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Adamou H, Amadou Magagi I, Adakal O, Doutchi M, Habou O, Boukari M, James Didier L, Sani R. Perioperative management of gastrointestinal surgery in a resource-limited hospital in Niger: Cross-sectional study. Ann Med Surg (Lond) 2020; 54:10-15. [PMID: 32322389 PMCID: PMC7163210 DOI: 10.1016/j.amsu.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Perioperative management in digestive surgery is a challenge in sub-Saharan Africa. Objective: To describe the process and outcomes of perioperative management in gastrointestinal surgery. Materials and methods This was a single center cross-sectional study over a 4-month period from June 1 to September 30, 2017, in a Nigerien hospital (West Africa). This study included caregivers and patients operated on gastrointestinal surgery. Results We collected data for 56 caregivers and 253 patients underwent gastrointestinal surgery. The average age of caregivers was 38.6 ± 8.7. The median length of professional practice was 9 years. Almost 52% of caregivers (n = 29) did not know the standards of perioperative care. The median age of patients was 24 years, and male gender constituted 70% of cases (n = 177) with a sex ratio of 2.32. Patients came from rural areas in 78.2% (n = 198). Emergency surgery accounted for 60% (n = 152). The most surgical procedure was digestive ostomies performed in 28.9% (n = 73), followed by hernia repair and appendectomy in 24.5% (n = 62) and 13.9% (n = 35) respectively. The postoperative course was complicated in 28.1% (n = 71) among which 13 deaths. In the group of caregivers, the poor practice of perioperative management was associated with poor professional qualification, insufficient equipment, insufficient motivation (p < 0.05). The ASA3&ASA4 score, undernutrition, emergency surgery, poor postoperative monitoring, and poor psychological preparation were associated with complicated postoperative outcomes (p < 0.05). Conclusion The inadequacy of the technical platform and the lack of continuous training for healthcare staff represented the main dysfunctions of our hospital. The risk factors for complications found in this study need appropriate perioperative management to improve prognosis in gastrointestinal surgery. Perioperative care in gastrointestinal surgery in a challenge in Sub-Saharan countries. This setting is characterised by the difficulty of geographical access to hospital, lack of equipment. Risk factors for complications are multifactorial. This study can be a draft for improvement the quality of care in low resource settings.
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Affiliation(s)
- Harissou Adamou
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
- Corresponding author. surgeon at the Zinder National Hospital. Faculty of Health Sciences, University of Zinder, PO BOX: 656, Zinder, Niger.
| | - Ibrahim Amadou Magagi
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Ousseini Adakal
- Surgery Department, Maradi Hospital Center, Faculty of Health Sciences, University of Maradi, Niger
| | - Mahamadou Doutchi
- Infectiology Department - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Oumarou Habou
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Mamane Boukari
- Department of Surgery and Surgical Specialties - Zinder National Hospital, Faculty of Health Sciences, University of Zinder, Niger
| | - Lassey James Didier
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Niamey, Niger
| | - Rachid Sani
- Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Niamey, Niger
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Vendrely V, Launay V, Najah H, Smith D, Collet D, Gronnier C. Prognostic factors in esophageal cancer treated with curative intent. Dig Liver Dis 2018; 50:991-996. [PMID: 30166221 DOI: 10.1016/j.dld.2018.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023]
Abstract
The overall prognosis of patients with esophageal cancer has improved in recent decades due to surgical and medical progress, but overall survival remains poor. Better patient selection and tailored treatment are needed. Different prognostic factors linked with the patient, tumoral characteristics and treatment with curative intent have been identified and are the purpose of this review. Tumor detection at an earlier stage, the advent of new molecules and therapeutic combinations, and the centralization of management in high-volume centers should help to improve the prognosis of esophageal cancer. Improved imaging techniques and a better prediction strategy should guide future treatments.
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Affiliation(s)
- Véronique Vendrely
- Bordeaux University of Medicine, Bordeaux, France; Department of Radiation Oncology, Haut-Lévêque Hospital, Pessac, France; INSERM UMR1035 University of Bordeaux, Bordeaux, France
| | - Vincent Launay
- Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Haythem Najah
- Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Denis Smith
- Department of Hepatogastroenterology, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Denis Collet
- Bordeaux University of Medicine, Bordeaux, France; Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France
| | - Caroline Gronnier
- Bordeaux University of Medicine, Bordeaux, France; Esophageal and Endocrine Surgery Unit, Visceral Surgery Department, Magellan Center, Bordeaux University Hospital, Pessac, France; INSERM, UMR1053 Bordeaux Research in Translational Oncology, BaRITOn, University of Bordeaux, Bordeaux, France.
