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Kowatsch M, Szeverinski P, Clemens P, Künzler T, Söhn M, Alber M. Sensitivity and specificity of Monte Carlo based independent secondary dose computation for detecting modulation-related dose errors in intensity modulated radiotherapy. Z Med Phys 2023:S0939-3889(23)00117-4. [PMID: 37891103 DOI: 10.1016/j.zemedi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/09/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The recent availability of Monte Carlo based independent secondary dose calculation (ISDC) for patient-specific quality assurance (QA) of modulated radiotherapy requires the definition of appropriate, more sensitive action levels, since contemporary recommendations were defined for less accurate ISDC dose algorithms. PURPOSE The objective is to establish an optimum action level and measure the efficacy of a Monte Carlo ISDC software for pre-treatment QA of intensity modulated radiotherapy treatments. METHODS The treatment planning system and the ISDC were commissioned by their vendors from independent base data sets, replicating a typical real-world scenario. In order to apply Receiver-Operator-Characteristics (ROC), a set of treatment plans for various case classes was created that consisted of 190 clinical treatment plans and 190 manipulated treatment plans with dose errors in the range of 1.5-2.5%. All 380 treatment plans were evaluated with ISDC in the patient geometry. ROC analysis was performed for a number of Gamma (dose-difference/distance-to-agreement) criteria. QA methods were ranked according to Area under the ROC curve (AUC) and optimum action levels were derived via Youden's J statistics. RESULTS Overall, for original treatment plans, the mean Gamma pass rate (GPR) for Gamma(1%, 1 mm) was close to 90%, although with some variation across case classes. The best QA criterion was Gamma(2%, 1 mm) with GPR > 90% and an AUC of 0.928. Gamma criteria with small distance-to-agreement had consistently higher AUC. GPR of original treatment plans depended on their modulation degree. An action level in terms of Gamma(1%, 1 mm) GPR that decreases with modulation degree was the most efficient criterion with sensitivity = 0.91 and specificity = 0.95, compared with Gamma(3%, 3 mm) GPR > 99%, sensitivity = 0.73 and specificity = 0.91 as a commonly used action level. CONCLUSIONS ISDC with Monte Carlo proves highly efficient to catch errors in the treatment planning process. For a Monte Carlo based TPS, dose-difference criteria of 2% or less, and distance-to-agreement criteria of 1 mm, achieve the largest AUC in ROC analysis.
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Affiliation(s)
- Matthias Kowatsch
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria.
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Thomas Künzler
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria
| | - Matthias Söhn
- Scientific-RT GmbH, Welserstr. 7, 81373 München, Germany
| | - Markus Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Scientific-RT GmbH, Welserstr. 7, 81373 München, Germany
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Tschann P, Weigl MP, Clemens P, Szeverinski P, Attenberger C, Kowatsch M, Jäger T, Emmanuel K, Brock T, Königsrainer I. Sarcopenic Obesity Is a Risk Factor for Worse Oncological Long-Term Outcome in Locally Advanced Rectal Cancer Patients: A Retrospective Single-Center Cohort Study. Nutrients 2023; 15:nu15112632. [PMID: 37299595 DOI: 10.3390/nu15112632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/30/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Malnutrition and skeletal muscle waste (sarcopenia) are known as predictive factors for a poor postoperative outcome. Paradoxically, obesity seems to be associated with a survival advantage in wasting diseases such as cancer. Thus, the interpretation of body composition indices and their impact on rectal cancer therapy has become more and more complex. The aim of this study was to evaluate body composition indices in locally advanced rectal cancer patients prior to therapy and their impact on short- and long-term outcomes. METHODS Between 2008 and 2018, 96 patients were included in this study. Pre-therapeutic CT scans were used to evaluate visceral and subcutaneous fat mass, as well as muscle mass. Body composition indices were compared to body mass index, morbidity, anastomotic leakage rate, local recurrency rate, and oncological long-term outcomes. RESULTS Increased visceral fat (p < 0.01), subcutaneous fat (p < 0.01), and total fat mass (p = 0.001) were associated with overweight. Skeletal muscle waste (sarcopenia) (p = 0.045), age (p = 0.004), comorbidities (p < 0.01), and sarcopenic obesity (p = 0.02) were significantly associated with increased overall morbidity. The anastomotic leakage rate was significantly influenced when comorbidities were present (p = 0.006). Patients with sarcopenic obesity showed significantly worse disease-free (p = 0.04) and overall survival (p = 0.0019). The local recurrency rate was not influenced by body composition indices. CONCLUSION Muscle waste, older age, and comorbidities were demonstrated as strong risk factors for increased overall morbidity. Sarcopenic obesity was associated with worse DFS and OS. This study underlines the role of nutrition and appropriate physical activity prior to therapy.
