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Batra S, Bhandare MS, Chaudhari V, Esha P, Nikhil M, Ostwal V, Ramaswamy A, Ramadwar M, Kulkarni S, Shrikhande SV. 1657 Resected Gastric Adenocarcinomas at a Single Institution: Outcomes and Trends over 17 Years. Ann Surg Oncol 2024:10.1245/s10434-024-15842-4. [PMID: 39014164 DOI: 10.1245/s10434-024-15842-4] [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: 02/09/2024] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Outside of clinical trials, real-world data of advanced gastric cancers (AGCs) managed with perioperative or adjuvant chemotherapy with a backbone of D2 lymphadenectomy is limited. PATIENTS AND METHODS Curative resections for gastric adenocarcinoma between January 2003 and January 2020 at the Tata Memorial Centre were analyzed, comparing three time periods marking major increments in annual gastric resections (GRs). RESULTS 1657 radical gastric resections were performed with a morbidity and mortality rate of 34.9% and 1.4%, respectively. Over three consecutive periods, the number of annual GRs increased from 56/year to 97/year to 156/year (P < 0.001) with a significant escalation in surgical magnitude and complexity. Improvement in surgical quality indicators (median lymph node yield from 15 to 25, P < 0.001 and margin negativity from 8.2 to 5.5%, P = 0.002) was observed with no corresponding increase in severe complications (6.9%) or mortality (1.4%). The proportion of distal and signet ring cancers was found to decrease over time, with an increase in proximal cancers and younger age at presentation. Overall, 90% of GRs were for AGCs with a median overall survival (OS) of 4.4 years (± 6 months), and 5-year OS rate of 47.6% (± 1.9%). CONCLUSIONS Change in pattern of tumor characteristics was observed. Aggressive treatment options for AGC were employed progressively with excellent survival. With increase in volumes, improvements in surgical quality indicators, and a relative improvement in postoperative mortality was observed. These results provide a roadmap for developing dedicated gastric cancer centers.
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Affiliation(s)
- Swati Batra
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Manish S Bhandare
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Vikram Chaudhari
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Pai Esha
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Mehta Nikhil
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Vikas Ostwal
- Department of GI and HPB Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Anant Ramaswamy
- Department of GI and HPB Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Mukta Ramadwar
- Department of Oncopathology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Suyash Kulkarni
- Department of Radiology and Intervention Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India
| | - Shailesh Vinayak Shrikhande
- Department of GI and HPB Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India.
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Dal Cero M, Gibert J, Grande L, Gimeno M, Osorio J, Bencivenga M, Fumagalli Romario U, Rosati R, Morgagni P, Gisbertz S, Polkowski WP, Lara Santos L, Kołodziejczyk P, Kielan W, Reddavid R, van Sandick JW, Baiocchi GL, Gockel I, Davies A, Wijnhoven BPL, Reim D, Costa P, Allum WH, Piessen G, Reynolds JV, Mönig SP, Schneider PM, Garsot E, Eizaguirre E, Miró M, Castro S, Miranda C, Monzonis-Hernández X, Pera M, On Behalf Of The Spanish Eurecca Esophagogastric Cancer Group And The European Gastrodata Study Group. International External Validation of Risk Prediction Model of 90-Day Mortality after Gastrectomy for Cancer Using Machine Learning. Cancers (Basel) 2024; 16:2463. [PMID: 39001525 PMCID: PMC11240515 DOI: 10.3390/cancers16132463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 06/28/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Radical gastrectomy remains the main treatment for gastric cancer, despite its high mortality. A clinical predictive model of 90-day mortality (90DM) risk after gastric cancer surgery based on the Spanish EURECCA registry database was developed using a matching learning algorithm. We performed an external validation of this model based on data from an international multicenter cohort of patients. METHODS A cohort of patients from the European GASTRODATA database was selected. Demographic, clinical, and treatment variables in the original and validation cohorts were compared. The performance of the model was evaluated using the area under the curve (AUC) for a random forest model. RESULTS The validation cohort included 2546 patients from 24 European hospitals. The advanced clinical T- and N-category, neoadjuvant therapy, open procedures, total gastrectomy rates, and mean volume of the centers were significantly higher in the validation cohort. The 90DM rate was also higher in the validation cohort (5.6%) vs. the original cohort (3.7%). The AUC in the validation model was 0.716. CONCLUSION The externally validated model for predicting the 90DM risk in gastric cancer patients undergoing gastrectomy with curative intent continues to be as useful as the original model in clinical practice.
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Affiliation(s)
- Mariagiulia Dal Cero
- Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Joan Gibert
- Department of Pathology, Hospital Universitario del Mar, Cancer Research Program, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain
| | - Luis Grande
- Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Marta Gimeno
- Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
| | - Javier Osorio
- Section of Esophagogastric and Bariatric Surgery, Hospital Clinic, Department of Surgery, Universitat de Barcelona, 08193 Barcelona, Spain
| | - Maria Bencivenga
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, 37126 Verona, Italy
| | | | - Riccardo Rosati
- Department of GI Surgery, IRCCS, San Raffaele Hospital, Vita-Salute University, 20135 Milan, Italy
| | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, 47121 Forli, Italy
| | - Suzanne Gisbertz
- Department of Surgery, University Medical Center, 1007 Amsterdam, The Netherlands
| | - Wojciech P Polkowski
- Department of Surgical Oncology, Medical University of Lublin, 20-080 Lublin, Poland
| | - Lucio Lara Santos
- Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, 4200-072 Porto, Portugal
| | | | - Wojciech Kielan
- 2nd Department of General and Oncological Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Rossella Reddavid
- Department of Oncology, Division of Surgical Oncology and Digestive Surgery, University of Turin, San Luigi University Hospital, Orbassano, 10043 Turin, Italy
| | - Johanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, 1066 Amsterdam, The Netherlands
| | - Gian Luca Baiocchi
- General Surgery Unit, Department of Clinical and Experimental Sciences, University of Brescia, ASST Cremona, 26100 Cremona, Italy
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, 04103 Leipzig, Germany
| | - Andrew Davies
- Department of Digestive Surgery, Guy's & St Thomas' National Health Service Foundation Trust, London SE1 7EH, UK
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, 3015 Rotterdam, The Netherlands
| | - Daniel Reim
- Department of Surgery, School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | - Paulo Costa
- Department of General Surgery, Faculdade de Medicina, Universidade de Lisboa, Hospital Garcia de Orta, 1649-028 Lisboa, Portugal
| | - William H Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, Claude Huriez University Hospital, 59037 Lille, France
| | - John V Reynolds
- Department of Surgery, Trinity College Dublin, St. James's Hospital, D08 W9RT Dublin, Ireland
| | - Stefan P Mönig
- Division of Abdominal Surgery, University Hospital of Geneva, 1205 Geneva, Switzerland
| | - Paul M Schneider
- Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, 5000 Zurich, Switzerland
| | - Elisenda Garsot
- Department of Surgery, Universitat Autònoma de Barcelona, Hospital Universitari Germans Trias i Pujol, 08916 Barcelona, Spain
| | - Emma Eizaguirre
- Department of Surgery, Hospital Universitario de Donostia, 20014 Donostia, Spain
| | - Mònica Miró
- Department of Surgery, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Spain
| | - Sandra Castro
- Department of Surgery, Universitat Autónoma de Barcelona, Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain
| | - Coro Miranda
- Department of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Xavier Monzonis-Hernández
- Department of Pathology, Hospital Universitario del Mar, Cancer Research Program, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Hospital del Mar Research Institute (IMIM), Section of Gastrointestinal Surgery, Hospital del Mar, Department of Surgery, Universitat Autònoma de Barcelona, 08003 Barcelona, Spain
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3
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Herrera Kok JH, Marano L, van den Berg JW, Shetty P, Vashist Y, Lorenzon L, Rau B, van Hillegersberg R, de Manzoni G, Spallanzani A, Seo WJ, Nagata H, Eveno C, Mönig S, van der Sluis K, Solaini L, Wijnhoven BP, Puccetti F, Chevallay M, Lee E, D'Ugo D. Current trends in the management of Gastro-oEsophageal cancers: Updates to the ESSO core curriculum (ESSO-ETC-UGI-WG initiative). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108387. [PMID: 38796969 DOI: 10.1016/j.ejso.2024.108387] [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: 03/04/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
Gastro-oEsophageal Cancers (GECs) are severe diseases whose management is rapidly evolving. The European Society of Surgical Oncology (ESSO) is committed to the generation and spread of knowledge, and promotes the multidisciplinary management of cancer patients through its core curriculum. The present work discusses the approach to GECs, including the management of oligometastatic oesophagogastric cancers (OMEC), the diagnosis and management of peritoneal metastases from gastric cancer (GC), the management of Siewert Type II tumors, the importance of mesogastric excision, the role of robotic surgery, textbook outcomes, organ preserving options, the use of molecular markers and immune check-point inhibitors in the management of patients with GECs, as well as the improvement of current clinical practice guidelines for the management of patients with GECs. The aim of the present review is to provide a concise overview of the state-of-the-art on the management of patients with GECs and, at the same time, to share the latest advancements in the field and to foster the debate between surgical oncologists treating GECs worldwide. We are sure that our work will, at the same time, give an update to the advanced surgical oncologists and help the training surgical oncologists to settle down the foundations for their future practice.
