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Stibbard A, Brown M, Pons R, Ward J, Page N, Stefoska-Needham A. Factors affecting dietary progression post cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Clin Nutr ESPEN 2024; 63:520-529. [PMID: 38972376 DOI: 10.1016/j.clnesp.2024.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/09/2024] [Accepted: 06/30/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND & AIMS Peritoneal carcinomatosis (PC) is treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Timely postoperative nutrition is required to reduce the risk of malnutrition and other complications; thus the present study aims to evaluate factors that may impact dietary progression following CRS/HIPEC treatment. METHODS Forty-two patients undergoing CRS/HIPEC at a tertiary hospital were audited between April 2019 and August 2020. Patients were classified into two groups: fast dietary progression (FDP) and slow dietary progression (SDP), based on commencement of a full fluid diet (FF) within 7 days or after 7 days postoperatively. Between-group differences in patient characteristics, surgical factors and postoperative complications were evaluated statistically (significant at p < 0.05). RESULTS FDP and SDP groups comprised of 22 (52%) and 20 (40%) patients, respectively. A FF diet was established on a median of 7 (4.25-9.75) days, but not before day 2. Nineteen of the 31 (61.3%) patients receiving parenteral nutrition (PN) were in the SDP group (p = 0.009). The SDP group had longer surgery duration (p = 0.05), more gastrointestinal anastomoses (GIAs) (p = 0.02), more enterotomies (p = 0.008), higher rates of prolonged ileus (p = 0.007), longer duration to first bowel motion (p = 0.002), more returns to theatre (p = 0.03), higher Clavien Dindo scores ≥ IIIb (p = 0.01) and longer postoperative length-of-stay (p = 0.001), compared to the FDP group. CONCLUSIONS Postoperative complications were associated with SDP in PC patients undergoing CRS/HIPEC. Strategies that aim to limit SDP through timely commencement of nutrition, including PN, are important to improve postoperative outcomes in this patient group.
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Affiliation(s)
- Allysha Stibbard
- St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia; School of Medicine, Smart Foods Centre, Illawarra Health and Medical Research Institute, University of Wollongong, Building 32, Northfields Ave, Keiraville, NSW, 2500, Australia.
| | - Morgan Brown
- St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia
| | - Rachel Pons
- St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia
| | - Jessica Ward
- School of Medicine, Smart Foods Centre, Illawarra Health and Medical Research Institute, University of Wollongong, Building 32, Northfields Ave, Keiraville, NSW, 2500, Australia
| | - Naomi Page
- St George Hospital, Department of Nutrition and Dietetics, Level 2, Pritchard Wing, Kogarah, NSW, 2217, Australia
| | - Anita Stefoska-Needham
- School of Medicine, Smart Foods Centre, Illawarra Health and Medical Research Institute, University of Wollongong, Building 32, Northfields Ave, Keiraville, NSW, 2500, Australia
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Deftereos I, Yeung JMC, Arslan J, Carter VM, Isenring E, Kiss N, Cardamis A, Dorey A, Ottaway A, Maguire B, Cleeve B, Davis C, Zoanetti C, Gray C, Choong C, Douglas C, Nixon C, Platt D, Quinn E, Simpson E, Hamdorf E, McNamara E, Whelan E, Jegendran G, Moore G, Lockwood G, McNamara J, Corrigan J, Haaksma K, Fox K, Furness K, Cochrane KW, Huynh K, Lee KC, Hames N, Hendricks N, Page N, Brooks N, Nevin L, Parfrey L, Putrus E, Pons R, Hoevenaars R, Singh S, McCoy S, Wallin S, Mexias S, Daniells S, Storr T, Robertson T, Brown T. Adherence to ESPEN guidelines and associations with postoperative outcomes in upper gastrointestinal cancer resection: results from the multi-centre NOURISH point prevalence study. Clin Nutr ESPEN 2022; 47:391-398. [DOI: 10.1016/j.clnesp.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/23/2022]
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A WeChat-Based Mobile Platform for Perioperative Health Education for Gastrointestinal Surgery. Emerg Med Int 2021; 2021:6566981. [PMID: 34868685 PMCID: PMC8639266 DOI: 10.1155/2021/6566981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Appropriately instructing and guiding patients before and after surgery is essential for their successful recovery. In recent years, however, the development of the enhanced recovery after surgery (ERAS) protocol has restricted the opportunity for healthcare professionals to spend time with their patients before and after surgery because of efficiency-driven, shortened hospital stay. Here, we embedded health education information of the perioperative period for gastrointestinal surgery on a WeChat-based mobile platform and evaluated the platform through medical staff evaluation, patient volunteer evaluation, and quantitative grading rubric. Clinicians and nurses believed that the mobile platform was attractively designed and easy to navigate, valuable, and adequate for patient health education. The content of health education was embedded into the WeChat-based mobile platform, thereby allowing patients and caregivers to access information at their own pace and enable repeat reading.
