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Ueda Y, Yanagimoto H, Ajiki T, Tsugawa D, Asakura R, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Kuramitsu K, Goto T, Asari S, Toyama H, Kido M, Fukumoto T. Potential Role of Surgical Resection for Gallbladder Cancer in Elderly Patients. Am Surg 2023; 89:5118-5123. [PMID: 36341533 DOI: 10.1177/00031348221136570] [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] [Indexed: 12/22/2023]
Abstract
INTRODUCTION With the aging of the population in Japan, gallbladder cancer (GBC) in the elderly is increasing. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of surgical resection in GBC patients ≥75 years of age. METHODS A retrospective single center analysis of patients who had undergone surgical resection for GBC between 2000 and 2019 was carried out. Patients aged ≥75 years (elderly group, n = 24) or <75 years (younger group, n = 50) were compared. RESULTS Both younger and elderly patients exhibited similar clinicopathological characteristics, but comorbidity in the latter was significantly greater, as was the frequency of less invasive surgery. Nonetheless, the incidence of postoperative complications was similar in elderly and younger patients. The proportion of patients receiving adjuvant chemotherapy was lower in the elderly. Overall survival of elderly and younger patients was not significantly different (65.0 vs 62.4% at 5 years, P = .600). In multivariate analysis, residual tumor status but not age was an independent prognostic factor. DISCUSSION This study demonstrated that appropriate surgical treatment of elderly GBC patients was safe and effective, despite their having more comorbidities and lower rates of adjuvant chemotherapy than younger patients.
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Affiliation(s)
- Yasuhiro Ueda
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ajiki
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Riki Asakura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihide Nanno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Fukushima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadahiro Goto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sadaki Asari
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Zhao Z, Zhou S, Tang Y, Zhou L, Ji H, Tang Z, Dai R. Impact of age on short-term outcomes after pancreaticoduodenectomy: A retrospective case-control study of 260 patients. Front Surg 2023; 10:1031409. [PMID: 37066018 PMCID: PMC10097935 DOI: 10.3389/fsurg.2023.1031409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundAlthough the increase of perioperative complications in the elderly undergoing pancreaticoduodenectomy (PD) surgery has been recognized, the definition of the “old patient” of PD in the studies is different and there is no accepted cut-off value at present.Methods279 consecutive patients who have undergone PD in our center between January 2012 and May 2020 were analyzed. Demographic features, clinical-pathological data and short-term outcomes were collected. The patients were divided into two groups, and the cut-off value (62.5 years) is picked based on the highest Youden Index. Primary endpoints were perioperative morbidity and mortality, and complications were classified according to the Clavien-Dindo Score.ResultsA total of 260 patients with PD were included in this study. Postoperative pathology confirmed pancreatic tumors in 62 patients, bile duct tumor in 105, duodenal tumor in 90, and others in 3. Age (OR = 1.09, P < 0.01), and albumin (OR = 0.34, P < 0.05) were significantly correlated with postoperative Clavien-Dindo Score ≥3b. There were 173 (66.5%) patients in the younger group (<62.5 years) and 87 (33.5%) in the elderly group (≥62.5 years). Significant difference between two groups was demonstrated for Clavien-Dindo Score ≥3b (P < 0.01), postoperative pancreatic fistula (P < 0.05), and perioperative deceases (P < 0.05).ConclusionsAge and albumin were significantly correlated with postoperative Clavien-Dindo Score ≥3b, and there was no significant difference in predicting the grade of Clavien-Dindo Score. The cut-off value of elderly patients with PD was 62.5 years old and there were useful in predicting Clavien-Dindo Score ≥3b, pancreatic fistula, and perioperative death.
