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van der Burg SJ, Bleckman RF, van der Sluis PC, Hartgrink HH, Reyners AK, Bonenkamp JJ, van Sandick JW, Wouters MW, van Houdt WJ, Schrage YM. Improvement of perioperative outcomes of gastric gastrointestinal stromal tumour (GIST) resections and the influence of minimal invasive surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108479. [PMID: 38901292 DOI: 10.1016/j.ejso.2024.108479] [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: 04/08/2024] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Safety of minimally invasive surgery (MIS) for gastrointestinal stromal tumours (GISTs) is still under debate since it might increase the risk of tumour rupture, especially in larger tumours. The aim of this study was to investigate trends in treatment and perioperative outcomes of patients undergoing resections of gastric GISTs over time. METHODS This was a multicentre retrospective study of consecutive patients who underwent wedge resection or partial gastrectomy for localized gastric GIST at five GIST reference centres between January 2009 and January 2022. To evaluate changes in treatment and perioperative outcomes over time, patients were divided into four equal periods. Perioperative outcomes were analysed separately and as a novel composite measure textbook outcome (TO). RESULTS In total 385 patients were included. Patient and tumour characteristics did not change over time, except for median age (62-65-68-68 years, p = 0.002). The proportion of MIS increased (4.0%-9.8%-37.4%-53.0 %, p < 0.001). Postoperative complications (Clavien Dindo ≥2; 22%-15%-11%-10 %, p = 0.146), duration of admission (6-6-5-4 days, p < 0.001) and operating time (92-94-77-73 min, p = 0.007) decreased over time while TO increased (54.0%- 52.7%-65.9%-76.0 %, p < 0.001). No change was seen in perioperative ruptures (6.0%- 3.6%-1.6%-3.0 %, p = 0.499). MIS was correlated with less CD ≥ 2 complications (p = 0.006), shorter duration of admission (p < 0.001) and more TO (p < 0.001). Similar results were observed in tumours ≤5 cm and >5 cm. CONCLUSION A larger percentage of gastric GIST were treated with MIS over time. MIS was correlated with less complications, shorter duration of admission and more TO. Tumour rupture rates remained low over time.
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Affiliation(s)
- Stijn Jc van der Burg
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Roos F Bleckman
- University of Groningen, University Medical Centre Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - Pieter C van der Sluis
- Erasmus MC Cancer Institute, Department of Surgical Oncology, Rotterdam, the Netherlands
| | - Henk H Hartgrink
- Leiden University Medical Centre, Department of Surgical Oncology, Leiden, the Netherlands
| | - An Kl Reyners
- University of Groningen, University Medical Centre Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - Johannes J Bonenkamp
- Radboud University Medical Centre, Department of Surgical Oncology, Nijmegen, the Netherlands
| | - Johanna W van Sandick
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Michel Wjm Wouters
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Winan J van Houdt
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands
| | - Yvonne M Schrage
- The Netherlands Cancer Institute, Department of Surgical Oncology, Amsterdam, the Netherlands.
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Çetinkaya-Hosgör C, Seika P, Raakow J, Kröll D, Dobrindt EM, Maurer MM, Martin F, Ossami Saidy RR, Thuss-Patience P, Pratschke J, Biebl M, Denecke C. Textbook Outcome after Gastrectomy for Gastric Cancer Is Associated with Improved Overall and Disease-Free Survival. J Clin Med 2023; 12:5419. [PMID: 37629461 PMCID: PMC10455280 DOI: 10.3390/jcm12165419] [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: 06/22/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: The complexity of the perioperative outcome for patients with gastric cancer is not well reflected by single quality metrics. To study the effect of the surgical outcome on survival, we have evaluated the relationship between textbook outcome (TO)-a new composite parameter-and oncological outcome. (2) Methods: All patients undergoing total gastrectomy or trans-hiatal extended gastrectomy for gastric cancer with curative intent between 2017 and 2021 at our institution were included. TO was defined by negative resection margins (R0); collection of ≥25 lymph nodes; the absence of major perioperative complications (Clavien-Dindo ≥ 3); the absence of any reintervention; absence of unplanned ICU re-admission; length of hospital stay < 21 days; absence of 30-day readmission and 30-day mortality. We evaluated factors affecting TO by multivariate logistic regression. The correlation between TO and long-term survival was assessed using a multivariate cox proportional-hazards model. (3) Results: Of the patients included in this study, 52 (52.5 %) achieved all TO metrics. Open surgery (p = 0.010; OR 3.715, CI 1.334-10.351) and incomplete neoadjuvant chemotherapy (p = 0.020, OR 4.278, CI 1.176-15.553) were associated with failure to achieve TO on multivariate analysis. The achievement of TO significantly affected overall survival (p = 0.015). TO (p = 0.037, OD 0.448, CI 0.211-0.954) and CCI > 4 (p = 0.034, OR 2.844, CI 1.079-7.493) were significant factors affecting DFS upon univariate analysis. In multivariate analysis, CCI > 4 (p = 0.035, OR 2.605, CI 0.983-6.905) was significantly associated with DFS. (4) Conclusions: We identified patient- and procedure-related factors influencing TO. Importantly, achieving TO is strongly associated with improved long-term survival in gastric cancer patients and merits further focus on surgical quality improvement efforts.