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Rebibo L, Ebosse I, Iederan C, Mahjoub Y, Dupont H, Cosse C, Regimbeau JM. Does drainage of the peritoneal cavity have an impact on the postoperative course of community-acquired, secondary, lower gastrointestinal tract peritonitis? Am J Surg 2017; 214:29-36. [PMID: 28483060 DOI: 10.1016/j.amjsurg.2016.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the surgical management of lower gastrointestinal tract peritonitis (LGTP), drainage of the peritoneal cavity is often recommended. The objective of the study was to evaluate the impact of drainage of the abdominal cavity during management of LGTP. METHODS From January 2009 to January 2012, patients undergoing surgery for LGTP were included. The study comprised 3 steps: (1) description of the overall population; (2) comparison of the "no drainage" and "drainage" groups; and (3) a propensity score-matched analysis. The primary end point was the major complications rate; secondary end points were the overall complication, risk factors for postoperative complications, and the length of hospital stay. RESULTS A total of 205 patients underwent surgery for LGTP. Characteristics of the peritoneum were noted on the surgical report in 141 cases (68%). Abdominal drainage was implemented in 118 patients (83%). After propensity score matching, there was no difference between drainage and no drainage groups in the major postoperative complications (34.7% vs 34.8%; P = .89). CONCLUSIONS Drainage of the abdominal cavity had no impact on postoperative abscess and reoperation rates. Standardization of drainage in this context is required.
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Affiliation(s)
- Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Ingrid Ebosse
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Corina Iederan
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Medical and Surgical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Hervé Dupont
- Department of Medical and Surgical Intensive Care Unit, Amiens University Hospital, Amiens, France
| | - Cyril Cosse
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital, Amiens, France; EA4294, Jules Verne University of Picardie, Amiens, France; Clinical Research Center, Amiens University Hospital, Amiens, France.
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Abstract
Enhanced recovery programs (ERP) are without any doubt a major innovation in the care of surgical patients. This multimodal approach encompasses elements of both medical and surgical care. The goal of this in-depth review is to analyze the surgical aspects of ERP, underlining the scientific rationale behind each element of ERP after surgery and in particular, the role of mechanical bowel preparation before colorectal surgery, the place of minimal access surgery, the utility of nasogastric tube, abdominal drainage, bladder catheters and early re-feeding. Publication of factual data has allowed many dogmas to be discarded.
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Affiliation(s)
- P Mariani
- Département de Chirurgie Oncologique, Institut Curie, 26 rue d'Ulm, 75248 Paris Cedex 05, France.
| | - K Slim
- Service de Chirurgie Digestive & Unité de Chirurgie Ambulatoire CHU Estaing Clermont-Ferrand et GRACE (Groupe Francophone de Réhabilitation Améliorée après Chirurgie), France
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Zatevakhin II, Pasechnik IN, Gubaidullin RR, Reshetnikov EA, Berezenko MN. [Accelerated postoperative rehabilitation: multidisciplinary issue (Part 1)]. Khirurgiia (Mosk) 2016:4-8. [PMID: 26762072 DOI: 10.17116/hirurgia201594-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To discuss the main aspects of multimodal method of accelerated postoperative rehabilitation (fast track surgery). MATERIAL AND METHODS The program of accelerated rehabilitation consists of minimization of surgical treatment's stressful influence on patient's organism in perioperative period. The method implies use of efficient preoperative management, minimally invasive operations, regional anesthesia and short-acting anesthetics, early postoperative rehabilitation. RESULTS The program improves the results of surgical treatment, reduces number of complications and cost of treatment, improves the "quality" of hospital stay.
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Affiliation(s)
| | - I N Pasechnik
- Teaching and Research Medical Center of the Presidential Administration of the Russian Federation
| | - R R Gubaidullin
- Teaching and Research Medical Center of the Presidential Administration of the Russian Federation; Clinical Hospital of the Presidential Administration of the Russian Federation
| | - E A Reshetnikov
- Central Clinical Hospital and Polyclinic of the Presidential Administration of the Russian Federation, Moscow
| | - M N Berezenko
- Clinical Hospital of the Presidential Administration of the Russian Federation
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Peut-on nourrir précocement un patient ayant une suture digestive ? NUTR CLIN METAB 2015. [DOI: 10.1016/j.nupar.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
PURPOSE Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage. METHODS We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen. RESULTS Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs. CONCLUSION WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer.