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Affiliation(s)
- Zhirong Zhao
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
| | - Shibo Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Yaping Tang
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
| | - Lichen Zhou
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Hua Ji
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Zheng Tang
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
| | - Ruiwu Dai
- Hospital of Southwest Jiaotong University, The General Hospital of Western Theater Command, Chengdu, China
- General Surgery Center, General Hospital of Western Theater Command, Chengdu, China
- College of Clinical MedicineSouthwest Medical University, Luzhou, China
- Pancreatic Injury and Repair Key Laboratory of Sichuan Province, General Hospital of Western Theater Command, Chengdu, China
- Correspondence: Dai Ruiwu
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Seyfried S, Herrle F, Téoule P, Betzler A, Reissfelder C. Patient-Tailored Approach for Enhanced Recovery after Surgery. Visc Med 2022; 38:322-327. [PMID: 37970578 PMCID: PMC10642544 DOI: 10.1159/000526692] [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: 04/23/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2023] Open
Abstract
Background Enhanced recovery after surgery (ERAS®) is increasingly finding its way into clinical practice. ERAS® protocols have not been universally adopted, and they have often been criticized for being difficult to implement. So, the question for more tailor-made approaches arises. Methods We conducted a literature search on March 16, 2022, using the following search string, which was modified to fit the input of each of the queried databases: ("ERAS®" or "enhanced recovery after surgery" or "fast recovery" or "fast track") and ("tailored" or "individual"). Results Despite the massive increase in general hits on the subject, stratification according to phenotypic characteristics such as age or a classification according to disease patterns in the sense of specific guidelines is still fundamentally apparent. Evidence suggests that generic protocols can be followed by almost all patients. Prehabilitation, in particular, can be used as an adaptive tool. Conclusion ERAS® works only in the totality of its tools and can be followed by almost all patients. Prehabilitation is more adaptive and can also increase adherence to ERAS® protocols. A tailored program outside of disease-specific pathways does not seem to be useful.
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Affiliation(s)
- Steffen Seyfried
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Téoule
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Betzler
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
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Oji K, Otowa Y, Yamazaki Y, Arai K, Mii Y, Kakinoki K, Nakamura T, Kuroda D. Taking antithrombic therapy during emergency laparoscopic cholecystectomy for acute cholecystitis does not affect the postoperative outcomes: a propensity score matched study. BMC Surg 2022; 22:42. [PMID: 35120469 PMCID: PMC8817483 DOI: 10.1186/s12893-022-01501-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/27/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Continuing antithrombic therapy (ATT) during surgery increases the risk of bleeding. However, it is difficult to discontinue the ATT in emergency surgery. Therefore, safety of emergency laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) is still unclear. We aimed to clarify the affect of ATT during emergency LC for AC. METHODS Patients with AC were classified into ATT group (n = 30) and non-ATT group (n = 120). Postoperative outcomes were compared after propensity score matching (n = 22). RESULTS Higher level of c-reactive protein level and shorter activated partial thromboplastin time (APTT) was observed in ATT group than in non-ATT group after matching. No significant difference was found between other patient characteristics and perioperative results. Blood loss over 100 mL was observed in 8 patients. Multivariate analyze showed that APTT was an independent risk factor for bleeding over 100 mL (P = 0.039), while ACT and APT was not. CONCLUSIONS Taking ATT does not affect the blood loss or complications during emergency LC for AC. Controlling intraoperative bleeding is essential for a safe postoperative outcome.
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Affiliation(s)
- Kentaro Oji
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Yasunori Otowa
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan. .,Radiation Biology Branch, National Cancer Institute, 9000 Rockville Pike, Bethesda, Maryland, 20892, USA.
| | - Yuta Yamazaki
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Keisuke Arai
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Yasuhiko Mii
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Keitaro Kakinoki
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Tetsu Nakamura
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
| | - Daisuke Kuroda
- Department of Surgery, Kita-Harima Medical Center, 926-250 Ichiba-cho, Ono, Hyogo, 675-1392, Japan
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Kryzauskas M, Bausys A, Kuliavas J, Bickaite K, Dulskas A, Poskus E, Bausys R, Strupas K, Poskus T. Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer. BMC Geriatr 2021; 21:682. [PMID: 34876049 PMCID: PMC8650566 DOI: 10.1186/s12877-021-02648-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC. METHODS The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated. RESULTS In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19-0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival. CONCLUSIONS Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.