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Affiliation(s)
- Peter Tschann
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Markus P Weigl
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | | | - Matthias Kowatsch
- Institute of Medical Physics, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Thomas Brock
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
| | - Ingmar Königsrainer
- Department of General- and Thoracic Surgery, Academic Teaching Hospital, 6800 Feldkirch, Austria
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Tschann P, Weigl MP, Szeverinski P, Lechner D, Brock T, Rauch S, Rossner J, Eiter H, Girotti PNC, Jäger T, Presl J, Emmanuel K, De Vries A, Königsrainer I, Clemens P. Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? A single-centre cohort study. Langenbecks Arch Surg 2022; 407:2945-2957. [PMID: 35849193 DOI: 10.1007/s00423-022-02609-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Anastomotic leakage (AL) poses the most serious problem following low anterior resection in patients with rectal cancer independent of surgical approach or technique. The aim of this study was to evaluate risk factors for the occurrence of AL and how they affect the oncological long-term outcome of patients who received neoadjuvant therapy. METHODS A single centre cohort study of 163 consecutive locally advanced rectal cancer patients (cT3, cT4, N +) that received neoadjuvant therapy followed by resection with primary anastomosis between January 1998 and December 2020 were included in this study. Short- and long-term findings were compared between patients with AL (Leakage +) and without AL (Leakage -). RESULTS A complete follow-up was obtained from 163 patients; thereby, 33 patients (20%) developed an AL. We observed more patients with comorbidities (38% vs. 61%, p = 0.049) which developed a leakage in the course. Permanent stoma rate (36% vs. 18%, p = 0.03) was higher, and time between primary operation and stoma reversal was longer (219 days [172-309] vs. 93 days [50-182], p < 0.001) in this leakage group as well. Tumour distance lower than 6 cm from the anal verge (OR: 2.81 [95%CI: 1.08-7.29], p = 0.04) and comorbidities (OR: 2.22 [95%CI: 1.01-4.90], p = 0.049) was evaluated to be independent risk factors for developing an AL after rectal cancer surgery. Oncological outcome was not influenced by AL nor by other associated risk factors. CONCLUSION We could clearly detect the distance of tumour from the anal verge and comorbidities independent risk factors for the occurrence of AL. Oncological findings and long-term outcome were not influenced by these particular risk factors.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
| | - Markus P Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Thomas Brock
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Jana Rossner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Helmut Eiter
- Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria
| | - Paolo N C Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Alexander De Vries
- Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria
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Tschann P, Weigl MP, Lechner D, Mittelberger C, Jäger T, Gruber R, Girotti PNC, Mittermair C, Clemens P, Attenberger C, Szeverinski P, Brock T, Frick J, Emmanuel K, Königsrainer I, Presl J. Is Robotic Assisted Colorectal Cancer Surgery Equivalent Compared to Laparoscopic Procedures during the Introduction of a Robotic Program? A Propensity-Score Matched Analysis. Cancers (Basel) 2022; 14:cancers14133208. [PMID: 35804985 PMCID: PMC9264883 DOI: 10.3390/cancers14133208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary The introduction of a robotic program is challenging and requires extensive experience in minimally invasive surgery. Short-term outcomes and oncological quality should not differ between robotic and laparoscopic surgery. To our knowledge, no data on the quality of surgery at the time of introduction of the robotic platform are available. The aim of this study was to compare short-term outcomes and oncological findings of robotic-assisted colorectal resections with those of conventional laparoscopic surgery within the first three years after the introduction of the robotic platform. Abstract Background: Robotic surgery represents a novel approach for the treatment of colorectal cancers and has been established as an important and effective method over the last years. The aim of this work was to evaluate the effect of a robotic program on oncological findings compared to conventional laparoscopic surgery within the first three years after the introduction. Methods: All colorectal cancer patients from two centers that either received robotic-assisted or conventional laparoscopic surgery were included in a comparative study. A propensity-score-matched analysis