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Zhang Y, Ke J, Wang X, Xia S. Clinical characteristics and changes in serum CXCL10 and CXCL16 levels in patients with severe mycoplasma pneumonia. Medicine (Baltimore) 2024; 103:e37814. [PMID: 38640272 PMCID: PMC11029939 DOI: 10.1097/md.0000000000037814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/23/2023] [Accepted: 03/15/2024] [Indexed: 04/21/2024] Open
Abstract
To explore the clinical characteristics and changes in serum CXCL10 and CXCL16 in patients with severe mycoplasma pneumonia, and to analyze the risk factors of severe mycoplasma pneumonia. About 258 children with acute mycoplasma pneumoniae pneumonia (MPP) admitted to the respiratory department of a certain hospital from January 2020 to December 2022 were selected as the study subjects. According to the severity of MPP, patients are divided into 2 groups, namely the mild illness group (Q group) and the severe illness group (Z group). The number of cases in these 2 groups of children is 167 and 91, respectively. The serum CXCL10, CXCL16, and other indicators of 2 groups are tested. Compared to group Q, patients in group Z have a higher proportion of extrapulmonary complications, longer cough time, longer shortness of breath, and longer wheezing time (P < .05). The serum CXCL16 is higher and the proportion of pleural effusion is higher (P < .01). There are more cases of fever, longer fever duration, longer hospital stay, higher serum CXCL10, and higher D-dimer levels (P < .001). The area under the curve of the probability curve for predicting severe mycoplasma pneumonia is 0.975 (P < .05). Children with severe mycoplasma pneumonia have significantly longer fever duration and hospital stay than those with mild symptoms. The serum levels of CXCL10 and CXCL16 are significantly elevated.
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Affiliation(s)
- Yan Zhang
- Department of pediatrics, Lujiang County People’s Hospital, Anhui, 231500, Hefei, China
| | - Junlan Ke
- Department of pediatrics, Lujiang County People’s Hospital, Anhui, 231500, Hefei, China
| | - Xiaojuan Wang
- Department of pediatrics, Lujiang County People’s Hospital, Anhui, 231500, Hefei, China
| | - Shuozhi Xia
- Department of pediatrics, Lujiang County People’s Hospital, Anhui, 231500, Hefei, China
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Nishiguchi R, Katsube T, Shimakawa T, Asaka S, Yamaguchi K, Murayama M, Sagawa M, Kuhara K, Usui T, Yokomizo H, Ohigashi S, Shiozawa S. Predictive Postoperative Inflammatory Response Indicators of Infectious Complications Following Gastrectomy for Gastric Cancer. J NIPPON MED SCH 2024; 91:37-47. [PMID: 37558428 DOI: 10.1272/jnms.jnms.2024_91-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Perioperative factors are useful for predicting postoperative infectious complications (PIC) in gastric cancer. Specifically, postoperative inflammatory response indicators (PIRI), [C-reactive protein (CRP) level, body temperature (BT), and white blood cell (WBC) count], are widely used in clinical practice. We investigated predictive factors for PIC, including PIRI, to establish a simple and practical indicator of postoperative complications after gastrectomy. METHODS We retrospectively collected clinical data from 200 patients with fStage I-III gastric cancer. Univariate/multivariate analysis was performed to evaluate the relationship of predictive factors [host factors, clinicopathological factors, and PIRI (BT, WBC count, and CRP level on postoperative day (POD) 1 and 3) ]. Cut-off values of the predictive factors were analyzed using receiver operating characteristic (ROC) curve modulated by the presence/absence of PIC Grade II, III (Clavien-Dindo classification). RESULTS Age [Odds ratio (OR): 5.67], smoking history (OR: 3.51), and CRP level (OR: 5.65), WBC count (OR: 8.96), and BT (OR: 3.37) on POD3 were selected as independent factors from multivariate analysis. Cut-off values were 77 years, 14.8 mg/dL, 116.0×102/μL, and 37.4°C, respectively. CONCLUSIONS Predictive factors relative to PIC in gastric cancer were CRP level ≥ 14.8 mg/dL, WBC count ≥ 116.0×102/μL, and BT ≥ 37.4°C all on POD3. Age ≥ 77 years, and history of smoking were relative to PIC, suggesting a simple and practical indicator applicable in clinical practice.
