51
|
Lai CC, Liu KH, Tsai CY, Hsu JT, Hsueh SW, Hung CY, Chou WC. Risk factors and effect of postoperative delirium on adverse surgical outcomes in older adults after elective abdominal cancer surgery in Taiwan. Asian J Surg 2023; 46:1199-1206. [PMID: 36041906 DOI: 10.1016/j.asjsur.2022.08.079] [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: 06/29/2022] [Revised: 07/27/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication in older adults, with unknown epidemiology and effects on surgical outcomes in Asian geriatric cancer patients. This study evaluated incidence, risk factors, and association between adverse surgical outcomes and POD after intra-abdominal cancer surgery in Taiwan. METHODS Overall, 345 patients aged ≥65 years who underwent elective abdominal cancer surgery at a medical center in Taiwan were prospectively enrolled. Delirium was assessed daily using the Confusion Assessment Method. Univariate and multivariate logistic regression analyses investigated risk factors for POD occurrence and estimated the association with adverse surgical outcomes. RESULTS POD occurred in 19 (5.5%) of the 345 patients. Age ≥73 years, Charlson comorbidity index ≥3, and operative time >428 min were independent predictors for POD occurrence. Patients presenting with one, two, and three risk factors had 4.1-fold (95% confidence interval [CI], 0.4-35.8, p = 0.20), 17.4-fold (95% CI, 2.2-138, p = 0.007), and 30.8-fold likelihood (95% CI, 2.9-321, p = 0.004) for POD occurrence, respectively. Patients with POD had a higher probability of prolonged hospital stay (adjusted odds ratio [OR] 2.8; 95% CI, 1.0-8.1; p = 0.037), intensive care stay (adjusted OR: 3.9; 95% CI, 1.5-10.5; p = 0.008), 30-day readmission (adjusted OR 3.1; 95% CI, 1.1-9.7; p = 0.039), and 90-day postoperative death (adjusted OR: 4.2; 95% CI, 1.0-17.7; p = 0.041). CONCLUSION POD occurrence was significantly associated with adverse surgical outcomes in geriatric patients undergoing elective abdominal cancer surgery, highlighting the importance of early POD identification in geriatric patients to improve postoperative care quality.
Collapse
Affiliation(s)
- Cheng-Chou Lai
- Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 333, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Oncology, Chang Gung Memorial Hospital at Keelung, 204, Keelung, Taiwan
| | - Chia-Yen Hung
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, 104, Taiwan; Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
| |
Collapse
|
52
|
Newhook TE, Vreeland TJ, Griffin JF, Tidwell RSS, Prakash LR, Koay EJ, Ludmir EB, Smaglo BG, Pant S, Overman M, Wolff RA, Ikoma N, Maxwell J, Kim MP, Lee JE, Katz MHG, Tzeng CWD. Prognosis Associated With CA19-9 Response Dynamics and Normalization During Neoadjuvant Therapy in Resected Pancreatic Adenocarcinoma. Ann Surg 2023; 277:484-490. [PMID: 36649067 DOI: 10.1097/sla.0000000000005184] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To characterize associations between carbohydrate antigen 19-9 (CA19-9) dynamics during neoadjuvant therapy (NT) and survival for patients with pancreatic ductal adenocarcinoma (PDAC). BACKGROUND Although normalization of CA19-9 during NT is associated with improved outcomes following PDAC resection, we hypothesize that CA19-9 dynamics during NT can improve prognostication. METHODS Characteristics for patients with PDAC undergoing NT (July 2011-October 2018) with ≥3 CA19-9 results (bilirubin<2mg/dL) were collected and grouped by CA19-9 dynamics. Nonproducers (<1 U/ml) were excluded, and normal was ≤35 U/ml. Postresection survival was compared among groups. RESULTS Of 431 patients, 166 had eligible CA19-9 values. Median baseline CA19-9 was 98 U/ml. Overall 2-year postresection recurrence-free survival (RFS) and overall survival (OS) were 37% and 63%, respectively. Patients with normalization (53%) had improved 2-year RFS (47% vs. 28%, P = 0.01) and OS (75% vs. 49%, P = 0.01). CA19-9 dynamics during NT were analyzed by shape, direction, and normalization creating response types ("A-B-C-D-E"). Type A was "Always" decreasing to normalization, B "Bidirectional" with eventual normalization, C "Consistently" normal, D any "Decrease" without normalization, and E "Elevating" without normalization. Types A and B responses were associated with the longest postresection 2-year RFS (51% and 56%) and OS (75% and 92%, respectively) whereas Types D and E had the worst outcomes. After adjusting for node-positivity, perineural invasion, and margin-positivity, CA19-9 response types were independently associated with both RFS and OS, and predicted outcomes are better than CA19-9 normalization alone (likelihood ratio test RFS P < 0.001, OS P = 0.01). CONCLUSIONS This novel A-B-C-D-E classification of CA19-9 dynamics during NT was associated with postresection outcomes more precisely than CA19-9 normalization alone.
Collapse
Affiliation(s)
- Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Rebecca S S Tidwell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eugene J Koay
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ethan B Ludmir
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brandon G Smaglo
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shubham Pant
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Overman
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A Wolff
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jessica Maxwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
53
|
Soliman C, Sathianathen NJ, Thomas BC, Giannarini G, Lawrentschuk N, Wuethrich PY, Dundee P, Nair R, Furrer MA. A Systematic Review of Intra- and Postoperative Complication Reporting and Grading in Urological Surgery: Understanding the Pitfalls and a Path Forward. Eur Urol Oncol 2023:S2588-9311(23)00003-2. [PMID: 36697322 DOI: 10.1016/j.euo.2023.01.002] [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: 03/18/2022] [Revised: 11/30/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
CONTEXT Surgical outcomes and patient morbidity are often surrogate markers of health care quality and efficiency. These parameters can only be used with confidence if the reporting and grading of intra- and postoperative complications are reliable and reproducible. Without uniformity and regulation, the risk of under-reporting, and thus significant underestimation of the burden of intra- and postoperative morbidity, is high and should be of great concern to the international surgical community. OBJECTIVE To assess the quality and utility of currently available reporting and classification systems for intra- and postoperative complications, recognise their advantages and pitfalls, discuss the overall implications of these systems for urological surgery, and identify potential solutions for future reporting and classification systems. EVIDENCE ACQUISITION A comprehensive search was performed using multiple reputable databases and trial registries up to October 25, 2022. Only studies that adhered to predefined inclusion criteria were included. Study selection and data extraction were independently performed by two review authors. The review was performed according to strict methodological guidelines in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. EVIDENCE SYNTHESIS A total of 13 papers highlighting 13 various complication systems were critically assessed in this review. All studies proposed an intra- or postoperative complication reporting or grading system that was surgically related. At present, there is no single instrument in clinical practice to account for all relevant complication data. Six of the 13 studies were clinically validated (46%) and only three studies were urology-focused (23%). Meta-analysis was not possible. CONCLUSIONS Current individual complication tools are flawed, so there is a need for a novel, all-inclusive, specialty-specific reporting and classification system for intra- and postoperative complications. If successfully validated and integrated worldwide, such an instrument would have the potential to play a significant role in reshaping efficiency in health care systems and improving surgical and patient quality of care. PATIENT SUMMARY Current tools for reporting and classifying complications during and after surgery underestimate how burdensome such complications can be for patients. We summarise the reporting and classification tools currently available, discuss their advantages and drawbacks, and propose potential solutions for future systems. Our review can help in better understanding the changes required for future tools and how to improve overall surgical outcomes for patients.
Collapse
Affiliation(s)
- Christopher Soliman
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia.
| | - Niranjan J Sathianathen
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Benjamin C Thomas
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Nathan Lawrentschuk
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Patrick Y Wuethrich
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philip Dundee
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia
| | - Rajesh Nair
- Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Marc A Furrer
- Department of Urology, The University of Melbourne, The Royal Melbourne Hospital, Parkville, Australia; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Urology, University of Bern, Bern, Switzerland; Department of Urology, Solothurner Spitäler AG, Olten and Solothurn, Switzerland
| |
Collapse
|
54
|
van der Heijde N, Görgec B, Beane JD, Ratti F, Belli G, Benedetti Cacciaguerra A, Calise F, Cillo U, De Boer MT, Fagenson AM, Fretland ÅA, Gleeson EM, de Graaff MR, Kok NFM, Lassen K, van der Poel MJ, Ruzzenente A, Sutcliffe RP, Edwin B, Aldrighetti L, Pitt HA, Abu Hilal M, Besselink MG. Transatlantic registries for minimally invasive liver surgery: towards harmonization. Surg Endosc 2023; 37:3580-3592. [PMID: 36624213 DOI: 10.1007/s00464-022-09765-y] [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: 06/21/2022] [Accepted: 11/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several registries focus on patients undergoing minimally invasive liver surgery (MILS). This study compared transatlantic registries focusing on the variables collected and differences in baseline characteristics, indications, and treatment in patients undergoing MILS. Furthermore, key variables were identified. METHODS The five registries for liver surgery from North America (ACS-NSQIP), Italy, Norway, the Netherlands, and Europe were compared. A set of key variables were established by consensus expert opinion and compared between the registries. Anonymized data of all MILS procedures were collected (January 2014-December 2019). To summarize differences for all patient characteristics, treatment, and outcome, the relative and absolute largest differences (RLD, ALD) between the smallest and largest outcome per variable among the registries are presented. RESULTS In total, 13,571 patients after MILS were included. Both 30- and 90-day mortality after MILS were below 1.1% in all registries. The largest differences in baseline characteristics were seen in ASA grade 3-4 (RLD 3.0, ALD 46.1%) and the presence of liver cirrhosis (RLD 6.4, ALD 21.2%). The largest difference in treatment was the use of neoadjuvant chemotherapy (RLD 4.3, ALD 20.6%). The number of variables collected per registry varied from 28 to 303. From the 46 key variables, 34 were missing in at least one of the registries. CONCLUSION Despite considerable variation in baseline characteristics, indications, and treatment of patients undergoing MILS in the five transatlantic registries, overall mortality after MILS was consistently below 1.1%. The registries should be harmonized to facilitate future collaborative research on MILS for which the identified 46 key variables will be instrumental.
Collapse
Affiliation(s)
- Nicky van der Heijde
- Department of Surgery, University Hospital Southampton, Southampton, UK.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Burak Görgec
- Department of Surgery, University Hospital Southampton, Southampton, UK.,Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands.,Department of Surgery, Instituto Ospedale Fondazione Poliambulanza, Brescia, Italy
| | - Joal D Beane
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | | | - Giulio Belli
- Department of Surgery, University Hospital Naples, Naples, Italy
| | - Andrea Benedetti Cacciaguerra
- Department of Surgery, Instituto Ospedale Fondazione Poliambulanza, Brescia, Italy.,Hepatobiliary and Abdominal Transplantation Surgery, Department of Experimental and Clinical Medicine, Riuniti Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Fulvio Calise
- Department of Surgery, University Hospital Naples, Naples, Italy
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital, Padua, Italy
| | - Marieke T De Boer
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Åsmund A Fretland
- The Intervention Center and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | | | - Michelle R de Graaff
- Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, The Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niels F M Kok
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kristoffer Lassen
- The Intervention Center and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - Marcel J van der Poel
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | | | - Robert P Sutcliffe
- Department of Hepato-Pancreato-Biliary and Liver Transplant Surgery, Queen Elizabeth University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bjørn Edwin
- The Intervention Center and Department of HPB Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | | | - Henry A Pitt
- Department of Surgery, Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Mohammad Abu Hilal
- Department of Surgery, University Hospital Southampton, Southampton, UK. .,Department of Surgery, Instituto Ospedale Fondazione Poliambulanza, Brescia, Italy.
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Cancer Center Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
55
|
Narasimhulu DM, Fagotti A, Scambia G, Weaver AL, McGree M, Quagliozzi L, Langstraat C, Kumar A, Cliby W. Validation of a risk-based algorithm to reduce poor operative outcomes after complex surgery for ovarian cancer. Int J Gynecol Cancer 2023; 33:83-88. [PMID: 36517075 PMCID: PMC9972179 DOI: 10.1136/ijgc-2022-003799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE We developed an algorithm that identifies patients at high risk of morbidity/mortality after cytoreductive surgery for advanced ovarian cancer. We have previously shown that the Mayo triage algorithm reduces operative mortality internally, followed by validation using an external low complexity national dataset. However, validation in a higher complexity surgical setting is required before widespread acceptance of this approach, and this was the goal of our study. METHODS We included patients who underwent debulking surgery (including primary or interval debulking surgery) for stage IIIC/IV ovarian cancer between October 2011 and November 2019 (SCORPION trial patients until May 2016 and non-trial patients thereafter) at Fondazione Policlinico A Gemelli, Italy. Using the algorithm, we classified patients as either high-risk or triage-appropriate and compared 30-day grade 3+ complications and 90-day mortality using a χ2 test or Fisher's exact test. RESULTS A total of 625 patients were included. The mean age was 58.7±11.4 years, 73.6% (n=460) were stage IIIC, and 63.0% (n=394) underwent primary debulking surgery. Surgical complexity was intermediate or high in 82.6% (n=516) of patients (95.7% (n=377) for primary surgery and 60.2% (n=139) for interval surgery), and 20.3% (n=127) were classified as high-risk. When compared with triage-appropriate patients, high-risk patients had (1) a threefold higher rate of 90-day mortality (6.3% vs 2.0%, p=0.02); (2) a higher likelihood of 90-day mortality following a grade 3+ complication (25.9% vs 10.0%, p=0.05); and (3) comparable rates of grade 3+ complications (21.3% vs 16.1%, p=0.17). CONCLUSION The evidence-based triage algorithm identifies patients at high risk of morbidity/mortality after cytoreductive surgery. Triage high-risk patients are poor candidates for surgery when complex surgery is required. This algorithm has been validated in heterogeneous settings (internal, national, and international) and degree of surgical complexity. Risk-based decision making should be standard of care when planning surgery for patients with advanced ovarian cancer, whether primary or interval surgery.
