier E, Perdigao F, Rousseau G, Ramos E, Lopez-Dominguez J, Cachero A, Toubert C, Roucaute S, Al Taweel B, Georges P, Poppen T, Lioret P, Herrero A, Navarro F, Heyd B, Soubrane O, Azoulay D, Scatton O. European validation of the classification for the anticipated difficulty of liver transplantation. HPB (Oxford) 2024; 26:1033-1039. [PMID: 38806366 DOI: 10.1016/j.hpb.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/03/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Appropriate risk stratification for the difficulty of liver transplantation (LT) is essential to guide the selection and acceptance of grafts and avoid morbidity and mortality. METHODS Based on 987 LTs collected from 5 centers, perioperative outcomes were analyzed across the 3 difficulty levels. Each LT was retrospectively scored from 0 to 10. Scores of 0-2, 3-5 and 6-10 were then translated into respective difficulty levels: low, moderate and high. Complications were reported according to the comprehensive complication index (CCI). RESULTS The difficulty level of LT in 524 (53%), 323 (32%), and 140 (14%) patients was classified as low, moderate and high, respectively. The values of major intraoperative outcomes, such as cold ischemia time (p = 0.04) and operative time (p < 0.0001) increased gradually with statistically significant values among difficulty levels. There was a corresponding increase in CCI (p = 0.04), severe complication rates (p = 0.05) and length of ICU (p = 0.01) and hospital (p = 0.004) stays across the different difficulty levels. CONCLUSION The LT difficulty classification has been validated.
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Affiliation(s)
- Lazare Sommier
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Chetana Lim
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Research Unit, Université de Picardie-Jules Verne, UR UPJV 7518 SSPC, Amiens, France; Sorbonne Université, Paris, France
| | - Florence Jeune
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Claire Goumard
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Célia Turco
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Besançon University Hospital, Besancon, France
| | - Chady Salloum
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Laura Llado
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Eric Savier
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Fabiano Perdigao
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Géraldine Rousseau
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Emilio Ramos
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Josefina Lopez-Dominguez
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Alba Cachero
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Cyprien Toubert
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Simon Roucaute
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Bader Al Taweel
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Pauline Georges
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Besançon University Hospital, Besancon, France
| | - Théo Poppen
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Besançon University Hospital, Besancon, France
| | - Perrine Lioret
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Besançon University Hospital, Besancon, France
| | - Astrid Herrero
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Francis Navarro
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Montpellier University Hospital, Montpellier, France
| | - Bruno Heyd
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Besançon University Hospital, Besancon, France
| | - Olivier Soubrane
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Daniel Azoulay
- Centre Hépato-Biliaire, Hôpital Universitaire Paul Brousse, Université Paris-Saclay, Villejuif, France
| | - Olivier Scatton
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France; Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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17
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Moscovici A, Hershkovitz Y, Shamah S, Peleg N, Lavy R, Ben-Yehuda A. Laparoscopic Gastrojejunostomy Versus Endoscopic Stenting as a Palliative Treatment for Gastric Outlet Obstruction. J Laparoendosc Adv Surg Tech A 2024; 34:727-730. [PMID: 38973556 DOI: 10.1089/lap.2024.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction: Gastric outlet obstruction (GOO) is a common complication in advanced stage upper gastrointestinal malignancies. The symptoms of severe nausea and protracted vomiting can lead to a decline in quality of life and cachexia. Symptoms of GOO can be effectively managed with either operative or nonoperative palliative interventions. In our article, we aim to compare laparoscopic gastrojejunostomy (GJ) to endoscopic stenting as palliative interventions for GOO. Methods: We retrospectively evaluated the charts of patients who underwent palliative procedure for gastric outlet obstruction. Group I included patients who underwent endoscopic stenting, and group II patients underwent Laparoscopic GJ. The groups' demographics (age, gender), length of procedure, length of stay, days to oral intake, overall survival, complications rate, and 30-day mortality rates were compared. Results: Overall, 38 patients were included in the study. Nineteen patients underwent endoscopic stenting and 19 underwent laparoscopic GJ. Comparing the groups, no significant differences were noted. Surgical time was significantly longer than the endoscopic procedures (83 minutes versus 25 minutes, P = .001). No significant differences were noted in days of oral intake initiation, overall survival and 30-day mortality rates. Five patients in the stenting group had complications (26.3%) versus none in the surgical group (P = .046). No postoperative complications were noted. Conclusion: Laparoscopic GJ is a safe and feasible treatment for GOO, demonstrating early resumption of oral intake. The relative short hospital stay, combined with an encouraging postoperative complications profile and low reintervention rate, should be kept in mind especially among patients with longer life expectancy.
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Affiliation(s)
- Avihai Moscovici
- General Surgery Department, Shamir medical center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Hershkovitz
- General Surgery Department, Shamir medical center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Steven Shamah
- Division of Gastroenterology, Rabin medical center, Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Peleg
- Division of Gastroenterology, Rabin medical center, Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Lavy
- General Surgery Department, Shamir medical center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Ben-Yehuda
- General Surgery Department, Shamir medical center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Lluís N, Villodre C, Zapater P, Cantó M, Mena L, Ramia JM, Lluís F. Laparoscopic vs open approach for acute cholecystitis in octogenarians. A prospective multicenter observational nationwide study. Cir Esp 2024:S2173-5077(24)00170-4. [PMID: 39067699 DOI: 10.1016/j.cireng.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/25/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The world population is aging, with octogenarians expected to reach over 400 million by 2050. Acute cholecystitis is a serious complication in the elderly. Age is not a contraindication for emergency cholecystectomy, an option that can both save lives and preserve quality of life. METHODS The present study aimed to compare open and laparoscopic surgical approaches. Over six months, 38 emergency surgery units enrolled all consecutive octogenarians with acute cholecystitis undergoing cholecystectomy. Postoperative outcomes were compared after propensity score matching analysis. RESULTS The study included 212 patients (84 years [81-86], 47.2% women). The open approach was used in 32.1% of patients, and the laparoscopic approach in 67.9%. After propensity score matching, a decrease in hospital stays (open, 8 days [6-13]; laparoscopic, 5 days [4-8]; P < .001), 30-day morbidity (open, 48.5%; laparoscopic, 26.5%; P = .01), and 30-day mortality (open, 13.2%, laparoscopic, 1.5%; P = .02) was found. Among the specific postoperative complications, a decrease in septicemia (open, 14.7%; laparoscopic, 0%; P = .001) was observed. CONCLUSIONS Laparoscopic approach was used in two out of three octogenarians. After propensity score matching, octogenarians undergoing laparoscopic approach had shorter length of hospital stay, fewer 30-day postoperative complications, fewer episodes of septicemia, and less 30-day mortality than octogenarians undergoing open approach. These findings suggest that the laparoscopic approach may be the preferred choice for octogenarians with acute cholecystitis undergoing cholecystectomy.
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Affiliation(s)
- N Lluís
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - C Villodre
- Department of Surgery, Dr. Balmis General University Hospital, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain.
| | - P Zapater
- Department of Clinical Pharmacology, Dr. Balmis General University Hospital, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - M Cantó
- Computing, BomhardIP, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - L Mena
- Department of Clinical Documentation, Dr. Balmis General University Hospital, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - J M Ramia
- Department of Surgery, Dr. Balmis General University Hospital, Alicante, Spain; Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
| | - F Lluís
- Institute for Health and Biomedical Research of Alicante, ISABIAL, Alicante, Spain
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19
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Raguz I, Meissner T, von Ahlen C, Clavien PA, Bueter M, Thalheimer A. Incidence of postoperative complications is underestimated if outcome data are recorded by interns and first year residents in a low volume hospital setting. Sci Rep 2024; 14:17009. [PMID: 39043731 PMCID: PMC11266497 DOI: 10.1038/s41598-024-67754-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 07/15/2024] [Indexed: 07/25/2024] Open
Abstract
The aim of this study is to evaluate the accuracy of outcome reporting after elective visceral surgery in a low volume district hospital. Outcome measurement as well as transparent reporting of surgical complications becomes more and more important. In the future, financial and personal resources may be distributed due to reported quality and thus, it is in the main interest of healthcare providers that outcome data are accurately collected. Between 10/2020 and 09/2021 postoperative complications during the hospitalisation were recorded using the Clavien-Dindo classification (CDC) and comprehensive complication index by residents of a surgical department in a district hospital. After one year of prospective data collection, data were retrospectively analyzed and re-evaluated for accuracy by senior consultant surgeons. In 575 patients undergoing elective general or visceral surgery interns and residents reported an overall rate of patients with complications of 7.3% (n = 42) during the hospitalization phase, whereas a rate of 18.3% (n = 105) was revealed after retrospective analysis by senior consultant surgeons. Thus, residents failed to report patients with postoperative complications in 60% of cases (63/105). In the 42 cases, in which complications were initially reported, the grading of complications was correct only in 33.3% of cases (n = 14). Complication grades that were most missed were CDC grade I and II. Quality of outcome measurement in a district hospital is poor if done by unexperienced residents and significantly underestimates the true complication rate. Outcome measurement must be done or supervised by experienced surgeons to ensure correct and reliable outcome data.