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Affiliation(s)
- Johnn Henry Herrera Kok
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; ESSO-European Young Surgeons and Alumni Club (EYSAC), Research Academy (RA), Belgium; Department of General and Digestive Surgery, Upper GI Unit, University Hospital of León, León, Spain.
| | - Luigi Marano
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Medicine, Academy of Applied Medical and Social Sciences (AMiSNS), Akademia Medycznych i Społecznych Nauk Stosowanych, Elbląg, Poland
| | - Jan Willem van den Berg
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Preethi Shetty
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Department of Surgical Oncology, Kasturba Medical College, MAHE Manipal, India
| | - Yogesh Vashist
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Organ Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Laura Lorenzon
- ESSO-European Young Surgeons and Alumni Club (EYSAC), Research Academy (RA), Belgium; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Beate Rau
- Department of Surgery, Campus Virchow-Klinikum and Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Germany
| | | | - Giovanni de Manzoni
- Department of General Surgery, Upper GI Unit, University Hospital of Verona, Verona, Italy
| | - Andrea Spallanzani
- Department of Oncology and Hematology, University of Modena and Reggio Emilia Hospital, Modena, Italy
| | - Won Jun Seo
- Department of Surgery, Korea University Guro Hospital, Seoul, Republic of Korea; PIPS-GC Study Group, Republic of Korea
| | - Hiromi Nagata
- Department of Gastric Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Clarisse Eveno
- Department of Surgery, Lille University Hospital, Lille, France
| | - Stefan Mönig
- Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Karen van der Sluis
- Department of Surgery, The Netherlands Cancer Institute Antoni van Leewenhoek, Amsterdam, the Netherlands
| | - Leonardo Solaini
- Department of General and Oncologic Surgery, Morgagni Pierantoni Hospital, Forli, Italy
| | - Bas Pl Wijnhoven
- Department of Surgery, Erasmus Medical Center Cancer Institute, Amsterdam, the Netherlands
| | - Francesco Puccetti
- Gastrointestinal Surgery Unit, Department of Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mickael Chevallay
- Department of Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Eunju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea; Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si, Republic of Korea
| | - Domenico D'Ugo
- European Society of Surgical Oncology (ESSO), Education and Training Committee (ETC), Upper Gastrointestinal (UGI), Working Group (WG), Belgium; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; ESSO Past-President, Republic of Korea
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Fazio R, Audisio A, Daprà V, Conti C, Benhima N, Abbassi FZ, Assaf I, Hendlisz A, Sclafani F. Non-operative management after immune checkpoint inhibitors for early-stage, dMMR/MSI-H gastrointestinal cancers. Cancer Treat Rev 2024; 128:102752. [PMID: 38772170 DOI: 10.1016/j.ctrv.2024.102752] [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: 02/15/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/23/2024]
Abstract
Surgery is a standard treatment for early-stage gastrointestinal cancers, often preceded by neoadjuvant chemo(radio)therapy or followed by adjuvant therapy. While leading to cure in a proportion of patients, it has some drawbacks such as intra/post-operative complications, mutilation and life-long functional sequelae. Further to the unprecedented efficacy data from studies of immune checkpoint inhibitors for advanced mismatch repair deficient/microsatellite instable (dMMR/MSI-H) tumours, a strong interest has recently emerged for the investigation of such agents in the neoadjuvant setting. Although limited by the exploratory design and small sample size, trials of neoadjuvant immune checkpoint inhibitors for early-stage dMMR/MSI-H gastrointestinal cancers have consistently reported complete response rates ranging from 70 % to 100 %. As a result, the question has arisen as to whether surgery is still needed or organ-preserving strategies should be offered to this especially immuno-sensitive population. In this article, we discuss the available evidence for neoadjuvant immune checkpoint inhibitors in dMMR/MSI-H gastrointestinal cancers and analyse opportunities and challenges to the implementation of non-operative management approaches in this setting.
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Affiliation(s)
- Roberta Fazio
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Alessandro Audisio
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Valentina Daprà
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Chiara Conti
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Nada Benhima
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Fatima-Zahara Abbassi
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Irene Assaf
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Alain Hendlisz
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium
| | - Francesco Sclafani
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Institut Jules Bordet, Brussels, Belgium.
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Visser MR, Voeten DM, Gisbertz SS, Ruurda JP, van Berge Henegouwen MI, van Hillegersberg R. Outcomes after gastrectomy according to the Gastrectomy Complications Consensus Group (GCCG) in the Dutch Upper GI Cancer Audit (DUCA). Gastric Cancer 2024:10.1007/s10120-024-01527-0. [PMID: 38943030 DOI: 10.1007/s10120-024-01527-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND In 2019, the Gastrectomy Complications Consensus Group (GCCG) published a standardized set of complications aiming toward uniform reporting of post-gastrectomy complications. This study aimed to report outcomes after gastrectomy in the Netherlands according to GCCG definitions and compare them to previously reported national results and the European database reported by the GCCG. METHODS This nationwide, population-based cohort study included all patients undergoing gastrectomy for gastric cancer registered in the DUCA in 2020-2021. Postoperative morbidity and 30-day/in-hospital mortality were analyzed according to the GCCG definitions. For all patients, baseline characteristics and outcomes were compared with the GCCG cohort consisting of 27 European expert centers (GASTRODATA; 2017-2018). RESULTS In 2020-2021, 782 patients underwent gastrectomy in the Netherlands. Variation was seen in baseline characteristics between the Dutch and the GCCG cohort (N = 1349), most notably in minimally invasive surgery (80.6% vs 19.6%, p < 0.001). In the Netherlands, 223 (28.5%) patients developed a total of 407 complications, the most frequent being non-surgical infections (28.5%) and anastomotic leakage (13.4%). The overall complication and 30-day mortality rates were similar between the Dutch and GCCG cohort (28.5% vs 29.8%, p = 0.563; 3.7% vs 3.6%, p = 0.953). Higher surgical and endoscopic/radiologic reintervention rates were observed in the Netherlands compared to the GCCG cohort (10.7% vs 7.8%, p = 0.025; 10.9% vs 2.9%, p < 0.001). CONCLUSION Reporting outcomes according to the standardized GCCG definitions allows for international benchmarking. Postoperative outcomes were comparable between Dutch and GCCG cohorts, but both exceed the international benchmark for expert gastrectomy care, highlighting targets for national and international quality improvement.
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Affiliation(s)
- Maurits R Visser
- Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Daan M Voeten
- Department of Surgery, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Mark I van Berge Henegouwen
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
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6
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Kreca SM, Albers IS, Musters SCW, van Dijkum EJMN, Tuinman PR, Eskes AM. The effect of family-centered care on unplanned emergency room visits, hospital readmissions and intensive care admissions after surgery: a root cause analysis from a prospective multicenter study in the Netherlands. Patient Saf Surg 2024; 18:14. [PMID: 38689336 PMCID: PMC11061973 DOI: 10.1186/s13037-024-00399-8] [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: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Optimizing transitional care by practicing family-centered care might reduce unplanned events for patients who undergo major abdominal cancer surgery. However, it remains unknown whether involving family caregivers in patients' healthcare also has negative consequences for patient safety. This study assessed the safety of family involvement in patients' healthcare by examining the cause of unplanned events in patients who participated in a family involvement program (FIP) after major abdominal cancer surgery. METHODS This is a secondary analysis focusing on the intervention group of a prospective cohort study conducted in the Netherlands. Data were collected from April 2019 to May 2022. Participants in the intervention group were patients who engaged in a FIP. Unplanned events were analyzed, and root causes were identified using the medical version of a prevention- and recovery-information system for monitoring and analysis (PRISMA) that analyses unintended events in healthcare. Unplanned events were compared between patients who received care from family caregivers and patients who received professional at-home care after discharge. A Mann-Whitney U test was used to analyze data. RESULTS Of the 152 FIP participants, 68 experienced an unplanned event and were included. 112 unplanned events occurred with 145 root causes since some unplanned events had several root causes. Most root causes of unplanned events were patient-related factors (n = 109, 75%), such as patient characteristics and disease-related factors. No root causes due to inadequate healthcare from the family caregiver were identified. Unplanned events did not differ statistically (interquartile range 1-2) (p = 0.35) between patients who received care from trained family caregivers and those who received professional at-home care after discharge. CONCLUSION Based on the insights from the root-cause analysis in this prospective multicenter study, it appears that unplanned emergency room visits and hospital readmissions are not related to the active involvement of family caregivers in surgical follow-up care. Moreover, surgical follow-up care by trained family caregivers during hospitalization was not associated with increased rates of unplanned adverse events. Hence, the concept of active family involvement by proficiently trained family caregivers in postoperative care appears safe and feasible for patients undergoing major abdominal surgery.
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Affiliation(s)
- Sani Marijke Kreca
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and quality of life, Meibergdeef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Iris Sophie Albers
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anesthesiology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Selma Clazina Wilhelmina Musters
- Cancer Center Amsterdam, Treatment and quality of life, Meibergdeef 9, 1105 AZ, Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Els Jaqueline Maria Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, Meibergdeef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pieter Roel Tuinman
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, G01 2.03 Gold Coast campus Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Intensive Care Amsterdam cardiovascular Sciences Amsterdam institute for Infection and Immunity, Amsterdam UMC location Vrije Universiteit Amsterdam NL, Amsterdam, The Netherlands
| | - Anne Maria Eskes
- Cancer Center Amsterdam, Treatment and quality of life, Meibergdeef 9, 1105 AZ, Amsterdam, the Netherlands.
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, G01 2.03 Gold Coast campus Griffith University, Gold Coast, QLD, 4222, Australia.
- Intensive Care, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, The Netherlands.
- Faculty of Health, Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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7
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Bencivenga M, Verlato G, de Manzoni G. Beyond years: evaluating the impact of surgeon age on outcomes after gastric cancer surgery. BJS Open 2024; 8:zrae016. [PMID: 38669193 PMCID: PMC11049578 DOI: 10.1093/bjsopen/zrae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 04/28/2024] Open
Affiliation(s)
- Maria Bencivenga
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Upper GI Surgery Unit, University of Verona, Verona, Italy
| | - Giuseppe Verlato
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Giovanni de Manzoni
- Department of Surgery, Dentistry, Pediatrics and Gynaecology, Upper GI Surgery Unit, University of Verona, Verona, Italy
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8
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Evans RP, Kamarajah SK, Evison F, Zou X, Coupland B, Griffiths EA. Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis. ANNALS OF SURGERY OPEN 2024; 5:e363. [PMID: 38883942 PMCID: PMC11175914 DOI: 10.1097/as9.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/28/2023] [Indexed: 06/18/2024] Open
Abstract
Objective The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality. Background Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear. Methods This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019. Results This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001). Conclusion Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.
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Affiliation(s)
- Richard Pt Evans
- From the Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
| | - Sivesh K Kamarajah
- From the Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, UK
| | - Felicity Evison
- Health Data Science Team, Research and Development, Queen Elizabeth Hospital, Birmingham, UK
| | - Xiaoxu Zou
- Health Data Science Team, Research and Development, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Coupland
- Health Data Science Team, Research and Development, Queen Elizabeth Hospital, Birmingham, UK
| | - Ewen A Griffiths
- From the Department of Upper Gastrointestinal Surgery, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, UK
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9
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Geroin C, Weindelmayer J, Camozzi S, Leone B, Turolo C, Hetoja S, Bencivenga M, Sacco M, De Pasqual CA, Mattioni E, de Manzoni G, Giacopuzzi S. Clinical predictors of postoperative complications in the context of enhanced recovery (ERAS) in patients with esophageal and gastric cancer. Updates Surg 2024:10.1007/s13304-023-01739-6. [PMID: 38358642 DOI: 10.1007/s13304-023-01739-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
The overall frequency of postoperative complications in patients with esophageal and gastric cancer diverges between studies. We evaluated the frequency and assessed the relationship between complications and demographic and clinical features. For this observational study, data were extracted from the ERAS Registry managed by the University of Verona, Italy. Patients were evaluated and compared for postoperative complications according to the consensus-based classification and the Clavien-Dindo scale. The study population was 877 patients: 346 (39.5%) with esophageal and 531 (60.5%) with gastric cancer; 492 (56.2%) reported one or more postoperative complications, 213 (61.6%) of those with esophageal and 279 (52.5%) of those with gastric cancer. When stratified by consensus-based classification, patients with esophageal cancer reported general postoperative complications more frequently (p < 0.001) than those with gastric cancer, but there was no difference in postoperative surgical complications between the two groups. Multiple logistic regression models revealed an association between postoperative complications and the Charlson Comorbidity Index (adjusted odds ratio [OR] 1.22; 95% confidence interval [CI] 1.08-1.36), operation time (adjusted OR, 1.08; 95% CI 1.00-1.15), and days to solid diet intake (adjusted OR, 1.39; 95% CI 1.20-1.59). Complications in patients with esophageal and gastric cancer are frequent, even in those treated according to ERAS principles, and are often associated with comorbidities, longer operative time, and longer time to solid diet intake.