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Affiliation(s)
- Ryohei Nishiguchi
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Takao Katsube
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Takeshi Shimakawa
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Shinichi Asaka
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Kentaro Yamaguchi
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Minoru Murayama
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Masano Sagawa
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Kotaro Kuhara
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Takebumi Usui
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Hajime Yokomizo
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Seiji Ohigashi
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
| | - Shunichi Shiozawa
- Department of Surgery, Tokyo Women's Medical University Adachi Medical Center
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Matsui R, Inaki N, Tsuji T, Fukunaga T. Preoperative Chronic Inflammation Is a Risk Factor for Postoperative Complications Independent of Body Composition in Gastric Cancer Patients Undergoing Radical Gastrectomy. Cancers (Basel) 2024; 16:833. [PMID: 38398224 PMCID: PMC10886510 DOI: 10.3390/cancers16040833] [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: 01/13/2024] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
The purpose of this study was to investigate the association between preoperative inflammation and postoperative complications in gastric cancer patients having elective gastrectomy. Participants in this study were those who underwent radical gastrectomy between April 2008 and June 2018 and were diagnosed with stage I-III primary gastric cancer. Preoperative CRP values were used to divide the patients into two groups: the inflammation group comprised individuals having a CRP level of ≥0.5 mg/dL; the other was the non-inflammation group. The primary outcome was overall complications of Clavien-Dindo grade II or higher after surgery. Using propensity score matching to adjust for background, we compared the postoperative outcomes of the groups and conducted a multivariate analysis to identify risk variables for complications. Of 951 patients, 852 (89.6%) were in the non-inflammation group and 99 (10.4%) were in the inflammation group. After matching, both groups included 99 patients, and no significant differences in patient characteristics were observed between both groups. The inflammation group had a significantly greater total number of postoperative complications (p = 0.019). The multivariate analysis revealed that a preoperative CRP level of ≥0.5 mg/dL was an independent risk factor for total postoperative complications in all patients (odds ratio: 2.310, 95% confidence interval: 1.430-3.730, p < 0.001). In conclusion, in patients undergoing curative resection for gastric cancer, preoperative inflammation has been found to be an independent risk factor for overall complications after surgery. Patients with chronic inflammation require preoperative treatment to reduce inflammation because chronic inflammation is the greatest risk factor for postoperative complications.
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Affiliation(s)
- Ryota Matsui
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8201, Japan;
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan;
- Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Noriyuki Inaki
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8201, Japan;
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8530, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa 920-8201, Japan;
- Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920-8530, Japan
| | - Tetsu Fukunaga
- Department of Upper Gastrointestinal Surgery, Juntendo University Hospital, Tokyo 113-8431, Japan;
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Chung JH, Hwang J, Park SH, Kim KY, Cho M, Kim YM, Shin HJ, Lee SH, Hwang SH, Hyung WJ, Kim HI. Identifying the best candidates for reduced port gastrectomy. Gastric Cancer 2024; 27:176-186. [PMID: 37872358 PMCID: PMC10761455 DOI: 10.1007/s10120-023-01438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Previous studies have focused on the non-inferiority of RPG compared with conventional port gastrectomy (CPG); however, we assumed that some candidates might derive more significant benefit from RPG over CPG. METHODS We retrospectively analyzed the clinicopathological and perioperative parameters of 1442 patients with gastric cancer treated by gastrectomy between 2009 and 2022. The C-reactive protein level on postoperative day 3 (CRPD3) was used as a surrogate parameter for surgical trauma. Patients were grouped according to the extent of gastrectomy [subtotal gastrectomy (STG) or total gastrectomy (TG)] and lymph node dissection (D1+ or D2). The degree of surgical trauma, bowel recovery, and hospital stay between RPG and CPG was compared among those patient groups. RESULTS Of 1442 patients, 889, 354, 129, and 70 were grouped as STGD1+, STGD2, TGD1+, and TGD2, respectively. Compared with CPG, RPG significantly decreased CRPD3 only among patients in the STGD1+ group (CPG: n = 653, 84.49 mg/L, 95% CI 80.53-88.45 vs. RPG: n = 236, 70.01 mg/L, 95% CI 63.92-76.09, P < 0.001). In addition, the RPG method significantly shortens bowel recovery and hospital stay in the STGD1+ (P < 0.001 and P < 0.001), STGD2 (P < 0.001 and P < 0.001), and TGD1+ (P = 0.026 and P = 0.007), respectively. No difference was observed in the TGD2 group (P = 0.313 and P = 0.740). CONCLUSIONS The best candidates for RPG are patients who undergo STGD1+, followed by STGD2 and TG D1+, considering the reduction in CRPD3, bowel recovery, and hospital stay.