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Affiliation(s)
- Ivana Raguz
- Department of Surgery, Spital Männedorf, 8708, Männedorf, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas Meissner
- Department of Surgery, Spital Männedorf, 8708, Männedorf, Switzerland
| | - Christine von Ahlen
- Department of Surgery, Spital Männedorf, 8708, Männedorf, Switzerland
- Department of Health Care Management, Technische Universität Berlin, 10623, Berlin, Germany
| | - Pierre Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery, Spital Männedorf, 8708, Männedorf, Switzerland
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andreas Thalheimer
- Department of Surgery, Spital Männedorf, 8708, Männedorf, Switzerland.
- Department of Surgery and Transplantation, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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20
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Velayudham GK, Dermanis A, Kamarajah SK, Griffiths EA. Predictors of textbook outcome following oesophagogastric cancer surgery. Dis Esophagus 2024; 37:doae023. [PMID: 38525934 PMCID: PMC11220663 DOI: 10.1093/dote/doae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/26/2024]
Abstract
Textbook outcome (TO) is a composite measure representing an ideal perioperative course, which has been utilized to assess the quality of care in oesophagogastric cancer (OGC) surgery. We aim to determine TO rates among OGC patients in a UK tertiary center, investigate predictors of TO attainment, and evaluate the relationship between TO and survival. A retrospective analysis of a prospectively collected departmental database between 2006 and 2021 was conducted. Patients that underwent radical OGC surgery with curative intent were included. TO attainment required margin-negative resection, adequate lymphadenectomy, uncomplicated postoperative course, and no hospital readmission. Predictors of TO were investigated using multivariable logistic regression. The association between TO and survival was evaluated using Kaplan-Meier analysis and Cox regression modeling. In sum, 667 esophageal cancer and 312 gastric cancer patients were included. TO was achieved in 35.1% of esophagectomy patients and 51.3% of gastrectomy patients. Several factors were independently associated with a low likelihood of TO attainment: T3 stage (odds ratio (OR): 0.41, 95% confidence interval (CI) [0.22-0.79], p = 0.008) and T4 stage (OR:0.26, 95% CI [0.08-0.72], p = 0.013) in the esophagectomy cohort and high BMI (OR:0.93, 95% CI [0.88-0.98], p = 0.011) in the gastrectomy cohort. TO attainment was associated with greater overall survival and recurrence-free survival in esophagectomy and gastrectomy cohorts. TO is a relevant quality metric that can be utilized to compare surgical performance between centers and investigate patients at risk of TO failure. Enhancement of preoperative care measures can improve TO rates and, subsequently, long-term survival.
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Affiliation(s)
- Ganesh K Velayudham
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alexander Dermanis
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sivesh K Kamarajah
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ewen A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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21
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Tezuka K, Yamakawa M, Murakami R, Hirai I, Toya R, Suzuki A, Kawamura H, Miyano Y, Sato H, Motoi F. Familial Intraductal Papillary Mucinous Neoplasm Associated With the Germline MSH6 Missense Variant and Progression of Pancreatic cancer. Pancreas 2024; 53:e476-e486. [PMID: 38416847 DOI: 10.1097/mpa.0000000000002313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Intraductal papillary mucinous neoplasm (IPMN) in individuals with at least one first-degree relative with IPMN is defined as familial IPMN. However, few studies have reported on familial IPMN, its clinical characteristics, or the associated genetic factors. MATERIALS AND METHODS We report the case of a 58-year-old woman with multifocal IPMN and a mural nodule in the pancreatic body. The patient underwent a distal pancreatectomy and developed pancreatic head cancer 1 year and 6 months postoperatively. The patient had a family history of multifocal IPMN in her father. Therefore, a genetic predisposition to IPMN and pancreatic cancer was suspected. The patient was analyzed for germline variants, and the resected IPMN was subjected to immunohistochemical and somatic variant analyses. RESULTS Next-generation sequencing revealed a heterozygous germline missense variant in exon 5 of MSH6 (c.3197A>G; Tyr1066Cys). The pathogenicity of this variant of uncertain significance was suspected based on multiple in silico analyses, and the same MSH6 variant was identified in the patient's father's colonic adenoma. The mural nodule in the pancreatic body was pathologically diagnosed as a high-grade IPMN with ossification and somatic KRAS and PIK3CA variants. CONCLUSIONS This case revealed a possible genetic factor for familial IPMN development and presented interesting clinicopathological findings.
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Affiliation(s)
| | | | - Ryoko Murakami
- Genome Informatics Unit, Institution for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | | | | | | | | | - Yuki Miyano
- Genome Informatics Unit, Institution for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | - Hidenori Sato
- Genome Informatics Unit, Institution for Promotion of Medical Science Research, Yamagata University Faculty of Medicine
| | - Fuyuhiko Motoi
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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22
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Finkenstedt A, Joannidis M. [Management of acute pancreatitis in the emergency department and the intensive care unit]. DIE ANAESTHESIOLOGIE 2024; 73:490-498. [PMID: 38884779 DOI: 10.1007/s00101-024-01431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Acute pancreatitis is a gastrointestinal emergency where diagnosis is based on typical symptoms, increased serum lipase concentration, and abdominal imaging. Local complications and organ failure in severe acute pancreatitis regularly necessitate treatment in the intensive care unit and are associated with increased mortality rates. Only optimal interdisciplinary treatment can improve the prognosis of patients with severe acute pancreatitis. This article gives guidance on the initial diagnostic and etiological examinations as well as on the evaluation of organ failure and the severity assessment according to common classification systems. Furthermore, the endoscopic management of biliary pancreatitis and infected necrosis is discussed and the basics of targeted volume therapy, nutrition, and indications for antibiotic treatment are reviewed.
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Affiliation(s)
- Armin Finkenstedt
- Gemeinsame Einrichtung für Internistische Notfall- und Intensivmedizin, Department für Innere Medizin, Landeskrankenhaus Innsbruck, Innsbruck, Österreich.
| | - Michael Joannidis
- Gemeinsame Einrichtung für Internistische Notfall- und Intensivmedizin, Department für Innere Medizin, Landeskrankenhaus Innsbruck, Innsbruck, Österreich
- Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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23
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de la Plaza Llamas R, Parés D, Soria Aledó V, Cabezali Sánchez R, Ruiz Marín M, Senent Boza A, Romero Simó M, Alonso Hernández N, Vallverdú-Cartié H, Mayol Martínez J. Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey. Cir Esp 2024; 102:364-372. [PMID: 38615908 DOI: 10.1016/j.cireng.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain.
| | - David Parés
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Víctor Soria Aledó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario JM Morales Meseguer, Murcia, Spain
| | | | - Miguel Ruiz Marín
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Ana Senent Boza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Romero Simó
- Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario Dr. Balmis de Alicante, Spain
| | - Natalia Alonso Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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24
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Law B, Windsor J, Connor S, Koea J, Srinivasa S. Best supportive care in advanced pancreas cancer: a systematic review to define a patient-care bundle. ANZ J Surg 2024; 94:1254-1259. [PMID: 38366699 DOI: 10.1111/ans.18906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics. METHODS A systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned. RESULTS Forty-four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health-related quality of life necessitates optimisation by involving family, carers and multi-disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required. CONCLUSION This is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.