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Affiliation(s)
- Christian Geroin
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy.
| | - Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Serena Camozzi
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Barbara Leone
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Cecilia Turolo
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Selma Hetoja
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Maria Bencivenga
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Michele Sacco
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | | | - Eugenia Mattioni
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy.
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10
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Bobrzynski L, Sędłak K, Rawicz-Pruszyński K, Kolodziejczyk P, Szczepanik A, Polkowski W, Richter P, Sierzega M. Evaluation of optimum classification measures used to define textbook outcome among patients undergoing curative-intent resection of gastric cancer. BMC Cancer 2023; 23:1199. [PMID: 38057839 DOI: 10.1186/s12885-023-11695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Textbook outcome (TO) is a composite measure reflecting various aspects of services provided to patients with solid malignancies. We sought to evaluate the importance of various TO components previously proposed for gastric cancer. METHODS Prospectively maintained electronic databases of 1,743 patients treated in two academic surgical centres were reviewed. Six candidate definitions of TO were evaluated based on their ability to accurately predict patients' prognosis by Cox proportional hazards modelling. RESULTS TO definition combining 10 measures corresponding to complete tumour resection with an uneventful postoperative course showed the best goodness of fit by achieving the lowest values of Akaike (AIC) and Bayesian (BIC) information criteria and the best predictive performance based on the highest value of c-index. The overall median survival was significantly longer for patients with than without textbook outcome (69.0 vs 20.1 months, P < 0.001). TO maintained its prognostic value in a multivariate model controlling for age, sex, comorbidities, treatment, and tumour related variables and was associated with a 39% lower risk of death (HR 0.61, 95%CI 0.51 - 0.73, P < 0.001). Nine variables identified as predictors of TO were used to develop a nomogram showing very good correlation between the predicted and actual probability of achieving TO. The AUC of ROC obtained from the nomogram was 0.752 (95% CI 0.727 to 0.781). CONCLUSIONS A uniform definition of textbook outcome provides clinically relevant prognostic information and could be used in quality improvement programs for gastric cancer patients.
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Affiliation(s)
- L Bobrzynski
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - K Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - K Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Kolodziejczyk
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - A Szczepanik
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - W Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - P Richter
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland
| | - M Sierzega
- First Department of Surgery, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow, 30-688, Poland.
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11
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Stüben BO, Plitzko GA, Stern L, Li J, Neuhaus JP, Treckmann JW, Schmeding R, Saner FH, Hoyer DP. Prognostic factors of poor postoperative outcomes in gastrectomies. Front Surg 2023; 10:1324247. [PMID: 38107405 PMCID: PMC10722220 DOI: 10.3389/fsurg.2023.1324247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
Background Gastric cancer is one of the most common cancers worldwide and is the third most common cause of cancer related death. Improving postoperative results by understanding risk factors which impact outcomes is important. The current study aimed to compare immediate perioperative outcomes following gastrectomy. Methods 302 patients following gastric resections over a 10-year period (January 2009-January 2020) were identified in a database and retrospectively analysed. Epidemiological as well as perioperative data was analysed, and a univariate and multivariate analysis performed to identify risk factors for in-hospital mortality. Results In general, gastrectomies were mainly performed electively (total vs. subtotal 95% vs. 85%, p = 0.004). Patients having subtotal gastrectomy needed significantly more PRBC transfusions compared to total gastrectomy (p = 0.039). Most emergency surgeries were performed for benign diseases, such as ulcer perforations or bleeding and gastric ischaemia. Only emergency surgery was significantly associated with poorer overall survival (HR 2.68, 95% CI 1.32-5.05, p = 0.003). Conclusion In-hospital mortality was comparable between total and subtotal gastrectomies. Only emergency interventions increased postoperative fatality risk.
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Affiliation(s)
- B. O. Stüben
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
| | - G. A. Plitzko
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L. Stern
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Li
- Department of Surgery, Jiahui International Hospital, Shanghai, China
| | - J. P. Neuhaus
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
| | - J. W. Treckmann
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
| | - R. Schmeding
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
| | - F. H. Saner
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - D. P. Hoyer
- Department of General, Visceral and Transplant Surgery, Medical Centre University Duisburg-Essen, Essen, Germany
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12
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Sędłak K, Rawicz-Pruszyński K, Mlak R, Van Sandick J, Gisbertz S, Pera M, Dal Cero M, Baiocchi GL, Celotti A, Morgagni P, Vittimberga G, Hoelscher A, Moenig S, Kołodziejczyk P, Richter P, Gockel I, Piessen G, Da Costa PM, Davies A, Baker C, Allum W, Romario UF, De Pascale S, Rosati R, Reim D, Santos LL, D'ugo D, Wijnhoven B, Degiuli M, De Manzoni G, Kielan W, Frejlich E, Schneider P, Polkowski WP. Textbook Oncological Outcome in European GASTRODATA. Ann Surg 2023; 278:823-831. [PMID: 37555342 DOI: 10.1097/sla.0000000000006054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in the European population based on the GASTRODATA registry. BACKGROUND TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer, TOO was proposed as a quality and optimal multimodal treatment parameter. METHODS TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with the addition of perioperative chemotherapy compliance. RESULTS Of the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy [odds ratio (OR) = 1.33, 95% CI: 1.04-1.70] and D2 or D2+ lymphadenectomy (OR = 1.55, 95% CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR = 0.73, 95% CI: 0.54-0.94), pT3/4 (OR = 0.79, 95% CI: 0.63-0.99), ASA 3/4 (OR = 0.68, 95% CI: 0.54-0.86) and total gastrectomy (OR = 0.56, 95% CI: 0.45-0.70), had a negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR = 0.37, 95% CI: 0.27-0.53), pT3 or pT4 (OR = 0.52, 95% CI: 0.39-0.69), and ASA 3 or 4 (OR = 0.58, 95% CI: 0.43-0.79) had a negative impact on TOO achievement. CONCLUSIONS Despite successively improved surgical outcomes, stage-appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of gastric cancer remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Radosław Mlak
- Department of Preclinical Sciences, Body Composition Research Laboratory, Medical University of Lublin, Lublin, Poland
| | - Johanna Van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Suzanne Gisbertz
- Department of Surgery, University Medical Center, Amsterdam, The Netherlands
| | - Manuel Pera
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Mariagiulia Dal Cero
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Celotti
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Stefan Moenig
- Department of General, Visceral and Thoracic Surgery, Agaplesion Markus Hospital, Frankfurt, Germany
| | | | - Piotr Richter
- Department of Surgery, Jagiellonian University Medical College
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, Lille, France
| | | | - Andrew Davies
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - Cara Baker
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Ricccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Daniel Reim
- Department of Surgery, TUM School of Medicine, Technical University of Munich, Germany
| | - Lucio Lara Santos
- Department of Surgical Oncology, Experimental Pathology and Therapeutics Group, Portuguese Institute Of Oncology, Porto, Portugal
| | - Domenico D'ugo
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Bas Wijnhoven
- Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Wojciech Kielan
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ewelina Frejlich
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Paul Schneider
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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13
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Su P, Jiang L, Zhang Y, Yu T, Huang H, Chen M, Cao C, Kang W, Liu Y, Yu J. Perioperative chemotherapy versus adjuvant chemotherapy treatment for resectable locally advanced gastric cancer: a retrospective cohort study. Eur J Med Res 2023; 28:409. [PMID: 37814327 PMCID: PMC10563233 DOI: 10.1186/s40001-023-01400-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is increasingly used in locally advanced gastric cancer (LAGC), but the clinical safety and efficacy are still controversial. This study aims to compare perioperative chemotherapy (PEC) with adjuvant chemotherapy (AC) for resectable LAGC. METHODS Patients who underwent D2 gastrectomy for resectable LAGC were retrospectively reviewed, and divided into NSA group (NAC plus surgery and AC) and SA group (surgery followed by AC). The baseline characteristics and perioperative data were compared. Survival analysis was based on Kaplan-Meier method. Multivariate analyses for prognostic factors were based on the Cox regression. RESULTS A total of 450 patients were eligible for this study. 218 patients received NAC plus surgery and AC, while 232 upfront surgery followed by AC. The baseline characteristics were comparable between the two groups. NSA group showed significant superiority in R0 resection rate (P = 0.014), excised tumor size (P = 0.038), and tumor downstage (all P < 0.001). NAC did not affect postoperative complications or AC-related grade 3/4 adverse events. Patients in NSA group achieved significantly longer OS (P = 0.021) and DFS (P = 0.002). The Cox regression model showed that NAC was independently associated with better OS (HR 0.245, P = 0.039) and DFS (HR 0.591, P = 0.031). CONCLUSIONS Compared with SA, the administration of NSA was considered safe and feasible for achieving higher R0 resection rate without increasing the postoperative complications or AC-related grade 3/4 adverse events, and NAC was independently associated with better OS and DFS for resectable LAGC.
