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Tustumi F, Pereira MA, Lisak AS, Ramos MFKP, Ribeiro Junior U, Dias AR. THE VALUE OF PREOPERATIVE PROGNOSTIC NUTRITIONAL INDEX IN GASTRIC CANCER AFTER CURATIVE RESECTION. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1805. [PMID: 38896701 PMCID: PMC11182628 DOI: 10.1590/0102-6720202400012e1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 03/23/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Predicting short- and long-term outcomes of oncological therapies is crucial for developing effective treatment strategies. Malnutrition and the host immune status significantly affect outcomes in major surgeries. AIMS To assess the value of preoperative prognostic nutritional index (PNI) in predicting outcomes in gastric cancer patients. METHODS A retrospective cohort analysis was conducted on patients undergoing curative-intent surgery for gastric adenocarcinoma between 2009 and 2020. PNI was calculated as follows: PNI=(10 x albumin [g/dL])+(0.005 x lymphocytes [nº/mm3]). The optimal cutoff value was determined by the receiver operating characteristic curve (PNI cutoff=52), and patients were grouped into low and high PNI. RESULTS Of the 529 patients included, 315 (59.5%) were classified as a low-PNI group (PNI<52) and 214 (40.5%) as a high-PNI group (PNI≥52). Older age (p=0.050), male sex (p=0.003), American Society of Anesthesiologists score (ASA) III/IV (p=0.001), lower hemoglobin level (p<0.001), lower body mass index (p=0.001), higher neutrophil-lymphocyte ratio (p<0.001), D1 lymphadenectomy, advanced pT stage, pN+ and more advanced pTNM stage were related to low-PNI patient. Furthermore, 30-day (1.4 vs. 4.8%; p=0.036) and 90-day (3.3 vs. 10.5%; p=0.002) mortality rates were higher in low-PNI compared to high-PNI group. Disease-free and overall survival were worse in low-PNI patients compared to high-PNI (p<0.001 for both). ASA III/IV score, low-PNI, pT3/T4, and pN+ were independent risk factors for worse survival. CONCLUSIONS Preoperative PNI can predict short- and long-term outcomes of patients with gastric cancer after curative gastrectomy. Low PNI is an independent factor related to worse disease-free and overall survival.
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Affiliation(s)
- Francisco Tustumi
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Marina Alessandra Pereira
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - André Safatle Lisak
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Marcus Fernando Kodama Pertille Ramos
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - André Roncon Dias
- Universidade de São Paulo, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
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Elliott JA, Guinan E, Reynolds JV. Measurement and optimization of perioperative risk among patients undergoing surgery for esophageal cancer. Dis Esophagus 2024; 37:doad062. [PMID: 37899136 PMCID: PMC10906714 DOI: 10.1093/dote/doad062] [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: 05/31/2023] [Revised: 08/28/2023] [Indexed: 10/31/2023]
Abstract
Esophagectomy is an exemplar of complex oncological surgery and is associated with a relatively high risk of major morbidity and mortality. In the modern era, where specific complications are targeted in prevention and treatment pathways, and where the principles of enhanced recovery after surgery are espoused, optimum outcomes are targeted via a number of approaches. These include comprehensive clinical and physiological risk assessment, specialist perioperative care by a high-volume team, and multimodal inputs throughout the patient journey that aim to preserve or restore nutritional deficits, muscle mass and function.
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Affiliation(s)
- Jessie A Elliott
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - Emer Guinan
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
| | - John V Reynolds
- Trinity St. James’s Cancer Institute, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
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Till BM, Mandel J, Unal E, Juckett L, Grenda T, Okusanya O, Palazzo F, Chojnacki K, Evans NR. Cessation of Routine Jejunostomy Tube Placement at Time of Minimally Invasive Ivor Lewis Esophagectomy and Impact on Body Mass Index. Semin Thorac Cardiovasc Surg 2022; 36:112-119. [PMID: 36243237 DOI: 10.1053/j.semtcvs.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
Jejunostomy tubes are frequently placed at time of esophagectomy. The purpose of this study is to evaluate cessation of routine j-tube placement on postoperative body mass index (BMI), return to the emergency room, and time until adjuvant therapy. We performed a retrospective review of an institutional database for consecutive patients undergoing minimally invasive Ivor Lewis Esophagectomy from 2014-2021 (after January 2019, routine j-tube placement was abandoned). Data was analyzed using Pearson's Chi-squared tests and Student's t test with 2-sided significance level of P < 0.05. In total,179 patients were included, 95 underwent j-tube placement and 84 did not. Cohorts had comparable baseline BMI's (no j-tube: 30.48 vs j-tube: 28.64, P = 0.06) and anastomotic leak rates (2.4% vs 4.2%, P = 0.5). Patients with no jejunostomy tubes were more likely to receive total parenteral nutrition (14.3% vs 5.3%, P < 0.05), but were no more likely to require total parenteral nutrition at discharge and had comparable durations of TPN requirement (7 days vs 12 days, P = 0.53). There was no difference in mean BMI reduction at 2 weeks (2.54 vs 2.09, P = 0.49) and 3-6 months postoperatively (6.11 vs 4.45 P = 0.15). There was no difference in return to the emergency room (8.3% vs 8.4%, P = 0.98) or readmissions (13.1% vs 11.6%, P = 0.76). There was a no difference in mean time to adjuvant therapy (83.5 days vs 72.6 days, P = 0.67). At esophagectomy centers with low anastomotic leak rates, cessation of routine j-tube placement at time of minimally esophagectomy can be undertaken without increasing risk of readmission, time until initiation of adjuvant therapy, or significantly impacting postoperative BMI loss.