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Affiliation(s)
- Jae Hun Chung
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Jawon Hwang
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Ki-Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Si-Hak Lee
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Sun-Hwi Hwang
- Division of Gastrointestinal Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- School of Medicine, Pusan National University, Busan, Republic of Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-Ro Seodaemun-Gu, Seoul, 03722, Republic of Korea.
- Gastric Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Republic of Korea.
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Kang MK, Kim J, Choi JH, Choe HN, Suh YS, Kong SH, Park DJ, Lee HJ, Yang HK. Can prospective monitoring improve complication rates after gastrectomy? Experience of Billroth I reconstruction at a high-volume tertiary center. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106985. [PMID: 37482519 DOI: 10.1016/j.ejso.2023.106985] [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: 06/18/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Prospective database is imperative in surgical outcome monitoring and has shown success in providing a comprehensive complication index to monitor surgical quality. This study aims to review whether prospective monitoring has an effect on postoperative complication rates, especially leakage after Billroth I (BI) anastomosis and to identify risk factors of anastomosis leakage after BI anastomosis. MATERIALS AND METHODS Patients who underwent distal gastrectomy with BI reconstruction at Seoul National University Hospital between January 2018 and April 2021 were enrolled. Clinicopathological characteristics and perioperative variables were retrieved. The risk factor that was statistically significant in univariate analysis was further analyzed by binomial logistic regression analysis. RESULTS BI leakage rate in three years has declined by half on a yearly basis from 5.7% to 1.8%. The leakage group patients were predominantly male (100%) when compared to the non-leakage group (67.6%) (p = 0.04). The BMI (25.00 ± 1.42 vs. 24.16 ± 3.15, p = 0.048) and CRP measured on POD#2 (16.47 ± 5.64 vs. 9.99 ± 5.42, p < 0.001) showed significant differences between the two groups. POD#2 CRP greater than 12.7 mg/dL was able to predict risk of anastomosis leak with sensitivity 73.3% and specificity 73.1%. CONCLUSION Understanding variations in outcomes is important for improvements in surgical care, and through prospective monitoring and intra-departmental feedback, it is possible to reduce complication rates after gastrectomy. This study shows that age, gender and BMI are risk factors to BI leakage and POD#2 CRP greater than 12.7 mg/dL can be used to suspect leakage after BI anastomosis.
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Affiliation(s)
- Min Kyu Kang
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jeesun Kim
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Choi
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hwi Nyeong Choe
- Department of Nursing, Seoul National University Hospital, Seoul, South Korea
| | - Yun-Suhk Suh
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seong-Ho Kong
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Do Joong Park
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Hyuk-Joon Lee
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Han-Kwang Yang
- Department of General Surgery, Seoul National University Hospital, Seoul, South Korea.