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Affiliation(s)
- Pengfei Su
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yingjing Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tian Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hongyun Huang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Moxi Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Can Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuqin Liu
- Department of Pathology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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14
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Murnane LC, Forsyth AK, Koukounaras J, Shaw K, King S, Brown WA, Mourtzakis M, Tierney AC, Burton PR. Malnutrition defined by GLIM criteria identifies a higher incidence of malnutrition and is associated with pulmonary complications after oesophagogastric cancer surgery, compared to ICD-10-defined malnutrition. J Surg Oncol 2023; 128:769-780. [PMID: 37291908 DOI: 10.1002/jso.27366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND & OBJECTIVES Low muscle mass, measured using computed tomography (CT), is associated with poor surgical outcomes. We aimed to include CT-muscle mass in malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM) criteria, compare it to the International Classification of Diseases 10th Revision (ICD-10) criteria, and assess the impact on postoperative outcomes after oesophagogastric (OG) cancer surgery. METHODS One hundred and eight patients who underwent radical OG cancer surgery and had preoperative abdominal CT imaging were included. GLIM and ICD-10 malnutrition data were assessed against complication and survival outcomes. Low CT-muscle mass was determined using predefined cut-points. RESULTS GLIM-defined malnutrition prevalence was significantly higher than ICD-10-malnutrition (72.2% vs. 40.7%, p < 0.001). Of the 78 patients with GLIM-defined malnutrition, low muscle mass (84.6%) was the predominant phenotypic criterion. GLIM-defined malnutrition was associated with pneumonia (26.9% vs. 6.7%, p = 0.010) and pleural effusions (12.8% vs. 0%, p = 0.029). Postoperative complications did not correlate with ICD-10 malnutrition. Severe GLIM (HR: 2.51, p = 0.014) and ICD-10 (HR: 2.15, p = 0.039) malnutrition were independently associated with poorer 5-year survival. CONCLUSIONS GLIM criteria appear to identify more malnourished patients and more closely relate to surgical risk than ICD-10 malnutrition, likely due to incorporating objective muscle mass assessment.
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Affiliation(s)
- Lisa C Murnane
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia
| | - Adrienne K Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Jim Koukounaras
- Department of Radiology, Alfred Health, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Kalai Shaw
- Department of Surgery, Monash University, Melbourne, Australia
- Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
| | - Susannah King
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- Department of Nutrition and Dietetics, Alfred Health, Melbourne, Australia
| | - Wendy A Brown
- Department of Surgery, Monash University, Melbourne, Australia
- Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Audrey C Tierney
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
- School of Allied Health, Health Implementation Science and Technology Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Australia
- Oesophagogastric Bariatric Surgery Unit, Alfred Health, Melbourne, Australia
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15
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Madadi-Sanjani O, Brendel J, Kuebler JF, Ure BM. Definition, Documentation, and Classification of Complications in Pediatric Surgical Literature-A Plea for Standardization. Eur J Pediatr Surg 2023; 33:105-113. [PMID: 36720251 DOI: 10.1055/s-0043-1760835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Severity grading systems for complications in surgical patients have been used since 1992. An increasing assessment of these instruments in pediatric surgery is also noticed, without their validation in children. To analyze the current practice, we performed a literature review with focus on the assessment and grading of complications. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies reporting on postoperative complications as a primary or secondary endpoint using a severity grading system were included. Definition for simple adverse events, classification systems used, and the time horizon of postoperative documentation were analyzed. A total of 566 articles were screened, of which 36 met the inclusion criteria. About 86.1% of the papers were retrospective and 13.9% prospective analyses. None of the studies were prospective-randomized trials. Twenty (55.6%) studies did not include a definition of adverse events, whereas the remaining 16 (44.4%) showed variations in their definitions. All studies applied the Clavien-Dindo classification, whereas five (13.9%) additionally used the Comprehensive Complication Index. One study compared alternative grading instruments with the Clavien-Dindo classification, without demonstrating the superiority of any classification in pediatric surgery. Twenty-two studies (61.1%) did not report the time horizon of perioperative complication documentation, while 8 studies (22.2%) used 30 days and 6 studies (16.7%) used 3 months of postoperative documentation. Definition and classification of postoperative complications are inconsistent in the pediatric surgical literature. Establishment of a standardized protocol is mandatory to accurately compare outcome data.
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Affiliation(s)
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Joachim F Kuebler
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
| | - Benno M Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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16
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State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience. Updates Surg 2023; 75:373-382. [PMID: 35727482 DOI: 10.1007/s13304-022-01311-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/26/2022] [Indexed: 01/24/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach based on actions focused on reducing physiological surgical stress in the preoperative, intraoperative, and postoperative periods are beneficial in reducing morbidity and hospital stay, without increasing readmissions across different surgical settings. The implementation of ERAS in resection procedures of esophageal and gastric cancer has been challenging due to the complexity of these surgical techniques and the high risk of complications. Despite the limited evidence of ERAS in esophagectomy operations, systematic reviews and meta-analysis have confirmed a reduction of pulmonary complications and hospital stay without increasing readmissions. In gastrectomy operations, the implementation of ERAS reduces the use of nasogastric tubes and intraabdominal drains, facilitates early diet, and reduces the length of hospital stay, without increasing complications. There is, however, wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability. Regardless growing evidence of the effectiveness of ERAS, the adherence rate is still low. The commitment of the multidisciplinary team and leadership is critical in the application and refinement of ERAS protocols in parallel with periodic audits. Pre- and post-habilitation methods are emerging concepts to be incorporated in ERAS protocols.
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17
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André T, Tougeron D, Piessen G, de la Fouchardière C, Louvet C, Adenis A, Jary M, Tournigand C, Aparicio T, Desrame J, Lièvre A, Garcia-Larnicol ML, Pudlarz T, Cohen R, Memmi S, Vernerey D, Henriques J, Lefevre JH, Svrcek M. Neoadjuvant Nivolumab Plus Ipilimumab and Adjuvant Nivolumab in Localized Deficient Mismatch Repair/Microsatellite Instability-High Gastric or Esophagogastric Junction Adenocarcinoma: The GERCOR NEONIPIGA Phase II Study. J Clin Oncol 2023; 41:255-265. [PMID: 35969830 PMCID: PMC9839243 DOI: 10.1200/jco.22.00686] [Citation(s) in RCA: 120] [Impact Index Per Article: 120.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE In patients with resectable gastric/gastroesophageal junction (GEJ) adenocarcinoma, surgery plus perioperative platinum-based chemotherapy is the standard of care. Perioperative chemotherapy remains debatable for gastric/GEJ adenocarcinoma with deficient mismatch repair (dMMR)/microsatellite instability-high (MSI-H). PATIENTS AND METHODS NEONIPIGA (ClinicalTrials.gov identifier: NCT04006262) phase II study evaluated neoadjuvant nivolumab 240 mg once every two weeks ×6 and ipilimumab 1 mg/kg once every six weeks ×2, followed by surgery and adjuvant nivolumab 480 mg once every four weeks (nine injections) in patients with locally advanced resectable dMMR/MSI-H, clinical (c) tumor (T)2-T4 node (N)x metastasis (M)0 gastric/GEJ adenocarcinoma. The primary end point was a pathological complete response (pCR) rate. RESULTS Between October 2019 and June 2021, 32 patients with dMMR/MSI-H gastric/GEJ adenocarcinoma were enrolled. The median age was 65.5 years (range, 40-80). Clinical stages were cT2-T3N0 (n = 9), cT2-T3N1 (n = 22), and cT3N1M1 (n = 1, wrongly included). With a median follow-up of 14.9 months (95% CI, 10.6 to 17.6), 32 patients received neoadjuvant immunotherapy (27 patients completed all cycles). Neoadjuvant therapy-related grade 3/4 adverse events occurred in six patients (19%). Twenty-nine patients underwent surgery; three did not have surgery and had complete endoscopic response with tumor-free biopsies and a normal computed tomography scan (two refused surgery and one had metastasis at inclusion). The rate of surgical morbidity (Clavien-Dindo classification) was 55% (one postoperative death occurred). All 29 patients had an R0 resection, and 17 (58.6%; 90% CI, 41.8 to 74.1) had pCR (pathological T0N0). Becker tumor regression grades 1a, 1b, 2, and 3 were observed in 17 patients, three (including two pathological T0N1), two, and seven patients, respectively. Of the 29 patients with surgery, 23 received adjuvant nivolumab. At database lock, no patient had relapse and one died without relapse. CONCLUSION Nivolumab and ipilimumab-based neoadjuvant therapy is feasible and associated with no unexpected toxicity and a high pCR rate in patients with dMMR/MSI-H resectable gastric/GEJ adenocarcinoma.
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Affiliation(s)
- Thierry André
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France,Thierry André, MD, Saint-Antoine Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France; e-mail:
| | - David Tougeron
- Department of Hepatology and Gastroenterology, Poitiers University Hospital, Poitiers, France
| | - Guillaume Piessen
- University of Lille, CNRS, INSERM, CHU Lille, Department of Digestive and Oncological Surgery, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, France
| | | | - Christophe Louvet
- Department of Medical Oncology, Institut Mutualiste Montsouris, Paris, France
| | - Antoine Adenis
- Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM, University of Montpellier, Montpellier Cancer Institute (ICM), Montpellier, France
| | - Marine Jary
- University Hospital of Besançon, Clinical Investigational Center, CIC-1431, Besançon, France
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor Hospital, AP-HP, Paris-East Créteil University, INSERM, IMRB, Creteil, France
| | - Thomas Aparicio
- Paris Cité University, Department of Gastroenterology, Saint Louis Hospital, Paris, France
| | - Jérôme Desrame
- Cancerology Institute, Jean Mermoz Hospital, Lyon, France
| | - Astrid Lièvre
- Department of Gastroenterology, CHU Pontchaillou, INSERM U1242, "Chemistry, Oncogenesis Stress Signaling", Rennes 1 University, Rennes, France
| | | | - Thomas Pudlarz
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France
| | - Romain Cohen
- Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, INSERM 938, SIRIC CURAMUS, Paris, France
| | - Salomé Memmi
- Sorbonne University, Department of Pathology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, University of Besançon, Besançon, France,Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, University of Besançon, Besançon, France,Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Jérémie H. Lefevre
- Sorbonne University, Department of Digestive Surgery, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Magali Svrcek
- Sorbonne University, Department of Pathology, Saint-Antoine Hospital, AP-HP, Paris, France
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18
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Baiocchi GL, Giacopuzzi S, Vittimberga G, De Pascale S, Pastorelli E, Gelmini R, Viganò J, Graziosi L, Vagliasindi A, Rosa F, Steccanella F, Demartini P, Reddavid R, Berselli M, Elmore U, Romario UF, Degiuli M, Morgagni P, Marrelli D, D’Ugo D, Rosati R, De Manzoni G. Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry. Updates Surg 2023; 75:419-427. [PMID: 35788552 PMCID: PMC9852164 DOI: 10.1007/s13304-022-01318-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015-2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien-Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.
