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Xia H, Zhang W, Zheng Q, Zhang Y, Mu X, Wei C, Wang X, Liu Y. Predictive value of the prognostic nutritional index in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors: A systematic review and meta-analysis. Heliyon 2023; 9:e17400. [PMID: 37520982 PMCID: PMC10374926 DOI: 10.1016/j.heliyon.2023.e17400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose The prognostic nutritional index (PNI), which is derived from the albumin concentration and absolute lymphocyte number, is an effective indicator of cancer patients' nutritional and immunological status. According to multiple studies, PNI was strongly linked to the prognosis of patients with non-small cell lung cancer (NSCLC). The predictive value of PNI for survival outcomes in NSCLC patients receiving immune checkpoint inhibitors (ICIs) is still in dispute at present. This meta-analysis is devoted to fill this information gap and investigate the predictive ability of PNI in NSCLC patients treated with ICIs. Methods The PubMed, Embase, Cochrane Library databases, and conference proceedings were searched for eligible studies without language restriction. Overall survival (OS) and progression-free survival (PFS) were included. The predictive value of PNI was estimated using hazard ratios and their 95% confidence intervals. Results Thirteen relevant retrospective cohort studies were included and these studies included 1119 patients with stage III-IV NSCLC. Lower PNI status was found to be an independent risk factor for worse survival outcomes in patients with NSCLC (OS HR = 2.68; 95%CI: 1.76-4.06; P < 0.0001; PFS HR = 1.84; 95%CI: 1.39-2.42; P < 0.0001). According to the subgroup analysis, PNI was similarly connected to OS in most subgroups of NSCLC patients receiving ICIs, except for those receiving chemoimmunotherapy or first-line treatment, and those with a cut-off value < 45. Conclusion Our findings indicated that lower PNI was associated with poorer prognosis in NSCLC patients undergoing ICI therapy. Further prospective research with bigger patient groups is required. Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO), identifier CRD42022327528.
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Affiliation(s)
- Handai Xia
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Wengang Zhang
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Qi Zheng
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Yuqing Zhang
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Xin Mu
- Department of Medical Imaging Center, Third People's Hospital of Jinan, Jinan, Shandong, China
| | - Chenxi Wei
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Xiuwen Wang
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
| | - Yanguo Liu
- Department of Medical Oncology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong, China
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Song X, Ma Y, Shi H, Liu Y. Application of Clavien-Dindo classfication-grade in evaluating overall efficacy of laparoscopic pancreaticoduodenectomy. Front Surg 2023; 10:1043329. [PMID: 36936657 PMCID: PMC10020176 DOI: 10.3389/fsurg.2023.1043329] [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: 09/13/2022] [Accepted: 01/16/2023] [Indexed: 03/06/2023] Open
Abstract
Background The Clavien-Dindo classification (CDC) has been widely accepted and applied in clinical practice. We investigated its effectiveness in prediction of major complications (LPPC) after laparoscopic pancreaticoduodenectomy (LPD) and associated risk factors. Methods A retrospective analysis was conducted covering clinical data of 793 patients undergoing LPD from April 2015 to November 2021. CDC was utilized to grade postoperative complications and analyze the differences. Risk factors of LPPC were identified according to univariate and multivariate analyses. Resluts For the 793 patients undergoing laparoscopic pancreaticoduodenectomy in the northeast of China, LPPC was reported in 260 (32.8%) patients, pancreatic fistula in 169 (21.3%), biliary fistula in 44 (5.5%), delayed gastric emptying in 17(2.1%), post pancreatectomy hemorrhage in 55 (6.9%), intestinal fistula in 7 (0.8%), abdominal infections in 59 (7.4%) and pulmonary complication in 28 (3.5%). All complications were classified into five levels with the C-D classification (Grade I-V), with 83 (31.9%) patients as grade I, 91 (35.0%) as grade II, 38 (14.6%) as grade IIIa, 24 (9.2%) as grade IIIb, 9 (3.5%) as grade IV and 15 (5.8%) as grade V. 86 (10.8%) patients experienced major complications (grade III-V).The results of univariate and multivariate analysis revealed the independent risk factors for laparoscopic pancreaticoduodenectomy complications to be preoperative total bilirubin (P = 0.029, OR = 1.523), soft pancreas texture (P < 0.001, OR = 1.399), male (P = 0.038, OR = 1.396) and intraoperative transfusion (P = 0.033, OR = 1.517). Preoperative total bilirubin (P = 0.036, OR = 1.906) and intraoperative transfusions (P = 0.004, OR = 2.123) were independently associated with major postoperative complications. The influence of different bilirubin levels on C-D grade of complications was statistically significant (P = 0.036, OR = 1.906). Conclusions The Clavien-Dindo classification (CDC) may serve as a valid tool to predict major postoperative complications and contribute to perioperative management and comparison of surgical techniques in different medical centers.