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Affiliation(s)
- Bena Law
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - John Windsor
- The Department of Surgery, University of Auckland, Auckland, New Zealand
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Saxon Connor
- The Department of Surgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand
| | - Jonathan Koea
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- The Department of Surgery, North Shore Hospital, Private Bag 93503, Auckland, New Zealand
- The Department of Surgery, University of Auckland, Auckland, New Zealand
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25
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Hernández-Bermejo D, García-Vega C, Rubio-García JJ, Villodre-Tudela C, Carbonell-Morote S, Ramia JM. The textbook outcome for cholecystectomy: Is it a good quality tool for a low-morbidity procedure? Cir Esp 2024:S2173-5077(24)00154-6. [PMID: 38908512 DOI: 10.1016/j.cireng.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/23/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The "textbook outcome"(TO) indicates the quality of care commonly used in oncological procedures, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained. The main objective of this study is to determine the TO for cholecystectomy and to see the factors that influence its achievement. METHODS Retrospective observational unicentric cohort study on patients who underwent cholecystectomy between 2018-2020. We defined TO as those patients who met the following premises: Clavien-Dindo complications < III, postsurgical stay less than the 75th percentile (<3 days), and no readmissions or mortality in the first ninety days. Perioperative characteristics were analyzed, and the patients were divided into two groups according to whether or not they achieved TO. We defined criteria for difficult cholecystectomy according to the operative report. RESULTS The percentage of TO was 72% (342/475) (82.6% in elective surgery and 60.5% in urgent surgery). The univariate analysis showed that the following factors are associated with achieving TO: female sex, age <63 years, ASA risk < III, elective surgery, laparoscopic approach, and not difficult cholecystectomy. After multivariate analysis ASA < III (OR 2.39 CI95% 1.37-4.16), elective surgery (OR 2.77 CI95% 1.64-4.67), laparoscopic approach (OR 5.71 CI95% 2.89-11.30) and not to be difficult cholecystectomy (OR 0.42 CI95% 0.259-0.71) remained statistically significant. CONCLUSIONS The TO is a healthcare quality tool that is simple to perform, easily interpretable, and helpful for evaluating quality in healthcare and comparing centers. It applies not only to oncological procedures but also to cholecystectomy.
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Affiliation(s)
| | - Celia García-Vega
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Juan Jesús Rubio-García
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain
| | - Celia Villodre-Tudela
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus Sant Joan, Alicante, Spain
| | - Silvia Carbonell-Morote
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain
| | - José Manuel Ramia
- Departamento de Cirugía, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Campus Sant Joan, Alicante, Spain
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26
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Aversano A, Lissandrini L, Macor D, Carbone M, Cassarano S, Marino M, Giuffrè M, De Pellegrin A, Terrosu G, Berretti D. The Role of Endoscopic Ultrasonography (EUS) in Metastatic Tumors in the Pancreas: 10 Years of Experience from a Single High-Volume Center. Diagnostics (Basel) 2024; 14:1250. [PMID: 38928665 PMCID: PMC11202536 DOI: 10.3390/diagnostics14121250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Metastatic pancreatic lesions (MPLs) are relatively uncommon, constituting 2 to 5% of all pancreatic tumors. They often manifest as solitary lesions without distinct clinical symptoms, usually identified incidentally during radiologic imaging for the surveillance of prior malignancies. Differentiating these lesions from primary pancreatic tumors presents a significant challenge due to their nonspecific presentation. METHODS We aimed to prospectively assess the effectiveness of endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration/biopsy (EUS-FNA/B) in diagnosing MPLs in a carefully selected cohort of patients presenting with pancreatic masses. Additionally, we sought to examine the relevance of specific EUS findings in supporting the initial diagnosis of MPLs and their agreement with the definitive cytological diagnosis. This study retrospectively analyzed data from 41 patients diagnosed with MPLs between 2013 and 2023, focusing on their clinical and pathological characteristics, the echogenic features of the pancreatic lesions, and the techniques used for tissue acquisition. RESULTS The incidence of MPLs in our cohort was 3.53%, with the most frequent primary tumors originating in the kidney (43.90%), colorectum (9.76%), lung (9.76%), lymphoma (9.76%), and breast (4.88%). MPLs typically presented as hypoechoic, oval-shaped lesions with well-defined borders and were predominantly hypervascular. Interestingly, 68.29% of the cases were discovered incidentally during follow-up of the primary tumors, while the involvement of the common bile duct was uncommon (19.51%). CONCLUSIONS EUS and EUS-FNA/B have been validated as valuable diagnostic tools for identifying MPLs. While our findings are promising, further multicenter studies are necessary to corroborate these results and elucidate the predictive value of specific EUS characteristics in determining the metastatic origin of pancreatic lesions.
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Affiliation(s)
| | - Laura Lissandrini
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
| | - Daniele Macor
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
| | - Martina Carbone
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
| | - Sara Cassarano
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
| | - Marco Marino
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
| | - Mauro Giuffrè
- Department of Internal Medicine (Digestive Diseases), Yale School of Medicine, New Haven, CT 06511, USA
| | | | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, 33100 Udine, Italy
| | - Debora Berretti
- Gastroenterology Unit, University Hospital of Udine, 33100 Udine, Italy
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27
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Neuhaus M, Friedrichs J, Grilli M, Ukkat J, Klose J, Ronellenfitsch U, Kleeff J, Rebelo A. Multivisceral Oncological Resections Involving the Pancreas: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2024; 13:e54089. [PMID: 38861712 PMCID: PMC11200041 DOI: 10.2196/54089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. OBJECTIVE This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing evidence concerning the outcomes of multivisceral oncological pancreatic resections across diverse tumor entities. METHODS We will conduct a systematic search of the PubMed or MEDLINE, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The predefined outcomes encompass postoperative mortality, postoperative morbidity, overall and disease-free survival (1- to 5-year survival rates), the proportion of macroscopically complete (R0) resections (according to the Royal College of Pathologists definition), duration of hospital stay (in days), reoperation rate (%), postoperative complications (covering all complications according to the Clavien-Dindo classification), as well as pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying (all according to the definitions of the International Study Group of Pancreas Surgery). RESULTS Systematic database searches will begin in July 2024. The completion of the meta-analysis is anticipated by December 2024. Before completion, the literature search will be checked for new publications that must be considered in the context of the work. CONCLUSIONS The forthcoming findings will provide an up-to-date overview of the feasibility, safety, and oncological efficacy of multivisceral pancreatic resections across diverse tumor entities. This data will serve as a valuable resource for health care professionals and patients to make well-informed clinical decisions. TRIAL REGISTRATION PROSPERO CRD42023437858; https://tinyurl.com/bde5xmfw. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54089.
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Affiliation(s)
| | | | - Maurizio Grilli
- Professional Life Science Information Service, Karlsruhe, Germany
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28
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Paganetti C, Heigl A, Rosenberg R, Vetter M, Haslbauer J, Steuerwald M. Case report: 65-year-old man with metachronous left sided adrenal metastasis of hepatocellular carcinoma. Int J Surg Case Rep 2024; 119:109683. [PMID: 38688153 PMCID: PMC11067464 DOI: 10.1016/j.ijscr.2024.109683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Due to therapeutic advances and improvements in follow-up care, the diagnosis and treatment of extrahepatic metastases of hepatocellular carcinoma [HCC] have gained clinical significance. However, adrenal gland metastases of HCC remain a rare clinical encounter. Several systemic and local treatment options are discussed in current literature. Adrenalectomy in cases of isolated adrenal metastases with well-controlled intrahepatic lesions has been shown to benefit patients in case series. PRESENTATION OF THE CASE This 65-year-old patient presented with suspected metachronous left sided adrenal metastasis seven years after bisegmentectomy for HCC and after undergoing trans-arterial chemoembolization [TACE] for multifocal intrahepatic recurrences while being listed for liver transplantation "beyond Milan criteria". Adrenalectomy was suggested for histopathological confirmation of the suspected metastasis and re-consideration for liver transplant. The resection was performed laparoscopically and metastasis of HCC was confirmed in histopathological analysis. Postoperatively, the patient recovered quickly. However, the patient decided against re-listing for liver transplantation. CLINICAL DISCUSSION Current literature suggests, that minimally-invasive adrenalectomy should be considered in patients with no more than two extrahepatic lesions, a Child-Pugh-Score of less than A5, low alpha-fetoprotein [AFP] levels <100 ng/ml and size <3 cm. The oncological goal should be to achieve a tumor free extrahepatic situation with a potential oncological benefit. CONCLUSION Our patient presented as an ideal candidate for resection of the adrenal gland metastasis and could have been re-assessed postoperatively for liver transplantation. Still, more research is needed to improve patient-selection for metastasectomy in HCC.