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Affiliation(s)
- Gian Luca Baiocchi
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy ,UOC General Surgery, ASST Cremona, Cremona, Italy
| | - Simone Giacopuzzi
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | | | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Department of Digestive Tract Surgery, IEO, Milan, Italy
| | - Elisabetta Pastorelli
- grid.7637.50000000417571846Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Roberta Gelmini
- grid.7548.e0000000121697570Department of Oncological Surgery, University of Modena, Modena, Italy
| | - Jacopo Viganò
- grid.419425.f0000 0004 1760 3027General Surgery, Department of Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigina Graziosi
- grid.9027.c0000 0004 1757 3630General and Emergency Surgery, University of Perugia, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Alessio Vagliasindi
- grid.415207.50000 0004 1760 3756UOC General and Emergency Surgery, SSD Emergency Surgery, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Fausto Rosa
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | | | - Paolo Demartini
- grid.414818.00000 0004 1757 8749General, Oncological and Minimally Invasive Surgery, Cà Granda-Niguarda Hospital, Milan, Italy
| | - Rossella Reddavid
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Mattia Berselli
- General Surgery Unit, Department of Surgery, ASST Settelaghi, Varese, Italy
| | - Ugo Elmore
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | | | - Maurizio Degiuli
- grid.7605.40000 0001 2336 6580Department of Oncology, Digestive and Surgical Oncology, University of Torino, and San Luigi University Hospital, Orbassano, Italy
| | - Paolo Morgagni
- GB Morgagni-L Pierantoni Surgical Department, Forlì, Italy
| | - Daniele Marrelli
- grid.9024.f0000 0004 1757 4641Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Domenico D’Ugo
- grid.411075.60000 0004 1760 4193Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Riccardo Rosati
- grid.15496.3f0000 0001 0439 0892Gastrointestinal Surgery, San Raffaele Hospital and San Raffaele Vita-Salute University, Milan, Italy
| | - Giovanni De Manzoni
- grid.5611.30000 0004 1763 1124Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
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Romario UF, Ascari F, De Pascale S, Bencini L, Cocozza E, Cotsoglou C, Degiuli M, Palma G, Ferrari G, Lucianetti A, Marchesi F, Merigliano S, Millo P, Navarra G, Petri R, Portolani N, Puzziello A, Rosati R, Weindelmayer J, Ercolani G, De Palma G. Implementation of the ERAS program in gastric surgery: a nationwide survey in Italy. Updates Surg 2023; 75:141-148. [PMID: 36307670 PMCID: PMC9616397 DOI: 10.1007/s13304-022-01400-8] [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: 05/19/2022] [Accepted: 10/04/2022] [Indexed: 01/14/2023]
Abstract
Enhanced recovery after surgery (ERAS) programs have been developed by combining several evidence-based techniques for perioperative care, with the intention of reducing the stress response and organ dysfunction, thus allowing improved clinical results. ERAS programs have been widely adopted for colorectal surgery; however, their adoption for upper gastrointestinal surgery has been challenging even though good results have been reported in the literature. Our intent was to investigate the adoption of ERAS programs for resective gastric surgery in Italy. A survey was conducted among 20 departments of surgery belonging to the Italian Group for Research on Gastric Cancer (GC). Analysis of our survey showed that several evidence-based practices and many items of the ERAS guidelines for gastric surgery are not implemented in real practice in Italian centers dedicated to GC. This situation may be related to the hesitation of surgeons to introduce radical changes to the traditional postoperative management after gastrectomy. A multidisciplinary approach to the perioperative care of these patients is not routinely applied in many Italian centers. A strict collaboration of all clinicians involved in the perioperative care of patients undergoing gastrectomy for GC is key for the future implementation of ERAS in gastric surgery in our departments.
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Affiliation(s)
- Uberto Fumagalli Romario
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Filippo Ascari
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
| | - Stefano De Pascale
- grid.15667.330000 0004 1757 0843Digestive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, Milan, Italy
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20
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Puértolas N, Osorio J, Jericó C, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Molinas J, Pulido L, Gimeno M, Pera M. Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection. Cancers (Basel) 2022; 15:cancers15010144. [PMID: 36612141 PMCID: PMC9818188 DOI: 10.3390/cancers15010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06−2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14−2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40−1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88−2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64−4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence.
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Affiliation(s)
- Noelia Puértolas
- Service of Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
- Correspondence: ; Tel.: +34-637286009
| | - Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, 17007 Girona, Spain
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Alexis Luna
- Service of Surgery, Consorci Corporació Sanitària Parc Taulí de Sabadell, 08208 Sabadell, Spain
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, 08402 Granollers, Spain
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, 43005 Tarragona, Spain
| | - Joan Molinas
- Service of Surgery, Hospital Universitari de Vic, 08500 Vic, Spain
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
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21
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Muir D, Antonowicz S, Whiting J, Low D, Maynard N. Implementation of the Esophagectomy Complication Consensus Group definitions: the benefits of speaking the same language. Dis Esophagus 2022; 35:6603615. [PMID: 35673848 DOI: 10.1093/dote/doac022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/17/2022] [Indexed: 12/24/2022]
Abstract
In 2015 the Esophagectomy Complication Consensus Group (ECCG) reported consensus definitions for complications after esophagectomy. This aimed to reduce variation in complication reporting, attributed to heterogeneous definitions. This systematic review aimed to describe the implementation of this definition set, including the effect on complication frequency and variation. A systematic literature review was performed, identifying all observational and randomized studies reporting complication frequencies after esophagectomy since the ECCG publication. Recruitment periods before and subsequent to the index ECCG publication date were included. Coefficients of variance were calculated to assess outcome heterogeneity. Of 144 studies which met inclusion criteria, 70 (48.6%) used ECCG definitions. The median number of separately reported complication types was five per study; only one study reported all ECCG complications. The coefficients of variance of the reported frequencies of eight of the 10 most common complications were reduced in studies which used the ECCG definitions compared with those that did not (P = 0.036). Among ECCG studies, the frequencies of postoperative pneumothorax, reintubation, and pulmonary emboli were significantly reduced in 2020-2021, compared with 2015-2019 (P = 0.006, 0.034, and 0.037 respectively). The ECCG definition set has reduced variation in esophagectomy morbidity reporting. This adds greater confidence to the observed gradual improvement in outcomes with time, and its ongoing use and wider dissemination should be encouraged. However, only a handful of outcomes are widely reported, and only rarely is it used in its entirety.
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Affiliation(s)
- Duncan Muir
- Department of Upper GI Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Stefan Antonowicz
- Department of Upper GI Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jack Whiting
- Department of Upper GI Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Donald Low
- Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - Nick Maynard
- Department of Upper GI Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
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22
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Mengardo V, Weindelmayer J, Veltri A, Giacopuzzi S, Torroni L, de Manzoni G, Agresta F, Alfieri R, Alfieri S, Antonacci N, Baiocchi GL, Bencini L, Bencivenga M, Benedetti M, Berselli M, Biondi A, Capolupo GT, Carboni F, Casadei R, Casella F, Catarci M, Cerri P, Chiari D, Cocozza E, Colombo G, Cozzaglio L, Dalmonte G, Degiuli M, De Luca M, De Luca R, De Manzini N, De Pasqual CA, De Pascale S, De Ruvo N, Di Cosmo M, Di Leo A, Di Paola M, Elio A, Ferrara F, Ferrari G, Fiscon V, Fumagalli U, Garulli G, Gennai A, Gentile I, Germani P, Gualtierotti M, Guerini F, Gurrado A, Inama M, La Torre F, Laterza E, Losurdo P, Macrì A, Marano A, Marano L, Marchesi F, Marino F, Massani M, Menghi R, Milone M, Molfino S, Montuori M, Moretto G, Morgagni P, Morpurgo E, Abdallah M, Nespoli L, Olmi S, Palaia R, Pallabazer G, Parise P, Pasculli A, Pericoli Ridolfini M, Pesce A, Pinotti E, Pisano M, Poiasina E, Postiglione V, Rausei S, Rella A, Rosa F, Rosati R, Rossi G, Rossit L, Rovatti M, Ruspi L, Sacco L, Saladino E, Sansonetti A, Sartori A, Scaglione D, Scaringi S, Schoenthaler C, Sena G, Simone M, Solaini L, Strignano P, Tartaglia N, Testa S, Testini M, Tiberio GAM, Treppiedi E, Vagliasindi A, Valmasoni M, Viganò J, Zanchettin G, Zanoni A, Zardini C, Zerbinati A. Current practice on the use of prophylactic drain after gastrectomy in Italy: the Abdominal Drain in Gastrectomy (ADiGe) survey. Updates Surg 2022; 74:1839-1849. [PMID: 36279038 DOI: 10.1007/s13304-022-01397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 10/31/2022]
Abstract
AbstractEvidence against the use of prophylactic drain after gastrectomy are increasing and ERAS guidelines suggest the benefit of drain avoidance. Nevertheless, it is unclear whether this practice is still widespread. We conducted a survey among Italian surgeons through the Italian Gastric Cancer Research Group and the Polispecialistic Society of Young Surgeons, aiming to understand the current use of prophylactic drain. A 28-item questionnaire-based survey was developed to analyze the current practice and the individual opinion about the use of prophylactic drain after gastrectomy. Groups based on age, experience and unit volume were separately analyzed. Response of 104 surgeons from 73 surgical units were collected. A standardized ERAS protocol for gastrectomy was applied by 42% of the respondents. Most of the surgeons, regardless of age, experience, or unit volume, declared to routinely place one or more drain after gastrectomy. Only 2 (1.9%) and 7 surgeons (6.7%) belonging to high volume units, do not routinely place drains after total and subtotal gastrectomy, respectively. More than 60% of the participants remove the drain on postoperative day 4–6 after performing an assessment of the anastomosis integrity. Interestingly, less than half of the surgeons believe that drain is the main tool for leak management, and this percentage further drops among younger surgeons. On the other hand, drain’s role seems to be more defined for duodenal stump leak treatment, with almost 50% of the surgeons recognizing its importance. Routine use of prophylactic drain after gastrectomy is still a widespread practice even if younger surgeons are more persuaded that it could not be advantageous.