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Affiliation(s)
- Brian M Till
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jenna Mandel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ece Unal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Luke Juckett
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tyler Grenda
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Olugbenga Okusanya
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Chojnacki
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nathaniel R Evans
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Abstract
Objective: To systematically review the problem of appetite loss after major abdominal surgery. Summary of Background Data: Appetite loss is a common problem after major abdominal surgery. Understanding of etiology and treatment options is limited. Methods: We searched Medline, Cochrane Central Register of Controlled Trials, and Web of Science for studies describing postoperative appetite loss. Data were extracted to clarify definition, etiology, measurement, surgical influence, pharmacological, and nonpharmacological treatment. PROSPERO registration ID: CRD42021224489. Results: Out of 6144 articles, we included 165 studies, 121 of which were also analyzed quantitatively. A total of 19.8% were randomized, controlled trials (n = 24) and 80.2% were nonrandomized studies (n = 97). The studies included 20,506 patients undergoing the following surgeries: esophageal (n = 33 studies), gastric (n = 48), small bowel (n = 6), colon (n = 27), rectal (n = 20), hepatobiliary (n = 6), and pancreatic (n = 13). Appetite was mostly measured with the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30, n = 54). In a meta-analysis of 4 randomized controlled trials gum chewing reduced time to first hunger by 21.2 hours among patients who had bowel surgery. Other reported treatment options with positive effects on appetite but lower levels of evidence include, among others, intravenous ghrelin administration, the oral Japanese herbal medicine Rikkunshito, oral mosapride citrate, multidisciplin-ary-counseling, and watching cooking shows. No studies investigated the effect of well-known appetite stimulants such as cannabinoids, steroids, or megestrol acetate on surgical patients. Conclusions: Appetite loss after major abdominal surgery is common and associated with increased morbidity and reduced quality of life. Recent studies demonstrate the influence of reduced gastric volume and ghrelin secretion, and increased satiety hormone secretion. There are various treatment options available including level IA evidence for postoperative gum chewing. In the future, surgical trials should include the assessment of appetite loss as a relevant outcome measure.
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Deepjyoti K, Bannoth S, Purkayastha J, Borthakur BB, Talukdar A, Pegu N, Das G. Nasojejunal Feeding Is Safe and Effective Alternative to Feeding Jejunostomy for Postoperative Enteral Nutrition in Gastric Cancer Patients. South Asian J Cancer 2020; 9:70-73. [PMID: 33354547 PMCID: PMC7745742 DOI: 10.1055/s-0040-1721218] [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] [Indexed: 11/18/2022] Open
Abstract
Background and Aim
Carcinoma of the stomach is one of the leading causes of mortality worldwide. Surgery for gastric cancer in the form of total or distal gastrectomy is definitive treatment. Feeding jejunostomy (FJ) though improves postoperative nutritional status and outcome, it is not devoid of its complications. In this study, we present the outcomes of nasojejunal (NJ) feeding and FJ and complications associated with them.
Materials and Methods
It is both retrospective and prospective observational study in patients with gastric cancer undergoing surgery. Patients were divided into two groups: those who underwent FJ and those who underwent NJ route of feeding placed intraoperatively.
Results
A total of 279 patients of gastric cancer who underwent surgery were taken into study, of which, 165 were male and 114 females. FJ was done in 42 and NJ in 237 patients, respectively. Gastrectomy + NJ was done in 128 patients, gastrectomy + FJ in 27 patients, gastrojejunostomy + NJ in 109 patients, and FJ in 15 patients. We had three patients of bile leaks in FJ group, of which one patient had intraperitoneal leak who needed re-exploration; rest of the two had peri-FJ external leaks, who were managed conservatively. Most of the complications of NJ group were minor.
Conclusion
Our study of 279 patients in gastric cancer has shown that FJ is sometimes associated with major complications with increased hospital stay and morbidity when compared with NJ tube feeding without any difference in nutritional outcomes. Hence, NJ route of postoperative enteral nutrition can be considered as an alternative to FJ wherever feasible in view of its technical safety and minor complications and morbidity.