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Affiliation(s)
- Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
| | - Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre for Visceral Medicine and Translational Research, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justas Kuliavas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantas Bausys
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology, and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Okazaki M, Hayashi H, Gabata R, Ohbatake Y, Shinbashi H, Nakanuma S, Makino I, Tajima H, Takamura H, Ohta T. Analysis of perioperative glucose metabolism using an artificial pancreas. Artif Organs 2021; 45:998-1005. [PMID: 33819346 DOI: 10.1111/aor.13962] [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: 11/25/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/24/2022]
Abstract
Hyperglycemia associated with insulin resistance is common in surgical patients with and without diabetes and is associated with poor surgical outcomes. Several studies have recently shown that a closed-loop blood glucose monitoring system in the form of an artificial pancreas is safe and effective for surgical patients. In this study, we analyzed the risk factors for insulin resistance in patients using an artificial pancreas. We investigated 109 patients who underwent surgical management by an artificial pancreas for 24 hours from the start of surgery during either major hepatectomy (MH), defined as resection of more than two liver segments, or pancreaticoduodenectomy (PD). The target glucose range was from 80 to 110 mg/dL using an artificial pancreas. We analyzed the risk factors for and predictors of a high insulin dose, including sarcopenia markers, according to the median 24-hour total insulin infusion. The median total insulin dose and glycemic control rate (GCR), which is the rate of achieving the target blood glucose range, per 24 hours were 78.0 IU and 30.4% in the MH group and 82.6 IU and 23.5% in the PD group, respectively. The muscle volume was the only independent factor in the high-dose subgroup, and the GCR was significantly lower in the high-dose subgroup despite a high insulin dose in both the MH and PD groups. The results of this study suggest that preoperative sarcopenia is closely associated with insulin resistance in the perioperative period. Clinicians must effectively manage sarcopenia, which may result in improved perioperative glycemic control and reduced postoperative complications.
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Affiliation(s)
- Mitsuyoshi Okazaki
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hironori Hayashi
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Ryousuke Gabata
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Yoshinao Ohbatake
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Shinbashi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Shinichi Nakanuma
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Isamu Makino
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hidehiro Tajima
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Takamura
- Department of General and Digestive Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Tetsuo Ohta
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Kanazawa, Japan
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Sneidere M, Schrem HH, Mahlmann JC, Beetz O, Cammann S, Oldhafer F, Kleine M, Klempnauer J, Kaltenborn A, Zwirner U, Kulik U. Proposal of a Multivariable Prediction Model for Graded Morbidity after Liver Resection for Colorectal Metastases. Zentralbl Chir 2020; 148:147-155. [PMID: 33091938 DOI: 10.1055/a-1243-0746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prognostic models to predict individual early postoperative morbidity after liver resection for colorectal liver metastases (CLM) are not available but could enable optimized preoperative patient selection and postoperative surveillance for patients at greater risk of complications. The aim of this study was to establish a prognostic model for the prediction of morbidity after liver resection graded according to Dindo. METHODS N = 679 cases of primary liver resection for CLM were retrospectively analyzed using univariable and multivariable ordinal regression analyses. Receiver operating characteristics curve (ROC) analysis was utilised to assess the sensitivity and specificity of predictions and their potential usefulness as prognostic models. Internal validation of the score was performed using data derived from 129 patients. RESULTS The final multivariable regression model revealed lower preoperative levels, a greater number of units of intraoperatively transfused packed red blood cells (pRBCs), longer duration of surgery, and larger metastases to independently influence postoperatively graded morbidity. ROC curve analysis demonstrated that the multivariable regression model is able to predict each individual grade of postoperative morbidity with high sensitivity and specificity. The areas under the receiver operating curves (AUROC) for all of these predictions of individual grades of morbidity were > 0.700, indicating potential usefulness as a predictive model. Moreover, a consistent concordance in Grades I, II, IV, and V according to the classification proposed by Dindo et al. was observed in the internal validation. CONCLUSION This study proposes a prognostic model for the prediction of each grade of postoperative morbidity after liver resection for CLM with high sensitivity and specificity using pre- and intraoperatively available variables.