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Affiliation(s)
- Ch Paganetti
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland.
| | - A Heigl
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - R Rosenberg
- Department of Surgery, Cantonal Hospital Baselland, Liestal, Switzerland
| | - M Vetter
- Department of Oncology, Cancer Center, Medical University Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | - J Haslbauer
- Department of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - M Steuerwald
- Praxis für Gastroenterologie und Hepatologie, Liestal, Switzerland
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29
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Alvanos A, Bechmann I, Steinke H. Presenting embryologically defined peripancreatic compartments and fusion planes in the search for pancreatic cancer fields. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108272. [PMID: 38552419 DOI: 10.1016/j.ejso.2024.108272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/20/2024] [Accepted: 03/14/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Clinical progress in form of "total mesometrial resection" (TMMR) in cervical cancer and "total mesorectal excision" (TME) in rectal cancer can be traced to a paradigm-shift regarding the extent and range of resection. More significance is bestowed upon embryologically defined borders which define compartments, "morphogenetic units" and "cancer fields", that have to be addressed in order to avoid incomplete tumor resection. We want to transfer this rationale on the pancreas and define such borders for pancreatic compartments. MATERIAL AND METHODS We used 26 unfixed body donors (16 male, 10 female) ranging in age from 64 to 98 years. Manual preparation consisted of performing the Cattell-Braasch maneuver to restore embryologic anatomy and define fascial remnants of the borders of the dorsal and ventral mesogastrium with focus on the pancreatic fusion fasciae and peripancreatic spaces. RESULTS We tracked what used to be the dorsal and ventral mesogastrium and assigned their remnants to the bowel and pancreas. Following avascular embryologic fascial fusion planes along the mesogastria we could demonstrate peripancreatic spaces, which were sealed off from bordering surfaces of presumably different morphogenetic units and possible cancer fields. Reverting embryologic development also seemed possible within the pancreas, demonstrating the embryologic fusion plane between the ventral and dorsal pancreatic buds as two distinct compartments. CONCLUSIONS Following pancreatic fusion fasciae by separating embryologic fusion planes enables to define the pancreatic compartments which might play a major role in applying the success of TMMR and TME on pancreatic resection and define pancreatic cancer fields.
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Affiliation(s)
- Athanasios Alvanos
- University of Leipzig, Faculty of Medicine, Institute of Anatomy, Liebigstraße 13, 04103 Leipzig, Germany.
| | - Ingo Bechmann
- University of Leipzig, Faculty of Medicine, Institute of Anatomy, Liebigstraße 13, 04103 Leipzig, Germany.
| | - Hanno Steinke
- University of Leipzig, Faculty of Medicine, Institute of Anatomy, Liebigstraße 13, 04103 Leipzig, Germany.
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Trigui A, Fendri S, Saumtally MS, Akrout A, Trabelsi J, Daoud R, Toumi N, Ketata S, Boujelbene W, Mzali R, Dziri C, Ben Amar M, Boujelben S. Standardized approach to the conservative surgery of hepatic cystic echinococcosis: A prospective study. PLoS Negl Trop Dis 2024; 18:e0012289. [PMID: 38924053 PMCID: PMC11232992 DOI: 10.1371/journal.pntd.0012289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 07/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Surgery is the mainstay of hepatic cystic echinococcosis (HCE). The conservative surgery of HCE carries a non-negligible risk of recurrence and significant morbidity, dominated by Deep Surgical Site Infections (DSSI). To address these issues, we have improved and standardized this technique, which could reduce complications and achieve better postoperative outcomes. PATIENTS AND METHODS We conducted a prospective study from June 2017 to June 2022 involving of patient operated using a standardized open technique for uncomplicated HCE at Habib Bourguiba University Hospital, Sfax, Tunisia. The aim was to obtain results at least similar to radical management in terms of DSSI. Patients with large cystobiliary fistulas or patients with complicated cysts were excluded. RESULTS Fifty patients with 106 cysts were operated using the standardized technique comprising of liver mobilization, intraoperative ultrasound, systematic methylene blue injection to detect cystobiliary fistulas and omentoplasty. The median age of the patients was 44(semi-interquartile range: 16) years. The main symptom described by the patient was pain in 43 cases (86%). An abnormal liver test was found in 20 cases (40%). On imaging studies, the cyst had a median size of 7.4(3.0) cm. Cyst of the hepatic dome accounted for 38 cases (35.8%) with most cysts being situated in the right hemi-liver. Visual inspection of the cavity and Methylene blue testing allowed for the discovery of 57 cysts (53.7%) that had cystobiliary fistulas that were sutured. Omentoplasty was performed in 77 cysts (72.6%). Postoperatively, only 2 cases (1.9%) developed a DSSI in the form of an external bile leak with resolved with conservative management. No case of recurrence was found after a median follow-up of 24 months. CONCLUSION The standardized conservative surgical technique, in selected patients, shows promise in reducing DSSI rates and overall morbidity, and achieve as equally good result as radical management.
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Affiliation(s)
- Aymen Trigui
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sami Fendri
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mohammad Saad Saumtally
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Amira Akrout
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Jihen Trabelsi
- University of Sfax, Faculty of Medicine; Department of Epidemiology. Hédi Chaker Hospital, Sfax, Tunisia
| | - Rahma Daoud
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Nozha Toumi
- University of Sfax, Faculty of Medicine; Department of Radiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salma Ketata
- University of Sfax, Faculty of Medicine; Department of Anaesthesiology. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Wael Boujelbene
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Rafik Mzali
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Chadli Dziri
- University of Tunis, General Surgery; Honoris Medical Simulation Centre director, Tunisia
| | - Mohamed Ben Amar
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
| | - Salah Boujelben
- University of Sfax, Faculty of Medicine; Department of General and Digestive surgery. Habib Bourguiba Hospital, Sfax, Tunisia
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Alpuche HAV, Torres FR, González JPS. Early results of eTEP access surgery with preperitoneal repair of primary midline ventral hernias and diastasis recti. A 33 patient case series of "PeTEP". Surg Endosc 2024; 38:3204-3211. [PMID: 38637338 DOI: 10.1007/s00464-024-10832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti. METHODS The analysis included 33 patients operated with the preperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4 cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique. RESULTS 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63 years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90 min ± 25 min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported. CONCLUSIONS We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.
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Affiliation(s)
- Héctor Alí Valenzuela Alpuche
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico.
| | - Francisco Regin Torres
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico
| | - Juan Pablo Saucedo González
- General Surgeon, Staff Member at Hospital Ángeles del Carmen Guadalajara, Tarascos 3469 int. 217 condominio profesional del Carmen. colonia Frac. Monraz Guadalajara, Jalisco, CP:44670, Mexico
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Díaz López MI, Crespo Álvarez E, Martínez Manzano Á, Urrechaga E, Orgaz Morales MT, González Morales M, Martín García E, de Guadiana-Romualdo LG. Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests. Cir Esp 2024; 102:300-306. [PMID: 38342139 DOI: 10.1016/j.cireng.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 02/13/2024]
Abstract
AIM Accurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as "Extended Inflammation Parameters" (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. METHOD Prospective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. RESULTS Our population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. CONCLUSIONS Novel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.