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Qian B, Zheng Y, Jia H, Zheng X, Gao R, Li W. Neutrophil-lymphocyte ratio as a predictive marker for postoperative infectious complications: A systematic review and meta-analysis. Heliyon 2023; 9:e15586. [PMID: 37159687 PMCID: PMC10163603 DOI: 10.1016/j.heliyon.2023.e15586] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
Objective Postoperative infection is a common but costly complication. The neutrophil-lymphocyte ratio is a promising marker for the identification of postsurgical infectious events. We aimed to perform this meta-analysis to assessed the accuracy of the neutrophil-lymphocyte ratio for the prediction of postsurgical infection. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library without language restriction from their inceptions to April 2022, and checked reference lists of included studies. Studies were included if they assessed predictive accuracy of neutrophil-lymphocyte ratio for postsurgical infection. We estimated its predictive value and explored the source of heterogeneity. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess methodological quality and the Deeks' test to evaluate publication bias. The bivariate model and hierarchical summary receiver operating characteristic (HSROC) curve were used for meta-analysis and generated a summary receiver operating characteristic space (ROC) curve. Results Our search returned 379 reports, of which 12 fulfilled the inclusion criteria, accounting for 4375 cases. The bivariate analysis yielded a pooled sensitivity of 0.77 (95%C.I.: 0.65-0.85) and specificity of 0.78 (95%C.I.: 0.67-0.86). Pooled positive LR and negative LR were 3.48 (95%C.I.: 2.26-5.36) and 0.30 (95%C.I.: 0.20-0.46), respectively. A negative LR of 0.30 reduces the post-test probability to 2% for a negative test result. The area under of receiver operating characteristic curve was 0.84 (95%C.I.: 0.80-0.87). Subgroups comparisons revealed difference by study design, surgical site, presentence of implant, time of sampling, type of infection event and prevalence of infection. The Deeks' test showed no publication bias. The sensitivity analysis showed no study affected the robustness of combined results. Conclusions Low-certainty evidence suggests that the neutrophil-lymphocyte ratio is a helpful marker for predicting postoperative infectious complication. The negative predictive value of the neutrophil-lymphocyte ratio enables for reliable exclusion of postoperative infection.Trial registrationPROSPERO registration number CRD42022321197. Registered on 27 April 2022.
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Yuan Z, Han M, Li D, Hao R, Guo X, Sang S, Zhang H, Ma X, Jin H, Xing Z, Zhao C. A cost-effective smartphone-based device for rapid C-reaction protein (CRP) detection using magnetoelastic immunosensor. LAB ON A CHIP 2023; 23:2048-2056. [PMID: 36916284 DOI: 10.1039/d2lc01065h] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
C-Reaction protein (CRP) is a marker of nonspecific immunity for vital signs and wound assessment, and it can be used to diagnose infections in clinical medicine. However, measuring CRP level currently requires hospital-based instruments, high-cost reagents, and a complex process, all of which have limited its full capabilities for self-detection, a growing trend in modern medicine. In this study, we developed a novel smartphone-based device using advanced methods of magnetoelastic immunosensing to mitigate these limitations. We combined a system-on-chip (SoC) hardware architecture with smartphone apps to realize the sampling of resonance frequency shift on magnetoelastic chips, which can determine the ultra-sensitivity to mass change caused by the binding of anti-CRP antibody and CRP. Through detecting a multi-group of samples, we found that the resonance frequency shift was linearly proportional to the CRP concentration in the range from 0.1 to 100 μg mL-1, with a sensitivity of 12.90 Hz μg-1 mL-1 and a detection limit of 2.349 × 10-4 μg mL-1. Meanwhile, compared with the large-scale instrument used in clinical settings, the performance of our device was stable and significantly more portable, rapid and cost-effective, offering excellent potential for modern home-based diagnosis.
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Affiliation(s)
- Zhongyun Yuan
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Mengshu Han
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Donghao Li
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Runfang Hao
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Xing Guo
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Shengbo Sang
- Shanxi Key Laboratory of Micro Nano Sensors & Artificial Intelligence Perception, College of Information and Computer, Taiyuan University of Technology, Taiyuan, 030024, China.
