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Tupper HI, Roybal BO, Jackson RW, Banks KC, Kwak HV, Alcasid NJ, Wei J, Hsu DS, Velotta JB. The impact of minimally-invasive esophagectomy operative duration on post-operative outcomes. Front Surg 2024; 11:1348942. [PMID: 38440416 PMCID: PMC10909993 DOI: 10.3389/fsurg.2024.1348942] [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: 12/03/2023] [Accepted: 02/07/2024] [Indexed: 03/06/2024] Open
Abstract
Background Esophagectomy, an esophageal cancer treatment mainstay, is a highly morbid procedure. Prolonged operative time, only partially predetermined by case complexity, may be uniquely harmful to minimally-invasive esophagectomy (MIE) patients for numerous reasons, including anastomotic leak, tenuous conduit perfusion and protracted single-lung ventilation, but the impact is unknown. This multi-center retrospective cohort study sought to characterize the relationship between MIE operative time and post-operative outcomes. Methods We abstracted multi-center data on esophageal cancer patients who underwent MIE from 2010 to 2021. Predictor variables included age, sex, comorbidities, body mass index, prior cardiothoracic surgery, stage, and neoadjuvant therapy. Outcomes included complications, readmissions, and mortality. Association analysis evaluated the relationship between predictor variables and operative time. Multivariate logistic regression characterized the influence of potential predictor variables and operative time on post-operative outcomes. Subgroup analysis evaluated the association between MIE >4 h vs. ≤4 h and complications, readmissions and survival. Results For the 297 esophageal cancer patients who underwent MIE between 2010 and 2021, the median operative duration was 4.8 h [IQR: 3.7-6.3]. For patients with anastomotic leak (5.1%) and 1-year mortality, operative duration was elevated above the median at 6.3 h [IQR: 4.8-8.6], p = 0.008) and 5.3 h [IQR: 4.4-6.8], p = 0.04), respectively. In multivariate logistic regression, each additional hour of operative time increased the odds of anastomotic leak and 1-year mortality by 39% and 19%, respectively. Conclusions Esophageal cancer is a poor prognosis disease, even with optimal treatment. Operative efficiency, a modifiable surgical variable, may be an important target to improve MIE patient outcomes.
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Affiliation(s)
- Haley I. Tupper
- Division of General Surgery, Department of Surgery, University of California, Los Angeles, CA, United States
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Belia O. Roybal
- Division of Research, Biostatistical Consulting Unit, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Riley W. Jackson
- UCSF School of Medicine, University of California, San Francisco, CA, United States
| | - Kian C. Banks
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
- Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States
| | - Hyunjee V. Kwak
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
- Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States
| | - Nathan J. Alcasid
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
- Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States
| | - Julia Wei
- Division of Research, Biostatistical Consulting Unit, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Diana S. Hsu
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
- Division of General Surgery, Department of Surgery, University of California, San Francisco-East Bay, Oakland, CA, United States
| | - Jeffrey B. Velotta
- Division of Thoracic Surgery, Department of Surgery, Kaiser Permanente Northern California, Oakland, CA, United States
- UCSF School of Medicine, University of California, San Francisco, CA, United States
- Division of Clinical Medicine, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
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van de Beld JJ, Crull D, Mikhal J, Geerdink J, Veldhuis A, Poel M, Kouwenhoven EA. Complication Prediction after Esophagectomy with Machine Learning. Diagnostics (Basel) 2024; 14:439. [PMID: 38396478 PMCID: PMC10888312 DOI: 10.3390/diagnostics14040439] [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: 11/21/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024] Open
Abstract
Esophageal cancer can be treated effectively with esophagectomy; however, the postoperative complication rate is high. In this paper, we study to what extent machine learning methods can predict anastomotic leakage and pneumonia up to two days in advance. We use a dataset with 417 patients who underwent esophagectomy between 2011 and 2021. The dataset contains multimodal temporal information, specifically, laboratory results, vital signs, thorax images, and preoperative patient characteristics. The best models scored mean test set AUROCs of 0.87 and 0.82 for leakage 1 and 2 days ahead, respectively. For pneumonia, this was 0.74 and 0.61 for 1 and 2 days ahead, respectively. We conclude that machine learning models can effectively predict anastomotic leakage and pneumonia after esophagectomy.