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Manekk RS, Gharde P, Gattani R, Lamture Y. Surgical Complications and Its Grading: A Literature Review. Cureus 2022; 14:e24963. [PMID: 35706751 PMCID: PMC9187255 DOI: 10.7759/cureus.24963] [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] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
The demand for improvement in healthcare delivery has been increasing. Thus, a standardized method allows quality assessment of data and its comparison between various institutions over time. Many attempts have been made to classify surgical complications before 1990; however, none of those attempts gained popularity and acceptance. Clavien and his colleagues started the wave by explaining negative outcomes on the basis of complications, failure to cure, and sequelae. Complications were primarily defined as “any deviation from the normal postoperative course”. Since then, many such classification systems and grading systems have been introduced and studied for analyzing the post-operative complications. The purpose of this study was to review the revolution in the classification systems for surgical complications, its validation, and to analyze the results of various qualitative indicators for post-operative complications obtained by using these classification systems. A global set of keywords were built such as “grading of surgical complications”, “abdominal surgery”, “classification of surgical complications”, and the “Clavien Dindo Classification”. A literature review was done using PubMed, Medline, and Google Scholar. A list of reference articles concerning the literature on classification systems for surgical complications was manually analyzed from the year 1992 and the data was summarized.
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Andresciani L, Calabrò C, Laforgia M, Ronchi M, De Summa S, Cariddi C, Boccuzzi R, De Rosa A, Rizzo E, Losito G, Bradascio G, Napoli G, Simone M, Carravetta G, Mastrandrea G. A New Score to Assess the Perioperative Period of the Cancer Patient Undergoing Non-Palliative Elective Surgery: A Retrospective Evaluation of a Case Report by PERIDIA Score. Front Oncol 2021; 11:733621. [PMID: 34765547 PMCID: PMC8577042 DOI: 10.3389/fonc.2021.733621] [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: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
The complexity of cancer patients and the use of advanced and demolitive surgical techniques frequently need post-operatory ICU hospitalization. To increase safety and to select the best medical strategies for the patient, a multidisciplinary team has performed a new peri-operatory assessment, arising from evidence-based literature data. Verifying that most of the cancer patients, admitted to the intensive care unit, undergo major surgery with localizations in the supramesocolic thoraco-abdominal area, the team focused the attention on supramesocolic peridiaphragmatic cancer surgery. Some scores already in use in clinical practice were selected for the peri-operatory evaluation process. None of them evaluate parameters relating to the entire peri-operative period. In detail, only a few study models were found that concern the assessment of the intra-operative period. Therefore, we wanted to see if using a mix of validated scores, it was possible to build a single evaluation score (named PERIDIAphragmatic surgery score or PERIDIA-score) for the entire peri-operative period that could be obtained at the end of the patient's hospitalization period in post-operative ICU. The main property sought with the creation of the PERIDIA-score is the proportionality between the score and the incidence of injuries, deaths, and the length of stay in the ward. This property could organize a tailor-made therapeutic path for the patient based on pre-rehabilitation, physiotherapy, activation of social assistance services, targeted counseling, collaborations with the continuity of care network. Furthermore, if the pre-operative score is particularly high, it could suggest different or less invasive therapeutic options, and if the intra-operative score is particularly high, it could suggest a prolongation of hospitalization in ICU. The retrospective prospective study conducted on 83 patients is still ongoing. The first data would seem to prove an increase of clinical complications in patients who were assigned a one-third score with respect to the maximum (16/48) of PERIDIA-score. Moreover, patients with a 10/16 score within each phase of the evaluation (pre, peri, and post) more frequently develop injuries. In the light of these evidence, the 29-point score assigned to our patient can be considered as predictive for the subsequent critical and fatal complications the patient faced up.