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Ortega Deballon P, Pieri DE, Verret S. Perioperative immunonutrition. Cir Esp 2014; 92:701-2. [PMID: 25110107 DOI: 10.1016/j.ciresp.2014.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Pablo Ortega Deballon
- Service de Chirurgie Digestive et Cancérologique, CHU Bocage Central, Université de Bourgogne, Equipe INSERM 866, Thérapies loco-régionales en cancérologie, Dijon cedex, Francia.
| | - Dominique Eouzan Pieri
- Service de Chirurgie Digestive et Cancérologique, CHU Bocage Central, Université de Bourgogne, Equipe INSERM 866, Thérapies loco-régionales en cancérologie, Dijon cedex, Francia
| | - Stéphanie Verret
- Service de Chirurgie Digestive et Cancérologique, CHU Bocage Central, Université de Bourgogne, Equipe INSERM 866, Thérapies loco-régionales en cancérologie, Dijon cedex, Francia
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Piessen G, Messager M, Le Malicot K, Robb WB, Di Fiore F, Guilbert M, Moreau M, Christophe V, Adenis A, Mariette C. Phase II/III multicentre randomised controlled trial evaluating a strategy of primary surgery and adjuvant chemotherapy versus peri-operative chemotherapy for resectable gastric signet ring cell adenocarcinomas - PRODIGE 19 - FFCD1103 - ADCI002. BMC Cancer 2013; 13:281. [PMID: 23758655 PMCID: PMC3694478 DOI: 10.1186/1471-2407-13-281] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/04/2013] [Indexed: 02/08/2023] Open
Abstract
Background A dramatic increase in the incidence of the diffuse form of gastric adenocarcinomas and particularly signet ring cell carcinomas has been observed in Western countries. Evidence is accruing that signet ring cell carcinomas may have inherent chemo resistance leaving many clinicians unsure of the benefits of delaying surgery to pursue a neoadjuvant approach. Methods/design PRODIGE-19-FFCD1103-ADCI002 is a prospective multicentre controlled randomised phase II/III trial comparing current standard of care of perioperative chemotherapy (2x3 cycles of Epirubicin, cisplatin, 5-fluorouracil) with a strategy of primary surgery followed by adjuvant chemotherapy (6 cycles of Epirubicin, cisplatin, 5-fluorouracil) in patients with a stage IB-III gastric signet ring cell tumour. The principal objective of the phase II study (84 patients) is to determine if the experimental arm (primary surgery followed by adjuvant chemotherapy) has sufficient interest in terms of percentage of living patients at 24 months to be evaluated in a phase III trial. If 7 or less patients in the experimental arm are alive at 24 months, phase III will not be initiated. The primary objective of phase III (230 additional patients) is to demonstrate superiority of the experimental arm in terms of overall survival. Secondary endpoints include overall survival at 36 months, disease free survival at 24 and 36 months, R0 resection rates, treatment tolerance, postoperative mortality and morbidity evaluated by Clavien-Dindo severity index, the prognostic impact of positive peritoneal cytology and the assessment of quality of life. An ancillary study will assess the emotional and cognitive impact of surgery and perioperative chemotherapy for both the patient and their partner. Discussion As inherent chemo resistance of signet ring cell tumours and delay in definitive surgery may favour tumour progression we hypothesise that a policy of primary surgery followed by adjuvant chemotherapy will improve overall survival compared to a standard perioperative chemotherapeutic strategy. This randomised phase II/III trial is the first dedicated to this histological subtype. Whilst the development of new biomarkers and targeted therapies are awaited, the results of this trial should further help in devising individualised protocols of patient care in a tumour group whose diversity increasingly demands assessment of alternative strategies. Trial registration ClinicalTrials.gov, NCT01717924
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Affiliation(s)
- Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Hospital of Lille, F-59037 Lille, France.
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Mariette C, De Botton ML, Piessen G. Surgery in esophageal and gastric cancer patients: what is the role for nutrition support in your daily practice? Ann Surg Oncol 2012; 19:2128-34. [PMID: 22322948 DOI: 10.1245/s10434-012-2225-6] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Indexed: 12/18/2022]
Abstract
Cancers of the esophagus and stomach have a major impact on patients' nutritional status by virtue of these organs' inherent digestive functions. Many patients with these cancers will require surgical intervention, which imposes further metabolic demands and compounds preexisting nutritional disorders. Patients with esophagogastric cancer are likely to have lost weight by the time the diagnosis is made. This fact alone is of clinical importance, because it is well known that patients who have lost weight will have higher operative mortality and morbidity rates than patients who maintain their weight. Initial assessment of patients with esophagogastric cancer should include a routine evaluation of nutritional status. This will allow the identification of patients who are at risk of complications, particularly in the postoperative setting. These patients should be targeted for specific nutritional support.
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Affiliation(s)
- Christophe Mariette
- Department of Digestive and Oncological Surgery, University Hospital C. Huriez, Centre Hospitalier Régional Universitaire, and University of Lille-Nord de France, Lille, Cedex, France.
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Slim K, Launay-Savary MV, Vicaut E, Chipponi J. Le débat sur la préparation mécanique du côlon avant chirurgie colorectale est-il clos ? ACTA ACUST UNITED AC 2008; 145:424-7. [DOI: 10.1016/s0021-7697(08)74650-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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