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Affiliation(s)
- Kalita Deepjyoti
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Srinivas Bannoth
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Joydeep Purkayastha
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Bibhuti B Borthakur
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Niju Pegu
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Gaurav Das
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
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Yang HC, Choi JH, Kim MS, Lee JM. Delayed Gastric Emptying after Esophagectomy: Management and Prevention. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:226-232. [PMID: 32793457 PMCID: PMC7409889 DOI: 10.5090/kjtcs.2020.53.4.226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/10/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
Abstract
The quality of life associated with eating is becoming an increasingly significant problem for patients who undergo esophagectomy as a result of the improved survival rate after esophageal cancer surgery. Delayed gastric emptying (DGE) is a common complication after esophagectomy. Although several strategies have been proposed for the management and prevention of DGE, no clear consensus exists. The purpose of this review is to present a brief overview of DGE and to help clinicians choose the most appropriate treatment through an analysis of DGE by cause. Furthermore, we would like to suggest some tips to prevent DGE based on our experience.
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Affiliation(s)
- Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jin Ho Choi
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Moon Soo Kim
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jong Mog Lee
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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7
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Li Y, Liu Z, Liu G, Fang Q, Zhao L, Zhao P, Wang J, Yang M. Impact on Short-Term Complications of Early Oral Feeding in Patients with Esophageal Cancer After Esophagectomy. Nutr Cancer 2020; 73:609-616. [PMID: 32482102 DOI: 10.1080/01635581.2020.1769690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To evaluate early oral feeding (EOF) in short-term outcomes of patients with esophageal cancer after esophagectomy. 179 patients with esophageal cancer who underwent esophagectomy between January 2016 and February 2018 were enrolled for this study. 87 patients with EOF without nasogastric tube or nasogastric tube was removed within 24 h, were selected as the experimental group, whereas 92 patients who received nasojejunal tube feeding were set as the control group. All laboratory testing, clinical features, and hospitalization expenses were compared between the two groups. No statistical significance was observed between the two groups in hemoglobin, albumin, and prealbumin levels after esophagectomy. Notably, there was no significant difference in the incidence of severe pneumonia and anastomotic leakage between the two groups. Admittance period, postoperative defecation time, and medical expenses were significantly decreased among patients with EOF (P < 0.001). Multivariate Cox multiple-factor regression analysis revealed that there was no correlation between EOF and the risk of anastomotic leakage. EOF might not be a risk factor for increasing the incidence of severe pneumonia and anastomotic leakage in patients with esophageal cancer after esophagectomy, and it could reduce the hospitalization period as well as control medical expenses.
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Affiliation(s)
- Yi Li
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Zhenjun Liu
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Guangyuan Liu
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Lili Zhao
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Pei Zhao
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Jiuhui Wang
- Department of Intensive Care Unit, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
| | - Mu Yang
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center. School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Translational Centre for Oncoimmunology, Sichuan Cancer Hospital & Institute, Chengdu, Sichuan, China
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8
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de Vasconcellos Santos FA, Torres Júnior LG, Wainstein AJA, Drummond-Lage AP. Jejunostomy or nasojejunal tube after esophagectomy: a review of the literature. J Thorac Dis 2019; 11:S812-S818. [PMID: 31080663 DOI: 10.21037/jtd.2018.12.62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Patients undergoing esophagectomy for cancer are a difficult to treat group of patients. At diagnosis they will present some degree of malnutrition in up to 80% and the causes are from multifactorial origin: the inability of food ingestion, advanced age, taste disturbances, and morbidity related to neoadjuvant treatment. In order to restaure the nutritional status, enteral nutritional support is preferable to parenteral support because of the risks of septic complications associated with venous catheters. During the postoperative period, the oral route is often inaccessible in these patients due to swallowing disorders and eventually mechanical ventilation, and if possible, often it does not provide sufficient caloric amounts for postoperative energy balance. For these reasons, it is usually recommended additional nutritional support. There are few studies in the literature that specifically address which is the most adequate route for enteral nutrition in patients undergoing esophagectomy. Nasojejunal catheters present a higher incidence of local complications, such as displacement and occlusion, whereas jejunostomy is more associated with reinterventions for the treatment of complications secondary to extravasation. Although there is weak evidence in the literature and a lack of randomized, prospective and multicenter studies evaluating the best enteral nutrition route in the postoperative period of esophagectomy, the use of the nasoenteric catheter seems to be adequate due to its simplicity of positioning and low rates of severe complications. In this paper a review is performed of the evidence about this subject.