- Key Lab of Advanced Transducers and Intelligent Control System of the Ministry of Education, Taiyuan University of Technology, Taiyuan, 030024, China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, 100853, Beijing, China
| | - Xingyi Ma
- School of Science, Harbin Institute of Technology, Shenzhen, Guangdong 518055, China
| | - Hu Jin
- Division of Electrical Engineering, Hanyang University, 15588 Ansan, Republic of Korea
| | - Zhijin Xing
- Department of Ultrasound Medicine, Shenzhen Hospital of the University of Hong Kong, 518053, Shenzhen, China
| | - Chun Zhao
- College of Information and Communication Engineering, Sungkyunkwan University, Chunchun-Dong, Changan-Ku, 440746 Suwon, Republic of Korea.
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Kana M, Kalfert D, Lukes P, Zabrodsky M, Plzak J. C-reactive protein as an early marker of postoperative leakage in patients after endoscopic laser assisted Zenker's diverticulotomy. Eur Arch Otorhinolaryngol 2023; 280:2007-2016. [PMID: 36449093 DOI: 10.1007/s00405-022-07764-2] [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: 10/11/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND AIM Minimally invasive endoscopic techniques are the treatment of choice for Zenker's diverticulum (ZD). Our objective was to evaluate the results and efficacy of endoscopic and open approaches, to determine whether postoperative C-reactive protein (CRP) serum levels can be used as a marker to exclude the presence of esophageal leakage, and to identify risk factors for development of postoperative leakage and complications. MATERIALS AND METHODS Patients who underwent transcervical myotomy and diverticulotomy (TMD) or endoscopic cricopharyngeal myotomy (ECM) with CO2 laser for ZD in years 2008-2021 at our department were included in this retrospective study. RESULTS Of the 101 patients enrolled, 83 patients underwent ECM and 18 TMD. The procedure time of the endoscopic technique was significantly shorter compared to that of transcervical method (p < 0.001). The median time to oral intake was 6 days for ECM and 10.5 days in the TMD group (p < 0.001). There was a 13% (n = 11) and 16.7% (n = 3) symptomatic recurrence rate and 3.6% (n = 3) and 16.7% (n = 3) major complications rate for ECM and TMD groups, respectively. The incidence of contrast leak (CL) evaluated by postoperative swallow study was 8.9% (9 from 83 patients in the ECM group only). In patients with CL, a significant increase in CRP levels on postoperative day (POD) 2 and 3 was detected when compared to patients without CL. CONCLUSIONS Endoscopic diverticulotomy with CO2 laser represents a safe and efficient treatment of ZD. Elevation of postoperative CRP serum levels over 123.8 mg/L on POD2 and 98.8 mg/L on POD3 may indicate presence of an esophageal leakage.
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Affiliation(s)
- Martin Kana
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic.
| | - Petr Lukes
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Michal Zabrodsky
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Motol, First Faculty of Medicine, Charles University, V Uvalu 84, 150 06, Prague, Czech Republic
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Park JH, Kong SH, Berlth F, Choi JH, Kim S, Kim SH, Kang SH, Lee S, Yoo J, Goo E, Jeong K, Kim HM, Park YS, Ahn SH, Suh YS, Park DJ, Lee HJ, Kim HH, Yang HK. Comparison of perioperative outcomes between bipolar sealing, ultrasonic shears and a hybrid device during laparoscopic gastrectomy for early gastric cancer: a prospective, multicenter, randomized study. Gastric Cancer 2023; 26:438-450. [PMID: 36735157 DOI: 10.1007/s10120-023-01365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although EBDs are essential for minimally invasive surgery, well-established prospective randomized studies comparing EBDs are scarce. This study aimed to compare the intraoperative inflammatory response and short-term surgical outcomes among different energy-based devices (EBDs) in laparoscopic distal gastrectomy (LDG). METHODS Patients with clinical stage I gastric cancer scheduled for LDG at two different medical centers were prospectively randomized into three groups: ultrasonic shears (US), advanced bipolar (BP) and ultrasonic-bipolar hybrid (HB). The C-reactive protein (CRP) level, operation time, intraoperative blood loss (IBL), laboratory tests, cytokines (interleukin (IL)-6 and IL-10), hospital stay, and complication rate were analyzed. A novel semiquantitative measurement method using indocyanine green (ICG) and a near-infrared camera measured the amount of lymphatic leakage. RESULTS The primary endpoint, the CRP level, was significantly lower in the BP (n = 60) group than in the US (n = 57) or HB (n = 57) group [9.03 ± 5.55 vs. 11.12 ± 5.02 vs. 12.67 ± 6.14, p = 0.001, on postoperative day (POD) 2 and 7.48 vs. 9.62 vs. 9.48, p = 0.026, on POD 4]. IBL was significantly lower in BP than in US or HB (26.3 ± 25.3 vs. 43.7 ± 42.0 vs. 34.9 ± 37.0, p = 0.032). Jackson-Pratt drainage triglycerides were significantly lower in BP than in US (53.6 ± 33.7 vs. 84.2 ± 59.0, p = 0.11; HB: 71.3 ± 51.4). ICG fluorescence intensity, operation time, laboratory results, cytokines, hospital stay, and complication rate were not significantly different among the 3 groups. CONCLUSION BP showed a lower postoperative CRP level and less IBL than US and HB, suggesting less collateral thermal damage and better sealing function. Surgeons may consider this when selecting EBDs for laparoscopic surgery.