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23
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Lacueva FJ, Escrig-Sos J, Marti-Obiol R, Zaragoza C, Mingol F, Oviedo M, Peris N, Civera J, Roig A. Short-term postoperative outcomes of gastric adenocarcinoma patients treated with curative intent in low-volume centers. World J Surg Oncol 2022; 20:344. [PMID: 36253780 PMCID: PMC9575241 DOI: 10.1186/s12957-022-02804-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality standards in postoperative outcomes have not yet been defined for gastric cancer surgery. Also, the effect of centralization of gastric cancer surgery on the improvement of postoperative outcomes continues to be debated. Short-term postoperative outcomes in gastric carcinoma patients in centers with low-volume of annual gastrectomies were assessed. The effect of age on major postoperative morbidity and mortality was also analyzed. METHODS Patients with gastric or gastroesophageal junction Siewert III type carcinomas who underwent surgical treatment with curative intent between January 2013 and December 2016 were included. Data were obtained from the population-based surgical registry Esophagogastric Carcinoma Registry of the Comunitat Valenciana (RECEG-CV). The RECEG-CV gathers information on demographic characteristics and comorbidity, preoperative study and neoadjuvant treatment, surgical procedure, pathological study, postoperative outcomes, and follow-up. Seventeen hospitals belonging to the public network participated in this registry. RESULTS Data from 591 patients were analyzed. Postoperative major morbidity occurred in 154 (26.1%) patients. Overall 30-day or in-hospital mortality, and 90-day postoperative mortality rates were 8.6% and 10.1% respectively. Failure-to-rescue was 39% and it was significantly higher in patients aged 75 years or older in comparison with younger patients (55.3% vs 23.1% p < 0.001). In the multivariable analysis, age ≥ 75 years (p = 0.029), laparoscopic approach (p = 0.005), and total gastrectomy (p = 0.005) were associated with major postoperative morbidity. Age ≥ 75 years (p = 0.027), pulmonary complications (p = 0.001), cardiac complications (p = 0.001), leakage (p = 0.003), and hemorrhage (p = 0.013) were associated with postoperative mortality. CONCLUSIONS Centralization of gastric adenocarcinoma treatment in centers with higher annual caseload should be considered to improve the short-term postoperative outcomes in low-volume centers. Patients aged 75 or older had a significantly increased risk of major postoperative morbidity and mortality, and higher failure-to-rescue.
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Affiliation(s)
| | - Javier Escrig-Sos
- Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | | | | | - Fernando Mingol
- Hospital Universitario y Politécnico La Fe de Valencia, Valencia, Spain
| | - Miguel Oviedo
- Hospital General Universitario de Valencia, Valencia, Spain
| | - Nuria Peris
- Hospital Universitario Doctor Peset de Valencia, Valencia, Spain
| | - Joaquin Civera
- Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - Amparo Roig
- Hospital Lluis Alcanyis de Xativa, Valencia, Spain
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Abdominal subcutaneous obesity and the risk of burst abdomen: a matched case-control study. Langenbecks Arch Surg 2022; 407:3719-3726. [PMID: 36125516 DOI: 10.1007/s00423-022-02682-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/12/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The causes of burst abdomen after midline laparotomy remain uncertain. Obesity is a suspected risk factor. The purpose of this study was to investigate the association between abdominal subcutaneous obesity (ASO) and burst abdomen in patients undergoing emergency midline laparotomy. METHODS We conducted a single-centre, retrospective, matched case-control study of patients undergoing emergency midline laparotomy from May 2016 to August 2021. Patients suffering from burst abdomen were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. ASO was defined as the highest sex-specific quartile (≥ 75%) of subcutaneous fat layer evaluated on CT. The primary outcome was the association between ASO and burst abdomen, stratified between cases and controls. Secondary outcomes included 30- and 90-day mortality, length of stay, and suspected risk factors of burst abdomen, assessed by multivariate analysis across cases and controls. RESULTS A total of 475 patients were included in this study, with 95 cases matched to 380 controls. Liver cirrhosis, active smoking, and high alcohol consumption were more common among cases in an unadjusted analysis. Liver cirrhosis (odds ratio (OR) 3.32, p = 0.045) and active smoking (OR 1.98, p = 0.009) remained significant in a multivariate analysis and were associated with burst abdomen. One hundred twenty-four patients had ASO. ASO was not significantly associated with burst abdomen (OR 1.11, p = 0.731). CONCLUSION ASO was not found to be associated with an increased risk of burst abdomen after emergency midline laparotomy.
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Zheng X, Ding S, Wu M, Sun C, Wu Y, Wang S, Du Y, Yang L, Xue L, Wang B, Wang C, Cui W, Xie Y. Dynamic monitoring revealed a slightly prolonged waiting time for total gastrectomy during the COVID-19 pandemic without increasing the short-term complications. Front Oncol 2022; 12:944602. [PMID: 36119493 PMCID: PMC9471957 DOI: 10.3389/fonc.2022.944602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/17/2022] [Indexed: 01/08/2023] Open
Abstract
We aimed to determine the pattern of delay and its effect on the short-term outcomes of total gastrectomy before and during the coronavirus disease 2019 (COVID-19) pandemic. Overlaid line graphs were used to visualize the dynamic changes in the severity of the pandemic, number of gastric cancer patients, and waiting time for a total gastrectomy. We observed a slightly longer waiting time during the pandemic (median: 28.00 days, interquartile range: 22.00–34.75) than before the pandemic (median: 25.00 days, interquartile range: 18.00–34.00; p = 0.0071). Moreover, we study the effect of delayed surgery (waiting time > 30 days) on short-term outcomes using postoperative complications, extreme value of laboratory results, and postoperative stay. In patients who had longer waiting times, we did not observe worse short-term complication rates (grade II–IV: 15% vs. 19%, p = 0.27; grade III–IV: 7.3% vs. 9.2%, p = 0.51, the short waiting group vs. the prolonged waiting group) or a higher risk of a longer POD (univariable: OR 1.09, 95% CI 0.80–1.49, p = 0.59; multivariable: OR 1.10, 95% CI 0.78–1.55, p = 0.59). Patients in the short waiting group, rather than in the delayed surgery group, had an increased risk of bleeding in analyses of laboratory results (plasma prothrombin activity, hemoglobin, and hematocrit). A slightly prolonged preoperative waiting time during COVID-19 pandemic might not influence the short-term outcomes of patients who underwent total gastrectomy.
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Affiliation(s)
- Xiaohao Zheng
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shikang Ding
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Wu
- Department of Gastrointestinal Surgery, Yun Cheng Center Hospital, Yuncheng, China
| | - Chunyang Sun
- Department of General Surgery, The Central Hospital of Jia Mu Si City, Jiamusi, China
| | - Yunzi Wu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shenghui Wang
- Department of General Surgery, Civil Aviation General Hospital, Beijing, China
| | - Yongxing Du
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
| | - Wei Cui
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
| | - Yibin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China
- *Correspondence: Chengfeng Wang, ; Wei Cui, ; Yibin Xie,
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Bian L, Wu D, Chen Y, Ni J, Qu H, Li Z, Chen X. Associations of radiological features of adipose tissues with postoperative complications and overall survival of gastric cancer patients. Eur Radiol 2022; 32:8569-8578. [PMID: 35704109 DOI: 10.1007/s00330-022-08918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To evaluate the associations of the radiological features of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) with the postoperative complications and overall survival (OS) of patients undergoing laparoscopic radical gastrectomy for gastric cancer. METHODS One hundred forty-two patients underwent laparoscopic radical gastrectomy for gastric cancer from February 2013 to May 2016. The radiological features of SAT and VAT were studied by preoperative computed tomography, and the relationships between the parameters of adipose tissues and the intraoperative and postoperative conditions and OS rate of patients were evaluated. RESULTS A positive linear correlation was found between VAT area and operation duration, and a negative linear correlation was found between VAT density and intraoperative blood loss (p < 0.05 in both). VAT area was an independent risk factor for postoperative complications. VAT area and VAT density were independent risk factors for OS in gastric cancer. CONCLUSIONS A high VAT area was an independent risk factor for postoperative complications of gastric cancer, whereas a low VAT area and high VAT density were independent risk factors for poor prognosis in terms of OS in gastric cancer. KEY POINTS • A large visceral adipose tissue (VAT) area is an unfavourable factor affecting the outcomes of radical gastrectomy for gastric cancer. • Low VAT density may be more likely to cause intraoperative bleeding. • VAT area and VAT density were independent risk factors for the OS of patients with gastric cancer.
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Affiliation(s)
- Linjie Bian
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Danping Wu
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Yigang Chen
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Jianming Ni
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - Huiheng Qu
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Zhen Li
- Information Section, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xulei Chen
- Department of Pathology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
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Jensen TK, Nielsen YW, Gögenur I, Tolstrup MB. "Sarcopenia is associated with increased risk of burst abdomen after emergency midline laparotomy: a matched case-control study". Eur J Trauma Emerg Surg 2022; 48:4189-4196. [PMID: 35353215 DOI: 10.1007/s00068-022-01958-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Burst abdomen is a serious complication commonly observed after emergency midline laparotomy. Sarcopenia has been associated with increased morbidity and mortality after abdominal surgery. This single-center, retrospective, matched case-control study aimed to investigate the association between sarcopenia and burst abdomen in patients undergoing emergency midline laparotomy. METHODS Patients who had burst abdomen after emergency midline laparotomy were matched 1:4 with controls based on age and sex. Abdominal wall closure was standardized in the study period with the small bites, small stitches technique. CT assessed psoas cross-sectional area was used as a surrogate measure of sarcopenia. Sarcopenia was defined as the sex-specific lowest quartile of psoas cross-sectional area adjusted for body surface area. The primary outcome was the incidence rate of sarcopenia amongst cases and controls. Secondary outcomes were risk factors for burst abdomen and death that were identified using multivariate logistic regression analysis. RESULTS 67 cases were matched to 268 controls during May 2016-December 2019. BMI > 30 kg/m2, liver cirrhosis, smoking, high ASA score and peritonitis were more frequently observed among cases. Multivariate analysis revealed that sarcopenia (odds ratio (OR) 2.3, p = 0.01), active smoking (OR 2.3, p = 0.006) and liver cirrhosis (OR 3.7, p = 0.042) were significantly associated with burst abdomen. ASA score ≥ 3 (OR 5.5, p = 0.001) and ongoing malignant disease (OR 3.2, p = 0.001) were significantly associated with increased 90-day mortality. CONCLUSION Sarcopenia is associated with increased risk of burst abdomen after midline laparotomy. Prospective trials are needed.