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Affiliation(s)
- Letizia Andresciani
- DETO Dipartimento di Emergenze e Trapianti d'Organo, Università degli Studi di Bari, Bari, Italy
| | - Concetta Calabrò
- Unità Operativa Complessa Farmacia e UMACA, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Mariarita Laforgia
- Unità Operativa Complessa Farmacia e UMACA, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Maria Ronchi
- Unità Operativa Complessa Chirurgia Generale Oncologica, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Simona De Summa
- Diagnostica Molecolare e Farmacogenetica, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Christel Cariddi
- DETO Dipartimento di Emergenze e Trapianti d'Organo, Università degli Studi di Bari, Bari, Italy
| | - Rosa Boccuzzi
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Anna De Rosa
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Elisabetta Rizzo
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Giulia Losito
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Grazia Bradascio
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Gaetano Napoli
- Unità Operativa Complessa Chirurgia Toracica, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Michele Simone
- Unità Operativa Complessa Chirurgia Generale Oncologica, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Giuseppe Carravetta
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
| | - Giovanni Mastrandrea
- Unità Operativa Complessa Anestesia, Rianimazione e Terapia Intensiva PostOperatoria, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II-Bari, Bari, Italy
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Correlation between Intraoperative Fluid Administration and Outcomes of Pancreatoduodenectomy. Gastroenterol Res Pract 2020; 2020:8914367. [PMID: 32802047 PMCID: PMC7414365 DOI: 10.1155/2020/8914367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/05/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Intraoperative fluid (IOF) administration plays an important role during major abdominal surgery although increased fluid intake can adversely influence postoperative outcomes. However, the effect of the IOF rate on the outcomes of pancreatoduodenectomy (PD) is unclear. Methods 151 patients, who underwent PD at Binzhou Medical University Hospital between January 2010 and May 2017, were categorized into three groups according to IOF rates (ml/kg/hr): restricted (<10, n = 47), standard (10–15, n = 76), and liberal (>15, n = 28). Results The overall postoperative morbidity was 56.95%. The incidence of postoperative pancreatic fistula (POPF) was 11.26%. The in-hospital mortality rate was 7.28% with the most common cause being grade C POPF and secondary intra-abdominal infections. The patients in the liberal group had significantly higher incidences of POPF (25%) and respiratory complications (21.43%). The other outcome parameters such as recovery of bowel function, hospital stay, and postoperative daily drainage were similar among the groups. Multivariable analysis confirmed the IOF rate to be most strongly associated with POPF (odds ratio: 5.195, confidence interval: 1.142–23.823, P = 0.023) and respiratory complications (odds ratio: 7.302, confidence interval: 0.676–58.231, P = 0.025). Conclusions The IOF rate significantly affects the incidence of POPF and respiratory complications after PD. Careful patient-oriented fluid therapy may help to prevent these complications.
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Chang WF, Luo AJ, Yuan YF, Chen Y, Xin ZR, Xu SS. Perioperative Complications and Safety Evaluation of Robot-Assisted Radical Hysterectomy of Cervical Cancer After Neoadjuvant Chemotherapy. Cancer Manag Res 2020; 12:4483-4492. [PMID: 32606942 PMCID: PMC7305848 DOI: 10.2147/cmar.s243986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/22/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To evaluate the perioperative complications of patients with cervical cancer who are treated with robot-assisted radical hysterectomy (RRH) and to further evaluate the safety of patients undergoing NACT. Methods A total of 805 consecutive cervical cancer patients undergoing RRH were involved in this report. Their clinical characteristics were retrieved from hospital medical records. Perioperative complications were subdivided into intraoperative and postoperative complications, which were graded according to the Clavien-Dindo classification (CDC), and the complications of grade III and above were defined as severe complications. Furthermore, the two-level logistic regression model was used to estimate the risk factors of perioperative and severe complications and to further confirm the relationship between NACT and perioperative and severe complications. Results The perioperative complication rate and severe complications were 45.09% and 7.83%, respectively. Poorly differentiated tumor and NACT were identified as independent risk factors for perioperative complications by multifactor analysis. Furthermore, we concentrated on the relations between NACT and complications. The risk of perioperative complications of the group with NACT (OR = 11.08, 95% CI: 5.70-21.54) was significantly higher than the group without NACT, especially in postoperative complications (OR=17.65, 95% CI: 8.63-36.08), even after adjusting confounding factors. However, there was no statistically significant difference in terms of severe complications (OR=1.68, 95% CI: 0.64-4.41) and intraoperative complications (OR=0.51, 95% CI: 0.18-1.41). Moreover, as the times of NACT increase, the impact on perioperative complications is more pronounced. A similar trend was observed in postoperative complications, while this statistical difference was still not observed in intraoperative and severe complications. Conclusion This result demonstrates the feasibility and safety of RRH of cervical carcinoma after NACT in generally, since it only causes mild complications, not severe complications.