was used to reduce confounding differences. Results: A laparoscopic resection (LR Group) was performed in 82 cases, and 93 patients were treated robotic-assisted surgery (RR Group). Patients’ characteristics did not differ between groups. In right-sided resections, an intracorporeal anastomosis was significantly more often performed in the RR Group (LR Group: 5 (26.31%) vs. RR Group: 10 (76.92%), p = 0.008). Operative time was shown to be significantly shorter in the LR Group (LR Group: 200 min (150–243) vs. 204 min (174–278), p = 0.045). Conversions to open surgery did occur more often in the LR Group (LR Group: 16 (19.51%) vs. RR Group: 5 (5.38%), p = 0.004). Postoperative morbidity, the number of harvested lymph nodes, quality of resection and postoperative tumor stage did not differ between groups. Conclusion: In this study, we could clearly demonstrate robotic-assisted colorectal cancer surgery as effective, feasible and safe regarding postoperative morbidity and oncological findings compared to conventional laparoscopy during the introduction of a robotic system.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
- Correspondence: ; Tel.: +43-(0)-5522-303-0; Fax: +43-(0)-5522-303-7505
| | - Markus P. Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Christa Mittelberger
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Ricarda Gruber
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Paolo N. C. Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, 6800 Feldkirch, Austria;
| | - Christian Attenberger
- Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein;
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Thomas Brock
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Jürgen Frick
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, Carinagasse 47, 6800 Feldkirch, Austria; (M.P.W.); (D.L.); (C.M.); (P.N.C.G.); (T.B.); (J.F.); (I.K.)
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University/Salzburger Landeskliniken (SALK), 5020 Salzburg, Austria; (T.J.); (R.G.); (K.E.); (J.P.)
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Tschann P, Szeverinski P, Weigl MP, Rauch S, Lechner D, Adler S, Girotti PNC, Clemens P, Tschann V, Presl J, Schredl P, Mittermair C, Jäger T, Emmanuel K, Königsrainer I. Short- and Long-Term Outcome of Laparoscopic- versus Robotic-Assisted Right Colectomy: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11092387. [PMID: 35566512 PMCID: PMC9103048 DOI: 10.3390/jcm11092387] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 12/17/2022] Open
Abstract
Background: There is a rapidly growing literature available on right hemicolectomy comparing the short- and long-term outcomes of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). The aim of this meta-analysis is to revise current comparative literature systematically. Methods: A systematic review of comparative studies published between 2000 to 2021 in PubMed, Scopus and Embase was performed. The primary endpoint was postoperative morbidity, mortality and long-term oncological results. Secondary endpoints consist of blood loss, conversion rates, complications, time to first flatus, hospital stay and incisional hernia rate. Results: 25 of 322 studies were considered for data extraction. A total of 16,099 individual patients who underwent RRC (n = 1842) or LRC (n = 14,257) between 2002 and 2020 were identified. Operative time was significantly shorter in the LRC group (LRC 165.31 min ± 43.08 vs. RRC 207.38 min ± 189.13, MD: −42.01 (95% CI: −51.06−32.96), p < 0.001). Blood loss was significantly lower in the RRC group (LRC 63.57 ± 35.21 vs. RRC 53.62 ± 34.02, MD: 10.03 (95% CI: 1.61−18.45), p = 0.02) as well as conversion rate (LRC 1155/11,629 vs. RRC 94/1534, OR: 1.65 (1.28−2.13), p < 0.001) and hospital stay (LRC 6.15 ± 31.77 vs. RRC 5.31 ± 1.65, MD: 0.84 (95% CI: 0.29−1.38), p = 0.003). Oncological long-term results did not differ between both groups. Conclusion: The advantages of robotic colorectal procedures were clearly demonstrated. RRC can be regarded as safe and feasible. Most of the included studies were retrospective with a limited level of evidence. Further randomized trials would be suitable.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
- Correspondence: ; Tel.: +43-(0)-5522-303-2400; Fax: +43-(0)-5522-303-7505
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
- Private University in the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Markus P. Weigl
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Stephanie Adler
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Paolo N. C. Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Veronika Tschann
- Department of Internal Medicine II, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria;
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, 5020 Salzburg, Austria; (J.P.); (P.S.); (T.J.); (K.E.)