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Affiliation(s)
| | - Elena Crespo Álvarez
- General Surgery Department, Hospital Universitario Santa Lucía, Cartagena, Spain
| | | | - Eloísa Urrechaga
- Biocruces Bizkaia Health Research Institute, Baracaldo, Spain; Laboratory Medicine Department, Hospital Galdakao-Usansolo, Galdakao, Spain
| | | | | | - Elena Martín García
- Laboratory Medicine Department, Hospital Universitario Santa Lucía, Cartagena, Spain
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Herrera Ortiz AF, Del Castillo V, Duarte JN, Gutiérrez MJ, Noguera V, Martínez de Los Ríos DA, Maldonado Acevedo SP, Torres JL, Pinzón B, Moreno A, Quiroz Alfaro AJ. Pulmonary Calcifying Fibrous Tumor in a Pediatric Patient: A Case Report. Cureus 2024; 16:e62053. [PMID: 38989355 PMCID: PMC11234803 DOI: 10.7759/cureus.62053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
A calcifying fibrous tumor (CFT), also known as calcifying fibrous pseudotumor, is an uncommon non-cancerous neoplasm usually located in the gastrointestinal tract. Its location in the lung is extremely rare, and only a few case reports have been published. This case report describes our diagnostic approach in a 9-year-old male patient with an incidental pulmonary mass. The mass was initially misdiagnosed, requiring multiple imaging tests and interventions to obtain the definitive diagnosis of pulmonary CFT. This paper aims to contribute to the limited information available on pulmonary CFT by presenting detailed findings from computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Andrés Felipe Herrera Ortiz
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Valeria Del Castillo
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - José N Duarte
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - María J Gutiérrez
- Department of Medicine and Health Sciences, Universidad del Rosario, Bogotá D.C., COL
| | - Valeria Noguera
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | | | - Sandra P Maldonado Acevedo
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Jhon L Torres
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
| | - Bibiana Pinzón
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Angela Moreno
- Department of Radiology, Fundación Santa Fe de Bogotá, Bogotá D.C., COL
- Department of Radiology, Universidad El Bosque, Bogotá D.C., COL
| | - Alejandro J Quiroz Alfaro
- Department of Internal Medicine, North Mississippi Medical Center, Tupelo, USA
- Department of Medicine and Health Sciences, Universidad del Rosario, Bogotá D.C., COL
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Balaban DV, Coman LI, Balaban M, Costache RS, Jinga M. Novel Insights into Postoperative Surveillance in Resected Pancreatic Cystic Neoplasms-A Review. Diagnostics (Basel) 2024; 14:1056. [PMID: 38786354 PMCID: PMC11119521 DOI: 10.3390/diagnostics14101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/11/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Pancreatic cystic lesions (PCL) are frequently encountered in clinical practice and some are referred to surgery due to their neoplastic risk or malignant transformation. The management of PCL involves complex decision-making, with postoperative surveillance being a key component for long-term outcomes, due to the potential for recurrence and postoperative morbidity. Unfortunately, the follow-up of resected patients is far from being optimal and there is a lack of consensus on recommendations with regard to timing and methods of surveillance. Here, we summarize the current knowledge on the postoperative surveillance of neoplastic pancreatic cysts, focusing on the mechanisms and risk factors for recurrence, the recurrence rates according to the initial indication for surgery, the final result of the surgical specimen and neoplastic risk in the remaining pancreas, as well as the postsurgical morbidity comprising pancreatic exocrine insufficiency, metabolic dysfunction and diabetes after resection, according to the type of surgery performed. We analyze postsurgical recurrence rates and morbidity profiles, as influenced by different surgical techniques, to better delineate at-risk patients, and highlight the need for tailored surveillance strategies adapted to preoperative and operative factors with an impact on outcomes.
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Affiliation(s)
- Daniel Vasile Balaban
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.-I.C.); (R.S.C.); (M.J.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Laura-Ioana Coman
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.-I.C.); (R.S.C.); (M.J.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Marina Balaban
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Raluca Simona Costache
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.-I.C.); (R.S.C.); (M.J.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (L.-I.C.); (R.S.C.); (M.J.)
- Gastroenterology Department, Central Military Emergency University Hospital, 010825 Bucharest, Romania
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Tiwari P, Yadav A, Kaushik M, Dada R. Cancer risk and male Infertility: Unravelling predictive biomarkers and prognostic indicators. Clin Chim Acta 2024; 558:119670. [PMID: 38614420 DOI: 10.1016/j.cca.2024.119670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
In recent years, there has been a global increase in cases of male infertility. There are about 30 million cases of male infertility worldwide and male reproductive health is showing rapid decline in last few decades. It is now recognized as a potential risk factor for developing certain types of cancer, particularly genitourinary malignancies like testicular and prostate cancer. Male infertility is considered a potential indicator of overall health and an early biomarker for cancer. Cases of unexplained male factor infertility have high levels of oxidative stress and oxidative DNA damage and this induces both denovo germ line mutations and epimutations due to build up of 8-hydroxy 2 deoxygunaosine abase which is highly mutagenic and also induces hypomethylation and genomic instability. Consequently, there is growing evidence to explore the various factors contributing to an increased cancer risk. Currently, the available prognostic and predictive biomarkers associated with semen characteristics and cancer risk are limited but gaining significant attention in clinical research for the diagnosis and treatment of elevated cancer risk in the individual and in offspring. The male germ cell being transcriptionally and translationally inert has a highly truncated repair mechanism and has minimal antioxidants and thus most vulnerable to oxidative injury due to environmental factors and unhealthy lifestyle and social habits. Therefore, advancing our understanding requires a thorough evaluation of the pathophysiologic mechanisms at the DNA, RNA, protein, and metabolite levels to identify key biomarkers that may underlie the pathogenesis of male infertility and associated cancer. Advanced methodologies such as genomics, epigenetics, proteomics, transcriptomics, and metabolomics stand at the forefront of cutting-edge approaches for discovering novel biomarkers, spanning from infertility to associated cancer types. Henceforth, in this review, we aim to assess the role and potential of recently identified predictive and prognostic biomarkers, offering insights into the success of assisted reproductive technologies, causes of azoospermia and idiopathic infertility, the impact of integrated holistic approach and lifestyle modifications, and the monitoring of cancer susceptibility, initiation and progression. Comprehending these biomarkers is crucial for providing comprehensive counselling to infertile men and cancer patients, along with their families.
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Affiliation(s)
- Prabhakar Tiwari
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Anjali Yadav
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Meenakshi Kaushik
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Shkundin A, Halaris A. IL-8 (CXCL8) Correlations with Psychoneuroimmunological Processes and Neuropsychiatric Conditions. J Pers Med 2024; 14:488. [PMID: 38793070 PMCID: PMC11122344 DOI: 10.3390/jpm14050488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Interleukin-8 (IL-8/CXCL8), an essential CXC chemokine, significantly influences psychoneuroimmunological processes and affects neurological and psychiatric health. It exerts a profound effect on immune cell activation and brain function, suggesting potential roles in both neuroprotection and neuroinflammation. IL-8 production is stimulated by several factors, including reactive oxygen species (ROS) known to promote inflammation and disease progression. Additionally, CXCL8 gene polymorphisms can alter IL-8 production, leading to potential differences in disease susceptibility, progression, and severity across populations. IL-8 levels vary among neuropsychiatric conditions, demonstrating sensitivity to psychosocial stressors and disease severity. IL-8 can be detected in blood circulation, cerebrospinal fluid (CSF), and urine, making it a promising candidate for a broad-spectrum biomarker. This review highlights the need for further research on the diverse effects of IL-8 and the associated implications for personalized medicine. A thorough understanding of its complex role could lead to the development of more effective and personalized treatment strategies for neuropsychiatric conditions.
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Affiliation(s)
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA;
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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Gao R, Yin B, Jin J, Tian X, Zhang Y, Wei J, Cao F, Wang Z, Ma Z, Wang M, Gou S, Cong L, Xu Q, Wu W, Zhao Y. Preoperative pancreatic stent placement before the enucleation of insulinoma located in the head and neck of the pancreas in proximity to the main pancreatic duct: study protocol for a multicentre randomised clinical trial in Chinese tertiary medical centres. BMJ Open 2024; 14:e078516. [PMID: 38569703 PMCID: PMC10989159 DOI: 10.1136/bmjopen-2023-078516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION The surgical intervention approach to insulinomas in proximity to the main pancreatic duct remains controversial. Standard pancreatic resection is recommended by several guidelines; however, enucleation (EN) still attracts surgeons with less risk of late exocrine/endocrine insufficiency, despite a higher postoperative pancreatic fistula (POPF) rate. Recently, the efficacy and safety of preoperative pancreatic stent placement before the EN have been demonstrated. Thus, a multicentre open-label study is being conducted to evaluate the efficacy and safety of stent placement in improving the outcome of EN of insulinomas in proximity to the main pancreatic duct. METHODS AND ANALYSIS This is a prospective, randomised, open-label, superiority clinical trial conducted at multiple tertiary centres in China. The major eligibility criterion is the presence of insulinoma located in the head and neck of the pancreas in proximity (≤2 mm) to the main pancreatic duct. Blocked randomisation will be performed to allocate patients into the stent EN group and the direct EN group. Patients in the stent EN group will go through stent placement by the endoscopist within 24 hours before the EN surgery, whereas other patients will receive EN surgery directly. The primary outcome is the assessment of the superiority of stent placement in reducing POPF rate measured by the International Study Group of Pancreatic Surgery standard. Both interventions will be performed in an inpatient setting and regular follow-up will be performed. The primary outcome (POPF rate) will be tested for superiority with the Χ2 test. The difference in secondary outcomes between the two groups will be analysed using appropriate tests. ETHICS AND DISSEMINATION The study has been approved by the Peking Union Medical College Hospital Institutional Review Board (K23C0195), Ruijin Hospital Ethics Committee (2023-314), Peking University First Hospital Ethics Committee (2024033-001), Institutional Review Board of Xuanwu Hospital of Capital Medical University (2023223-002), Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2023LSK-473), Institutional Review Board of Tongji Medical College Tongji Hospital (TJ-IRB202402059), Ethics Committee of Tongji Medical College Union Hospital (2023-0929) and Shanghai Cancer Center Institutional Review Board (2309282-16). The results of the study will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT05523778.