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Affiliation(s)
- Fernando Augusto de Vasconcellos Santos
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil.,Departmet of Surgery, Hospital Governador Israel Pinheiro, Belo Horizonte, MG, Brazil
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9
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Lorimer PD, Motz BM, Watson M, Trufan SJ, Prabhu RS, Hill JS, Salo JC. Enteral Feeding Access Has an Impact on Outcomes for Patients with Esophageal Cancer Undergoing Esophagectomy: An Analysis of SEER-Medicare. Ann Surg Oncol 2019; 26:1311-1319. [PMID: 30783851 DOI: 10.1245/s10434-019-07230-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Optimal nutrition after esophagectomy is challenging due to alterations in eating, both from the tumor and during surgical recovery. Enteral nutrition via feeding tube is commonly used. The impact of feeding tubes on post-esophagectomy outcomes was examined in a large national data set. METHODS Patients with esophageal cancer (1998-2013) undergoing esophagectomy were extracted from the Surveillance Epidemiology and End Results-Medicare database. Chi-square and t tests were used to compare categorical and continuous variables. Time trend analyses were performed with Cochran-Armitage survival using log-rank and multivariable analysis with generalized linear modeling. RESULTS The study examined 2495 patients. The majority had enteral feeding access (71%, n = 1794) during the perioperative period. Mortality among the patients with feeding tubes was lower at 30 days (5.4% vs 8.4%), 60 days (9.0% vs 13.0%), and 90 days (12.2% vs 15.8%). In the multivariable analysis, the patients with feeding tubes had improved short-term survival at 30 days (odds ratio [OR], 0.65, 95% confidence interval [CI], 0.46-0.93), 60 days (OR, 0.64; 95% CI, 0.49-0.85), and 90 days (OR, 0.70; 95% CI, 0.54-0.90). The hospital stay was shorter for the patients undergoing enteral feeding tube placement (17.9 vs 19.5 days; p = 0.04). Discharge destination (home vs health care facility) showed no difference. CONCLUSIONS Feeding tubes in patients undergoing esophagectomy were associated with an increase in short-term survival up to 90 days after surgery. Feeding tube placement was not associated with higher rates of non-home discharges and did not prolong the hospital stay.
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Affiliation(s)
- Patrick D Lorimer
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Benjamin M Motz
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Michael Watson
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Sally J Trufan
- Department of Biostatistics, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | | | - Joshua S Hill
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA
| | - Jonathan C Salo
- Division of Surgical Oncology, Department of Surgery, Carolinas Medical Center, Levine Cancer Institute, Charlotte, NC, USA.
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Liu L, Hong YL, Liu GY. Role of rational diet in postoperative treatment of gastric cancer and application prospect of traditional Chinese medicine diet. Shijie Huaren Xiaohua Zazhi 2018; 26:2057-2063. [DOI: 10.11569/wcjd.v26.i35.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The toxic side effects of postoperative radiotherapy and chemotherapy in gastric cancer (GC) often cause patients to have cancer cachexia and poor quality of life. Dietary adjuvant therapy can significantly promote GC patients to recover the body function, alleviate inflammation, improve anticancer treatment tolerance, improve postoperative quality of life and prolong survival. Given the advantages of diet in the postoperative treatment of GC, this paper discusses the role of modern medicine's elemental nutrition diet and traditional Chinese medicine diet in the postoperative treatment of GC, which can help clinicians better understand traditional Chinese medicine treatment in relieving the overall dysfunction of the body. Furthermore, the combination of traditional Chinese medicine diet with the modern medical nutrition diet evaluation system can expand the use of traditional Chinese medicine diet in the clinical treatment of GC.
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Affiliation(s)
- Lei Liu
- School of Pharmaceutical Sciences Xiamen University, Huayan Science and Technology Cancer Prevention and Rehabilitation Research Center, Xiamen 361000, Fujian Province, China
| | - Yu-Ling Hong
- School of Pharmaceutical Sciences Xiamen University, Huayan Science and Technology Cancer Prevention and Rehabilitation Research Center, Xiamen 361000, Fujian Province, China
| | - Guo-Yan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen 361000, Fujian Province, China
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Chen MJ, Wu IC, Chen YJ, Wang TE, Chang YF, Yang CL, Huang WC, Chang WK, Sheu BS, Wu MS, Lin JT, Chu CH. Nutrition therapy in esophageal cancer-Consensus statement of the Gastroenterological Society of Taiwan. Dis Esophagus 2018; 31:5025886. [PMID: 29860406 DOI: 10.1093/dote/doy016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A number of clinical guidelines on nutrition therapy in cancer patients have been published by national and international societies; however, most of the reviewed data focused on gastrointestinal cancer or non-cancerous abdominal surgery. To collate the corresponding data for esophageal cancer (EC), a consensus panel was convened to aid specialists from different disciplines, who are involved in the clinical nutrition care of EC patients. The literature was searched using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the ISI Web of Knowledge. We searched for the best evidence pertaining to nutrition therapy in the case of EC. The panel summarized the findings in 3 sections of this consensus statement, based on which, after the diagnosis of EC, an initial distinction is made between the patients, as follows: (1) Assessment; (2) Therapy in patients with resectable disease; patients receiving chemotherapy or chemoradiotherapy prior to resection, and patients with unresectable disease, requiring chemoradiotherapy or palliative therapy; and (3) Formula. The resulting consensus statement reflects the opinions of a multidisciplinary group of experts, and a review of the current literature, and outlines the essential aspects of nutrition therapy in the case of EC. The statements are: Patients with EC are among one of the highest risk to have malnutrition. Patient generated suggestive global assessment is correlated with performance status and prognosis. Nutrition assessment for patients with EC at the diagnosis, prior to definitive therapy and change of treatment strategy are suggested and the timing interval can be two weeks during the treatment period, and one month while the patient is stable. Patients identified as high risk of malnutrition should be considered for preoperative nutritional support (tube feeding) for at least 7-10 days. Various routes for tube feedings are available after esophagectomy with similar nutrition support benefits. Limited intrathoracic anastomotic leakage postesophagectomy can be managed with intravenous antibiotics and self-expanding metal stent (SEMS) or jejunal tube. Enteral nutrition in patients receiving preoperative chemotherapy or chemoradiation provides benefits of maintaining weight, decreasing toxicity, and preventing treatment interruption. Tube feeding or SEMS can offer nutrition support in patients with unresectable esophageal cancer, but SEMS is not recommended for those with neoadjuvant chemoradiation before surgery. Enteral immunonutrition may preserve lean body mass and attenuates stress response after esophagectomy. Administration of glutamine may decrease the severity of chemotherapy induced mucositis. Enteral immunonutrition achieves greater nutrition status or maintains immune functions during concurrent chemoradiation.