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Mandl LA, Sasaki M, Yang J, Choi S, Cummings K, Goodman SM. Incidence and Risk of Severe Ileus After Orthopedic Surgery: A Case-Control Study. HSS J 2020; 16:272-279. [PMID: 33376458 PMCID: PMC7749875 DOI: 10.1007/s11420-019-09712-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-operative ileus (POI) is common and can be associated with significant morbidity. QUESTIONS/PURPOSES We aimed to identify the incidence of and risk factors associated with severe post-operative ileus (SPOI) after elective orthopedic surgery. METHODS We conducted a retrospective case-control study of patients undergoing elective orthopedic procedures at a single musculoskeletal specialty hospital. SPOI cases matched 1:2 to non-POI controls. International Classification of Diseases, Ninth Revision (ICD-9), codes were used to identify patients who were coded as having an episode of POI. After chart review, a subset was classified as clinical SPOI cases, based on set criteria. Regression models were constructed to identify variables associated with SPOI. RESULTS Of 273 POI cases, 77 (28.2%) were classified as SPOI. Overall rates of SPOI were 2.74/1000 orthopedic discharges, with SPOI most common in spine surgeries (9.07/1000 spine procedure discharges). Hypothesis-generating multivariable conditional logistic regression suggested that, for hip and knee cases, not being on a full diet by post-operative day (POD) 2 posed an increased risk of SPOI. For spine cases, not being on a full diet on POD 2 and longer surgery times were associated with risk of SPOI. CONCLUSIONS In this retrospective case-control study, patients undergoing elective orthopedic procedures who had not progressed to full diet by POD 2 and spine patients with longer operative times were most at risk for SPOI. These data can be used clinically by peri-operative physicians to stratify patients according to risk.
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Affiliation(s)
- Lisa A. Mandl
- Department of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10021 USA
| | - Mayu Sasaki
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Jingyan Yang
- Department of Biostatistics and Epidemiology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Sara Choi
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Kelianne Cummings
- Quality Research Center, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
| | - Susan M. Goodman
- Department of Rheumatology, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA
- Weill Cornell Medicine, 525 E. 68th Street, New York, NY 10021 USA
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Delestre M, Berge P, Aubé C, Hamy A, Hamel JF, Paisant A, Venara A. Nasogastric tube after small bowel obstruction surgery could be avoided: a retrospective cohort study. Eur J Trauma Emerg Surg 2020; 48:39-45. [PMID: 33095278 DOI: 10.1007/s00068-020-01529-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/09/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The safety and feasibility of early removal of nasogastric tube (NGT) after small bowel obstruction (SBO) surgery have not yet been assessed. Such a practice could allow to implement enhanced recovery after surgery (ERAS) protocols after acute SBO surgery. The aims of this study were to assess the safety of early NGT removal by comparing the short-term outcomes of patients with postoperative NGTs and those with no postoperative NGT. METHODS All patients undergoing surgery for strangulation or adhesive SBO between January the 1st of 2014 and December the 31st of 2017 were retrospectively included. RESULTS Among the 123 included, NGT was removed immediately after the end of the procedure in 26 cases (21.1%) and 19 patients required NGT replacement (15.4%). In univariate analysis, early removal of NGT was significantly associated with a reduction of overall morbidity, severe morbidity and postoperative ileus occurrence. Multivariate analysis confirmed that NGT left in place was a risk factor for postoperative ileus [Odd Ratio (OR) 4.9, Confidence Interval (CI) 95% 1.3-19.2; p = 0.02], while it has no incidence on severe morbidity. CONCLUSIONS Early NGT removal after ASBO surgery seemed to be feasible, safe and efficient, at least in selected patients. This primary study represents the initial foundations for building the implementation of ERAS protocols after ASBO surgery.