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria; (M.P.W.); (S.R.); (D.L.); (S.A.); (P.N.C.G.); (I.K.)
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Tschann P, Lechner D, Girotti PNC, Adler S, Rauch S, Presl J, Jäger T, Schredl P, Mittermair C, Szeverinski P, Clemens P, Weiss HG, Emmanuel K, Königsrainer I. Incidence and risk factors for umbilical incisional hernia after reduced port colorectal surgery (SIL + 1 additional port)-is an umbilical midline approach really a problem? Langenbecks Arch Surg 2022; 407:1241-1249. [PMID: 35066629 DOI: 10.1007/s00423-021-02416-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/14/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Umbilical midline incisions for single incision- or reduced port laparoscopic surgery are still discussed controversially because of a higher rate of incisional hernia compared to conventional laparoscopic techniques. The aim of this study was to evaluate incidence and risk factors for incisional hernia after reduced port colorectal surgery. METHODS A total 241 patients underwent elective reduced port colorectal surgery between 2014 and 2020. Follow-up was achieved through telephone interview or clinical examination. The study collective was examined using univariate and multivariate analysis. RESULTS A total of 150 patients with complete follow-up were included into this study. Mean follow-up time was 36 (IQR 24-50) months. The study collective consists of 77 (51.3%) female and 73 (48.7%) male patients with an average BMI of 26 kg/m2 (IQR 23-28) and an average age of 61 (± 14). Indication for surgery was diverticulitis in 55 (36.6%) cases, colorectal cancer in 65 (43.3%) patients, and other benign reasons in 30 (20.0%) cases. An incisional hernia was observed 9 times (6.0%). Obesity (OR 5.8, 95% CI 1.5-23.1, p = 0.02) and pre-existent umbilical hernia (OR 161.0, 95% CI 23.1-1124.5, p < 0.01) were significant risk factors for incisional hernia in the univariate analysis. Furthermore, pre-existent hernia is shown to be a risk factor also in multivariate analysis. CONCLUSION We could demonstrate that reduced port colorectal surgery using an umbilical single port access is feasible and safe with a low rate of incisional hernia. Obesity and pre-existing umbilical hernia are significant risk factors for incisional hernia.
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Affiliation(s)
- Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria.
| | - Daniel Lechner
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Paolo N C Girotti
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Stephanie Adler
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Stephanie Rauch
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
| | - Jaroslav Presl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Schredl
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Christof Mittermair
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria
| | - Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital, Feldkirch, Austria
| | - Helmut G Weiss
- Department of Surgery, St. John of God Hospital, Teaching Hospital of Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department of Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Ingmar Königsrainer
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Carinagasse 47, A-6800, Feldkirch, Austria
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Szeverinski P, Kowatsch M, Künzler T, Meinschad M, Clemens P, DeVries AF. Evaluation of 4-Hz log files and secondary Monte Carlo dose calculation as patient-specific quality assurance for VMAT prostate plans. J Appl Clin Med Phys 2021; 22:235-244. [PMID: 34151502 PMCID: PMC8292700 DOI: 10.1002/acm2.13315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose In this study, 4‐Hz log files were evaluated with an independent secondary Monte Carlo dose calculation algorithm to reduce the workload for patient‐specific quality assurance (QA) in clinical routine. Materials and Methods A total of 30 randomly selected clinical prostate VMAT plans were included. The used treatment planning system (TPS) was Monaco (Elekta, Crawley), and the secondary dose calculation software was SciMoCa (Scientific‐RT, Munich). Monaco and SciMoCa work with a Monte Carlo algorithm. A plausibility check of Monaco and SciMoCa was performed using an ionization chamber in the BodyPhantom (BP). First, the original Monaco RT plans were verified with SciMoCa (pretreatment QA). Second, the corresponding 4‐Hz log files were converted into RT log file plans and sent to SciMoCa as on‐treatment QA. MLC shift errors were introduced for one prostate plan to determine the sensitivity of on‐treatment QA. For pretreatment and on‐treatment QA, a gamma analysis (2%/1mm/20%) was performed and dosimetric values of PTV and OARs were ascertained in SciMoCa. Results Plausibility check of TPS Monaco vs. BP measurement and SciMoCa vs. BP measurement showed valid accuracy for clinical VMAT QA. Using SciMoCa, there was no significant difference in PTV Dmean between RT plan and RT log file plan. Between pretreatment and on‐treatment QA, PTV metrics, femur right and left showed no significant dosimetric differences as opposed to OARs rectum and bladder. The overall gamma passing rate (GPR) ranged from 96.10% to 100% in pretreatment QA and from 93.50% to 99.80% in on‐treatment QA. MLC shift errors were identified for deviations larger than −0.50 mm and +0.75 mm using overall gamma criterion and PTV Dmean. Conclusion SciMoCa calculations of Monaco RT plans and RT log file plans are in excellent agreement to each other. Therefore, 4‐Hz log files and SciMoCa can replace labor‐intensive phantom‐based measurements as patient‐specific QA.