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Affiliation(s)
- M-J Chen
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
| | - I-C Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung and College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Y-J Chen
- Department of Radiation Oncology, MacKay Memorial Hospital
| | - T-E Wang
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
| | - Y-F Chang
- Division of Hematology and Oncology, Department of Internal Medicine
| | - C-L Yang
- Department of Dietetics and Nutrition, Taipei Veterans General Hospital
| | - W-C Huang
- Division of Thoracic Surgery, Department of Surgery, MacKay Memorial Hospital and MacKay Medical College
| | - W-K Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center
| | - B-S Sheu
- Departments of Institute of Clinical Medicine and Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - M-S Wu
- Department of Internal Medicine, National Taiwan University Hospital, Kaohsiung Medical University, Kaohsiung
| | - J-T Lin
- School of Medicine, Fu Jen Catholic University, Taipei, Kaohsiung Medical University, Kaohsiung
| | - C-H Chu
- Division of Gastroenterology, Kaohsiung Medical University, Kaohsiung
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12
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Lahoud J, Bazzi K, Yeo D, Carey S. Survey of nutritional practices in total gastrectomy and oesophagectomy procedures. Nutr Diet 2018; 76:135-140. [DOI: 10.1111/1747-0080.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
- John Lahoud
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - Khalil Bazzi
- School of MedicineThe University of Notre Dame Australia Sydney New South Wales Australia
| | - David Yeo
- Department of Hepatobiliary and Upper Gastrointestinal SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
- Institute of Academic SurgeryRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Sharon Carey
- Department of Nutrition and DieteticsRoyal Prince Alfred Hospital Sydney New South Wales Australia
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Soriano TT, Eslick GD, Vanniasinkam T. Long-Term Nutritional Outcome and Health Related Quality of Life of Patients Following Esophageal Cancer Surgery: A Meta-Analysis. Nutr Cancer 2017; 70:192-203. [PMID: 29281327 DOI: 10.1080/01635581.2018.1412471] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Long term health related quality of life (HRQL) and nutritional outcome of patients following esophagectomy for cancer has become increasingly significant as the 5-year survival rate in this patient group is increasing. This meta-analysis aims to investigate the HRQOL, nutritional impact symptoms and nutritional outcomes of patients following an esophagectomy at greater than 12 months after surgery. In studies reporting on HRQL as an outcome, global QOL score at 6-month compare to greater than 12-month showed no statistically significant difference (65.92 vs. 75.78, p = 0.07). Forty-one percent of patients reported a greater than 10% weight loss at six-month follow-up (95% CI: 20-65%; I2 = 94.27, p < 0.001), and at the greater than 12-month follow-up, 33% of patients had the greater than 10% weight loss (95% CI: 15-57%; I2 = 96.18, p < 0.001). At the 12-month or longer post esophagectomy, just over half the patients reported dysphagia (51%, 95% CI: 25-76%; I2 = 95.70, p < 0.001), nausea was reported by 11% (95% CI: 7-19%; I2 = 59.31, p = 0.09), dumping syndrome reported by 60% (95% CI: 43-76%; I2 = 96.92, p < 0.001). Symptoms such as dysphagia, diarrhea, reflux, dumping syndrome, and nausea were found to persist following esophagectomy. There were insufficient robust research investigating how these symptoms impact on the adequacy of dietary intake and micronutrient status.