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Affiliation(s)
- Mara Sneidere
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | | | | | - Oliver Beetz
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - Sebastian Cammann
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - Felix Oldhafer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - Moritz Kleine
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - Juergen Klempnauer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | | | - Ulrich Zwirner
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
| | - Ulf Kulik
- General, Visceral and Transplantation Surgery, Hannover Medical School, Germany
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The Effect of Age on Short- and Long-Term Outcomes in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Laparoscopic Pancreaticoduodenectomy. Pancreas 2020; 49:1063-1068. [PMID: 32769853 DOI: 10.1097/mpa.0000000000001620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effect of age on outcomes with pancreatic ductal adenocarcinoma (PDAC) undergoing laparoscopic pancreaticoduodenectomy (LPD). METHODS We retrospectively collected clinical data of consecutive patients with PDAC undergoing LPD from January 2012 to April 2019. The patients were divided into 2 groups according to age at admission for LPD: younger than 70 and 70 years or older. RESULTS A total of 147 patients were included (<70 years, n = 96; ≥70 years, n = 51). The elderly LPD patients had lower serum albumin levels (mean, 37.9 [standard deviation, 4.8] g/L vs 40.7 [standard deviation, 6.8] g/L, P = 0.004) and a larger frequency of comorbidities (62.7% vs 36.5%, P = 0.002) than younger patients. The short-term outcomes showed no significant differences. The median overall survival time of the younger patients was not significantly greater than that of the elderly patients (20.0 [95% confidence interval, 16.1-23.9] months vs 19.0 [95% confidence interval, 13.8-24.2] months, P = 0.902). CONCLUSIONS The short- and long-term outcomes of elderly patients with PDAC after LPD were similar to those of younger patients, despite a higher prevalence of multiple chronic illnesses and poorer nutritional conditioning among the elderly patients. These results show that LPD can be applied safely to elderly patients.
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Hu Y, Lin K, Lin K, Lin H, Chen R, Li S, Wang J, Zeng Y, Liu J. Developing a risk prediction model for multidrug-resistant bacterial infection in patients with biliary tract infection. Saudi J Gastroenterol 2020; 26:291753. [PMID: 32769261 PMCID: PMC8019140 DOI: 10.4103/sjg.sjg_128_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/02/2020] [Accepted: 05/20/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to develop a tool to predict multidrug-resistant bacteria infections among patients with biliary tract infection for targeted therapy. PATIENTS AND METHODS We conducted a single-center retrospective descriptive study from January 2016 to December 2018. Univariate and multivariable logistic regression analysis were used to identify independent risk factors of multidrug-resistant bacterial infections. A nomogram was constructed according to multivariable regression model. Moreover, the clinical usefulness of the nomogram was estimated by decision curve analysis. RESULTS 121 inpatients were randomly divided into a training cohort (n = 79) and validation cohort (n = 42). In multivariate analysis, 5 factors were associated with biliary tract infections caused by multidrug-resistant bacterial infections: aspartate aminotransferase (Odds ratio (OR), 13.771; 95% confidence interval (CI), 3.747-64.958; P < 0.001), previous antibiotic use within 90 days (OR, 4.130; 95% CI, 1.192-16.471; P = 0.032), absolute neutrophil count (OR, 3.491; 95% CI, 1.066-12.851; P = 0.046), previous biliary surgery (OR, 3.303; 95% CI, 0.910-13.614; P = 0.079), and hemoglobin (OR, 0.146; 95% CI, 0.030-0.576; P = 0.009). The nomogram model was constructed based on these variables, and showed good calibration and discrimination in the training set [area under the curve (AUC), 0.86] and in the validation set (AUC, 0.799). The decision curve analysis demonstrated the clinical usefulness of our nomogram. Using the nomogram score, high risk and low risk patients with multidrug-resistant bacterial infection could be differentiated. CONCLUSIONS This simple bedside prediction tool to predict multidrug-resistant bacterial infection can help clinicians identify low versus high risk patients as well as choose appropriate, timely initial empirical antibiotics therapy. This model should be validated before it is widely applied in clinical settings.