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Affiliation(s)
- Ruichen Gao
- Peking Union Medical College, Beijing, People's Republic of China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Bohui Yin
- Peking Union Medical College, Beijing, People's Republic of China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Jiabin Jin
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Research Institute of Pancreatic Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Department of General Surgery, Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine, Hainan, People's Republic of China
| | - Xiaodong Tian
- Department of Hapatobiliary and Pancreatic Surgery, Peking University First Hospital, Beijing, People's Republic of China
| | - Yuhua Zhang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, People's Republic of China
| | - Jishu Wei
- Pancreas Center, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Feng Cao
- Xuanwu Hospital, Beijing, People's Republic of China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhijun Ma
- Panjin People's Hospital, Panjin, Liaoning, People's Republic of China
| | - Min Wang
- Department of Biliary-Pancreatic Surgery, Huazhong University of Science and Technology Tongji Medical College Tongji Hospital, Wuhan, Hubei, People's Republic of China
| | - Shanmiao Gou
- Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lin Cong
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Wenming Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
| | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, People's Republic of China
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Kwak J, Bae HL, Jung Y, Choi J, Hwang H, Kim JH, Kim SJ, Lee KE. Comparative outcomes and prognostic indicators in adrenalectomy for adrenal metastasis. Surg Endosc 2024; 38:1884-1893. [PMID: 38316662 PMCID: PMC10978604 DOI: 10.1007/s00464-024-10691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE The indications for adrenalectomy and feasibility of laparoscopic adrenalectomy for adrenal metastasis are controversial. This study aimed to compare the surgical outcomes between open adrenalectomy (OA) and laparoscopic adrenalectomy (LA) and to evaluate the prognostic factors for oncological outcomes of adrenal metastasis. MATERIALS AND METHODS We conducted a retrospective chart review of 141 consecutive patients who underwent adrenalectomy for adrenal metastasis at Seoul National University Hospital from April 2005 to February 2021. Surgical and oncological outcomes were compared between OA and LA. RESULTS OA was performed in 95 (67.4%) patients, and 46 (32.6%) patients underwent LA. Among the patients who underwent adrenalectomy without adjacent organ resection for adrenal tumors less than 8 cm, LA was associated with a shorter operation time (100.1 ± 48.8 vs. 158.6 ± 81.2, P = 0.001), less blood loss (94.8 ± 93.8 vs. 566.8 ± 1156.0, P = 0.034), and a shorter hospital stay (3.7 ± 1.3 vs. 6.9 ± 5.8, P = 0.003). For locoregional recurrence-free survival (LRRFS), on multivariate analysis, a positive pathological margin (hazard ratio [HR]: 5.777, P = 0.002), disease activity at the primary site (HR: 6.497, P = 0.005), other metastases (HR: 4.154, P = 0.015), and a relatively larger tumor size (HR: 1.198, P = 0.018) were significantly associated with poor LRRFS. Multivariate analysis indicated that metachronous metastasis (HR: 0.51, P = 0.032) was associated with a longer overall survival (OS), whereas a positive pathological margin (HR: 2.40, P = 0.017), metastases to other organs (HR: 2.08, P = 0.025), and a relatively larger tumor size (HR: 1.11, P = 0.046) were associated with a shorter OS. CONCLUSIONS LA is a feasible treatment option for adrenal metastasis in selected patients. The pathological margin, metastases to other organs, and tumor size should be considered in adrenalectomy for adrenal metastasis.
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Affiliation(s)
- JungHak Kwak
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrine Surgery, Department of Surgery, Gibbeum Hospital, Seoul, Korea
| | - Hye Lim Bae
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Younghoon Jung
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jaebong Choi
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyeonuk Hwang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Medical Big Data Research Center, Institute of Medical and Biological Engineering, Seoul National University, Seoul, Korea
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Rubio-García JJ, Gil Navarro R, Franco Campello M, Costa Navarro R, Gomis Martín A, Villodre Tudela C, Zaragoza Zaragoza C, Carrión Tomás A, Ramia-Ángel JM. A novel study, textbook outcome in adrenalectomy: retrospective observational study in an endocrine surgical unit. Updates Surg 2024; 76:565-571. [PMID: 38316738 DOI: 10.1007/s13304-024-01756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
Textbook outcome is a multidimensional quality management tool that uses a set of traditional surgical measures to reflect an "ideal" surgical result for a particular pathology. Retrospective study of all patients undergoing scheduled for adrenal tumors surgery at an endocrine surgery unit from January 2010-December 2022. The definition of Textbook Outcome were: R0 resection, no Clavien-Dindo ≥ IIIa complications, no prolonged stay (< P75), no readmissions, and no mortality in the first 30 days. The main objective was to analyze the rate of Textbook Outcome obtained. One hundred and five patients were included in the study. Textbook Outcome was achieved in 71.4%. Surgical approach (p < 0.001), Charlson scale (p = 0.031), American Society of Anesthesiologists Classification (p = 0.047) and surgical time (p < 0.001) were all significantly associated with the achievement of Textbook Outcome. The laparoscopic approach was associated as an independent factor with obtaining Textbook Outcome (OR:5.394; p = 0.016), as was surgical time (OR:0.986; p = 0.004). Textbook Outcome is a novel, useful, easy-to-interpret tool for measuring results in adrenal surgery. The laparoscopic approach is associated with a higher rate of "ideal" surgical results. The study was registered in the public accessible database clinicaltrials.gov with the ClinicalTrials.gov ID: NCT05888753.
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Affiliation(s)
- J J Rubio-García
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain.
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | | | - M Franco Campello
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - R Costa Navarro
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - A Gomis Martín
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - C Villodre Tudela
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
| | - C Zaragoza Zaragoza
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
| | - A Carrión Tomás
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
| | - J M Ramia-Ángel
- Servicio de Cirugía General y Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
- Universidad Miguel Hernández, Alicante, Spain
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Araújo Soares C, Duarte ML, Silva MDQPD. Cholecystocutaneous Fistula Secondary to Cholelithiasis: A Case Report. ACTA MEDICA PORT 2024; 37:292-293. [PMID: 38631054 DOI: 10.20344/amp.20726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/08/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Carutia Araújo Soares
- Department of Internal Medicine. Universidade de Ribeirão Preto (UNAERP) - Campus Guarujá. Guarujá. Brasil
| | - Márcio Luís Duarte
- Department of Radiology. Universidade de Ribeirão Preto (UNAERP) - Campus Guarujá. Guarujá. Brasil
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42
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Berry AJ, Bilbo A. Exocrine pancreatic insufficiency and pancreatic exocrine replacement therapy in clinical practice. Nutr Clin Pract 2024; 39 Suppl 1:S78-S88. [PMID: 38429965 DOI: 10.1002/ncp.11124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 03/03/2024] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is a complex condition that disrupts normal digestion and absorption. Patients with EPI may suffer from mild to debilitating malabsorption with a constellation of symptoms that can have a significant effect on quality of life and nutrition status. Pancreatic enzyme replacement therapy (PERT) is effective and safe to treat EPI and is the standard of care for this condition. A wide variety and various forms of these products exist, as well as numerous guidelines and recommendations. Obtaining PERT for patients can oftentimes be cost prohibitive. Determining the presence and extent of EPI can be challenging and patient specific, making it difficult for practitioners. This narrative review will explore these issues, as well as several disease states potentially affected by EPI, and review current management strategies.