Collapse
Affiliation(s)
- Deepa Maheswari Narasimhulu
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna Fagotti
- Department of Gynecological Oncology, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
- Department for Women's and Children's Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Giovanni Scambia
- Department of Gynecological Oncology, Catholic University of the Sacred Heart, Milano, Lombardia, Italy
- Department for Women's and Children's Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela McGree
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorena Quagliozzi
- Department for Women's and Children's Health and Public Health, Gynecologic Oncology Unit, Policlinico Universitario Agostino Gemelli, Roma, Lazio, Italy
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - William Cliby
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
56
|
Aghayan DL, d'Albenzio G, Fretland ÅA, Pelanis E, Røsok BI, Yaqub S, Palomar R, Edwin B. Laparoscopic parenchyma-sparing liver resection for large (≥ 50 mm) colorectal metastases. Surg Endosc 2023; 37:225-233. [PMID: 35922606 PMCID: PMC9839797 DOI: 10.1007/s00464-022-09493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/16/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Traditionally, patients with large liver tumors (≥ 50 mm) have been considered for anatomic major hepatectomy. Laparoscopic resection of large liver lesions is technically challenging and often performed by surgeons with extensive experience. The current study aimed to evaluate the surgical and oncologic safety of laparoscopic parenchyma-sparing liver resection in patients with large colorectal metastases. METHODS Patients who primarily underwent laparoscopic parenchyma-sparing liver resection (less than 3 consecutive liver segments) for colorectal liver metastases between 1999 and 2019 at Oslo University Hospital were analyzed. In some recent cases, a computer-assisted surgical planning system was used to better visualize and understand the patients' liver anatomy, as well as a tool to further improve the resection strategy. The surgical and oncologic outcomes of patients with large (≥ 50 mm) and small (< 50 mm) tumors were compared. Multivariable Cox-regression analysis was performed to identify risk factors for survival. RESULTS In total 587 patients met the inclusion criteria (large tumor group, n = 59; and small tumor group, n = 528). Median tumor size was 60 mm (range, 50-110) in the large tumor group and 21 mm (3-48) in the small tumor group (p < 0.001). Patient age and CEA level were higher in the large tumor group (8.4 μg/L vs. 4.6 μg/L, p < 0.001). Operation time and conversion rate were similar, while median blood loss was higher in the large tumor group (500 ml vs. 200 ml, p < 0.001). Patients in the large tumor group had shorter 5 year overall survival (34% vs 49%, p = 0.027). However, in the multivariable Cox-regression analysis tumor size did not impact survival, unlike parameters such as age, ASA score, CEA level, extrahepatic disease at liver surgery, and positive lymph nodes in the primary tumor. CONCLUSION Laparoscopic parenchyma-sparing resections for large colorectal liver metastases provide satisfactory short and long-term outcomes.
Collapse
Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Gabriella d'Albenzio
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Åsmund A Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Egidijus Pelanis
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Bård I Røsok
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Sheraz Yaqub
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Rafael Palomar
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| |
Collapse
|
57
|
Larsen SG, Graf W, Mariathasan AB, Sørensen O, Spasojevic M, Goscinski MA, Selboe S, Lundstrøm N, Holtermann A, Revheim ME, Bruland ØS. First experience with 224Radium-labeled microparticles (Radspherin®) after CRS-HIPEC for peritoneal metastasis in colorectal cancer (a phase 1 study). Front Med (Lausanne) 2023; 10:1070362. [PMID: 36936230 PMCID: PMC10016379 DOI: 10.3389/fmed.2023.1070362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/23/2023] [Indexed: 03/05/2023] Open
Abstract
Background Peritoneal metastasis (PM) from colorectal cancer carries a dismal prognosis despite extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). With a median time to recurrence of 11-12 months, there is a need for novel therapies. Radspherin® consists of the α-emitting radionuclide radium-224 (224Ra), which has a half-life of 3.6 days and is adsorbed to a suspension of biodegradable calcium carbonate microparticles that are designed to give short-range radiation to the serosal peritoneal surface linings, killing free-floating and/or tumor cell clusters that remain after CRS-HIPEC. Methods A first-in-human phase 1 study (EudraCT 2018-002803-33) was conducted at two specialized CRS-HIPEC centers. Radspherin® was administered intraperitoneally 2 days after CRS-HIPEC. Dose escalation at increasing activity dose levels of 1-2-4-7-MBq, a split-dose repeated injection, and expansion cohorts were used to evaluate the safety and tolerability of Radspherin®. The aim was to explore the recommended dose and biodistribution using gamma-camera imaging. The results from the planned safety interim analysis after the completion of the dose-limiting toxicity (DLT) period of 30 days are presented. Results Twenty-three patients were enrolled: 14 in the dose escalation cohort, three in the repeated cohort, and six in the expansion cohort. Of the 23 enrolled patients, seven were men and 16 were women with a median age of 64 years (28-78). Twelve patients had synchronous PM stage IV and 11 patients had metachronous PM [primary stage II; (6) and stage III; (5)], with a disease-free interval of 15 months (3-30). The peritoneal cancer index was median 7 (3-19), operation time was 395 min (194-515), and hospital stay was 12 days (7-37). A total of 68 grade 2 adverse events were reported for 17 patients during the first 30 days; most were considered related to CRS and/or HIPEC. Only six of the TEAEs were evaluated as related to Radspherin®. One TEAE, anastomotic leakage, was reported as grade 3. Accordion ≥3 grade events occurred in a total of four of the 23 patients: reoperation due to anastomotic leaks (two) and drained abscesses (two). No DLT was documented at the 7 MBq dose level that was then defined as the recommended dose. The biodistribution of Radspherin® showed a relatively even peritoneal distribution. Conclusion All dose levels of Radspherin® were well tolerated, and DLT was not reached. No deaths occurred, and no serious adverse events were considered related to Radspherin®.Clinical Trial Registration: Clinicaltrials.gov, NCT03732781.
Collapse
Affiliation(s)
- Stein Gunnar Larsen
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- *Correspondence: Stein Gunnar Larsen,
| | - Wilhelm Graf
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Uppsala Academic Hospital, Uppsala, Sweden
| | - Anthony Burton Mariathasan
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Olaf Sørensen
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Milan Spasojevic
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Mariusz Adam Goscinski
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Silje Selboe
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Nadja Lundstrøm
- Uppsala Academic Hospital, Uppsala, Sweden
- Department of Nuclear Medicine, Uppsala, Sweden
| | - Anne Holtermann
- Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind Sverre Bruland
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Oncoinvent AS, Oslo, Norway
| |
Collapse
|
58
|
Cos H, Zárate Rodríguez JG, Srivastava R, Bewley A, Raper L, Li D, Dai R, Williams GA, Fields RC, Hawkins WG, Lu C, Sanford DE, Hammill CW. 4,300 steps per day prior to surgery are associated with improved outcomes after pancreatectomy. HPB (Oxford) 2023; 25:91-99. [PMID: 36272956 DOI: 10.1016/j.hpb.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/04/2022] [Accepted: 09/28/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased preoperative physical fitness and low physical activity have been associated with preoperative functional reserve and surgical complications. We sought to evaluate daily step count as a measure of physical activity and its relationship with post-pancreatectomy outcomes. METHODS Patients undergoing pancreatectomy were given a remote telemonitoring device to measure their preoperative levels of physical activity. Patient activity, demographics, and perioperative outcomes were collected and compared in univariate and multivariate logistic regression analysis. RESULTS 73 patients were included. 45 (61.6%) patients developed complications, with 17 (23.3%) of those patients developing severe complications. These patients walked 3437.8 (SD 1976.7) average daily steps, compared to 5918.8 (SD 2851.1) in patients without severe complications (p < 0.001). In logistic regression analysis, patients who walked less than 4274.5 steps had significantly higher odds of severe complications (OR = 7.5 (CI 2.1, 26.8), p = 0.002). CONCLUSION Average daily steps below 4274.5 before surgery are associated with severe complications after pancreatectomy. Preoperative physical activity levels may represent a modifiable target for prehabilitation protocols.
Collapse
Affiliation(s)
- Heidy Cos
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Jorge G Zárate Rodríguez
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Rohit Srivastava
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Alice Bewley
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Lacey Raper
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dingwen Li
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ruixuan Dai
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chenyang Lu
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA.
| |
Collapse
|
59
|
Thorgersen EB, Asvall J, Schjalm C, McAdam KE, Bruland ØS, Larsen SG, Mollnes TE. Effect of Intraperitoneal 224Radium-Labelled Microparticles on Compartmentalized Inflammation After Cytoreductive Surgery and Hypertherm Intraperitoneal Chemotherapy. Technol Cancer Res Treat 2023; 22:15330338231192902. [PMID: 37574949 PMCID: PMC10426314 DOI: 10.1177/15330338231192902] [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: 08/15/2023] Open
Abstract
Despite extensive treatment with surgery and chemotherapy many patients with peritoneal metastases from colorectal cancer experience intraperitoneal disease relapse. The α-emitting 224radium-labelled microparticle radionuclide therapeutic Radspherin® is being explored as a novel treatment option for these patients. Radspherin® is specially designed to give local radiation to the surface of the peritoneal cavity and potentially kill remaining attached micrometastases as well as free-floating cancer cells, thus preventing future relapse. The effect of Radspherin® on the immune system is not known. Systemic and local inflammatory responses were analyzed in plasma, intraperitoneal fluid and urine collected prospectively as part of a phase 1 dose-escalation study of intraperitoneal instillation of the α-emitting therapeutic radiopharmaceutical Radspherin®, at baseline and the first 7 postoperative days from nine patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. All patients additionally received intraperitoneal instillation of Radspherin® on postoperative day 2. Complement activation products C3bc and the terminal complement complex were analyzed using enzyme-linked immunosorbent assay. Cytokines (n = 27), including interleukins, chemokines, interferons and growth factors, were analyzed using multiplex technique. The time course and magnitude of the postoperative cytokine response after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy displayed a modest systemic response in plasma, in contrast to a substantial local intraperitoneal response. After administration of Radspherin®, a significant increase (P < 0.05) in TNF and MIP-1β was observed in both plasma and peritoneal fluid, whereas IL-9 increased only in plasma and IFNγ and IL1-RA only in peritoneal fluid. Only minor changes were seen for the majority of the inflammatory markers after Radspherin® administration. Our study showed a predominately local rather than systemic inflammatory response to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Radspherin® had overall modest impact on the inflammation.
Collapse
Affiliation(s)
- Ebbe Billmann Thorgersen
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Jørund Asvall
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Camilla Schjalm
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Karin Ekholt McAdam
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Øyvind Sverre Bruland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Stein Gunnar Larsen
- Department of Gastroenterological Surgery, Oslo University Hospital, The Radium Hospital, Oslo, Norway
| | - Tom Eirik Mollnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Research Laboratory, Nordland Hospital, Bodø, Norway
| |
Collapse
|
60
|
Scott JE, Auzenne DA, Massari F, Singh A, Donovan V, Mayhew PD, Case B, Scharf VF, Buote N, Wallace ML. Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs. Vet Surg 2023; 52:106-115. [PMID: 36168280 DOI: 10.1111/vsu.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 07/10/2022] [Accepted: 08/09/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To describe complications and outcomes of dogs undergoing thoracoscopic-assisted (TA) lung lobectomy. STUDY DESIGN Multi-institutional, retrospective study. ANIMALS Client-owned dogs (n = 30). METHODS Medical records of dogs that underwent TA lung lobectomy were reviewed. Signalment, bodyweight, clinical signs, imaging findings, surgical variables, complications, and short-term/long-term outcome were assessed. Thoracoscopic-assisted lung lobectomy was performed with a mini-thoracotomy. RESULTS Twelve intraoperative complications were recorded in 11 dogs, 6 requiring conversion to open thoracotomy. Reasons for conversion were reported in 5/6 dogs and included adhesions (2), difficultly manipulating the lesion through the mini-thoracotomy (2), and acute oxygen desaturation (1). One lung ventilation was successful in 4 of the 7 dogs in which this was attempted. A linear stapling device (DST series Medtronic, Minneapolis, Minnesota) was used for lung lobe ligation in 14 dogs. Twenty-three dogs underwent surgery for a neoplastic lesion, with 19 of these being carcinoma. The median lesion size was 4.3 cm (range 1-10 cm); margins were clean, except in 1 dog. Complications were documented in 8 dogs prior to discharge, 5 of these being classified as mild. Twenty-nine dogs were discharged at a median of 47 h postoperatively (range 24-120 h). Death was reported in 9 dogs, with a median survival time of 168 days (range 70-868 days). CONCLUSION Thoracoscopic-assisted lung lobectomy was achieved with few major complications in the population reported here. Dogs were able to be discharged from hospital quickly, with most surviving beyond the follow-up period. CLINICAL SIGNIFICANCE Thoracoscopic-assisted lung lobectomy may be considered to facilitate the excision of larger pulmonary lesions or to treat smaller dogs, in which a thoracoscopic excision may be technically more challenging.