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Affiliation(s)
- Yingying Hu
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Kongying Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Kecan Lin
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20, Fuzhou, China
| | - Haitao Lin
- The Big Data Institute of Southeast Hepatobiliary Health Information, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Ruijia Chen
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Shengcong Li
- Department of Microbiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Jinye Wang
- Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
| | - Jingfeng Liu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, China
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Carli F, Baldini G. From preoperative assessment to preoperative optimization of frail older patiens. Eur J Surg Oncol 2020; 47:519-523. [PMID: 32753116 DOI: 10.1016/j.ejso.2020.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
Abstract
Physiological and mental reserve decreases with age and the ability to mount a response to a stress like surgery can represent a burden to the frail and sarcopenic patient. It is necessary to evaluate the cardiorespiratory capacity and muscle strength before surgery in the older persons and prepare adequately to the same extent the marathon runner prepares before a full marathon. Assessment and stratification of risk are necessary for decision-making, but also for planning interventions aimed at improving the functional and emotional status in anticipation of surgery. Prehabilitation can improve the physiological reserve by optimizing cardiorespiratory capacity, muscle strength, and mental resiliency. Patients with low reserve and chronic medical conditions at high risk can benefit.
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Affiliation(s)
- Francesco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Room D10.165, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada.
| | - Gabriele Baldini
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Room D10.165, 1650 Cedar Ave, Montreal, Quebec, H3G 1A4, Canada
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Di Franco G, Palmeri M, Guadagni S, Furbetta N, Gianardi D, Bronzoni J, Palma A, Bianchini M, Musetti S, Bastiani L, Caprili G, Biancofiore G, Mosca F, Di Candio G, Morelli L. Pancreatic resections in elderly patients with high American Society of Anesthesiologists' risk score: a view from a tertiary care center. Aging Clin Exp Res 2020; 32:935-950. [PMID: 31347102 DOI: 10.1007/s40520-019-01276-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/12/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND More than 60% of patients affected by pancreatic cancer are ≥ 65 years of age. Surgery represents the only potentially curative treatment for malignant pancreatic neoplasia and a useful treatment for benign diseases. AIM To evaluate outcomes in elderly patients with ASA risk score 4 who underwent pancreatic resection compared to younger patients and elderly patients with lower anesthesiological risk. METHODS A consecutive series of 345 patients underwent pancreatic resection between 2010 and 2017 was reviewed. We compared three groups based on age at the time of surgery: < 65 years (group A), 65-74 years (group B), and ≥ 75 years (group C). Patients in group C were split into two subgroups, ASA 1-3 versus ASA 4, and compared. RESULTS Group A consisted of 117 (34%) patients, group B 128 (37%) patients, and group C 100 (29%) patients. Group C had a significantly higher incidence of comorbidity and ASA 4 status (p < 0.05), and of overall post-operative complications (p < 0.01), because of the higher incidence of post-operative medical complications. No differences in terms of overall surgical complications and post-operative mortality were reported. The mean overall survival was significantly lower for group C (p < 0.01), with no difference in mortality for cancer. Within group C, no differences were reported regarding surgical complications (p = 0.59), mortality (p = 0.34), and mean overall survival (p = 0.53) between ASA 1-3 and ASA 4 patients. CONCLUSIONS Advanced age should not preclude elderly patients with pancreatic diseases from being treated surgically, and ASA 4 in subjects aged ≥ 75 years should not be an absolute contraindication.