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Affiliation(s)
- Wei-Fu Chang
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.,The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan, People's Republic of China.,Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Ai-Jing Luo
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China.,Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China.,The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, People's Republic of China
| | - Yi-Feng Yuan
- School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Yang Chen
- School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Zi-Rui Xin
- Key Laboratory of Medical Information Research, Central South University, Changsha 410013, Hunan, People's Republic of China.,School of Life Sciences, Central South University, Changsha 410013, Hunan, People's Republic of China
| | - Shuai-Shuai Xu
- Xiangya School of Public Health, Central South University, Changsha 410008, Hunan, People's Republic of China
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Pan J, Ge X, Zhou W, Zhong X, Gu L, Zhu H, Li X, Qi W, Wang X. Comparison of clinical outcomes between mesh-reinforced pancreatojejunostomy and pancreatogastrostomy following pancreaticoduodenectomy: a cohort study. World J Surg Oncol 2018; 16:190. [PMID: 30223846 PMCID: PMC6142426 DOI: 10.1186/s12957-018-1491-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/05/2018] [Indexed: 01/13/2023] Open
Abstract
Background Postoperative complications, especially postoperative pancreatic fistulas, remain the major concern following pancreaticoduodenectomy (PD). Mesh-reinforced pancreatic anastomoses, including pancreatojejunostomy (PJ) and pancreatogastrostomy (PG), are a new effective technique in PD. This study was conducted to analyze the safety and efficacy of this new technique and to compare the results of mesh-reinforced PJ vs PG. Methods A total of 110 patients who underwent PD between August 2005 and January 2016 were eligible in this study. Perioperative and postoperative data of patients with a mesh-reinforced technique were analyzed. Data were also grouped according to the procedure performed: mesh-reinforced PJ and mesh-reinforced PG. Results Among patients undergoing PD with the mesh-reinforced technique, 42 had postoperative complications, and the comprehensive complication index (CCI) was 32.7 ± 2.5. Only 10% of patients had pancreatic fistula; three were grade A, six were grade B, and two were grade C. Biliary fistula occurred in only 8.2% of patients. Patients undergoing mesh-reinforced PG showed a significantly lower rate of CCI than did mesh-reinforced PJ patients (27.0 ± 2.1 vs 37.0 ± 3.9, p < 0.05). The mesh-reinforced PG was also favored over mesh-reinforced PJ because of significant differences in intra-abdominal fluid collection (5.9% vs 18.6%, p < 0.05) and delayed gastric emptying (3.9% vs 15.3%, p < 0.05). Conclusions PD with the mesh-reinforced technique was a safe and effective method of decreasing postoperative pancreatic fistula. Compared with mesh-reinforced PJ, mesh-reinforced PG did not show significant differences in the rates of pancreatic fistula or biliary fistula. However, CCI, intra-abdominal fluid collection, and delayed gastric emptying were significantly reduced in patients with mesh-reinforced PG.
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Affiliation(s)
- Junhai Pan
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiaolong Ge
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Wei Zhou
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
| | - Xin Zhong
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Lihu Gu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Hepan Zhu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xinlong Li
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Weilin Qi
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xianfa Wang
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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