Collapse
Affiliation(s)
- Jacqueline E Scott
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Champaign, Illinois, USA
| | - Danielle A Auzenne
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Champaign, Illinois, USA
| | - Federico Massari
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Clinica Veterinaria Nervianese, Nerviano, Italy
| | | | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, California, USA
| | - Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Valery F Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Nicole Buote
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
61
|
Barrett FM, Bleedorn JA, Hutcheson KD, Torres BT, Fox DB. Comparison of two postoperative complication grading systems after treatment of stifle and shoulder instability in 68 dogs. Vet Surg 2023; 52:98-105. [PMID: 36189979 PMCID: PMC10092473 DOI: 10.1111/vsu.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/27/2022] [Accepted: 09/04/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE (1) To adapt and apply the Clavien-Dindo (aCD) postoperative complication grading system to dogs experiencing complications following a single orthopedic procedure. (2) To compare the reliability of the Clavien-Dindo system to the Cook complication grading system. STUDY DESIGN Retrospective study. SAMPLE POPULATION Sixty-eight client-owned dogs. METHODS Scenarios derived from complications following TightRope stabilization of the stifle and shoulder were graded by four ACVS-boarded surgeons using two systems; the Cook 3-point scale and the aCD 5-point scale. Because the aCD system distinguishes complications from outcomes ("sequelae" or "failure to cure"), two data sets were created: one with (n = 76) and without (n = 67) inclusion of "sequelae" and "failure to cure" cases. Interobserver reliability was evaluated using intraclass correlation coefficient (ICC) calculations. RESULTS Seventy-six scenarios from 68 records were evaluated. The ICC of the aCD system was 0.620 consistent with moderate reliability. The reliability of the Cook system was good, with an ICC of 0.848. Exclusion of cases with "sequelae" or "failure to cure" resulted in excellent reliability of the aCD system (ICC = 0.975) and good reliability of the Cook systems (ICC = 0.857). CONCLUSION The aCD grading system was less reliable than the Cook system when evaluating all cases but more reliable when evaluating cases of complications excluding "sequelae" and "failures to cure". CLINICAL SIGNIFICANCE The Cook grading system is reliably good in grading postoperative complications in dogs. The aCD system can also be used to assess postoperative complications with excellent reliability but is less reliable when distinguishing complications from other postoperative outcomes.
Collapse
Affiliation(s)
- Faolain M Barrett
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Jason A Bleedorn
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kyle D Hutcheson
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Bryan T Torres
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Derek B Fox
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
62
|
Individual components of post-hepatectomy care pathways have differential impacts on length of stay. Am J Surg 2023; 225:53-57. [PMID: 36207173 DOI: 10.1016/j.amjsurg.2022.09.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The value of individual variable contributions to post-hepatectomy length of stay (LOS) are difficult to quantify within bundled care pathways. METHODS Poisson regression and marginal effects models for prolonged post-hepatectomy LOS (>25% median) included Kawaguchi-Gayet (KG) complexity, perioperative variables, and pathways (minimally-invasive = MIS; low-intermediate-risk = KGI/II; high-risk = KGIII; combination). RESULTS Median LOS was 2, 4, 5, and 5 days for MIS, KGI/II, KGIII and combination pathways (N = 978). Poisson regression identified age, intraoperative fluids, delayed diet tolerance, and combination cases as associated with increased LOS (p < 0.01). Marginal effects analysis demonstrated the following added probability of longer LOS: each year of age 0.03x, 250 mL intraoperative fluids 0.06x, each operative hour 0.2x, additional day before diet tolerance 0.4x, combination cases 0.7x. MIS was associated with 1.2x increased probability of shorter LOS. CONCLUSIONS Optimizing intraoperative fluids, operative time, and postoperative diet, while favoring MIS approach when feasible, may maximize effects of post-hepatectomy care pathways to reduce LOS.
Collapse
|
63
|
Leborne P, Huberlant S, Masia F, de Tayrac R, Letouzey V, Allegre L. Clinical outcomes following surgical management of deep infiltrating endometriosis. Sci Rep 2022; 12:21800. [PMID: 36526707 PMCID: PMC9758215 DOI: 10.1038/s41598-022-25751-9] [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] [Received: 07/03/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
The main aim of the study was to evaluate severe post-operative complications following deep endometriosis surgery in a tertiary referral centre. This is a retrospective cohort study that included women who had surgery for deep infiltrating endometriosis between 1st January 2013 and 31st December 2019. Endometriosis was diagnosed based on clinical, imaging and histological parameters. We evaluated the rates of post-operative complications, potential risk factors for such complications and postoperative pregnancy rates. A total of 165 patients were included in the final analysis. The median follow-up was 63 (25-106) months. Thirty-seven patients (22.42%) had hysterectomy, 60 (36.81%) had ureterolysis and 44 (26.67%) had colorectal surgery. The overall and severe rates of post-operative complications were 16.20% (n = 23) and 2.42% (n = 4) respectively. Of the variables assessed, operative time and age were the only statistically significant risk factor for complications on multivariate analysis. Among women operated on for infertility, 34.5% (n = 20/58) got pregnant following surgery with 30% of these spontaneously. This study demonstrates acceptable overall and severe post-operative complications and pregnancy rates after deep endometriosis surgery. This information should help clinicians when counselling women to enable them making an informed choice about their management.
Collapse
Affiliation(s)
- Perrine Leborne
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Stephanie Huberlant
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France ,grid.121334.60000 0001 2097 0141Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Florent Masia
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| | - Renaud de Tayrac
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France ,grid.121334.60000 0001 2097 0141Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Vincent Letouzey
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France ,grid.121334.60000 0001 2097 0141Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Lucie Allegre
- grid.411165.60000 0004 0593 8241Department of Obstetrics and Gynecology, Nîmes University Hospital, Nîmes, France
| |
Collapse
|
64
|
Banerjee N, Bagaria D, Agarwal H, Kumar Katiyar A, Kumar S, Sagar S, Mishra B, Gupta A. Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center. Turk J Surg 2022; 38:391-400. [PMID: 36875271 PMCID: PMC9979560 DOI: 10.47717/turkjsurg.2022.5793] [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: 05/26/2022] [Accepted: 11/01/2022] [Indexed: 01/11/2023]
Abstract
Objectives Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients. Material and Methods The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days. Results A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care. Conclusion We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.
Collapse
Affiliation(s)
- Niladri Banerjee
- Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - Dinesh Bagaria
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Harshit Agarwal
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Rae Bareli, India
| | | | - Subodh Kumar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
65
|
Jiang C, Liu Y, Tang J, Li Z, Min W. Nomogram to predict postoperative complications after cytoreductive surgery for advanced epithelial ovarian cancer: A multicenter retrospective cohort study. Front Oncol 2022; 12:1052628. [PMID: 36505869 PMCID: PMC9728142 DOI: 10.3389/fonc.2022.1052628] [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] [Received: 09/24/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To establish nomograms to predict the risk of postoperative complications following cytoreductive surgery in patients with advanced epithelial ovarian cancer (AEOC). Methods A multicenter retrospective cohort study that included patients with FIGO stage IIIC-IV epithelial ovarian cancer who underwent cytoreductive surgery was designed. By using univariate and multivariate analyses, patient preoperative characteristics were used to predict the risk of postoperative complications. Multivariate modeling was used to develop Nomograms. Results Overall, 585 AEOC patients were included for analysis (training cohort = 426, extrapolation cohort = 159). According to the findings, the training cohort observed an incidence of postoperative overall and severe complications of 28.87% and 6.10%, respectively. Modified frailty index (mFI) (OR 1.96 and 2.18), FIGO stage (OR 2.31 and 3.22), and Surgical Complexity Score (SCS) (OR 1.16 and 1.23) were the clinical factors that were most substantially associated to the incidence of overall and severe complications, respectively. The resulting nomograms demonstrated great internal discrimination, good consistency, and stable calibration, with C-index of 0.74 and 0.78 for overall and severe complications prediction, respectively. A satisfactory external discrimination was also indicated by the extrapolation cohort, with the C-index for predicting overall and severe complications being 0.92 and 0.91, respectively. Conclusions The risk of considerable postoperative morbidity exists after cytoreductive surgery for AEOC. These two nomograms with good discrimination and calibration might be useful to guide clinical decision-making and help doctors assess the probability of postoperative complications for AEOC patients.
Collapse
Affiliation(s)
- Caixia Jiang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yingwei Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junying Tang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengyu Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhengyu Li, ; Wenjiao Min,
| | - Wenjiao Min
- Psychosomatic Department, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China,*Correspondence: Zhengyu Li, ; Wenjiao Min,
| |
Collapse
|
66
|
Maxillomandibular Advancement and Upper Airway Stimulation for Treatment of Obstructive Sleep Apnea: A Systematic Review. J Clin Med 2022; 11:jcm11226782. [PMID: 36431259 PMCID: PMC9697253 DOI: 10.3390/jcm11226782] [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] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
This systematic review aimed to comparatively evaluate the efficacy and safety of maxillomandibular advancement (MMA) and upper airway stimulation (UAS) in obstructive sleep apnea (OSA) treatment. A MEDLINE and Embase database search of articles on MMA and/or UAS for OSA was conducted. Twenty-one MMA studies and nine UAS studies were included. All the MMA studies demonstrated a reduction in apnea hypopnea index (AHI) postoperatively, and success rates ranged from 41.1% to 100%. Ten MMA studies reported pre- and postoperative Epworth sleepiness scale (ESS), and all but one study demonstrated a reduction in ESS. In the UAS studies, all but one demonstrated a reduction in AHI, and success rates ranged from 26.7% to 77.8%. In the eight UAS studies reporting pre- and postoperative ESS, an ESS reduction was demonstrated. No studies reported any deaths related to MMA or UAS. The most common postoperative complications after MMA and UAS were facial paresthesia in the mandibular area and discomfort due to electrical stimulation, respectively. This systematic review suggests that both MMA and UAS are effective and generally safe therapies for OSA. However, due to the limitations of the included studies, there is no evidence yet to directly compare these two procedures in OSA treatment.
Collapse
|
67
|
Les complications en chirurgie urologique. Recueil et classification. Prog Urol 2022; 32:906-918. [DOI: 10.1016/j.purol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
|
68
|
Complications of Extended Pelvic Lymph Node Dissection in Patients Undergoing Minimally Invasive Radical Prostatectomy: Analysis and Risk Factors. Prostate Cancer 2022; 2022:7631903. [PMID: 36317165 PMCID: PMC9617711 DOI: 10.1155/2022/7631903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/15/2022] [Indexed: 11/20/2022] Open
Abstract
Background The knowledge of risk factors and complications related to extended pelvic lymph node dissection (ePLND) during radical prostatectomy can help selecting patients who will benefit the most with lymph node dissection concomitant to radical prostatectomy. Materials and Methods Retrospective cohort evaluating 135 patients with PC, with a high risk for lymph node metastasis, submitted to ePLND by a single surgeon between 2013 and 2019, performed either by the laparoscopic or laparoscopic robot-assisted approach. Data related to complications were properly recorded using the Martin's criteria and were classified by the Satava and Clavien–Dindo–Strasberg methods. Logistic regression was used to determine predictors of complications related to ePLND. Results The mean number of lymph nodes removed was 10.2 ± 4.9, and in 28.2%, they were positive for metastasis. There were five intraoperative complications (4%), all in patients operated by laparoscopic approach. There were nine severe postoperative complications (7.3%), four of which occurred after postoperative day 30. Three patients (2.4%) had thromboembolic complications and five patients (4.0%) had lymphocele that required treatment. There was a correlation between the American Society of Anesthesiologists (ASA) physical status classification and postoperative complications (p=0.06), but it was not possible to identify statistically significant predictors. Conclusion ePLND during radical prostatectomy has a low rate of intraoperative complications and may change prostate cancer staging. Postoperative complications, especially venous thromboembolism and lymphocele, need to be monitored even in the late postoperative period.