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Affiliation(s)
- Trang Thuy Soriano
- a Department of Nutrition and Dietetics , Nepean Blue Mountains Local Health District, Nepean Hospital , Penrith , New South Wales , Australia
| | - Guy D Eslick
- b Department of Surgery , Nepean Hospital, Clinical School Building , Penrith , New South Wales , Australia
| | - Thiru Vanniasinkam
- c School of Biomedical Sciences , Charles Sturt University , Wagga Wagga , New South Wales , Australia
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Zhu Z, Li Y, Zheng Y, Sun H, Liu X, Zhang R, Wang Z, Liu S, Chen X, Hua X, Yu Y, Li H, Zhang J, Liu Q. Chewing 50 times per bite could help to resume oral feeding on the first postoperative day following minimally invasive oesophagectomy. Eur J Cardiothorac Surg 2017; 53:325-330. [DOI: 10.1093/ejcts/ezx291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 07/07/2017] [Accepted: 07/18/2017] [Indexed: 12/11/2022] Open
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15
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Chao PC, Lin CF. Successful early elemental diet nutritional support in an esophageal cancer patient. JOURNAL OF CANCER RESEARCH AND PRACTICE 2017. [DOI: 10.1016/j.jcrpr.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Elliott JA, Reynolds JV, le Roux CW, Docherty NG. Physiology, pathophysiology and therapeutic implications of enteroendocrine control of food intake. Expert Rev Endocrinol Metab 2016; 11:475-499. [PMID: 30058920 DOI: 10.1080/17446651.2016.1245140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
With the increasing prevalence of obesity and its associated comorbidities, strides to improve treatment strategies have enhanced our understanding of the function of the gut in the regulation of food intake. The most successful intervention for obesity to date, bariatric surgery effectively manipulates enteroendocrine physiology to enhance satiety and reduce hunger. Areas covered: In the present article, we provide a detailed overview of the physiology of enteroendocrine control of food intake, and discuss its pathophysiologic correlates and therapeutic implications in both obesity and gastrointestinal disease. Expert commentary: Ongoing research in the field of nutrient sensing by L-cells, as well as understanding the role of the microbiome and bile acid signaling may facilitate the development of novel strategies to combat the rising population health threat associated with obesity. Further refinement of post-prandial satiety gut hormone based therapies, including the development of chimeric peptides exploiting the pleiotropic nature of the gut hormone response, and identification of novel methods of delivery may hold the key to optimization of therapeutic modulation of gut hormone physiology in obesity.
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Affiliation(s)
- Jessie A Elliott
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- b Department of Surgery, Trinity Centre for Health Sciences , Trinity College Dublin and St. James's Hospital , Dublin , Ireland
| | - John V Reynolds
- b Department of Surgery, Trinity Centre for Health Sciences , Trinity College Dublin and St. James's Hospital , Dublin , Ireland
| | - Carel W le Roux
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- c Gastrosurgical Laboratory, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
| | - Neil G Docherty
- a Diabetes Complications Research Centre, Conway Institute of Biomedical and Biomolecular Research , University College Dublin , Dublin , Ireland
- c Gastrosurgical Laboratory, Sahlgrenska Academy , University of Gothenburg , Gothenburg , Sweden
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17
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Weijs TJ, Berkelmans GHK, Nieuwenhuijzen GAP, Dolmans ACP, Kouwenhoven EA, Rosman C, Ruurda JP, van Workum F, van Det MJ, Silva Corten LC, van Hillegersberg R, Luyer MDP. Immediate Postoperative Oral Nutrition Following Esophagectomy: A Multicenter Clinical Trial. Ann Thorac Surg 2016; 102:1141-8. [PMID: 27324526 DOI: 10.1016/j.athoracsur.2016.04.067] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/01/2016] [Accepted: 04/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immediate start of oral intake is beneficial following colorectal surgery. However, following esophagectomy the safety and feasibility of immediate oral intake is unclear, thus these patients are still kept nil by mouth. This study therefore aimed to determine the feasibility and safety of oral nutrition immediately after esophagectomy. METHODS A multicenter, prospective trial was conducted in 3 referral centers between August 2013 and May 2014, including 50 patients undergoing a minimally invasive esophagectomy. Oral nutrition was started postoperatively immediately (clear liquids on postoperative day [POD] 0, liquid nutrition on POD 1 to 6, solid food from POD 7). Nonoral enteral nutrition was started when <50% of caloric need was met on postoperative day POD 5 or when oral intake was impossible. A comparison was made with a retrospective cohort (n = 50) with a per-protocol delayed start of oral intake until POD 4 to 7. RESULTS The median caloric intake at POD 5 was 58% of required. In 38% of the patients nonoral nutrition was started, mainly due to complications (36%). The pneumonia rate was 28% following immediate oral intake and 40% following delayed oral intake (p = 0.202). The aspiration pneumonia rate was 4% in both groups. The anastomotic leakage rate was 14% after immediate oral intake versus 24% following delayed oral intake (p = 0.202). The 90-day mortality rate was 2% in both groups. Hospital stay and intensive care unit stay were significantly shorter following immediate oral intake. CONCLUSIONS Immediate start of oral nutrition following esophagectomy seems to be feasible and does not increase complications compared to a retrospective cohort and literature. However, if complications arise an alternative nutritional route is required. This explorative study shows that a randomized controlled trial is needed.