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Affiliation(s)
- Jorn-Jan van de Beld
- Faculty of EEMCS, University of Twente, 7500 AE Enschede, The Netherlands
- Hospital Group Twente (ZGT), 7609 PP Almelo, The Netherlands
| | - David Crull
- Hospital Group Twente (ZGT), 7609 PP Almelo, The Netherlands
| | - Julia Mikhal
- Hospital Group Twente (ZGT), 7609 PP Almelo, The Netherlands
- Faculty of BMS, University of Twente, 7500 AE Enschede, The Netherlands
| | - Jeroen Geerdink
- Hospital Group Twente (ZGT), 7609 PP Almelo, The Netherlands
| | - Anouk Veldhuis
- Hospital Group Twente (ZGT), 7609 PP Almelo, The Netherlands
| | - Mannes Poel
- Faculty of EEMCS, University of Twente, 7500 AE Enschede, The Netherlands
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Chen J, Wang X, Lv H, Zhang W, Tian Y, Song L, Wang Z. Development and external validation of a clinical-radiomics nomogram for preoperative prediction of LVSI status in patients with endometrial carcinoma. J Cancer Res Clin Oncol 2023; 149:13943-13953. [PMID: 37542548 DOI: 10.1007/s00432-023-05044-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: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To develop and validate a model that incorporates radiomics based on MRI scans and clinical characteristics to predict lymphovascular invasion (LVSI) in endometrial cancer (EC) patients. METHODS There were 332 patients with EC enrolled retrospectively in this multicenter study. Radiomics score (Radscore) were computed using the valuable radiomics features. The independent predictors of LVSI were identified by univariate logistic analysis. Multivariate logistic regression was used to develop a clinical-radiomics predictive model. Based on the model, a nomogram was developed and validated internally and externally. The nomogram was evaluated with discrimination, calibration, decision curve analysis (DCA), and clinical impact curves (CIC). RESULTS Three predictive models were constructed based on clinicopathological features, radiomic factors and a combination of them, and that the clinic-radiomic model performed best among the three models. Four independent factors comprised the clinical-radiomics model: dynamic contrast enhancement rate of late arterial phase (DCE2), deep myometrium invasion (DMI), lymph node metastasis (LNM), and Radscore. Clinical-radiomics model performance was 0.901 (95% CI 0.84-0.96) in the training cohort, 0.80 (95% CI 0.68-0.92) in the internal validation cohort, and 0.81 (95% CI 0.73-0.9) in the external validation cohort for identifying patients with LVSI, respectively. The model is used to develop a nomogram for clinical use. CONCLUSIONS The MRI-based radiomics nomogram could serve as a noninvasive tool to predict LVSI in EC patients.
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Affiliation(s)
- Jingya Chen
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | | | - Haoyi Lv
- University of Science and Technology of China, Hefei, Anhui, China
| | - Wei Zhang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, Jiangsu Province, China
| | - Ying Tian
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | - Lina Song
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China
| | - Zhongqiu Wang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210009, Jiangsu, China.
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C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies. J Clin Med 2022; 11:jcm11195654. [PMID: 36233522 PMCID: PMC9571314 DOI: 10.3390/jcm11195654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate the predictive value of CRP in RAMIE. Material and Methods: Patients undergoing RAMIE or completely open esophagectomy (OE) at our University Center were included. Clinical data, CRP- and Procalcitonin (PCT)-values were retrieved from a prospectively maintained database and evaluated for their predictive value for subsequent postoperative infectious complications (PIC) (AL, gastric conduit leakage or necrosis, pneumonia, empyema). Results: Three hundred and five patients (RAMIE: 160, OE: 145) were analyzed. PIC were noted in 91 patients on postoperative day (POD) 10 and 123 patients on POD 30, respectively. Median POD of diagnosis of PIC was POD 8. Post-operative CRP-values in the robotic-group peaked one and two days later, respectively, and converged from POD 5 onward compared to the open-group. In the group with PIC, CRP-levels in the robotic-group were initially lower and started to differ significantly from POD 3 onward. In the open-group, increases were already noticed from POD 3 on. Procalcitonin levels did not differ. Best Receiver operating curve (ROC)-results were on POD 4, highest negative predictive values at POD 5 (RAMIE) and POD 4 (OE) with cut-off values of 70 mg/L and 88.3 mg/L, respectively. Conclusion: Post-operative CRP is a good negative predictor for PIC, after both RAMIE and OE. After RAMIE, CRP peaks later with a lower cut-off value.
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