Collapse
|
69
|
Occurrence and Definitions of Intra and Postoperative Complications Related to Laparoscopy in Equids: A Scoping Review. Vet Sci 2022; 9:vetsci9100577. [PMID: 36288190 PMCID: PMC9609183 DOI: 10.3390/vetsci9100577] [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: 09/15/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Laparoscopy and laparoscopic-assisted procedures in equines are nowadays common procedures with several advantages compared to laparotomy. However, despite the numerous benefits of minimally invasive surgery, there can be surgical complications which could have important welfare and economic consequences. Nevertheless, standard definitions of intra and postoperative complications are rarely reported and there is a lack of standard criteria to define and classify complications, limiting comparison of complication rates between studies. Thus, there is a need for implementation of rigorous criteria for defining complications and for greater numbers of research study with high quality of evidence. Adoption of classification systems and standard definitions would help surgeons to have a complete picture of the efficacy of a procedure or treatment and it is also essential to allow comparisons between studies, centers or time periods. Abstract Laparoscopy is a common approach in equine surgery and has the advantage of improved visibility and diagnostic accuracy, decreased morbidity and hospitalization time. However, despite the numerous benefits, there can be intraoperative and postoperative complications which could have important welfare and economic consequences. The aim of this study was to perform a scoping review to identify current evidence on the occurrence, definition and classification of intra and postoperative complications in equine laparoscopy. A scoping review was conducted in scientific databases. Peer-reviewed scientific articles in the English language on laparoscopy in equids between 1992 and 2022 were included. Data on the study method, sample size, surgical procedure, intra and postoperative complications were extracted and charted. One hundred sixty-four articles met the final inclusion criteria. A definition of “intraoperative complication” was given in one study. Difference between “minor” or “major” intraoperative complications were reported in 12 articles and between “minor” or “major” postoperative complications in 22 articles. A total of 22 intraoperative and 34 postoperative complications were described. The most reported intraoperative complication was hemorrhage from ovary or mesovary (12.7%), while the most reported postoperative complications were incisional complications (64.2%) and postoperative pain (32.7%). There is a need for implementation of criteria for defining complications. The adoption of classification systems and standard definitions would help surgeons to make decisions about the most appropriate treatment, and it is also essential to allow comparisons between research results.
Collapse
|
70
|
McGrath AM, Chen CL, Abrams B, Hixon L, Grimes JA, Viani E, McLoughlin MA, Tremolada G, Lapsley J, Selmic LE. Clinical presentation and outcome in cats with aural squamous cell carcinoma: a review of 25 cases (2010-2021). J Feline Med Surg 2022; 24:e420-e432. [PMID: 36066435 PMCID: PMC10812305 DOI: 10.1177/1098612x221119144] [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: 11/16/2022]
Abstract
CASE SERIES SUMMARY Ear canal neoplasia is uncommon in cats. Ceruminous gland adenocarcinoma is the most frequently reported malignant neoplasm of the feline ear canal, and squamous cell carcinoma (SCC) is the most common malignant neoplasm diagnosed in the feline middle ear. However, limited information exists on the outcome of cats diagnosed with SCC of the ear canal, middle or inner ear. Therefore, the objective of this study was to describe the outcome of cats diagnosed with SCC affecting these locations. Medical records were reviewed at multiple institutions to identify cats with a definitive diagnosis of SCC. Twenty-five cats were identified. Eleven cats were treated with surgery, eight with medical management, two with coarse fractionated radiation therapy, two with a combination of coarse fractionated radiation therapy and chemotherapy, one with a combination of surgery and coarse fractionated radiation therapy, one cat with systemic chemotherapy and one cat received no treatment following diagnosis. The median survival time of cats treated with surgery was 168 days vs 85 days (P = 0.28) for those treated palliatively with either medical management, radiation therapy, chemotherapy, or a combination of radiation therapy and chemotherapy. RELEVANCE AND NOVEL INFORMATION This case series documented that SCC of the ear canal, middle and/or internal ear is a locally aggressive tumor that carries an overall poor prognosis. The median survival time for cats treated with surgery was longer than that with any other modality, but this difference was not statistically significant.
Collapse
Affiliation(s)
- Alysha M McGrath
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Carolyn L Chen
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
| | - Brittany Abrams
- Department of Veterinary Clinical Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Leah Hixon
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
| | - Emily Viani
- Department of Surgery, Angell Animal Medical Center, Jamaica Plain, MA, USA
| | - Mary A McLoughlin
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Giovanni Tremolada
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Janis Lapsley
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
71
|
Protocol for CAMUS Delphi Study: A Consensus on Comprehensive Reporting and Grading of Complications After Urological Surgery. Eur Urol Focus 2022; 8:1493-1511. [PMID: 35221259 DOI: 10.1016/j.euf.2022.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reproducible assessment of postoperative complications is essential for reliable evaluation of quality of care to enable comparison between healthcare centres and ensure transparent patient counselling. Currently, significant discrepancies exist in complication reporting and grading due to heterogeneous definitions and methodologies. OBJECTIVE To develop a standardised and reproducible assessment of perioperative complications and overall associated morbidity, to allow for the construction of a uniform language for complication reporting and grading. DESIGN, SETTING, AND PARTICIPANTS The 12-part REDCap-based Delphi survey was developed in conjunction with methodologist review and experienced urologist opinion. International urologists, anaesthetists, and intensive care unit specialists will be included. A minimum sample size of 750 participants (500 urologists and 250 critical care specialities) is targeted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The survey assesses participant demographics, opinion on complication reporting and the proposed Complications After Major & Minor Urological Surgery (CAMUS) reporting recommendations, grading of intervention events using the existing Clavien-Dindo classification and the proposed CAMUS classification, and rating of various clinical scenarios. Consensus will be defined as ≥75% majority agreement. If consensus is not reached, then subsequent Delphi rounds will be performed under steering committee guidance. RESULTS AND LIMITATIONS Twenty-one participants completed the draft survey. The median survey completion time was 128 min (interquartile range 88-135). The survey revealed that 90% of participants believe that the current complication classification systems are useful but inaccurate, while 100% of participants believe that there is a universal demand for reporting consensus. Several amendments were made following feedback. Limitations include complexity of the proposed supplemental grades and time to completion of the survey. CONCLUSIONS To ensure comprehensive and comparable complication reporting and grading across centres worldwide, a conclusive uniform language for complication reporting must be created. We intend to address shortcomings of the current complication reporting and classification systems with a new CAMUS classification system developed through multidisciplinary expert consensus obtained through a Delphi survey. Ultimately, standardisation of urological complication reporting and grading may improve patient counselling and quality of care. PATIENT SUMMARY The reporting and grading of operative complications that occur during or after an operation and associated costs provide a means to stratify quality of patient care. Current complication reporting and classification systems are not standardised and somewhat inaccurate, and thus significantly underestimate patient morbidity and surgical risk. This Delphi survey will provide the basis for the creation of a uniform complication reporting and grading system. Our new system may allow improved reporting and grading between centres, and ultimately improve patient counselling and care.
Collapse
|
72
|
Jończyk J, Jankau J. Accordion: A Useful and Workable Classification of Complications After Breast Reconstructive Surgery. Plast Surg (Oakv) 2022; 30:197-203. [PMID: 35990398 PMCID: PMC9389063 DOI: 10.1177/22925503211008439] [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: 08/10/2020] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 08/03/2023] Open
Abstract
Background: The aim of this study was to evaluate whether Accordion Severity Grading System can serve as a tool for classification, and severity assessment in reporting postoperative complications after breast reconstructive surgery. Methods: A retrospective analysis covered 88 breast reconstruction surgeries following mastectomy and prophylactic breast amputation with simultaneous reconstruction conducted from January 2015 to December 2017. All registered postoperative complications were evaluated using the Accordion Severity Grading System. The time horizon selected was 6 weeks after surgery. Results: Eighty-two adverse events which met the criteria for complications according to the Accordion classification were observed in 53.4% (n = 47) of the patients. The highest percentage of complications was observed in the group where reconstruction involved using autologous tissues (pedicled transverse rectus abdominis myocutaneous), which were associated with 77.4% risk of complications. In patients with combined methods (latissimus dorsi + prosthesis), complications occurred in half of the cases (51.4%). In patients who underwent reconstructive procedures with artificial materials (expander/prosthesis), complications occurred in 20% of cases. A high γ correlation coefficient of 0.7 (P < .001) was observed between the Accordion degree assigned to the patient and the length of hospital stay. A moderately strong correlation was found between the degree of Accordion system and rehospitalization rate (r = 0.54; P < .0001) and cost of hospital care (r = 0.65; P < .001). Discussion: Based upon the presented study, Accordion Severity Grading System is a workable, intuitive and universal scale for classifying and assessing the severity of postoperative complications and may be recommended for documenting complications in breast reconstructive procedures.
Collapse
Affiliation(s)
- Justyna Jończyk
- Department of Plastic Surgery, Medical University of Gdańsk,
Poland
| | - Jerzy Jankau
- Department of Plastic Surgery, Medical University of Gdańsk,
Poland
| |
Collapse
|
73
|
Eriksen KS, Lode K, Husebø SIE, Kørner H. Exploring variables affecting sense of coherence and social support in recovery after colorectal cancer surgery among the oldest old. Geriatr Nurs 2022; 47:81-86. [PMID: 35878524 DOI: 10.1016/j.gerinurse.2022.06.008] [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: 04/28/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the associations between sense of coherence, perceived social support, and demographic and clinical characteristics among survivors ≥80 years treated for curable colorectal cancer. METHODS This exploratory, cross-sectional survey investigates 56 individuals surgically treated for stage I-III colorectal cancer between one and five years prior. Statistical analysis permitted exploration of associations between sense of coherence, perceived social support, and demographic- and clinical variables. RESULTS Lower sense of coherence was associated with higher age, limitations in physical function, and the need for homecare nursing. Lower perceived social support was associated with re-admission, higher age at time of surgery, and male gender. No correlations were found between sense of coherence and perceived social support. CONCLUSION The results are important for healthcare professionals to consider when dealing with older people who underwent surgery for colorectal cancer, especially in the discharge process to facilitate optimal follow-up care and recovery.
Collapse
Affiliation(s)
- Kristina Sundt Eriksen
- Department of Research, Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
| | - Kirsten Lode
- Department of Research, Stavanger University Hospital, Stavanger, Norway; Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Sissel Iren Eikeland Husebø
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
74
|
Association of Patient Controlled Analgesia and Total Inpatient Opioid Use After Pancreatectomy. J Surg Res 2022; 275:244-251. [DOI: 10.1016/j.jss.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 12/31/2022]
|
75
|
Polen-De C, Fadadu P, Weaver AL, Moynagh M, Takahashi N, Jatoi A, LeBrasseur NK, McGree M, Cliby W, Kumar A. Quality is more important than quantity: pre-operative sarcopenia is associated with poor survival in advanced ovarian cancer. Int J Gynecol Cancer 2022; 32:ijgc-2022-003387. [PMID: 35680140 DOI: 10.1136/ijgc-2022-003387] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sarcopenia is prevalent among older patients with cancer and is associated with poor outcomes. OBJECTIVE To explore the relationship between muscle mass, quality, and patient age with overall survival after surgery for advanced ovarian cancer. METHODS Patients with advanced stage (IIIC/IV) ovarian cancer who underwent primary cytoreductive surgery between January 2006 and July 2016 were included. Body composition measures were calculated from pre-operative CT imaging: skeletal muscle index (skeletal muscle index=skeletal muscle area normalized for height), skeletal muscle density, and skeletal muscle gauge (product of skeletal muscle index and skeletal muscle density). Each measure was transformed to a z-score and evaluated for association with risk of death using Cox proportional hazards models. Recursive partitioning was used to classify patients into homogeneous subgroups considering age and skeletal muscle gauge as predictors of overall survival. RESULTS The study included 429 patients (mean age 64.2 years). Increased age moderately correlated with decreased skeletal muscle gauge (r=-0.45). Decreasing skeletal muscle density and skeletal muscle gauge were significantly associated with increased risk of death; HR (95% CI) per 1-unit decrease in z-score of 1.24 (1.10 to 1.39) for skeletal muscle density and 1.27 (1.12 to 1.44) for skeletal muscle gauge. Associations were diluted after adjusting for age (1.13 (1.00 to 1.29) skeletal muscle density and 1.14 (0.99 to 1.30) skeletal muscle gauge). Recursive partitioning identified three subgroups: <60 years old, ≥60 years old with skeletal muscle gauge ≥937.3, and ≥60 years old with skeletal muscle gauge <937.3; median overall survival was 5.8, 3.3, and 2.3 years, respectively (p<0.001). CONCLUSIONS Skeletal muscle gauge, a novel sarcopenia measure incorporating quantity and quality, was associated with poorer survival in patients with advanced ovarian cancer, particularly among patients older than 60. Expanding our knowledge of how sarcopenia relates to solid tumor outcomes among high-risk patients can modify our treatment approach.