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Affiliation(s)
- Candan Çetinkaya-Hosgör
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Philippa Seika
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jonas Raakow
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Dino Kröll
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Eva Maria Dobrindt
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Max Magnus Maurer
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Friederike Martin
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
- Division of Transplant Surgery, Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Ramin Raul Ossami Saidy
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Johann Pratschke
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
| | - Matthias Biebl
- Department of General, Visceral, Thoracic and Transplant Surgery, Congregational Hospital Linz, Seilerstätte 4, 4010 Linz, Austria
- Kepler University Hospital Linz, Med. Campus III, Krankenhaussstrasse 7a, 4020 Linz, Austria
| | - Christian Denecke
- Chirurgische Klinik, Campus Charité Mitte, Campus Virchow-Klinikum, Charité Universitätsmedizin, 10117 Berlin, Germany
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Wu DH, Liao CY, Wang DF, Huang L, Li G, Chen JZ, Wang L, Lin TS, Lai JL, Zhou SQ, Qiu FN, Zhang ZB, Chen YL, Wang YD, Zheng XC, Tian YF, Chen S. Textbook outcomes of hepatocellular carcinoma patients with sarcopenia: A multicenter analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:802-810. [PMID: 36586787 DOI: 10.1016/j.ejso.2022.12.009] [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: 08/17/2022] [Revised: 12/10/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of sarcopenia on textbook outcome (TO) after hepatectomy in hepatocellular carcinoma (HCC) patients remains unclear. This study aimed to investigate the association between sarcopenia and TO, to clarify its long and short-term prognostic value, and to develop a nomogram model based on sarcopenia and TO for survival prediction. METHODS Patients who underwent HCC resection between January 2012 and March 2017 in three large hospitals in Fujian were retrospectively recruited and divided into sarcopenia and non-sarcopenia groups based on skeletal muscle index (SMI) values. TO was defined as no 30-day morality, no 30-day readmission, negative margins, no prolonged hospital stay, and no major complications. Multivariate regression was used to screen for clinical factors associated with TO. Nomograms of overall survival (OS) and recurrence-free survival (RFS) after hepatectomy for HCC were developed. RESULTS A total of 1172 patients were included in the study. The TO rates were 28.74% (121/421 patients) in the sarcopenia group and 43.4% (326/751 patients) in the non-sarcopenia group. The results showed that sarcopenia was an independent predictor of TO (p < 0.001), TO was an independent predictor of perioperative treatment-related sarcopenia (PTRS)(p = 0.002), and TO was an independent predictor of OS and RFS (p < 0.001). Nomogram models based on sarcopenia and TO were generated and accurately predicted OS and RFS at 1, 3, and 5 years. CONCLUSION Both sarcopenia and TO are independent predictors of OS and RFS after HCC resection. Sarcopenia was an independent predictor of TO. Sarcopenia influenced long-term survival by affecting short-term postoperative outcomes.
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Affiliation(s)
- Di-Hang Wu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Cheng-Yu Liao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Dan-Feng Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Long Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Ge Li
- Fujian Medical University Union Hospital, Fuzhou, China
| | | | - Liang Wang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Tian-Sheng Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Jian-Lin Lai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Song-Qiang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Fu-Nan Qiu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Zhi-Bo Zhang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan-Ling Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Yao-Dong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Chun Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Yi-Feng Tian
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
| | - Shi Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China; Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
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Xu SJ, Lin LQ, Chen TY, You CX, Chen C, Chen RQ, Chen SC. Nomogram for prognosis of patients with esophageal squamous cell cancer after minimally invasive esophagectomy established based on non-textbook outcome. Surg Endosc 2022; 36:8326-8339. [PMID: 35556169 DOI: 10.1007/s00464-022-09290-y] [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: 12/15/2021] [Accepted: 04/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Non-textbook outcome (non-TO) represents a new prognostic evaluation index for surgical oncology. The present study aimed to develop new nomograms based on non-TO to predict the mortality and recurrence rate in patients with esophageal squamous cell cancer (ESCC) after minimally invasive esophagectomy (MIE). METHODS The study involved a retrospective analysis of 613 ESCC patients, from the prospectively maintained database from January 2011 to December 2018. All the included ESCC patients underwent MIE, and they were randomly (1:1) assigned to the training cohort (307 patients) and the validation cohort (306 patients). Kaplan-Meier survival analysis was used to analyze the differences recorded between overall survival (OS) and disease-free survival (DFS). In the case of the training cohort, the nomograms based on non-TO were developed using Cox regression, and the performance of these nomograms was calibrated and evaluated in the validation cohort. RESULTS Significant differences were recorded for 5-year OS and DFS between non-TO and TO groups (p < 0.05). Multivariate cox analysis revealed that non-TO, intraoperative bleeding, T stage, and N stage acted as independent risk factors that affected OS and DFS (p < 0.05). The results for multivariate regression were used to build non-TO-based nomograms to predict OS and DFS of patients with ESCC, the t-AUC curve analysis showed that the nomograms predicting OS and DFS were more accurate as compared to TNM staging, during the follow-up period in the training cohort and validation cohort. Further, the nomogram score was used to divide ESCC patients into low-, middle-, and high-risk groups and significant differences were recorded for OS and DFS between these three groups (p < 0.001). CONCLUSIONS Non-TO was identified as an independent prognostic factor for ESCC patients. The nomograms based on non-TO could availably predict OS and DFS in ESCC patients after MIE.
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Affiliation(s)
- Shao-Jun Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Lan-Qin Lin
- Department of Operation, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Ting-Yu Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Cheng-Xiong You
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Chao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Rui-Qin Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Shu-Chen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No. 29 Xin quan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China.
- Fujian Provincial Key Laboratory of Cardiothoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
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