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Affiliation(s)
- Amy J Berry
- Department of Clinical Nutrition, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amy Bilbo
- Department of Clinical Nutrition, Medical University of South Carolina, Charleston, South Carolina, USA
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Villodre C, Del Río-Martín J, Blanco-Fernández G, Cantalejo-Díaz M, Pardo F, Carbonell S, Muñoz-Forner E, Carabias A, Manuel-Vazquez A, Hernández-Rivera PJ, Jaén-Torrejimeno I, Kälviäinen-Mejia HK, Rotellar F, Garcés-Albir M, Latorre R, Longoria-Dubocq T, De Armas-Conde N, Serrablo A, Esteban Gordillo S, Sabater L, Serradilla-Martín M, Ramia JM. Textbook outcome in distal pancreatectomy: A multicenter study. Surgery 2024; 175:1134-1139. [PMID: 38071134 DOI: 10.1016/j.surg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/01/2023] [Accepted: 11/11/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. METHODS Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). RESULTS Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. CONCLUSION The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.
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Affiliation(s)
- Celia Villodre
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
| | | | | | | | - Fernando Pardo
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Silvia Carbonell
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Elena Muñoz-Forner
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | | | | | | | | | | | - Fernando Rotellar
- Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain
| | - Marina Garcés-Albir
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Raquel Latorre
- Hospital Universitario de Guadalajara, Guadalajara, Spain
| | | | | | - Alejandro Serrablo
- Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Luis Sabater
- Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - José M Ramia
- Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain
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Hang K, Wei L, Yi M, Liu H, Huang Y, Zhang H, Tan C, Li K, Xiong J. Pedicled ligament flaps during pancreatoduodenectomy are associated with reduced hemorrhage from hepatic artery and gastroduodenal artery stump during pancreatoduodenectomy: a systematic review, meta-analysis and trial sequential analysis. HPB (Oxford) 2024; 26:476-485. [PMID: 38195309 DOI: 10.1016/j.hpb.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/12/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The aim of this study was to investigate whether pedicled ligament flaps (PLF) covering around the hepatic and gastroduodenal artery stump can provide better clinical outcomes in pancreatoduodenectomy (PD). METHODS We conducted a comprehensive search of databases (inception to January 2023) to identify studies comparing PD with or without PLF covering the skeletonized arteries. The perioperative and postoperative outcomes were compared. Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using fixed-effects models. RESULTS Ten studies were included in the qualitative synthesis. Six studies with 3538 patients met the inclusion criteria for the meta-analysis. Patients in the PLF group had a significantly lower rate of PPH from the hepatic artery or gastroduodenal artery stump (H/G PPH) (OR: 0.41; 95 % CI, 0.22-0.75; P < 0.01) and overall PPH (OR: 0.65; 95 % CI, 0.46-0.93; P = 0.02). There were no significant differences between the two groups in terms of morbidity, grade B/C postoperative pancreatic fistula (B/C POPF), delayed gastric emptying (DGE), reoperation, or mortality. CONCLUSION Prophylactic pedicled ligament flaps covering around the skeletonized arteries significantly reduced overall PPH and H/G PPH, and it seemed to have no obvious influence on other complications.
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Affiliation(s)
- Kuan Hang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Lijuan Wei
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Mingchao Yi
- The People's Hospital of Jianyang City, Jianyang, Sichuan Province, China
| | - Haoheng Liu
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan Province, China
| | - Yang Huang
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan Province, China
| | - Hao Zhang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Chunlu Tan
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Kezhou Li
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China
| | - Junjie Xiong
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, Sichuan Province, China.
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Mínguez Ojeda C, Gómez Dos Santos V, Álvaro Lorca J, Ruz-Caracuel I, Pian H, Sanjuanbenito Dehesa A, Gutiérrez Gutiérrez E, Sanz Miguelañez JL, Pozo Mengual B, Burgos Revilla FJ, Araujo-Castro M. Surgery for adrenal metastasis: Surgical outcomes and prognostic factors for long-term survival. ANNALES D'ENDOCRINOLOGIE 2024; 85:104-109. [PMID: 38342223 DOI: 10.1016/j.ando.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE To analyze surgical outcomes and predictive factors for long-term overall and disease-specific survival in patients undergoing surgical resection of adrenal metastasis. METHODS A multicenter retrospective study included patients who underwent adrenalectomy for adrenal metastasis in two Spanish hospitals between 2005 and 2021. Clinical variables associated with surgical complications and survival during follow-up were analyzed. RESULTS Thirty-three patients were included. Adrenalectomy was performed laparoscopically in 27 patients and by an open approach in 6. The most common primary tumor site was the lung (n=15), followed by the kidney (n=7). Most patients had metachronous lesions (n=28). Six patients (18.2%) had intra- and/or postoperative complications; synchronous metastasis was a risk factor (odds ratio 12.5 [1.45-107.6]) for their development. Progression-free survival and disease-specific survival were 7.5months (range 1-64) and 22.5months (6-120), respectively. Survival rates at 1, 2, 3 and 5years were 94%, 65%, 48% and 29%, respectively. Survival was significantly lower in patients with lung cancer than with other cancers (hazard ratio 4.23 [1.42-12.59]). CONCLUSIONS Adrenalectomy for solitary adrenal metastases was associated with intra- or postoperative complications in 18% of cases. Synchronous metastasis was a risk factor for complications.
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Affiliation(s)
- César Mínguez Ojeda
- Urology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Javier Álvaro Lorca
- Urology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Ignacio Ruz-Caracuel
- Pathology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Héctor Pian
- Pathology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Marta Araujo-Castro
- Endocrinology & Nutrition Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
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Wilson EA, Woodbury A, Williams KM, Coopersmith CM. OXIDATIVE study: A pilot prospective observational cohort study protocol examining the influence of peri-reperfusion hyperoxemia and immune dysregulation on early allograft dysfunction after orthotopic liver transplantation. PLoS One 2024; 19:e0301281. [PMID: 38547092 PMCID: PMC10977716 DOI: 10.1371/journal.pone.0301281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/10/2024] [Indexed: 04/02/2024] Open
Abstract
Early allograft dysfunction (EAD) is a functional hepatic insufficiency within a week of orthotopic liver transplantation (OLT) and is associated with morbidity and mortality. The etiology of EAD is multifactorial and largely driven by ischemia reperfusion injury (IRI), a phenomenon characterized by oxygen scarcity followed by paradoxical oxidative stress and inflammation. With the expanded use of marginal allografts more susceptible to IRI, the incidence of EAD may be increasing. This necessitates an in-depth understanding of the innate molecular mechanisms underlying EAD and interventions to mitigate its impact. Our central hypothesis is peri-reperfusion hyperoxemia and immune dysregulation exacerbate IRI and increase the risk of EAD. We will perform a pilot prospective single-center observational cohort study of 40 patients. The aims are to determine (1) the association between peri-reperfusion hyperoxemia and EAD and (2) whether peri-reperfusion perturbed cytokine, protein, and hypoxia inducible factor-1 alpha (HIF-1α) levels correlate with EAD after OLT. Inclusion criteria include age ≥ 18 years, liver failure, and donation after brain or circulatory death. Exclusion criteria include living donor donation, repeat OLT within a week of transplantation, multiple organ transplantation, and pregnancy. Partial pressure of arterial oxygen (PaO2) as the study measure allows for the examination of oxygen exposure within the confines of existing variability in anesthesiologist-administered fraction of inspired oxygen (FiO2) and the inclusion of patients with intrapulmonary shunting. The Olthoff et al. definition of EAD is the primary outcome. Secondary outcomes include postoperative acute kidney injury, pulmonary and biliary complications, surgical wound dehiscence and infection, and mortality. The goal of this study protocol is to identify EAD contributors that could be targeted to attenuate its impact and improve OLT outcomes. If validated, peri-reperfusion hyperoxemia and immune perturbations could be targeted via FiO2 titration to a goal PaO2 and/or administration of an immunomodulatory agent by the anesthesiologist intraoperatively.