Collapse
Affiliation(s)
- Clarissa Polen-De
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Priyal Fadadu
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy L Weaver
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Moynagh
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan K LeBrasseur
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela McGree
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - William Cliby
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
76
|
Qu C, Li R, Ma Z, Han J, Yue W, Aigner C, Casiraghi M, Tian H. Comparison of the perioperative outcomes between robotic-assisted thoracic surgery and video-assisted thoracic surgery in non-small cell lung cancer patients with different body mass index ranges. Transl Lung Cancer Res 2022; 11:1108-1118. [PMID: 35832453 PMCID: PMC9271441 DOI: 10.21037/tlcr-22-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/16/2022] [Indexed: 11/09/2022]
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common malignancy and one of the most common causes of cancer-related death worldwide. Robotic-assisted thoracic surgery (RATS) has gradually become a prevalent surgical method for patients with NSCLC. Previous studies have found that body mass index (BMI) is associated with postoperative outcomes. This study aimed to investigate the effectiveness of RATS compared to video-assisted thoracic surgery (VATS) in the treatment of NSCLC with different BMI, in terms of perioperative outcomes. Methods The baseline and perioperative data, including BMI, of 849 NSCLC patients who underwent minimally invasive anatomic lung resections from August 2020 to April 2021 were retrospectively collected and analyzed. Propensity score matching analysis was applied to minimize potential bias between the two groups (VATS and RATS), and the perioperative outcomes were compared. Subgroup analysis was subsequently performed. Results Compared to VATS, RATS had more lymph nodes dissected {9 [inter-quartile range (IQR), 6–12] vs. 7 (IQR, 6–10), P<0.001}, a lower estimated bleeding volume [40 (IQR, 30–50) vs. 50 (IQR, 40–60) mL, P<0.001], and other better postoperative outcomes, but a higher cost of hospitalization [¥83,626 (IQR, 77,211–92,686) vs. ¥75,804 (IQR, 66,184–83,693), P<0.001]. Multivariable logistic regression analysis indicated that RATS (P=0.027) and increasing BMI (P=0.030) were associated with a statistically significant reduction in the risk of postoperative complications. Subgroup analysis indicated that the advantages of RATS may be more obvious in patients with a BMI of 24–28 kg/m2, in which the RATS group had more lymph nodes dissected [9 (IQR, 6–12) vs. 7 (IQR, 5–10), P<0.001] and a decreased risk of total postoperative complications [odds ratio (OR), 0.443; 95% confidence interval (CI), 0.212–0.924; P=0.030] compared to the VATS group. Conclusions Both, RATS and VATS can be safely applied for patients with NSCLC. Perioperative outcome parameters indicate advantages for RATS, however at a higher cost of hospitalization. The advantages of RATS might be more obvious in patients with a BMI of 24–28 kg/m2.
Collapse
Affiliation(s)
- Chenghao Qu
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Rongyang Li
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Zheng Ma
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jingyi Han
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Weiming Yue
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Monica Casiraghi
- Division of Thoracic Surgery, European Institute of Oncology-IEO IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy
| | - Hui Tian
- Department of Thoracic Surgery, Qilu Hospital of Shandong University, Jinan, China
| |
Collapse
|
77
|
Manekk RS, Gharde P, Gattani R, Lamture Y. Surgical Complications and Its Grading: A Literature Review. Cureus 2022; 14:e24963. [PMID: 35706751 PMCID: PMC9187255 DOI: 10.7759/cureus.24963] [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] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
The demand for improvement in healthcare delivery has been increasing. Thus, a standardized method allows quality assessment of data and its comparison between various institutions over time. Many attempts have been made to classify surgical complications before 1990; however, none of those attempts gained popularity and acceptance. Clavien and his colleagues started the wave by explaining negative outcomes on the basis of complications, failure to cure, and sequelae. Complications were primarily defined as “any deviation from the normal postoperative course”. Since then, many such classification systems and grading systems have been introduced and studied for analyzing the post-operative complications. The purpose of this study was to review the revolution in the classification systems for surgical complications, its validation, and to analyze the results of various qualitative indicators for post-operative complications obtained by using these classification systems. A global set of keywords were built such as “grading of surgical complications”, “abdominal surgery”, “classification of surgical complications”, and the “Clavien Dindo Classification”. A literature review was done using PubMed, Medline, and Google Scholar. A list of reference articles concerning the literature on classification systems for surgical complications was manually analyzed from the year 1992 and the data was summarized.
Collapse
|
78
|
Handley K, Sood AK, Molin GZD, Westin SN, Meyer LA, Fellman B, Soliman PT, Coleman RL, Fleming ND. Frailty repels the knife: The impact of frailty index on surgical intervention and outcomes. Gynecol Oncol 2022; 166:50-56. [DOI: 10.1016/j.ygyno.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
|
79
|
Flick M, Bergholz A, Sierzputowski P, Vistisen ST, Saugel B. What is new in hemodynamic monitoring and management? J Clin Monit Comput 2022; 36:305-313. [PMID: 35394584 PMCID: PMC9122861 DOI: 10.1007/s10877-022-00848-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Bergholz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pawel Sierzputowski
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon T Vistisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Outcomes Research Consortium, Cleveland, Ohio, USA.
| |
Collapse
|
80
|
Larsen SG, Goscinski MA, Dueland S, Steigen SE, Hofsli E, Torgunrud A, Lund-Iversen M, Dagenborg VJ, Flatmark K, Sorbye H. Impact of KRAS, BRAF and microsatellite instability status after cytoreductive surgery and HIPEC in a national cohort of colorectal peritoneal metastasis patients. Br J Cancer 2022; 126:726-735. [PMID: 34887523 PMCID: PMC8888568 DOI: 10.1038/s41416-021-01620-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with metastatic colorectal cancer (mCRC) carrying BRAF (mutBRAF) or KRAS mutation (mutKRAS) have an inferior prognosis after liver or lung surgery, whereas the prognostic role in the context of peritoneal metastasis (PM) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been less investigated. METHODS In total, 257 patients with non-appendiceal PM-CRC were included from the Norwegian National Unit for CRS-HIPEC. RESULTS In total, 180 patients received CRS-HIPEC with Mitomycin C, 77 patients received palliative surgery only. In the CRS-HIPEC group, mutBRAF was found in 24.7%, mutKRAS 33.9% and double wild-type 41.4% without differences in survival. MSI was found in 29.3% of mutBRAF cases. Patients with mutBRAF/MSI had superior 5-year survival compared to mutBRAF with MSS (58.3% vs 25.2%, P = 0.022), and better 3-year disease-free survival (DFS) compared to mutKRAS (48.6% vs 17.2%, P = 0.049). Peritoneal Cancer Index and the number of lymph node metastasis were prognostic for OS, and the same two, location and gender prognostic for DFS in multivariate analysis. CONCLUSIONS PM-CRC with CRS-HIPEC patients has a surprisingly high proportion of mutBRAF (24.7%). Survival was similar comparing mutBRAF, mutKRAS and double wild-type cases, whereas a small subgroup with mutBRAF and MSI had better survival. Patients with mutBRAF tumours and limited PM should be considered for CRS-HIPEC.
Collapse
Affiliation(s)
- S. G. Larsen
- grid.55325.340000 0004 0389 8485Section for Surgical Oncology, Norwegian Radium Hospital, Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - M. A. Goscinski
- grid.55325.340000 0004 0389 8485Section for Surgical Oncology, Norwegian Radium Hospital, Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - S. Dueland
- grid.55325.340000 0004 0389 8485Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - S. E. Steigen
- grid.412244.50000 0004 4689 5540Department of Clinical Pathology, University Hospital of North Norway, Tromsø, Norway
| | - E. Hofsli
- grid.52522.320000 0004 0627 3560The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - A. Torgunrud
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - M. Lund-Iversen
- grid.5510.10000 0004 1936 8921Department of Clinical Pathology, University of Oslo, Oslo, Norway
| | - V. J. Dagenborg
- grid.55325.340000 0004 0389 8485Section for Surgical Oncology, Norwegian Radium Hospital, Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway
| | - K. Flatmark
- grid.55325.340000 0004 0389 8485Section for Surgical Oncology, Norwegian Radium Hospital, Department of Gastroenterological Surgery, Oslo University Hospital, Oslo, Norway ,grid.55325.340000 0004 0389 8485Department of Tumor Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - H. Sorbye
- grid.7914.b0000 0004 1936 7443Department of Oncology, Haukeland University Hospital and Department of Clinical Science, University of Bergen, Bergen, Norway
| |
Collapse
|
81
|
Kuemmerli C, Fichtinger RS, Moekotte A, Aldrighetti LA, Aroori S, Besselink MGH, D’Hondt M, Díaz-Nieto R, Edwin B, Efanov M, Ettorre GM, Menon KV, Sheen AJ, Soonawalla Z, Sutcliffe R, Troisi RI, White SA, Brandts L, van Breukelen GJP, Sijberden J, Pugh SA, Eminton Z, Primrose JN, van Dam R, Hilal MA. Laparoscopic versus open resections in the posterosuperior liver segments within an enhanced recovery programme (ORANGE Segments): study protocol for a multicentre randomised controlled trial. Trials 2022; 23:206. [PMID: 35264216 PMCID: PMC8908665 DOI: 10.1186/s13063-022-06112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/15/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A shift towards parenchymal-sparing liver resections in open and laparoscopic surgery emerged in the last few years. Laparoscopic liver resection is technically feasible and safe, and consensus guidelines acknowledge the laparoscopic approach in the posterosuperior segments. Lesions situated in these segments are considered the most challenging for the laparoscopic approach. The aim of this trial is to compare the postoperative time to functional recovery, complications, oncological safety, quality of life, survival and costs after laparoscopic versus open parenchymal-sparing liver resections in the posterosuperior liver segments within an enhanced recovery setting. METHODS The ORANGE Segments trial is an international multicentre randomised controlled superiority trial conducted in centres experienced in laparoscopic liver resection. Eligible patients for minor resections in the posterosuperior segments will be randomised in a 1:1 ratio to undergo laparoscopic or open resections in an enhanced recovery setting. Patients and ward personnel are blinded to the treatment allocation until postoperative day 4 using a large abdominal dressing. The primary endpoint is time to functional recovery. Secondary endpoints include intraoperative outcomes, length of stay, resection margin, postoperative complications, 90-day mortality, time to adjuvant chemotherapy initiation, quality of life and overall survival. Laparoscopic liver surgery of the posterosuperior segments is hypothesised to reduce time to functional recovery by 2 days in comparison with open surgery. With a power of 80% and alpha of 0.04 to adjust for interim analysis halfway the trial, a total of 250 patients are required to be randomised. DISCUSSION The ORANGE Segments trial is the first multicentre international randomised controlled study to compare short- and long-term surgical and oncological outcomes of laparoscopic and open resections in the posterosuperior segments within an enhanced recovery programme. TRIAL REGISTRATION ClinicalTrials.gov NCT03270917 . Registered on September 1, 2017. Before start of inclusion. PROTOCOL VERSION version 12, May 9, 2017.
Collapse
Affiliation(s)
- Christoph Kuemmerli
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
- Department of Surgery, Foundation Poliambulanza, Via Bissolati, Brescia, Italy
| | - Robert S. Fichtinger
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ Maastricht, The Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - Alma Moekotte
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | | | - Somaiah Aroori
- Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Marc G. H. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Mathieu D’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Rafael Díaz-Nieto
- Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, UK
| | - Bjørn Edwin
- Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Research Centre, Moscow, Russia
| | - Giuseppe M. Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
| | | | - Aali J. Sheen
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
| | - Zahir Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Robert Sutcliffe
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Roberto I. Troisi
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Steven A. White
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lloyd Brandts
- Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht UMC+, Maastricht, The Netherlands
| | - Gerard J. P. van Breukelen
- Department of Methodology and Statistics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jasper Sijberden
- Department of Surgery, Foundation Poliambulanza, Via Bissolati, Brescia, Italy
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Siân A. Pugh
- Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - John N. Primrose
- Department of Surgery, University of Southampton, Southampton, UK
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ Maastricht, The Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- GROW – School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Mohammed Abu Hilal
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
- Department of Surgery, Foundation Poliambulanza, Via Bissolati, Brescia, Italy
| | - on behalf of the ORANGE trials collaborative
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
- Department of Surgery, Foundation Poliambulanza, Via Bissolati, Brescia, Italy
- Department of Surgery, Maastricht University Medical Centre+, 6202 AZ Maastricht, The Netherlands
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
- Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
- Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, UK
- Department of HPB Surgery, Oslo University Hospital, Oslo, Norway
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Research Centre, Moscow, Russia
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
- Institute of Liver Studies, Kings College Hospital, London, UK
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
- Division of HPB, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK
- Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht UMC+, Maastricht, The Netherlands
- Department of Methodology and Statistics, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Oncology, Addenbrooke’s Hospital, Cambridge, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- Department of Surgery, University of Southampton, Southampton, UK
- GROW – School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
82
|
Krueger CM, Chikhladze S, Adam U, Patrzyk M, Kramer A, Riediger H. The clinical impact of preoperative biliary drainage on isolated infectious complications (iiC) after pancreatic head resection—a retrospective study. BMC Surg 2022; 22:71. [PMID: 35219316 PMCID: PMC8882266 DOI: 10.1186/s12893-021-01366-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The perioperative morbidity after pancreatoduodenectomy (PD) is mostly influenced by intraabdominal complications which are often associated with infections. In patients with preoperative biliary drainage (PBD), the risk for postoperative infections may be even elevated. The aim of this study is to explore if isolated infectious complications without intraabdominal focus (iiC) can be observed after PD and if they are associated to PBD and antibiotic prophylaxis with potential conclusions for their treatment.