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Affiliation(s)
- Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Matthias Kowatsch
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thomas Künzler
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Marco Meinschad
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Alexander F DeVries
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Szeverinski P, Kowatsch M, Künzler T, Meinschad M, Clemens P, DeVries AF. Error sensitivity of a log file analysis tool compared with a helical diode array dosimeter for VMAT delivery quality assurance. J Appl Clin Med Phys 2020; 21:163-171. [PMID: 33095978 PMCID: PMC7700945 DOI: 10.1002/acm2.13051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/29/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Integrating log file analysis with LINACWatch® (LW) into clinical routine as part of the quality assurance (QA) process could be a time-saving strategy that does not compromise on quality. The purpose is to determine the error sensitivity of log file analysis using LINACWatch® compared with a measurement device (ArcCHECK®, AC) for VMAT delivery QA. MATERIALS AND METHODS Multi-leaf collimator (MLC) errors, collimator angle errors, MLC shift errors and dose errors were inserted to analyze error detection sensitivity. A total of 36 plans were manipulated with different magnitudes of errors. The gamma index protocols for AC were 3%/3 mm/Global and 2%/2 mm/Global, as well as 2%/2 mm/Global, and 1.5%/1.5 mm/Global for LW. Additionally, deviations of the collimator and monitor units between TPS and log file were calculated as RMS values. A 0.125 cm3 ionization chamber was used to independently examine the effect on dose. RESULTS The sensitivity for AC was 20.4% and 49.6% vs 63.0% and 86.5% for LW, depending on the analysis protocol. For MLC opening and closing errors, the detection rate was 19.0% and 47.7% for AC vs 50.5% and 75.5% for LW. For MLC shift errors, it was 29.6% and 66.7% for AC vs 66.7% and 83.3% for LW. AC could detect 25.0% and 44.4% of all collimator errors. Log file analysis detected all collimator errors using 1° detection level. 13.2% and 42.4% of all dose errors were detected by AC vs 59.0% and 92.4% for LW using gamma analysis. Using RMS value, all dose errors were detected by LW (1% detection level). CONCLUSION The results of this study clearly show that log file analysis is an excellent complement to phantom-based delivery QA of VMAT plans. We recommend a 1.5%/1.5 mm/Global criteria for log file-based gamma calculations. Log file analysis was implemented successfully in our clinical routine for VMAT delivery QA.
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Affiliation(s)
- Philipp Szeverinski
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.,Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Matthias Kowatsch
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Thomas Künzler
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Marco Meinschad
- Institute of Medical Physics, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Patrick Clemens
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
| | - Alexander F DeVries
- Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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Meinschad M, Pasler M, Leitold G, Szeverinski P, Kowatsch M, Künzler T. EP-1759: Logfile based detection and dosimetric effects of deviations between TPS and linac. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32068-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kowatsch M, Meinschad M, Leitold G, Szeverinski P, Künzler T. PO-0795: Comparison of Service graph log and Dynamic linac log of Elekta Linacs for patient QA. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31232-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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