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Affiliation(s)
- Maxime Delestre
- Department of Digestive and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- University of Medicine of Angers, Angers, France
| | - Pierre Berge
- University of Medicine of Angers, Angers, France
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Christophe Aubé
- University of Medicine of Angers, Angers, France
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- HIFIH, UPRES EA 3859, University of Angers, Angers, France
| | - Antoine Hamy
- Department of Digestive and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- University of Medicine of Angers, Angers, France
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Jean-François Hamel
- Department of Biostatistics, Maison de la Recherche, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
| | - Anita Paisant
- University of Medicine of Angers, Angers, France
- Department of Radiology, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France
- HIFIH, UPRES EA 3859, University of Angers, Angers, France
| | - Aurélien Venara
- Department of Digestive and Endocrinal Surgery, University Hospital of Angers, 4 rue Larrey, 49933, Angers Cedex 9, France.
- University of Medicine of Angers, Angers, France.
- HIFIH, UPRES EA 3859, University of Angers, Angers, France.
- UMR INSERM U1235, TENS, The Enteric Nervous System in Gut and Brain Disorders Institut Des Maladies de l'Appareil Digestif, 1, rue Gaston Veil, 44035, Nantes, France.
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The concept of peri-operative medicine to prevent major adverse events and improve outcome in surgical patients: A narrative review. Eur J Anaesthesiol 2020; 36:889-903. [PMID: 31453818 DOI: 10.1097/eja.0000000000001067] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Peri-operative Medicine is the patient-centred and value-based multidisciplinary peri-operative care of surgical patients. Peri-operative stress, that is the collective response to stimuli occurring before, during and after surgery, is, together with pre-existing comorbidities, the pathophysiological basis of major adverse events. The ultimate goal of Peri-operative Medicine is to promote high quality recovery after surgery. Clinical scores and/or biomarkers should be used to identify patients at high risk of developing major adverse events throughout the peri-operative period. Allocation of high-risk patients to specific care pathways with peri-operative organ protection, close surveillance and specific early interventions is likely to improve patient-relevant outcomes, such as disability, health-related quality of life and mortality.
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Narendra K, Kiss N, Margerison C, Johnston B, Chapman B. Impact of nutritional status/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study. J Hum Nutr Diet 2020; 33:587-597. [PMID: 32364298 DOI: 10.1111/jhn.12763] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malnutrition is prevalent in patients undergoing gastrointestinal (GI) surgery and has been linked to adverse outcomes. The present study aimed to determine the association between early post-operative nutritional status/risk, post-operative nutritional management and clinical outcomes. METHODS A prospective observational study was conducted in GI surgical patients with a minimum 3-day post-operative length of stay (LOS). Data on patient demographics, nutritional status/risk, post-operative nutritional management and clinical outcomes were collected. Four markers of nutritional status and risk were assessed: preoperative weight loss, nutrition risk, malnutrition status and hand grip strength. Clinical outcomes included: post-operative LOS, complication and readmissions rates. Multivariate linear and logistic regression were used to test for associations with clinical outcomes. RESULTS One hundred and fifteen patients (55% female) with mean (SD) age of 60.8 (16.2) years were included. Median (IQR) post-operative LOS was 8.0 days (4.5-11.5), 37% of participants developed at least one complication post-operatively and 24% were readmitted within 30-days of discharge. Mean number of nil-by mouth (NBM) days post-operatively was 0.7 (1.2) and the average time to commence feeding was 3.3 (2.2) days after surgery. Poor nutritional status/risk between days 3-5 post-operatively assessed through all four markers was associated with longer post-operative LOS (all P < 0.05). No association was found between number of NBM days, time to feeding and clinical outcomes. CONCLUSION Poor early post-operative nutritional status/risk is associated with longer post-operative LOS in patients undergoing GI surgery, which may facilitate simple identification of patients at high priority for nutritional intervention. The present study highlights the heterogeneity in post-operative nutritional management practices.
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Affiliation(s)
- K Narendra
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - N Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - C Margerison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - B Johnston
- Austin Health, Heidelberg, Victoria, Australia
| | - B Chapman
- Austin Health, Heidelberg, Victoria, Australia
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Kane TD, Tubog TD, Schmidt JR. The Use of Coffee to Decrease the Incidence of Postoperative Ileus: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2019; 35:171-177.e1. [PMID: 31859206 DOI: 10.1016/j.jopan.2019.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/10/2019] [Accepted: 07/21/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the efficacy of providing coffee to elective abdominal surgery patients, immediately postoperatively, to lessen postoperative ileus. DESIGN A systematic review with meta-analysis of six randomized controlled trials published since 2012. METHODS Methodological quality was evaluated using the Cochrane guidelines. The Grading of Recommendations, Assessment, Development, and Evaluations assessment tool evaluated the quality of the evidence. Subgroup analyses were completed if the I2 statistic demonstrated heterogeneity (greater than 50%). FINDINGS Coffee was statistically significant in shortening the time between surgery and the first passage of stool (mean difference, -9.38; 95% confidence interval, -17.60 to -1.16; P = .03). Although not statistically significant (P = .20), the overall effect favored shorter hospital stays for those patients receiving coffee. CONCLUSIONS The current systematic review and meta-analysis suggests that coffee given as early as 2 hours postoperatively decreases time to first bowel movement. In addition, patients tolerated solid food faster and were discharged sooner when given coffee immediately postoperatively.