Methods
During a 10-year period from 2009 to 2019, all consecutive PD were enrolled prospectively in a database and analyzed retrospectively. Bacteriobilia (BB) and Fungibilia (FB) were examined by intraoperatively acquired smears. A perioperative antibiotic prophylaxis was performed by Ampicillin/Sulbactam. For this study, iiC were defined as postoperative infections like surgical site infection (SSI), pneumonia, unknown origin etc. Statistics were performed by Fisher’s exact test and Mann Whitney U test.
Results
A total of 426 PD were performed at the Vivantes Humboldt-hospital. The morbidity was 56% (n = 238). iiC occurred in 93 patients (22%) and accounted for 38% in the subgroup of patients with postoperative complications. They were not significantly related to BB and PBD but to FB. The subgroup of SSI, however, had a significant relationship to BB and FB with a poly microbial profile and an accumulation of E. faecalis, E. faecium, Enterobacter, and Candida. BB was significantly more frequent in longer lay of PBD. Resistance to standard PAP and co-existing resistance to broad spectrum antibiotics is frequently found in patients with iiC. The clinical severity of iiC was mostly low and non-invasive therapy was adequate. Their treatment led to a significant prolongation of the hospital stay.
Conclusions
iiC are a frequent problem after PD, but only in SSI a significant association to BB and FB can be found in our data. Therefore, the higher resistance of the bacterial species to routine PAP, does not justify broad spectrum prophylaxis. However, the identification of high-risk patients with BB and PBD (length of lay) is recommended. In case of postoperative infections, an early application of broad-spectrum antibiotics and adaption to microbiological findings from intraoperatively smears may be advantageous.
Collapse
|
83
|
Zhang X, Li G, Li X, Liang Z, Lan X, Mou T, Xu Z, Fu J, Wu M, Li G, Wang Y. Effect of single-incision plus one port laparoscopic surgery assisted with enhanced recovery after surgery on colorectal cancer: study protocol for a single-arm trial. Transl Cancer Res 2022; 10:5443-5453. [PMID: 35116390 PMCID: PMC8799928 DOI: 10.21037/tcr-21-1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/05/2021] [Indexed: 12/20/2022]
Abstract
Background Studies have proved that the enhanced recovery after surgery (ERAS) protocol can significantly improve the recovery course of patients during the perioperative period. The application of minimally invasive surgery is a critical component of ERAS protocol. Single-incision plus one port laparoscopic surgery (SILS plus one) could achieve further minimally invasive surgical results than conventional laparoscopic surgery (CLS). The objective of this trial is to evaluate the safety and feasibility of SILS plus one with ERAS protocol in colorectal cancer. Methods This is a prospective, single-center, open-label, single-arm trial. A total of 120 eligible patients with colorectal cancer will receive SILS plus one followed by the ERAS management during the perioperative period. The primary endpoint is postoperative hospital stay. The secondary endpoints include rehabilitative rate of the fourth postoperative day, postoperative medical cost, postoperative pain score, postoperative recovery indexes, inflammatory immune response indexes, compliance with ERAS measures, 6 min postoperative walking test (6MWT), hospital readmissions, and early postoperative complications. Discussion This trial will be the first to evaluate the short-term outcomes of SILS plus one assisted with ERAS protocol for patients with colorectal cancer and will provide valuable clinical evidence on the benefit of the combination of these two techniques, hopefully, to provide patients with more safe, economic, feasible, and rapid surgery and perioperative strategies. Trial Registration Clinical Trial Registry, NCT0426829. Registered February 15, 2020 (https://clinicaltrials.gov/ct2/show/NCT04268290).
Collapse
Affiliation(s)
- Xuehua Zhang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Gaohua Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaojing Li
- The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenye Liang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoliang Lan
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenzhao Xu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Fu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mingyi Wu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanan Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
84
|
Assessment of Travel Distance for Hyperthermic Intraperitoneal Chemotherapy in Women with Ovarian Cancer. Gynecol Oncol Rep 2022; 40:100951. [PMID: 35392128 PMCID: PMC8980495 DOI: 10.1016/j.gore.2022.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
The median travel distance in women with EOC undergoing CRS with HIPEC was 57.0 miles in women with EOC. Over 20% of patients treated at our institution traveled more than 100 miles for HIPEC procedures. No differences were observed in post-operative complications or oncologic outcomes based upon travel distance.
Objective (s) To evaluate travel distance in women with advanced or recurrent epithelial ovarian cancer (OC) undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) and the subsequent impact upon outcomes. Methods An IRB-approved single-institution prospective registry was queried for women with OC who underwent HIPEC from 1/1/2009–12/1/2020. Demographic, oncologic, and surgical data were recorded. The patient's home zip code was compared to the institutional zip code to determine travel distance using Google Maps. Patients were divided into three strata for analysis: 1) local: ≤50 miles, 2) regional: 51–99 miles, and 3) distant: ≥100 miles and univariate analysis was performed. Results Of 127 women, the median distance travelled was 57.0 miles (IQR: 20.6, 84.6). There were no significant differences in mild (28.3% vs. 26.3 vs. 24.1%), moderate (21.7% vs. 15.8% vs. 17.2%) or severe postoperative complications (11.7% vs. 5.3% vs. 17.2%) (p = 0.75) for local, regional and distant patients, respectively. There was no difference in progression-free survival (17.4 vs. 22.2 vs. 12.8 months, p > 0.05) or overall survival (57.3 vs. 61.6 vs. 29.2 months, p > 0.05) for local, regional or distant patients, respectively. Conclusions This study demonstrates that women with OC are willing to travel for HIPEC, with over 50% traveling > 50 miles. Our results suggest that women who travel for HIPEC procedures are not at increased risk for perioperative complications or worse oncologic outcomes than those local to HIPEC centers.
Collapse
|
85
|
Madadi-Sanjani O, Zoeller C, Kuebler JF, Hofmann AD, Dingemann J, Wiesner S, Brendel J, Ure BM. Severity grading of unexpected events in paediatric surgery: evaluation of five classification systems and the Comprehensive Complication Index (CCI®). BJS Open 2022; 5:6504757. [PMID: 35022674 PMCID: PMC8756080 DOI: 10.1093/bjsopen/zrab138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background Postoperative adverse events may be associated with substantial morbidity and mortality. Numerous severity grading systems for these events have been introduced and validated but have not yet been systematically applied in paediatric surgery. This study aimed to analyse the advantages and disadvantages of these classifications in a paediatric cohort. Methods Unexpected events associated with interventional or organizational problems in the department of paediatric surgery during 2017–2020 were prospectively documented daily for all children. Events were classified according to the Clavien–Dindo grading system during monthly morbidity and mortality conferences. All events were also classified according to five additional grading systems: T92, contracted Accordion, expanded Accordion, Memorial Sloan Kettering Cancer Center, and Comprehensive Complication Index (CCI)®. Results Of 6296 patients, 673 (10.7 per cent) developed adverse events and 240 (35.7 per cent) had multiple events. Overall, 1253 adverse events were identified; of these, 574 (45.2 per cent) were associated with surgical or medical interventions and 679 (54.8 per cent) included organizational problems. The grading systems demonstrated high overall correlation (rpears = 0.9), with minor differences in sentinel events. The Clavien–Dindo classification offered the most detailed assessment. However, these details had only limited additional value. The CCI® scores were correlated with other grading systems (rpears = 0.9) and were useful in analysing multiple events within individual patients. Conclusion Grading systems demonstrated similar scoring patterns for minor and sentinel events, with none being superior for unexpected events in children. However, the CCI® can be a major improvement in assessing morbidity in patients with multiple events. Its use is therefore recommended in prospective studies on paediatric surgery.
Collapse
Affiliation(s)
- Omid Madadi-Sanjani
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Zoeller
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
- Department of Paediatric Surgery, University Hospital Muenster, Muenster, Germany
| | - Joachim F Kuebler
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Alejandro D Hofmann
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Dingemann
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Soeren Wiesner
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Julia Brendel
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
86
|
De Pastena M, Paiella S, Fontana M, Filippini C, Addari L, Giorgi A, Canton S, Zanusso G, Azzini AM, Bassi C, Tacconelli E, Salvia R. The clinical and economic impact of surgical site infections after distal pancreatectomy. Surgery 2022; 171:1652-1657. [PMID: 34972593 DOI: 10.1016/j.surg.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The present study aimed to evaluate surgical site infections' clinical and economic impact after distal pancreatectomy. METHODS The study was a prospective, monocentric, observational study, including all adult patients who underwent distal pancreatectomy. According to the American Centers for Disease Control and Prevention definition, the surgical site infection assessment was prospectively performed by trained personnel. The Accordion Severity Grading System was used to evaluate the clinical burden of surgical site infection. The hospitalization's total costs were calculated using the hospital expenditure report, excluding the intraoperative costs. RESULTS During the study period, 414 distal pancreatectomies were performed. The overall incidence of surgical site infection was 26% (106 patients). Surgical site infections were associated with a higher body mass index (P = .022, odds ratio 1.2), positive preoperative rectal swab for multidrug resistant bacteria (P = .010, odds ratio 4.2), and increased operative time (P = .037, odds ratio 1.1). Using the Accordion Severity Grading System, surgical site infections contributed significantly to the total clinical burden (25.5%) and prolonged hospitalization (P < .001). Furthermore, surgical site infection doubled the costs (12.915 vs 6.888 euros, P < .001). CONCLUSION Surgical site infection has a high clinical burden, negatively impacting the postoperative course. The costs and length of stay proportionally increased with the surgical site infection severity, doubling the hospitalization expenses.
Collapse
Affiliation(s)
- Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Michele Fontana
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Chiara Filippini
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Laura Addari
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Alice Giorgi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Simona Canton
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Giovanni Zanusso
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Anna Maria Azzini
- Infectious Diseases Unit, Department of Diagnostic and Public Health, University of Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy
| | - Evelina Tacconelli
- Infectious Diseases Unit, Department of Diagnostic and Public Health, University of Verona, Italy
| | - Roberto Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Italy.
| |
Collapse
|
87
|
Myrseth E, Nymo LS, Gjessing PF, Norderval S. Diverting stomas reduce reoperation rates for anastomotic leak but not overall reoperation rates within 30 days after anterior rectal resection: a national cohort study. Int J Colorectal Dis 2022; 37:1681-1688. [PMID: 35739403 PMCID: PMC9262798 DOI: 10.1007/s00384-022-04205-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE A diverting stoma is commonly formed to reduce the rate of anastomotic leak following anterior resection with anastomosis, although some studies question this strategy. The aim of this study was to assess the leak rates and overall complication burden after anterior resection with and without a diverting stoma. METHODS A 5-year national cohort with prospectively registered data of patients who underwent elective anterior resection for rectal cancer located < 15 cm from the anal verge. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and the Norwegian Colorectal Cancer Registry. Primary end point was relaparotomy or relaparoscopy for anastomotic leak within 30 days from index surgery. Secondary endpoints were postoperative complications including reoperation for any cause. RESULTS Some 1018 patients were included of whom 567 had a diverting stoma and 451 had not. Rate of reoperation for anastomotic leak was 13 out of 567 (2.3%) for patients with diverting stoma and 35 out of 451 (7.8%) (p > 0.001) for patients without. In multivariable analyses not having a diverting stoma (aOR 3.77, c.i 1.97-7.24, p < 0.001) was associated with increased risk for anastomotic leak. However, there were no differences in overall reoperation rates following anterior resection with or without diverting stoma (9.3% vs 10.9%, p = 0.423), and overall complication rates were similar. Reoperation was associated with increased mortality irrespective of the main intraoperative finding. CONCLUSION Diverting stoma formation after anterior resection is protective against reoperation for anastomotic leak but does not affect overall rates of reoperation or complications within 30 days.
Collapse
Affiliation(s)
- Elisabeth Myrseth
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway.
| | - Linn Såve Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Petter Fosse Gjessing
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Stig Norderval
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| |
Collapse
|
88
|
Shashi KK, Stone SSD, Berde CB, Padua HM. Intrathecal catheter and port placement for nusinersen infusion in children with spinal muscular atrophy and spinal fusion. Pediatr Radiol 2021; 51:2588-2595. [PMID: 34254153 DOI: 10.1007/s00247-021-05126-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/18/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spinal administration of medications is challenging in patients with complete posterior spinal fusion. We describe percutaneous image-guided intrathecal port placement for administration of the antisense oligonucleotide nusinersen for children and young adults with spinal muscular atrophy. OBJECTIVE To describe and present our initial experience with a new technique for administering nusinersen in patients with spinal muscular atrophy and posterior spinal fusion. MATERIALS AND METHODS We reviewed medical records of 13 patients who received intrathecal ports using DynaCT, biplane fluoroscopy and iGuide from April 2018 through June 2019, and we describe the clinical course over 1 year. RESULTS Image-guided catheter and port implantation was successful in all cases. Two ports were subsequently removed, one for persistent cerebrospinal fluid leak and one for superficial infection. The other 11 have functioned successfully for a minimum of 23 months. CONCLUSION We report our experience with image-guided intrathecal port placement in children with complete posterior spine fusion. The implanted port permits dosing in an outpatient setting and avoids the need for multiple future radiologic procedures, and it reduces discomfort, procedural costs and potential risks and sequelae of multiple anesthetics and radiation exposures. Further studies are needed to define the relative risks and benefits of intrathecal ports compared to other approaches such as repeated transforaminal lumbar punctures.