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Affiliation(s)
- Elizabeth A Wilson
- Department of Anesthesiology, Emory University School of Medicine, Emory University Hospital, Atlanta, GA, United States of America
| | - Anna Woodbury
- Department of Anesthesiology, Emory University School of Medicine, Emory University Hospital, Atlanta, GA, United States of America
| | - Kirsten M Williams
- Department of Pediatrics, Division of Hematology and Oncology, Emory University School of Medicine, Children's Hospital of Atlanta, Atlanta, GA, United States of America
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University School of Medicine, Emory University Hospital, Atlanta, GA, United States of America
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Al-Madhi S, Acciuffi S, Meyer F, Dölling M, Beythien A, Andric M, Rahimli M, Croner RS, Perrakis A. The Pancreas as a Target of Metastasis from Renal Cell Carcinoma: Is Surgery Feasible and Safe? A Single-Center Experience in a High-Volume and Certified Pancreatic Surgery Center in Germany. J Clin Med 2024; 13:1921. [PMID: 38610686 PMCID: PMC11012243 DOI: 10.3390/jcm13071921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Secondary malignant tumors of the pancreas are rare, representing 2-5% of all pancreatic malignancies. Nevertheless, the pancreas is one of the target organs in cases of metastatic clear cell renal cell carcinoma (CCRCC). Additionally, recurrent metastasis may occur. Surgical resection remains the best and prognostically most favorable therapeutic option in cases of solitary pancreatic metastasis. Aim: To review retrospectively the clinical tumor registry of the University Hospital of Magdeburg, Germany, for this rare entity, performing a clinical systematic single-center observational study (design). Methods: A retrospective cohort analysis of consecutive patients who had undergone pancreatic resection for metastatic CCRC was performed in a single high-volume certified center for pancreatic surgery in Germany from 2010 to 2022. Results: All patients (n = 17) included in this study had a metachronous metastasis from a CCRCC. Surgery was performed at a median time interval of 12 (range, 9-16) years after primary resection for CCRCC. All 17 patients were asymptomatic at the time of diagnosis. Three of those patients (17.6%) presented with recurrent metastasis in a different part of the pancreas during follow-up. In a total of 17 patients, including those with recurrent disease, a surgical resection was performed; Pancreatoduodenectomy was performed in 6 patients (35%); left pancreatectomy with splenectomy was performed in 7 patients (41%). The rest of the patients underwent either a spleen-preserving pancreatic tail resection, local resection of the tumor lesion or a total pancreatectomy. The postoperative mortality rate was 6%. Concerning histopathological findings, seven patients (41%) had multifocal metastasis. An R0 resection could be achieved in all cases. The overall survival at one, three and five years was 85%, 85% and 72%, respectively, during a median follow-up of 43 months. Conclusions: CCRC pancreatic metastases can occur many years after the initial treatment of the primary tumor. Surgery for such a malignancy seems feasible and safe; it offers very good short- and long-term outcomes, as indicated. A repeated pancreatic resection can also be safely performed.
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Affiliation(s)
- Sara Al-Madhi
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University with University Hospital, Leipziger Str. 44, 39120 Magdeburg, Germany; (S.A.); (F.M.); (A.B.); (M.A.); (M.R.); (R.S.C.); (A.P.)
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Kumari R, Sadarat F, Luhana S, Parkash O, Lohana AC, Rahaman Z, Wang HY, Mohammed YN, Kumar SK, Chander S. Evaluating the efficacy of different volume resuscitation strategies in acute pancreatitis patients: a systematic review and meta-analysis. BMC Gastroenterol 2024; 24:119. [PMID: 38528470 PMCID: PMC10962108 DOI: 10.1186/s12876-024-03205-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Acute pancreatitis poses a significant health risk due to the potential for pancreatic necrosis and multi-organ failure. Fluid resuscitation has demonstrated positive effects; however, consensus on the ideal intravenous fluid type and infusion rate for optimal patient outcomes remains elusive. METHODS A comprehensive literature search was conducted using PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar for studies published between 2005 and January 2023. Reference lists of potential studies were manually searched to identify additional relevant articles. Randomized controlled trials and retrospective studies comparing high (≥ 20 ml/kg/h), moderate (≥ 10 to < 20 ml/kg/h), and low (5 to < 10 ml/kg/h) fluid therapy in acute pancreatitis were considered. RESULTS Twelve studies met our inclusion criteria. Results indicated improved clinical outcomes with low versus moderate fluid therapy (OR = 0.73; 95% CI [0.13, 4.03]; p = 0.71) but higher mortality rates with low compared to moderate (OR = 0.80; 95% CI [0.37, 1.70]; p = 0.55), moderate compared to high (OR = 0.58; 95% CI [0.41, 0.81], p = 0.001), and low compared to high fluids (OR = 0.42; 95% CI [0.16, 1.10]; P = 0.08). Systematic complications improved with moderate versus low fluid therapy (OR = 1.22; 95% CI [0.84, 1.78]; p = 0.29), but no difference was found between moderate and high fluid therapy (OR = 0.59; 95% CI [0.41, 0.86]; p = 0.006). DISCUSSION This meta-analysis revealed differences in the clinical outcomes of patients with AP receiving low, moderate, and high fluid resuscitation. Low fluid infusion demonstrated better clinical outcomes but higher mortality, systemic complications, and SIRS persistence than moderate or high fluid therapy. Early fluid administration yielded better results than rapid fluid resuscitation.
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Affiliation(s)
- Roopa Kumari
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA
| | - Fnu Sadarat
- Department of Medicine, University of Buffalo, New York, USA
| | - Sindhu Luhana
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA
| | - Om Parkash
- Department of Medicine, Montefiore Medical Center, Weikfield, NY, USA
| | - Abhi Chand Lohana
- Department of Medicine, WVU Camden Clark Medical Center, West, VA, USA
| | - Zubair Rahaman
- Department of Medicine, University of Buffalo, New York, USA
| | - Hong Yu Wang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA
| | - Yaqub N Mohammed
- Department of Medicine, Western Michigan University, Pontiac, USA
| | - Sanjay Kirshan Kumar
- Department of Medicine, Bahria University Health Sciences Karachi, Karachi, Pakistan
| | - Subhash Chander
- Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy PI, New York, NY, USA.
- Department of Medicine, University of Buffalo, New York, USA.
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Thomaidou E, Karlafti E, Didagelos M, Megari K, Argiriadou E, Akinosoglou K, Paramythiotis D, Savopoulos C. Acalculous Cholecystitis in COVID-19 Patients: A Narrative Review. Viruses 2024; 16:455. [PMID: 38543820 PMCID: PMC10976146 DOI: 10.3390/v16030455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
Acute acalculous cholecystitis (AAC) represents cholecystitis without gallstones, occurring in approximately 5-10% of all cases of acute cholecystitis in adults. Several risk factors have been recognized, while infectious diseases can be a cause of cholecystitis in otherwise healthy people. Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has spread worldwide, leading to an unprecedented pandemic. The virus enters cells through the binding of the spike protein to angiotensin-converting enzyme 2 (ACE2) receptors expressed in many human tissues, including the epithelial cells of the gastrointestinal (GI) tract, and this explains the symptoms emanating from the digestive system. Acute cholecystitis has been reported in patients with COVID-19. The purpose of this review is to provide a detailed analysis of the current literature on the pathogenesis, diagnosis, management, and outcomes of AAC in patients with COVID-19.
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Affiliation(s)
- Evanthia Thomaidou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Eleni Karlafti
- Emergency Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Matthaios Didagelos
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
- 1st Cardiology Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kalliopi Megari
- CITY College, University of York Europe Campus, 54626 Thessaloniki, Greece;
| | - Eleni Argiriadou
- Department of Anesthesiology and Intensive Care Unit, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece; (E.T.); (M.D.); (E.A.)
| | - Karolina Akinosoglou
- Department of Medicine, University General Hospital of Patras, 26504 Rio, Greece;
| | - Daniel Paramythiotis
- First Propaedeutic Department of Surgery, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Christos Savopoulos
- First Propaedeutic Internal Medicine Department, AHEPA University General Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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50
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Sylvester R, Singh G, Haque A. The uncommon preoperative diagnosis of a De Garengeot hernia and its more novel laparoscopic treatment. BMJ Case Rep 2024; 17:e251938. [PMID: 38453231 PMCID: PMC10921507 DOI: 10.1136/bcr-2022-251938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
This case report involves an elderly woman who presented with a 3-day history of a tender groin swelling on her right side. Her admission bloods were fairly unremarkable, but a preoperative ultrasound impressively confirmed a femoral hernia containing the appendix (De Garengeot hernia) and she underwent emergency laparoscopic hernioplasty with a prosthetic mesh and appendicectomy. The procedure found an incarcerated hernia with a strangulated tip of the appendix that unexpectedly separated upon gentle manipulation and histopathology revealed appendiceal inflammation. There were no complications with the patient's recovery and she was discharged 2 days after surgery.
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Affiliation(s)
| | - Gautam Singh
- Frimley Health NHS Foundation Trust, Frimley, UK
| | - Ali Haque
- Frimley Health NHS Foundation Trust, Frimley, UK
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