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Affiliation(s)
- Ji-Hyeon Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Gachon University Gil Medical Center, Incheon, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea. .,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea. .,VITCAL Co., Ltd., Seoul, South Korea.
| | - Felix Berlth
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Eulji University, Seoul, South Korea
| | - Sara Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Sa-Hong Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea
| | - So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sangjun Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.,Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jaeun Yoo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Eunhee Goo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Kyoungyun Jeong
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyun Myong Kim
- Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Cancer Research Institute, Seoul National University, Seoul, South Korea
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10
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Guner A, Kim KY, Park SH, Cho M, Kim YM, Hyung WJ, Kim HI. Safe Discharge Criteria After Curative Gastrectomy for Gastric Cancer. J Gastric Cancer 2022; 22:395-407. [PMID: 36316113 PMCID: PMC9633928 DOI: 10.5230/jgc.2022.22.e32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose This study aimed to investigate the relationship between clinical and laboratory parameters and complication status to predict which patients can be safely discharged from the hospital on the third postoperative day (POD). Materials and Methods Data from a prospectively maintained database of 2,110 consecutive patients with gastric adenocarcinoma who underwent curative surgery were reviewed. The third POD vital signs, laboratory data, and details of the course after surgery were collected. Patients with grade II or higher complications after the third POD were considered unsuitable for early discharge. The performance metrics were calculated for all algorithm parameters. The proposed algorithm was tested using a validation dataset of consecutive patients from the same center. Results Of 1,438 patients in the study cohort, 142 (9.9%) were considered unsuitable for early discharge. C-reactive protein level, body temperature, pulse rate, and neutrophil count had good performance metrics and were determined to be independent prognostic factors. An algorithm consisting of these 4 parameters had a negative predictive value (NPV) of 95.9% (95% confidence interval [CI], 94.2–97.3), sensitivity of 80.3% (95% CI, 72.8–86.5), and specificity of 51.1% (95% CI, 48.3–53.8). Only 28 (1.9%) patients in the study cohort were classified as false negatives. In the validation dataset, the NPV was 93.7%, sensitivity was 66%, and 3.3% (17/512) of patients were classified as false negatives. Conclusions Simple clinical and laboratory parameters obtained on the third POD can be used when making decisions regarding the safe early discharge of patients who underwent gastrectomy.
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Affiliation(s)
- Ali Guner
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of General Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ki Yoon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Sung Hyun Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Minah Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Yoo Min Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
| | - Hyoung-Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Gastric Cancer Center, Yonsei Cancer Center, Seoul, Korea
- Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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11
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Hu Q, Sun J, Zhu KF. Postoperative C-reactive protein concentrations to predict infective complications of gastric cancer. J Surg Oncol 2021; 125:312-314. [PMID: 34791650 DOI: 10.1002/jso.26649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Qiang Hu
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Jing Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kai Feng Zhu
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
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