Collapse
Affiliation(s)
- Kumar K Shashi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Scellig S D Stone
- Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Horacio M Padua
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| |
Collapse
|
89
|
Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
Collapse
Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
| |
Collapse
|
90
|
Chambers LM, Chau D, Yao M, Costales AB, Rose PG, Michener CM, Debernardo R, Vargas R. Efficacy of hyperthermic intraperitoneal chemotherapy and interval debulking surgery in women with advanced uterine serous carcinoma. Gynecol Oncol Rep 2021; 38:100876. [PMID: 34761096 PMCID: PMC8567198 DOI: 10.1016/j.gore.2021.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/16/2021] [Accepted: 09/28/2021] [Indexed: 11/08/2022] Open
Abstract
In this small series, HIPEC is well tolerated in patients with advanced USC. HIPEC at IDS is associated with favorable PFS and OS in advanced USC. Further investigation of HIPEC in women with advanced USC is warranted.
Objective(s) To investigate the efficacy and safety of hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of iterval debulking surgery (IDS) in women with advanced uterine serous carcinoma (USC) following neoadjuvant chemotherapy (NACT). Methods An IRB-approved single-institution prospective registry was queried to identify women with incidentally identified USC at the time of IDS + HIPEC for high-grade serous carcinoma. Patient demographic, oncologic, and surgical outcomes data were recorded. Univariate analysis determined progression-free survival (PFS) and overall survival (OS). Results In total, seven patients were found to have advanced USC after undergoing IDS + HIPEC, with a median age of 64.5 years. The majority had stage IV, (n = 6, 85.7%), MMR proficient (n = 5, 71.4%), p53 mutant (n = 6, 85.1%) USC. The median pre-operative CA125 was 24.0U/mL. HIPEC regimen was cisplatin (n = 3, 42.9%) or cisplatin with paclitaxel (n = 4, 57.1%). All patients underwent optimal cytoreduction, with 71.4% (n = 5) having no gross residual disease. Accordion post-operative complications were mild in 14.3% (n = 1), moderate in 57.1% (n = 4) and severe in 14.3% (n = 1); 14.3% (n = 1) had no complications. The median length of stay was 6.5 days (IQR 4–8 days) with a median time to chemotherapy of 33.0 days. The median PFS was 14.0 months (95% CI 3.5–20.8 months), and the median OS was 27.0 months (95% CI 5.1- not reached). Conclusions In this small, prospective series, we demonstrate that IDS + HIPEC is well tolerated in patients with USC and is associated with favorable PFS and OS following NACT. Further prospective investigation is needed to validate these promising findings in larger, heterogeneous cohorts of women with advanced USC who are not candidates for primary surgical management.
Collapse
Affiliation(s)
- Laura M Chambers
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.,Division of Gynecologic Oncology, James Cancer Hospital and Solove Research Institute, The Ohio State University Medical Center, Columbus, OH 43210, United States
| | - Danielle Chau
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Anthony B Costales
- Department of Gynecologic Oncology, Baylor College of Medicine, Houston, TX 77030, United States
| | - Peter G Rose
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Chad M Michener
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Robert Debernardo
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| | - Roberto Vargas
- Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States
| |
Collapse
|
91
|
Evaluating the Validity of the Clavien-Dindo Classification in Colectomy Studies: A 90-Day Cost of Care Analysis. Dis Colon Rectum 2021; 64:1426-1434. [PMID: 34623350 PMCID: PMC8502230 DOI: 10.1097/dcr.0000000000001966] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Clavien-Dindo classification is widely used to report postoperative morbidity but may underestimate the severity of colectomy complications. OBJECTIVE The purpose of this study was to assess how well the Clavien-Dindo classification represents the severity of all grades of complications after colectomy using cost of care modeling. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted at a comprehensive cancer center. PATIENTS Consecutive patients (N = 1807) undergoing elective colon or rectal resections without a stoma performed at Memorial Sloan Kettering Cancer Center between 2009 and 2014 who were followed up for ≥90 days, were not transferred to other hospitals, and did not receive intraperitoneal chemotherapy were included in the study. MAIN OUTCOME MEASURES Complication severity was measured by the highest-grade complication per patient and attributable outpatient and inpatient costs. Associations were evaluated between patient complication grade and cost during 3 time periods: the 90 days after surgery, index admission, and postdischarge (<90 d). RESULTS Of the 1807 patients (median age = 62 y), 779 (43%) had a complication; 80% of these patients had only grade 1 or 2 complications. Increasing patient complication grade correlated with 90-day cost, driven by inpatient cost differences (p < 0.001). For grade 1 and 2 patients, most costs were incurred after discharge and were the same between these grade categories. Among patients with a single complication (52%), there was no difference in index hospitalization, postdischarge, or total 90-day costs between grade 1 and 2 categories. LIMITATIONS The study was limited by its retrospective design and generalizability. CONCLUSIONS The Clavien-Dindo classification correlates well with 90-day costs, driven largely by inpatient resource use. Clavien-Dindo does not discriminate well among patients with low-grade complications in terms of their substantial postdischarge costs. These patients represent 80% of patients with a complication after colectomy. Examining the long-term burden associated with complications can help refine the Clavien-Dindo classification for use in colectomy studies. See Video Abstract at http://links.lww.com/DCR/B521. EVALUACIN DE LA VALIDEZ DE LA CLASIFICACIN DE CLAVIENDINDO EN ESTUDIOS DE COLECTOMA ANLISIS DEL COSTO DE LA ATENCIN EN DAS ANTECEDENTES:La clasificación de Clavien-Dindo es utilizada ampliamante para conocer la morbilidad posoperatoria, pero puede subestimar la gravedad de las complicaciones de la colectomía.OBJETIVO:Evaluar que tan bien representa la clasificación de Clavien-Dindo la gravedad de todos los grados de complicaciones después de la colectomía utilizando un modelo de costo de la atención.DISEÑO:Estudio de cohorte retrospectivo.ENTORNO CLÍNICO:Centro oncológico integral.PACIENTES:Pacientes consecutivos (n = 1807) sometidos a resecciones electivas de colon o recto sin estoma realizadas en el Memorial Sloan Kettering Cancer Center entre 2009 y 2014 que fueron seguidos durante ≥ 90 días, no fueron transferidos a otros hospitales y no recibieron quimioterapia intraperitoneal.PRINCIPALES MEDIDAS DE VALORACION:Gravedad de la complicación medida por la complicación de mayor grado por paciente y los costos atribuibles para pacientes ambulatorios y hospitalizados. Se evaluó la asociación entre el grado de complicación del paciente y el costo durante 3 períodos de tiempo: posterior a la cirugía (hasta 90 días), a su ingreso y posterior al egreso (hasta 90 días).RESULTADOS:De los 1807 pacientes (mediana de edad de 62 años), 779 (43%) tuvieron una complicación; El 80% de estos pacientes tuvieron solo complicaciones de grado 1 o 2. El aumento del grado de complicación del paciente se correlacionó con el costo a 90 días, impulsado por las diferencias en el costo de los pacientes hospitalizados (p <0,001). Para los pacientes de grado 1 y 2, la mayoría de los costos se incurrieron después del alta y fueron los mismos entre ambas categorías. Entre los pacientes con una sola complicación (52%), no hubo diferencia en el índice de hospitalización, posterior al alta o en el costo total de 90 días entre las categorías de grado 1 y 2.LIMITACIONES:Diseño retrospectivo, generalizabilidad.CONCLUSIONES:La clasificación de Clavien-Dindo se correlaciona bien con los costos a 90 días, impulsados en gran parte por la utilización de recursos de pacientes hospitalizados. Clavien-Dindo no discrimina entre los pacientes con complicaciones de bajo grado en términos de sus costos sustanciales posterior al alta. Estos pacientes representan el 80% de los pacientes aquellos con una complicación tras la colectomía. Examinar la carga a largo plazo asociada a las complicaciones puede ayudar a mejorar la clasificación de Clavien-Dindo para su uso en estudios de colectomía. Consulte Video Resumen en http://links.lww.com/DCR/B521.
Collapse
|
92
|
Dholakia J, Cohn DE, Straughn JM, Dilley SE. Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis. J Gynecol Oncol 2021; 32:e92. [PMID: 34708594 PMCID: PMC8550928 DOI: 10.3802/jgo.2021.32.e92] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/03/2021] [Accepted: 08/21/2021] [Indexed: 01/24/2023] Open
Abstract
Objective To assess the potential cost-effectiveness of prehabilitation in medically frail patients undergoing surgery for epithelial ovarian cancer (EOC). Methods We created a cost-effectiveness model evaluating the impact of prehabilitation on a cohort of medically frail women undergoing primary surgical intervention for EOC. Cost was assessed from the healthcare system perspective via (1) inpatient charges from 2018–2019 institutional Diagnostic Related Grouping data for surgeries with and without major complications; (2) nursing facility costs from published market surveys. Major complication and non-home discharge rates were estimated from the literature. Based on published pilot studies, prehabilitation was determined to decrease these rates. Incremental cost-effectiveness ratio for cost per life year saved utilized a willingness-to-pay threshold of $100,000/life year. Modeling was performed with TreeAge software. Results In a cohort of 4,415 women, prehabilitation would cost $371.1 Million (M) versus $404.9 M for usual care, a cost saving of $33.8 M/year. Cost of care per patient with prehabilitation was $84,053; usual care was $91,713. When analyzed for cost-effectiveness, usual care was dominated by prehabilitation, indicating prehabilitation was associated with both increased effectiveness and decreased cost compared with usual care. Sensitivity analysis showed prehabilitation was more cost effective up to a cost of intervention of $9,418/patient. Conclusion Prehabilitation appears to be a cost-saving method to decrease healthcare system costs via two improved outcomes: lower complication rates and decreased care facility requirements. It represents a novel strategy to optimize healthcare efficiency. Prospective studies should be performed to better characterize these interventions in medically frail patients with EOC. Prehabilitation cost-effectiveness analysis was performed for medically frail epithelial ovarian cancer patients undergoing surgery. It was cost-saving for the healthcare system via lower complication rates and discharge care requirements. Prehabilitation was cost effective up to a cost of $9,418/patient.
Collapse
Affiliation(s)
- Jhalak Dholakia
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
| | - David E Cohn
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - J Michael Straughn
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah E Dilley
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
93
|
Chávez-Villa M, Dominguez-Rosado I, Figueroa-Méndez R, De Los Santos-Pérez A, Mercado MA. Subtotal Cholecystectomy After Failed Critical View of Safety Is an Effective and Safe Bail Out Strategy. J Gastrointest Surg 2021; 25:2553-2561. [PMID: 33532977 DOI: 10.1007/s11605-021-04934-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/16/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bile duct injury (BDI) is accompanied by significant morbidity and long-term impact in quality of life. Subtotal cholecystectomy (STC) is an alternative to prevent this outcome but is associated with other complications. The aim of this work is to demonstrate that BDI associated morbidity exceeds STC associated morbidity, underscoring STC as a reasonable bail out strategy. METHODS We compared 115 patients who underwent STC with 293 patients who were referred to our center with BDI type E1-E3 and underwent surgical repair. The groups were comparable because in both instances the surgeon had the opportunity to decide not to perform a total cholecystectomy once critical view of safety (CVS) was not achieved. RESULTS Bile leakage was found in 21% of the STC group with only one BDI (0.9%). More Accordion ≥ 4 were found in the STC group (10.4% vs 4.8%, p = 0.035); however, reoperations were more frequent in the BDI group (8.2% vs 0.9%, p = 0.006). No patient in the STC group required reintervention for completion cholecystectomy. After 3.8 years follow-up, 2.4% of patients had secondary biliary cirrhosis in the BDI group; none in the STC group. CONCLUSIONS Despite complications of STC, morbidity associated with BDI is much higher due to high long-term reoperation rate, in addition to secondary biliary cirrhosis. STC is a safe alternative that can prevent BDI if properly and timely performed in the context of difficult cholecystectomy.