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Affiliation(s)
- Teus J Weijs
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | | | | | | | - Camiel Rosman
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans van Workum
- Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT Hospital, Almelo, the Netherlands
| | | | | | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
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18
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Readmission predicts 90-day mortality after esophagectomy: Analysis of Surveillance, Epidemiology, and End Results Registry linked to Medicare outcomes. J Thorac Cardiovasc Surg 2015; 150:1254-60. [PMID: 26412319 DOI: 10.1016/j.jtcvs.2015.08.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/23/2015] [Accepted: 08/19/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Postoperative readmission is an increasingly scrutinized quality metric that affects patient satisfaction and cost. Even more important is its implication for short-term prognosis. The purpose of this study is to characterize postesophagectomy readmissions and determine their relationship with subsequent 90-day mortality. METHODS Data were extracted for esophagectomy patients from the linked SEER-Medicare Registry (2000-2009), which provides longitudinal information about Medicare beneficiaries who have cancer. We assessed demographics, comorbidities, 30-day readmission, and 90-day mortality. Readmitting facility and diagnoses were identified. A hierarchic multivariable regression model clustered at the hospital level assessed the relationship between readmission within 30 days of discharge and 90-day mortality. RESULTS We identified 1543 patients discharged alive after esophagectomy. Among patients discharged alive, the readmission rate was 319 of 1543 (20.7%); 107 of 319 (33.5%) readmissions were to facilities that did not perform the index operation. Mortality rate at 90 days among patients discharged alive was 98 of 1543 (6.4%). Readmission was associated with a 4-fold increase in mortality (16.3% vs 3.8%, P < .001). Using multivariable regression, readmission was the strongest predictor of mortality (odds ratio 6.64, P < .001), with a stronger association than age, Charlson score, and index length of stay. Readmission diagnoses with the highest mortality rates were those associated with pulmonary, gastrointestinal, and cardiovascular diagnoses. CONCLUSIONS Patients readmitted within 30 days of discharge after esophagectomy are at exceptionally high risk for early mortality. Early recognition of life-threatening readmission diagnoses is essential to providing optimal care.
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Dann GC, Squires MH, Postlewait LM, Kooby DA, Poultsides GA, Weber SM, Bloomston M, Fields RC, Pawlik TM, Votanopoulos KI, Schmidt CR, Ejaz A, Acher AW, Worhunsky DJ, Saunders N, Levine EA, Jin LX, Cho CS, Winslow ER, Russell MC, Cardona K, Staley CA, Maithel SK. An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative. J Surg Oncol 2015; 112:195-202. [DOI: 10.1002/jso.23983] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/10/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Gregory C. Dann
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Malcolm H. Squires
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Lauren M. Postlewait
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - David A. Kooby
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | | | - Sharon M. Weber
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Mark Bloomston
- Department of Surgery; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | - Ryan C. Fields
- Department of Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Timothy M. Pawlik
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | | | - Carl R. Schmidt
- Department of Surgery; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | - Aslam Ejaz
- Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Alexandra W. Acher
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - David J. Worhunsky
- Department of Surgery; Stanford University Medical Center; Stanford California
| | - Neil Saunders
- Department of Surgery; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | - Edward A. Levine
- Department of Surgery; Wake Forest University; Winston-Salem North Carolina
| | - Linda X. Jin
- Department of Surgery; Washington University School of Medicine; St. Louis Missouri
| | - Clifford S. Cho
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Emily R. Winslow
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Maria C. Russell
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Kenneth Cardona
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Charles A. Staley
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Shishir K. Maithel
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
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20
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Jang JS, Shin DG, Cho HM, Kwon Y, Cho DH, Lee KB, Park SS, Yoon J, Jang YS, Kim IM. Differences in the Survival of Gastric Cancer Patients after Gastrectomy according to the Medical Insurance Status. J Gastric Cancer 2013; 13:247-54. [PMID: 24511421 PMCID: PMC3915187 DOI: 10.5230/jgc.2013.13.4.247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 01/21/2023] Open
Abstract
PURPOSE In Korea, the entire population must enroll in the national health insurance system, and those who are classified as having a lower socioeconomic status are supported by the medical aid system. The aim of this study was to evaluate the association of the medical insurance status of gastric cancer patients with their survival after gastrectomy. MATERIALS AND METHODS A total of 247 patients who underwent surgical treatment for gastric cancer between January 1999 and December 2010 at the Seoul Medical Center were evaluated. Based on their medical insurance status, the patients were classified into two groups: the national health insurance registered group (n=183), and the medical aid covered group (n=64). The survival rates were calculated using the Kaplan-Meier method. RESULTS The median postoperative duration of hospitalization was longer in the medical aid covered group and postoperative morbidity and mortality were higher in the medical aid group than in the national health insurance registered group (P<0.05). The overall 5-year survival rate was 43.9% in the medical aid covered group and 64.3% in the national health insurance registered group (P=0.001). CONCLUSIONS The medical insurance status reflects the socioeconomic status of a patient and can influence the overall survival of gastric cancer patients. A more sophisticated analysis of the difference in the survival time between gastric cancer patients based on their socioeconomic status is necessary.