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Affiliation(s)
- Thomas Korgaard Jensen
- Surgical Section, Department of Gastrointestinal- and Hepatic Diseases, Copenhagen University Hospital Herlev, 2730, Herlev, Denmark.
| | | | - Ismail Gögenur
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Copenhagen University Hospital, 4600, Koege, Denmark
| | - Mai-Britt Tolstrup
- Department of Surgery, North-Zealand University Hospital, 3400, Hilleroed, Denmark
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Carboni F, Valle M. Letter to Editor of Annals of Surgical Oncology Concerning "Early Diagnosis of Anastomotic Leakage after Gastric Cancer Surgery via Analysis of Inflammatory Factors in Abdominal Drainage". Ann Surg Oncol 2022; 29:5107-5108. [PMID: 35296976 DOI: 10.1245/s10434-022-11612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Fabio Carboni
- IRCCS, Regina Elena National Cancer Institute, Peritoneal Neoplasms Unit, Rome, Italy.
| | - Mario Valle
- IRCCS, Regina Elena National Cancer Institute, Peritoneal Neoplasms Unit, Rome, Italy
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Inflection-Point Nutrition Support Determined by Oral Mucosal Apoptosis Rate Is a Novel Assessment Strategy for Personalized Nutrition: A Prospective Cohort Study. J Pers Med 2022; 12:jpm12030358. [PMID: 35330358 PMCID: PMC8948995 DOI: 10.3390/jpm12030358] [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: 01/10/2022] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Energy intake and nutritional status influences a patient’s recovery from major abdominal surgery. The aim of this study is to explore and validate the clinical feasibility of an inflection-point nutrition strategy for personalized nutrition in gastric cancer patients after surgery. Methods: We conducted a prospective cohort study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. We collected the demographic and clinic pathological characteristics of included patients. Patients were divided into a formular nutrition (FN) and inflection-point nutrition (IPN) group. We monitored the perioperative dynamics of the oral mucosal epithelia cell apoptosis rate. Predictive factors for inflection phenomenon were investigated in univariate and multivariate analysis. Results: A total of 53 gastric cancer patients were included. A total of 30 (56.6%) patients showed the inflection phenomenon, with 9 (34.6%) patients in the FN group and 21 (77.8%) patients in the IPN group, respectively. We found that patients with the inflection phenomenon had a shorter duration of hospital stay compared to patients without the inflection phenomenon (p = 0.04). In multivariate analysis, independent predictive factors for inflection phenomenon were age (p = 0.015), operation time ≤ 300 min (p = 0.012), and average energy intake ≥ 25 Kcal/kg/day (p = 0.038). Conclusions: Our findings for the first time revealed that the oral epithelial cell apoptosis rate can promptly reflect the patients’ perioperative nutrition needs. Meanwhile, we developing a novel and feasible nutrition therapy guided by the oral epithelial cell apoptosis rate is novel in gastric cancer patients that have undergone laparoscopic gastrectomy.
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How to Select Patients Affected by Neuroendocrine Neoplasms for Surgery. Curr Oncol Rep 2022; 24:227-239. [DOI: 10.1007/s11912-022-01200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 11/03/2022]
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Dan Zeng CD, Tong YX, Xiao AT, Gao C, Zhang S. Peripheral Lymphocyte Subsets Absolute Counts as Feasible Clinical Markers for Predicting Surgical Outcome in Gastric Cancer Patients After Laparoscopic D2 Gastrectomy: A Prospective Cohort Study. J Inflamm Res 2021; 14:5633-5646. [PMID: 34744447 PMCID: PMC8565983 DOI: 10.2147/jir.s335847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/15/2021] [Indexed: 12/14/2022] Open
Abstract
Background Immune function influenced patients’ recovery from major abdominal surgery. The aim of this study is to explore the clinical feasibility of peripheral lymphocyte absolute counts for predicting short-term surgical outcomes in gastric cancer patients after laparoscopic D2 gastrectomy. Methods This is a prospective cohort study from a single tertiary referral hospital. Patients diagnosed with gastric cancer who met the inclusion criteria were included in this study. We collected the demographic and clinicopathological characteristics of included patients. We monitored perioperative dynamics of absolute counts of peripheral lymphocyte subsets. Predictive factors for length of postoperative hospital stay and complications were investigated in univariate and multivariate analyses. Results A total of 137 gastric cancer patients were included. Decreased preoperative absolute counts of peripheral lymphocyte subsets were correlated with advanced clinical stage. In multivariate analysis, independent predictive factors for prolonged hospital stay were age (p=0.04), decreased preoperative B cell counts (p=0.05), decreased preoperative NK cell counts (p=0.05) and complications (p<0.01). For postoperative complication, independent predictive factors were age (p=0.02), operation time (p=0.05), lymphocyte to C-reactive protein ratio (p=0.01) and decreased preoperative B cell counts (p=0.01). Conclusion Our findings for the first time revealed that absolute counts of peripheral lymphocyte subsets are independent predictive factors for surgical outcomes in gastric cancer patients after D2 gastrectomy. We suggested that patients with impaired immune state should receive both preoperative immune modulator and nutritional support.
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Affiliation(s)
- Ci Dian Dan Zeng
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yi Xin Tong
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ai Tang Xiao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chun Gao
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Sheng Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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High rate of incisional hernia observed after mass closure of burst abdomen. Hernia 2021; 26:1267-1274. [PMID: 34674087 DOI: 10.1007/s10029-021-02523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study investigated the long-term development of incisional hernia after implementation of a standardized surgical treatment strategy for burst abdomen in abdominal midline incisions with a continuous mass closure technique. METHODS The study was a single-center, observational study evaluating all patients treated for burst abdomen between June 2014 and April 2019 with a long-term follow-up in October 2020. In June 2014, a standardized surgical treatment for burst abdomen involving a monofilament, slowly absorbable suture in a continuous mass-closure stitch with large bites of 3 cm and small steps of 5 mm was introduced. The occurrence of incisional hernia was investigated and defined as a radiological-, clinical-, or intraoperative finding of a hernia in the abdominal midline incision at follow-up. RESULTS Ninety-four patients suffered from burst abdomen during the study period. Eighty patients were eligible for follow-up. The index surgery prior to burst abdomen was an emergency laparotomy in 78% (62/80) of the patients. Nineteen patients died within the first 30 postoperative days and 61 patients were available for further analysis. The long-term incisional hernia rate was 33% (20/61) with a median follow-up of 17 months (min 4, max 67 months). CONCLUSION Standardized surgery for burst abdomen with a mass-closure technique using slow absorbable running suture results in high rates of long-term incisional hernias, comparable to the hernia rates reported in the literature among this group of patients.
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Zhong Q, Chen QY, Huang XB, Lin GT, Liu ZY, Chen JY, Wang HG, Weng K, Li P, Xie JW, Lin JX, Lu J, Lin M, Huang ZN, Zheng CH, Huang CM. Clinical implications of Indocyanine Green Fluorescence Imaging-Guided laparoscopic lymphadenectomy for patients with gastric cancer: A cohort study from two randomized, controlled trials using individual patient data. Int J Surg 2021; 94:106120. [PMID: 34543741 DOI: 10.1016/j.ijsu.2021.106120] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The value of indocyanine green (ICG) fluorescence imaging in tracing metastatic lymph nodes (LNs) has rarely been reported. We aimed to evaluate the clinical implications of fluorescence imaging-guided lymphadenectomy and the sensitivity of fluorescent lymphography to detect metastatic LN stations in gastric cancer (GC). MATERIALS AND METHODS This analysis pooled data from two randomized controlled trials (FUGES-012 and FUGES-019 studies) on laparoscopic ICG tracer-guided lymphadenectomy for GC between November 2018 and October 2020. Patients who received ICG injection using either the intraoperative subserosal or preoperative submucosal approaches 1 day before surgery and underwent fluorescence imaging-guided lymphadenectomy were defined as the ICG group. Patients who underwent conventional lymphadenectomy without ICG injection and intraoperative imaging were defined as the non-ICG group. RESULTS Among 514 enrolled patients, the ICG and non-ICG groups included 385 and 129, respectively. A significantly higher mean number of LNs was retrieved in the ICG group than in the non-ICG group (49.9 vs. 42.0, P < 0.001). The ICG group showed a lower LN noncompliance rate than that in the non-ICG group (31.9% vs. 57.4%, P < 0.001). The sensitivity of fluorescence imaging for detecting all metastatic LN stations was 86.8%. The negative predictive value was 92.2% for nonfluorescent stations. For detecting all metastatic stations, subgroup analysis revealed 97.7%, 91.7%, 86.2%, and 84.3% sensitivities for pT1, pT2, pT3, and pT4a tumors, respectively. Regardless of gastrectomy type, the diagnostic accuracy for detecting all metastatic stations in the D1+ and D2 stations for cT1-cT2 disease reached 100%. CONCLUSION ICG fluorescence imaging, using either the subserosal or submucosal approaches, assisted in the thorough dissection of potentially metastatic LNs, as recommended for individualized laparoscopic lymphadenectomy for GC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China Key Laboratory of Gastrointestinal Cancer (Fujian Medical University), Ministry of Education, Fuzhou, China Fujian Key Laboratory of Tumor Microbiology, Department of Medical Microbiology, Fujian Medical University, Fuzhou, China
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Sędłak K, Rawicz-Pruszyński K, Mlak R, Gęca K, Skórzewska M, Pelc Z, Małecka-Massalska T, Polkowski WP. Union is strength: Textbook outcome with perioperative chemotherapy compliance decreases the risk of death in advanced gastric cancer patients. Eur J Surg Oncol 2021; 48:356-361. [PMID: 34404560 DOI: 10.1016/j.ejso.2021.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Perioperative chemotherapy (POC) in advanced gastric cancer (GC) patients significantly increases the curative resection rate and overall survival (OS). Textbook outcome (TO) represents a composite of surgical quality metrics strongly associated with improved OS. However, the current definition of TO after resection for GC does not include POC. Herein we propose to supplement the current description of TO with an additional feature, POC compliance. The present study aimed to evaluate prognostic impact of thus defined textbook oncological outcome (TOO) among patients undergoing gastrectomy for advanced GC. PATIENTS AND METHODS We collected data from a prospectively maintained database of all patients operated for GC between 2010 and 2020 in our institution. Patients with histologically confirmed and resectable advanced GC but without distant metastases, in whom multimodal treatment was planned by institutional MDT were included. RESULTS A total of 194 patients were analyzed. In the multivariate analysis, patients with TOO had a 50 % lower risk of death than patients without TOO (medians: NR vs 42 months; HR = 0.50, p = 0.0109). Patients treated with POC had a 43 % lower risk of death than patients treated with only preoperative chemotherapy (medians: 78 vs 33 months; HR = 0.57, p = 0.0450). Patients with a pathological response (PR) in the primary tumor had a 59 % lower risk of death than patients without PR (medians: NR vs 36 months; HR = 0.41, p = 0.0229). POC combined with TO surgery significantly decreased the risk of death in advanced GC patients (medians: NR vs 42 months; HR = 0.35, p = 0.0258). CONCLUSION Since TOO is associated with improved survival, it may serve as a multimodal treatment quality parameter in patients with advanced GC.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Karol Rawicz-Pruszyński
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland.