Collapse
Affiliation(s)
- Mariana Chávez-Villa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ismael Dominguez-Rosado
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | - Rodrigo Figueroa-Méndez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Belisario Domínguez, Sección XVI, 14080, Tlalpan, Mexico City, México
| | - Aldair De Los Santos-Pérez
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel Angel Mercado
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
94
|
Tanis JB, Simlett-Moss AB, Ossowksa M, Maddox TW, Guillem J, Lopez-Jimenez C, Polton G, Burrow R, Finotello R. Canine anal sac gland carcinoma with regional lymph node metastases treated with sacculectomy and lymphadenectomy: Outcome and possible prognostic factors. Vet Comp Oncol 2021; 20:276-292. [PMID: 34590408 DOI: 10.1111/vco.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023]
Abstract
The staging system commonly used in canine anal sac gland carcinoma (ASGC) is a revised Tumour-Node-Metastasis (TNM) system published in 2007. This staging system consists in four stages and, for dogs with nodal metastases, the size of the metastatic lymph node (mLN) defines the N stage. However, we hypothesise that (1) the mLN size has no prognostic significance when the mLN can be excised, (2) a high number of mLNs is associated with poorer prognosis and (3) the measurement of the mLN on imaging is not reproducible. To investigate these hypotheses, medical records and diagnostic images of dogs with ASGC and mLN, treated with sacculectomy and lymphadenectomy, with or without chemotherapy, were reviewed. Interobserver variability for mLN measurement was assessed. Prognostic factors including mLN size and number were investigated. Time to documented progression (TDP) and disease-specific survival (DSS) were evaluated. Progression-free interval (PFI) was analysed with interval-censored data analysis. Fifty-seven dogs were included. The median PFI, TDP and DSS were 110 (95%CI 61.5-185.5), 196 (95%CI 162-283) and 340 days (95%CI 321-471), respectively. For measurement of the largest mLN, interobserver agreement was excellent but limits of agreement reached 39.7%. Neither the size of the largest mLN nor the use of adjuvant chemotherapy were associated with outcome. The number of mLNs was associated with outcome and having more than four mLNs was associated with shorter PFI (p < .001), TDP (p = .004) and DSS (p < .001). While mLN size measurement was not consistently reproducible and did not influence outcome in our cohort, number of mLNs did. Further studies are required for development of a revised staging system.
Collapse
Affiliation(s)
- Jean-Benoit Tanis
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Angharad B Simlett-Moss
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Malgorzata Ossowksa
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - Thomas W Maddox
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | - James Guillem
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| | | | - Gerry Polton
- North Downs Specialist Referrals, Bletchingley, UK
| | - Rachel Burrow
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK.,Northwest Veterinary Specialists, Runcorn, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Neston, UK
| |
Collapse
|
95
|
de Waal EEC, Frank M, Scheeren TWL, Kaufmann T, de Korte-de Boer D, Cox B, van Kuijk SMJ, Montenij LM, Buhre W. Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial. J Clin Anesth 2021; 75:110506. [PMID: 34536718 DOI: 10.1016/j.jclinane.2021.110506] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE The potential of perioperative goal-directed therapy (PGDT) to improve outcome after high-risk abdominal surgery remains subject of debate. In particular, there is a need for large, multicenter trials focusing on relevant patient outcomes to confirm the evidence found in small, single center studies including minor complications in their composite endpoints. The present study therefore aims to investigate the effect of an arterial waveform analysis based PGDT algorithm on the incidence of major complications including mortality after high-risk abdominal surgery. DESIGN Prospective randomized controlled multicenter trial. SETTING Operating theatres and Post-Anesthesia/Intensive Care units (PACU/ICU) of four tertiary hospitals in The Netherlands. PATIENTS A total number of 482 patients undergoing elective, abdominal surgery that is considered high-risk due to the extent of the procedure and/or patient comorbidities. INTERVENTIONS Hemodynamic therapy using an age-specific PGDT algorithm including cardiac index (CI) and stroke volume variation (SVV) measurements during a 24-h perioperative period starting at induction of anesthesia. MEASUREMENTS The average number of major complications (including mortality) within 30 days after surgery, the number of minor complications, hospital and PACU/ICU length of stay (LOS), amounts of fluids and vasoactive medications used. Complications were graded using the Accordion severity grading system. RESULTS The average number of major complications per patient was 0.79 (PGDT group) versus 0.69 (control group) (p = 0.195). There were no statistically significant differences in the number of minor complications, hospital LOS, PACU/ICU LOS, or grading of complications. Patients in the PGDT group received more fluids intraoperatively, more dobutamine intra- and postoperatively, while patients in the control group received more phenylephrine during the operation. CONCLUSIONS PGDT based on a CI and SVV driven algorithm did not result in improved outcomes after high-risk abdominal surgery. CLINICAL TRIAL REGISTRATION Netherlands Trial Registry: NTR3380.
Collapse
Affiliation(s)
- Eric E C de Waal
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Michael Frank
- Department of Anesthesiology and Intensive Care, Albert Schweitzer Hospital, Dordrecht, the Netherlands.
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Thomas Kaufmann
- Department of Anesthesiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Dianne de Korte-de Boer
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Boris Cox
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - L M Montenij
- Department of Anesthesiology and Intensive Care, Catharina Ziekenhuis, Eindhoven, the Netherlands.
| | - Wolfgang Buhre
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, the Netherlands.
| |
Collapse
|
96
|
Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closurewound closure. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:145-151. [PMID: 35600106 PMCID: PMC8977384 DOI: 10.7602/jmis.2021.24.3.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/13/2021] [Indexed: 12/04/2022]
Abstract
Purpose Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures. Methods A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon). Results The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia. Conclusion Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.
Collapse
|
97
|
Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
Collapse
Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
98
|
Myrseth E, Nymo LS, Gjessing PF, Kørner H, Kvaløy JT, Norderval S. Lower conversion rate with robotic assisted rectal resections compared with conventional laparoscopy; a national cohort study. Surg Endosc 2021; 36:3574-3584. [PMID: 34406469 PMCID: PMC9001201 DOI: 10.1007/s00464-021-08681-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/07/2021] [Indexed: 01/01/2023]
Abstract
Background Conversion from laparoscopic to open access colorectal surgery is associated with a poorer postoperative outcome. The aim of this study was to assess conversion rates and outcomes after standard laparoscopic rectal resection (LR) and robotic laparoscopic rectal resection (RR). Methods A national 5-year cohort study utilizing prospectively recorded data on patients who underwent elective major laparoscopic resection for rectal cancer. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and from the Norwegian Colorectal Cancer Registry. Primary end point was conversion rate. Secondary end points were postoperative complications within 30 days and histopathological results. Chi-square test, two-sided T test, and Mann–Whitney U test were used for univariable analyses. Both univariable and multivariable logistic regression analyses were used to analyze the relations between different predictors and outcomes, and propensity score matching was performed to address potential treatment assignment bias. Results A total of 1284 patients were included, of whom 375 underwent RR and 909 LR. Conversion rate was 8 out of 375 (2.1%) for RR compared with 87 out of 909 (9.6%) for LR (p < 0.001). RR was associated with reduced risk for conversion compared with LR (aOR 0.22, 95% CI 0.10–0.46). There were no other outcome differences between RR and LR. Factors associated with increased risk for conversion were male gender, severe cardiac disease and BMI > 30. Conversion was associated with higher rates of major complications (20 out of 95 (21.2%) vs 135 out of 1189 (11.4%) p = 0.005), reoperations (13 out of 95 (13.7%) vs 93 out of 1189 (7.1%) p = 0.020), and longer hospital stay (median 8 days vs 6 days, p = 0.001). Conclusion Conversion rate was lower with robotic assisted rectal resections compared with conventional laparoscopy. Conversions were associated with higher rates of postoperative complications.
Collapse
Affiliation(s)
- Elisabeth Myrseth
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway. .,Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway.
| | - Linn Såve Nymo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Petter Fosse Gjessing
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, 4068, Stavanger, Norway.,Institute of Clinical Medicine, University of Bergen, 5020, Bergen, Norway
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, University of Stavanger, 4036, Stavanger, Norway.,Department of Research, Stavanger University Hospital, 4068, Stavanger, Norway
| | - Stig Norderval
- Department of Gastrointestinal Surgery, University Hospital of North Norway, 9019, Tromsø, Norway.,Institute of Clinical Medicine, Faculty of Health Science, UiT, The Arctic University of Norway, 9019, Tromsø, Norway
| |
Collapse
|
99
|
Newhook TE, Prakash LR, Soliz J, Hancher-Hodges S, Speer BB, Wilks JA, Bruno ML, Dewhurst WL, Arvide EM, Maxwell JE, Ikoma N, Kim MP, Lee JE, Katz MHG, Tzeng CWD. Perioperative blood transfusions and survival in resected pancreatic adenocarcinoma patients given multimodality therapy. J Surg Oncol 2021; 124:1381-1389. [PMID: 34398988 DOI: 10.1002/jso.26650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/06/2021] [Accepted: 08/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The impact of perioperative blood transfusion (PBT) on outcomes for pancreatic ductal adenocarcinoma (PDAC) patients given multimodality therapy (MMT) remains undefined. We sought to evaluate the association of PBT with survival after PDAC resection. METHODS Pancreatectomy patients (July 2011-December 2017) who received MMT were abstracted from a prospective database. Overall survival (OS) was compared by PBT within 30 days, 24 h (24HR-BT), or 24 h until 30 days (Postop-BT). RESULTS Most (76.6%) of 312 MMT patients underwent neoadjuvant therapy (NT). Eighty-nine patients (28.5%) received PBT; 58 (18.6%) 24HR-BT, and 31 (9.9%) Postop-BT. Compared with surgery-first, NT patients received more 24HR-BTs (22.2% vs. 6.8%, p = 0.003) and PBTs overall (32.6% vs. 15.1%, p = 0.004). Overall median OS was 45 months. The association of PBT with shorter median OS appeared limited to first 24-h transfusions (34 months 24HR-BT vs. 48 months Postop-BT vs. 53 months no-PBT, p = 0.009) and was dose-dependent, with a median OS of 52 months for 0 units 24HR-BT, 35 months for 1 unit, and 25 months for ≥2 units (p = 0.004). Independent predictors of OS included node-positivity (hazard ratio [HR]: 1.93, p < 0.001), perineural invasion (HR: 1.64, p = 0.050), postoperative pancreatic fistula (HR: 1.94, p = 0.018), and 24HR-BT (HR: 1.75, p = 0.001). CONCLUSIONS Transfusions given within 24 h are associated with dose-dependent decreases in survival after pancreatectomy for PDAC.
Collapse
Affiliation(s)
- Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura R Prakash
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jose Soliz
- Departments of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shannon Hancher-Hodges
- Departments of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - B Bryce Speer
- Departments of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan A Wilks
- Departments of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Morgan L Bruno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Whitney L Dewhurst
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Elsa M Arvide
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jessica E Maxwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael P Kim
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
100
|
Costa G, Bersigotti L, Massa G, Lepre L, Fransvea P, Lucarini A, Mercantini P, Balducci G, Sganga G, Crucitti A. The Emergency Surgery Frailty Index (EmSFI): development and internal validation of a novel simple bedside risk score for elderly patients undergoing emergency surgery. Aging Clin Exp Res 2021; 33:2191-2201. [PMID: 33205380 PMCID: PMC8302529 DOI: 10.1007/s40520-020-01735-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Frailty assessment has acquired an increasing importance in recent years and it has been demonstrated that this vulnerable profile predisposes elderly patients to a worse outcome after surgery. Therefore, it becomes paramount to perform an accurate stratification of surgical risk in elderly undergoing emergency surgery. STUDY DESIGN 1024 patients older than 65 years who required urgent surgical procedures were prospectively recruited from 38 Italian centers participating to the multicentric FRAILESEL (Frailty and Emergency Surgery in the Elderly) study, between December 2016 and May 2017. A univariate analysis was carried out, with the purpose of developing a frailty index in emergency surgery called "EmSFI". Receiver operating characteristic curve analysis was then performed to test the accuracy of our predictive score. RESULTS 784 elderly patients were consecutively enrolled, constituting the development set and results were validated considering further 240 consecutive patients undergoing colorectal surgical procedures. A logistic regression analysis was performed identifying different EmSFI risk classes. The model exhibited good accuracy as regard to mortality for both the development set (AUC = 0.731 [95% CI 0.654-0.772]; HL test χ2 = 6.780; p = 0.238) and the validation set (AUC = 0.762 [95% CI 0.682-0.842]; HL test χ2 = 7.238; p = 0.299). As concern morbidity, our model showed a moderate accuracy in the development group, whereas a poor discrimination ability was observed in the validation cohort. CONCLUSIONS The validated EmSFI represents a reliable and time-sparing tool, despite its discriminative value decreased regarding complications. Thus, further studies are needed to investigate specifically surgical settings, validating the EmSFI prognostic role in assessing the procedure-related morbidity risk.
Collapse
Affiliation(s)
- Gianluca Costa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Laura Bersigotti
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
- Emergency Surgery Unit, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy.
| | - Giulia Massa
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, Rome, Italy
| | - Pietro Fransvea
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | - Alessio Lucarini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Paolo Mercantini
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Genoveffa Balducci
- Department of Medical-Surgical Science and Translational Medicine, Sant'Andrea Teaching Hospital, "Sapienza" University of Rome, Via di Grottarossa 1035, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency and Trauma Surgery - Fondazione Policlinico "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Rome, Italy
| | | | | |
Collapse
|