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Affiliation(s)
- Jae Seong Jang
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Gue Shin
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Hye Min Cho
- Department of Family Medicine, Seoul Medical Center, Seoul, Korea
| | - Yujin Kwon
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Dong Hui Cho
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Sang Soo Park
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Jin Yoon
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Yong Seog Jang
- Department of Surgery, Seoul Medical Center, Seoul, Korea
| | - Il Myung Kim
- GI Cancer Center, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
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Schwarz RE, Zhang C, Mansour JC. Laparoscopy-assisted resection of proximal gastric cancer: is less than all more or less complete, or is all more, nonetheless? Gastric Cancer 2013; 16:277-9. [PMID: 23247699 DOI: 10.1007/s10120-012-0222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ferrari P, Nicolini A, Manca ML, Rossi G, Anselmi L, Conte M, Carpi A, Bonino F. Treatment of mild non-chemotherapy-induced iron deficiency anemia in cancer patients: comparison between oral ferrous bisglycinate chelate and ferrous sulfate. Biomed Pharmacother 2012; 66:414-8. [PMID: 22795809 DOI: 10.1016/j.biopha.2012.06.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 06/10/2012] [Indexed: 12/18/2022] Open
Abstract
In cancer patients mild-moderate non-chemotherapy-induced iron deficiency anemia (IDA) is usually treated with oral iron salts, mostly ferrous sulfate. In this study, we compare efficacy and toxicity of oral ferrous bisglycinate chelate and ferrous sulfate in cancer patients with mild IDA. Twenty-four patients operated on for solid tumors (10 breast, 12 colorectal, 2 gastric), aged 61±10 years (range 45-75), with non-chemotherapy-induced hemoglobin (Hb) values between 10 and 12 g/dL and ferritin lower than 30 ng/mL were randomized to receive oral ferrous bisglycinate chelate, 28 mg per day for 20 days, and then 14 mg per day for 40 days (12 patients) (A group) or oral ferrous sulphate, 105 mg per day for 60 days (12 patients) (B group). Values of hemoglobin and ferritin obtained at diagnosis, 1 and 2 months from the beginning of treatment were compared. Adverse events (AEs) related to the two treatments were recorded. In the 12 patients treated with ferrous bisglycinate chelate, basal hemoglobin and ferritin values (mean±SD) were 11.6±0.8 g/dL and 16.1±8.0 ng/mL. After 2 months of treatment, they were 13.0±1.4 g/dL and 33.8±22.0 ng/mL, respectively (P=0.0003 and P=0.020). In the group treated with ferrous sulphate, hemoglobin and ferritin mean values were 11.3±0.6 g/dL and 19.0±6.4 ng/mL basally, and 12.7±0.70 g/dL and 40.8±28.1 ng/mL (P<0.0001 and P=0.017) after 2 months of treatment. AEs occurred in six cases. In all these six cases, two (17%) treated with ferrous bisglycinate chelate and four (33%) with ferrous sulphate, toxicity was grade 1. In conclusion, these data suggest that ferrous bisglycinate chelate has similar efficacy and likely lower GI toxicity than ferrous sulphate given at the conventional dose of 105 mg per day for the same time.
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Affiliation(s)
- Paola Ferrari
- Department of Oncology, University of Pisa, Pisa, Italy.
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23
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20:148-51. [PMID: 22555614 DOI: 10.1097/moo.0b013e328351a36c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mardin WA, Palmes D, Bruewer M. Current concepts in the management of leakages after esophagectomy. Thorac Cancer 2012; 3:117-124. [DOI: 10.1111/j.1759-7714.2012.00117.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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25
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O'Mara A, St Germain D. Improved outcomes in the malnourished patient: we're not there yet. J Natl Cancer Inst 2012; 104:342-3. [PMID: 22345711 DOI: 10.1093/jnci/djs031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Palmes D, Brüwer M, Bader FG, Betzler M, Becker H, Bruch HP, Büchler M, Buhr H, Ghadimi BM, Hopt UT, Konopke R, Ott K, Post S, Ritz JP, Ronellenfitsch U, Saeger HD, Senninger N. Diagnostic evaluation, surgical technique, and perioperative management after esophagectomy: consensus statement of the German Advanced Surgical Treatment Study Group. Langenbecks Arch Surg 2011; 396:857-66. [PMID: 21713594 DOI: 10.1007/s00423-011-0818-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 06/07/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Correct diagnosis, surgical treatment, and perioperative management of patients with esophageal carcinoma remain crucial for prognosis within multimodal treatment procedures. This study aims to achieve a consensus regarding current management strategies in esophageal cancer by questioning a panel of experts from the German Advanced Surgical Treatment Study (GAST) group, comprised of 9 centers specialized in esophageal surgery, with a combined total of >220 esophagectomies per year. MATERIALS AND METHODS The Delphi method, a systematic and interactive, evidence-based approach, was used to obtain consensus statements from the GAST group regarding ambiguities and disparities in diagnosis, patient selection, surgical technique, and perioperative management of patients with esophageal carcinoma. After four rounds of surveys, agreement was measured by Likert scales and defined as full (100% agreement), near (≥66.6% agreement), or no consensus (<66.6% agreement). RESULTS Full or near consensus was obtained for essential aspects of esophageal cancer staging, proper surgical technique, perioperative management and indication for primary surgery, and neoadjuvant treatment or palliative treatment. No consensus was achieved regarding acceptability of minimally invasive technique and postoperative nutrition after esophagectomy. CONCLUSION The GAST consensus statement represents a position paper for treatment of patients with esophageal carcinoma which both contributes to the development of clinical treatment guidelines and outlines topics in need of further clinical studies.
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Affiliation(s)
- Daniel Palmes
- Department of General and Visceral Surgery, University of Münster, Waldeyerstrasse 1, 48149 Münster, Germany.
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