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Affiliation(s)
- Terri D Kane
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX.
| | - Tito D Tubog
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
| | - James R Schmidt
- Graduate Programs of Nurse Anesthesia, Texas Wesleyan University, Fort Worth, TX
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Venara A, Bougard M, Mucci S, Lemoult A, Le Naoures P, Darsonval A, Barbieux J, Neunlist M, Hamy AP. Perioperative Transcutaneous Tibial Nerve Stimulation to Reduce Postoperative Ileus After Colorectal Resection: A Pilot Study. Dis Colon Rectum 2018; 61:1080-1088. [PMID: 30086057 DOI: 10.1097/dcr.0000000000001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative ileus involves an inflammatory pathway characterized by an increase of inflammation mediators in the colon wall; this could probably be prevented by sacral nerve neuromodulation. The posterior tibial nerve can be stimulated electrically to mimic neuromodulation. OBJECTIVE The aims of this study were to assess the efficacy of transcutaneous posterior tibial nerve stimulation in reducing the delay in GI motility recovery, to assess the safety of posterior tibial nerve stimulation in a perioperative setting, and to assess the efficacy of posterior tibial nerve stimulation in reducing the occurrence of postoperative ileus. DESIGN This was a preliminary randomized controlled study. SETTINGS This study was conducted in 1 academic hospital in France. PATIENTS Forty patients undergoing an elective colectomy were included and randomly assigned into 2 groups, posterior tibial nerve stimulation or placebo, according to the side of colectomy and the surgical access size. INTERVENTION Perioperative posterior tibial nerve stimulation or placebo was performed 3 times per day according to the randomly assigned group. MAIN OUTCOME MEASURES Delay in GI motility recovery (passage of stool and tolerance of solid food) was measured. RESULTS Of the 40 patients included, 34 were included in the final analysis, in which 2 patients in the placebo group were allocated the incorrect device. The 6 other patients were secondarily excluded because of protocol deviation. In the intention-to-treat analysis, the mean delay in GI motility recovery was 3.6 and 3.11 days (in the placebo and tibial nerve stimulation groups; p = 0.60). Occurrence of postoperative ileus was not significantly higher in the placebo group (35.3% vs 17.6%; p = 0.42). In the per-protocol analysis, we observed the same trends except for the occurrence of postoperative ileus, which was significantly higher in the placebo group (p = 0.045). Tolerance to posterior tibial nerve stimulation was good, and all of the patients completed the protocol. LIMITATIONS The amplitude of stimulation is set according to patient sensation, so some patients could have been aware of their group. In addition there were some inherent limitations because of the preliminary nature of the study and several deviations from the protocol. CONCLUSIONS Posterior tibial nerve stimulation was safe in a perioperative setting and had a potential effect on GI motility recovery. The results of this study will be useful for sample size calculations in a larger prospective randomized trial. See Video Abstract at http://links.lww.com/DCR/A708.
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Affiliation(s)
| | - Marie Bougard
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Stéphanie Mucci
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Annabelle Lemoult
- L'Université Nantes Angers Le Mans, University of Nantes, Nantes, France.,Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Paul Le Naoures
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Astrid Darsonval
- Department of Pharmacy, Centre Hospitalier Universitaire Angers, Angers, France
| | - Julien Barbieux
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
| | - Michel Neunlist
- Unité Mixte de Recherche Institut National de la Santé et de la Recherche Médicale U1235, University of Nantes, The Enteric Nervous System in Gut and Brain Disorders, Institut des Maladies de l'Appareil Digestif, Nantes, France.,L'Université Nantes Angers Le Mans, University of Nantes, Nantes, France
| | - Antoine P Hamy
- Department of Visceral and Endocrinal Surgery, Centre Hospitalier Universitaire d'Angers, Angers, France.,L'Université Nantes Angers Le Mans, University of Angers, Angers, France
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