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Bongers BC, Dejong CHC, den Dulk M. Enhanced recovery after surgery programmes in older patients undergoing hepatopancreatobiliary surgery: what benefits might prehabilitation have? Eur J Surg Oncol 2020; 47:551-559. [PMID: 32253075 DOI: 10.1016/j.ejso.2020.03.211] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/05/2020] [Accepted: 03/21/2020] [Indexed: 12/14/2022] Open
Abstract
Due to an aging population and the related growing number of less physically fit patients with multiple comorbidities, adequate perioperative care is a new and rapidly developing clinical science that is becoming increasingly important. This narrative review focuses on enhanced recovery after surgery (ERAS®) programmes and the growing interest in prehabilitation programmes to improve patient- and treatment-related outcomes in older patients undergoing hepatopancreatobiliary (HPB) surgery. Future steps required in the further development of optimal perioperative care in HPB surgery are also discussed. Multidisciplinary preoperative risk assessment in multiple domains should be performed to identify, discuss, and reduce risks for optimal outcomes, or to consider alternative treatment options. Prehabilitation should focus on high-risk patients based on evidence-based cut-off values and should aim for (partly) supervised multimodal prehabilitation tailored to the individual patient's risk factors. The program should be executed in the living context of these high-risk patients to improve the participation rate and adherence, as well as to involve the patient's informal support system. Developing tailored (multimodal) prehabilitation programmes for the right patients, in the right context, and using the right outcome measures is important to demonstrate its potential to further improve patient- and treatment-related outcomes following HPB surgery.
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Affiliation(s)
- Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands; Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany.
| | - Marcel den Dulk
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Department of Surgery, Uniklinikum RWTH-Aachen, Aachen, Germany.
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Papis D, Vagliasindi A, Maida P. Hepatobiliary and pancreatic surgery in the elderly: Current status. Ann Hepatobiliary Pancreat Surg 2020; 24:1-5. [PMID: 32181422 PMCID: PMC7061045 DOI: 10.14701/ahbps.2020.24.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
Hepato-pancreatico-biliary (HPB) surgery includes major hepatic resection and pancreatic surgery, both procedures are complex and have a potentially high complication rate. The presence of centers of excellence with a high patients volume has lowered the complication and increased the resection rate. Increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Since old patients have more co-morbidities and decreased life expectancy, the benefit of these procedures need to be critically evaluated in this group. Analysis of the literature related to this argument demonstrated that pancreatoduodenectomy can be performed safely in selected elderly patients (70 years of age or older), with morbidity and mortality rates comparable those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumor or gallbladder carcinoma. More studies are needed regarding the subgroup of very elderly patients (80 years or older). Nevertheless, those elderly patients who will benefit from surgery must be adequatelly selected.
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Affiliation(s)
- Davide Papis
- General Surgery Unit, Del Mare Hospital, Naples, Italy
| | | | - Pietro Maida
- General Surgery Unit, Del Mare Hospital, Naples, Italy
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Abstract
Geriatric medicine is a growing field filled with complicated patients who are susceptible to developing cancer. Surgical oncology is expanding while adapting to the increasing elderly population and creating novel treatment regimens for this group of patients. This article reviews surgical oncology in elderly patients and addresses surgical optimization, management of several cancer subtypes, surgical advances in minimally invasive surgery, and ethical considerations.
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[Preoperative conditioning in ageing patients-gerontosurgery]. Chirurg 2019; 90:524-528. [PMID: 30919018 DOI: 10.1007/s00104-019-0941-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adapting the daily hospital routine to changes in the aging structure of society and the patients will be one of the main challenges for surgeons in the coming years. Important factors regarding the outcome of aging patients will be preoperative conditioning, specific age-adapted surgical strategies and the organization of the hospital infrastructure. Nutritional protocols and liquid intake schedules should be taken into account as well as cognitive assessment tools and strategies to protect aging patients from postoperative delirium. The importance of changes in metabolism and the concomitant comorbidities are very similar in most specialty disciplines. The lack of a clear and widely accepted definition of biological age and the missing adaptations of, e. g. complication scores, currently exacerbate the compilation of a resilient survey. In the absence of a reimbursement-system for geriatric medicine it will be very difficult to achieve the necessary structural changes in the treatment regimens for older patients. The establishment of the necessary surgical treatment adapted to the needs of older patients therefore remains a challenging task.
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Zarzavadjian Le Bian A, Tabchouri N, Bennamoun M, Louvet C, Tubbax C, Sarran A, Lefevre M, Beaussier M, Pamoukdjian F, Wind P, Gayet B, Fuks D. After laparoscopic liver resection for colorectal liver metastases, age does not influence morbi-mortality. Surg Endosc 2019; 33:3704-3710. [DOI: 10.1007/s00464-019-06663-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/17/2019] [Indexed: 12/14/2022]
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