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080, Lublin, Poland
| | - Katarzyna Gęca
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Magdalena Skórzewska
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Zuzanna Pelc
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
| | - Teresa Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11 St., 20-080, Lublin, Poland
| | - Wojciech P Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Radziwiłłowska 13 St., 20-080, Lublin, Poland
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FLOT-regimen Chemotherapy and Transthoracic en bloc Resection for Esophageal and Junctional Adenocarcinoma. Ann Surg 2021; 274:814-820. [PMID: 34310355 DOI: 10.1097/sla.0000000000005097] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS The FLOT4-AIO trial established the FLOT regimen (Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel) as a compelling option for gastric, junctional and esophageal adenocarcinoma. Data on FLOT with en-bloc transthoracic esophagectomy (TTE) are limited. This study explored operative complications, tolerance, toxicity, physiological impact, and oncologic outcomes. STUDY DESIGN An observational cohort study on consecutive patients at 3 tertiary centers undergoing FLOT and TTE. Toxicity, operative complications (per ECCG definitions), tumor regression grade (TRG), recurrences and survival were documented, as well as pre- and post FLOT assessment of sarcopenia and pulmonary physiology. RESULTS 175 patients (cT2-4a, Nany) commenced treatment, 84% male, median age 65, 94% cT3/T4a, 73% cN+. 89% completed 4 preoperative cycles, and 35% all cycles. Grade 3/4 toxicities included neutropenia (12%), diarrhoea (13%), and infection (15%). Sarcopenia increased from 18% to 37% (p = 0.020), and diffusion capacity (DLCO) decreased by 8% (-34%+25%; p < 0.010). On pathology, ypT3/4 was 59%, and ypN+54%, with 10% TRG 1, 14% TRG 2, and 76% TRG3-5, and R0 95%. 161 underwent TTE, with an in-hospital mortality of 0.6%, 24%-pneumonia, 11%-anastomotic leak, and Clavien Dindo ≥III in 27%. At a median follow up of 12 months (1-85), 33 relapsed, 8 (5%) locally, and 3yr survival was 60%. CONCLUSION FLOT and en bloc TTE was safe, with no discernible impact on operative complications, with 24% having a major pathologic response. Caveats include a limited pathologic response in the majority, and negative impact on muscle mass and lung physiology, and low use of adjuvant cycles. These data may provide a real-world benchmark for this complex care pathway.
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Hallit R, Calmels M, Chaput U, Lorenzo D, Becq A, Camus M, Dray X, Gonzalez JM, Barthet M, Jacques J, Barrioz T, Legros R, Belle A, Chaussade S, Coriat R, Cattan P, Prat F, Goere D, Barret M. Endoscopic management of anastomotic leak after esophageal or gastric resection for malignancy: a multicenter experience. Therap Adv Gastroenterol 2021; 14:17562848211032823. [PMID: 35154387 PMCID: PMC8832292 DOI: 10.1177/17562848211032823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/25/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. METHODS We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. RESULTS Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6-13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively (p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage (p = 0.002). CONCLUSION Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.
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Affiliation(s)
| | - Mélanie Calmels
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Ulriikka Chaput
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Diane Lorenzo
- Gastroenterology Department, Beaujon University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Aymeric Becq
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Marine Camus
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP,
Hôpital Saint-Antoine, Paris, France
| | - Jean Michel Gonzalez
- Gastroenterology Department, North Hospital,
Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille,
Marseille, France
| | - Marc Barthet
- Gastroenterology Department, North Hospital,
Assistance Publique – Hôpitaux de Marseille and University of Aix-Marseille,
Marseille, France
| | - Jérémie Jacques
- Gastroenterology Department, Limoges
University Hospital, and University Limoges, Limoges, France
| | - Thierry Barrioz
- Gastroenterology Department, Poitiers
University Hospital, Poitiers, France
| | - Romain Legros
- Gastroenterology Department, Limoges
University Hospital, and University Limoges, Limoges, France
| | - Arthur Belle
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Pierre Cattan
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
| | - Diane Goere
- Digestive Surgery Department, St Louis
University Hospital, Assistance Publique Hôpitaux de Paris and University of
Paris, Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin University
Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris,
Paris, France
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Carboni F, Valle M. Letter to Roh CK et al. 'Incidence and treatment outcomes of leakage after gastrectomy for gastric cancer: Experience of 14,075 patients from a large volume centre'. Eur J Surg Oncol 2021; 47:2468-2469. [PMID: 34112561 DOI: 10.1016/j.ejso.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Fabio Carboni
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
| | - Mario Valle
- Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy
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Challine A, Voron T, Dousset B, Creavin B, Katsahian S, Parc Y, Lazzati A, Lefèvre JH. Postoperative outcomes after laparoscopic or open gastrectomy. A national cohort study of 10,343 patients. Eur J Surg Oncol 2021; 47:1985-1995. [PMID: 34078568 DOI: 10.1016/j.ejso.2021.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/15/2021] [Accepted: 05/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Laparoscopy for gastric cancer has not been as popular compared with other digestive surgeries, with conflicting reports on outcomes. The aim of this study focuses on the surgical techniques comparing open and laparoscopy by assessing the morbi-mortality and long-term complications after gastrectomy. METHODS A retrospective study (2013-2018) was performed on a prospective national cohort (PMSI). All patients undergoing resection for gastric cancer with a partial gastrectomy (PG) or total gastrectomy (TG) were included. Overall morbidity at 90 post-operative days and long-term results were the main outcomes. The groups (open and laparoscopy) were compared using a propensity score and volume activity matching after stratification on resection type (TG or PG). RESULTS A total of 10,343 patients were included. The overall 90-day mortality and morbidity were 7% and 45%, with reintervention required in 9.1%. High centre volume was associated with improved outcomes. There was no difference in population characteristics between groups after matching. An overall benefit for a laparoscopic approach after PG was found for morbidity (Open = 39.4% vs. Laparoscopy = 32.6%, p = 0.01), length of stay (Open = 14[10-21] vs. Laparoscopy = 11[8-17] days, p<0.0001). For TG, increased reintervention rate (Open = 10.8% vs. Laparoscopy = 14.5%, p = 0.04) and increased oesophageal stricture rate (HR = 2.54[1.67-3.85], p<0.001) were encountered after a laparoscopic approach. No benefit on mortality was found for laparoscopic approach in both type of resections after adjusted analysis. CONCLUSIONS Laparoscopy is feasible for PG with a substantial benefit on morbidity and length of stay, however, laparoscopic TG should be performed with caution, with of higher rates of reintervention and oesophageal stricture.
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Affiliation(s)
- Alexandre Challine
- Department of Digestive Surgery, APHP, Hôpital Cochin, Paris, France; Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France
| | - Thibault Voron
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France
| | - Bertrand Dousset
- Department of Digestive Surgery, APHP, Hôpital Cochin, Paris, France; Université de Paris, France
| | - Ben Creavin
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Sandrine Katsahian
- Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France; Department of Biostatics, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Yann Parc
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France
| | - Andrea Lazzati
- Université de Paris, France; INSERM UMR 1138 Team 22, Centre de Recherche des Cordeliers, France; Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Jérémie H Lefèvre
- Department of Digestive Surgery, AP-HP, Hôpital, Saint Antoine, F-75012, Paris, France; Sorbonne Université, France.
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Weindelmayer J, Mengardo V, Veltri A, Baiocchi GL, Giacopuzzi S, Verlato G, de Manzoni G. Utility of Abdominal Drain in Gastrectomy (ADiGe) Trial: study protocol for a multicenter non-inferiority randomized trial. Trials 2021; 22:152. [PMID: 33596959 PMCID: PMC7891135 DOI: 10.1186/s13063-021-05102-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prophylactic use of abdominal drain in gastrectomy has been questioned in the last 15 years, and a 2015 Cochrane meta-analysis on four RCTs concluded that there was no convincing evidence to the routine drain placement in gastrectomy. Nevertheless, the authors evidenced the moderate/low quality of the included studies and highlighted how 3 out of 4 came from Eastern countries. After 2015, only retrospective studies have been published, all with inconsistent results. METHODS ADiGe (Abdominal Drain in Gastrectomy) Trial is a multicenter prospective randomized non-inferiority trial with a parallel design. It aimed to verify whether avoiding routine use of abdominal drain is burdened with complications, particularly an increase in postoperative invasive procedures. Patients with gastric cancer, scheduled for subtotal or total gastrectomy with curative intent, are eligible for inclusion, irrespective of previous oncological treatment. The primary composite endpoint is reoperation or percutaneous drainage procedures within 30 postoperative days. The primary analysis will verify whether the incidence of the primary composite endpoint is higher in the experimental arm, avoiding routine drain placement, than control arm, undergoing prophylactic drain placement, in order to falsify or support the null hypothesis of inferiority. Secondary endpoints assessed for superiority are overall morbidity and mortality, Comprehensive Complications Index, incidence and time for diagnosis of anastomotic and duodenal leaks, length of hospital stay, and readmission rate. Assuming one-sided alpha of 5%, and cumulative incidence of the primary composite endpoint of 6.4% in the control arm and 4.2% in the experimental one, 364 patients allow to achieve 80% power to detect a non-inferiority margin difference between the arm proportions of 3.6%. Considering a 10% drop-out rate, 404 patients are needed. In order to have a balanced percentage between total and subtotal gastrectomy, recruitment will end at 202 patients for each type of gastrectomy. The surgeon and the patient are blinded until the end of the operation, while postoperative course is not blinded to the patient and caregivers. DISCUSSION ADiGe Trial could contribute to critically re-evaluate the role of prophylactic drain in gastrectomy, a still widely used procedure. TRIAL REGISTRATION Prospectively registered (last updated on 29 October 2020) at ClinicalTrials.gov with the identifier NCT04227951 .
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Affiliation(s)
- J Weindelmayer
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, Borgo Trento, 37126, Verona, Italy
| | - V Mengardo
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, Borgo Trento, 37126, Verona, Italy.
| | - A Veltri
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, Borgo Trento, 37126, Verona, Italy
| | - G L Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - S Giacopuzzi
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, Borgo Trento, 37126, Verona, Italy
| | - G Verlato
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - G de Manzoni
- General and Upper G.I. Surgery Division, Azienda Ospedaliera Universitaria Integrata, Piazzale Aristide Stefani 1, Borgo Trento, 37126, Verona, Italy
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Better Safe than Sorry: Prevention of Esophagojejunostomy Leak by Intraoperative Methylene Blue Test in Advanced Gastric Cancer. J Gastrointest Surg 2021; 25:2401-2403. [PMID: 33559098 PMCID: PMC8484250 DOI: 10.1007/s11605-021-04921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
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