1
|
Diverticulitis with abscess formation: Outcomes of non-operative management and nomogram for predicting emergency surgery: The Diplicab Study Collaborative Group. Surgery 2023; 174:492-501. [PMID: 37385866 DOI: 10.1016/j.surg.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND To assess short- and long-term outcomes from non-surgical management of diverticulitis with abscess formation and to develop a nomogram to predict emergency surgery. METHODS This nationwide retrospective cohort study was performed in 29 Spanish referral centers, including patients with a first episode of a diverticular abscess (modified Hinchey Ib-II) from 2015 to 2019. Emergency surgery, complications, and recurrent episodes were analyzed. Regression analysis was used to assess risk factors, and a nomogram for emergency surgery was designed. RESULTS Overall, 1,395 patients were included (1,078 Hinchey Ib and 317 Hinchey II). Most (1,184, 84.9%) patients were treated with antibiotics without percutaneous drainage, and 194 (13.90%) patients required emergency surgery during admission. Percutaneous drainage (208 patients) was associated with a lower risk of emergency surgery in patients with abscesses of ≥5 cm (19.9% vs 29.3%, P = .035; odds ratio 0.59 [0.37-0.96]). The multivariate analysis showed that immunosuppression treatment, C-reactive protein (odds ratio: 1.003; 1.001-1.005), free pneumoperitoneum (odds ratio: 3.01; 2.04-4.44), Hinchey II (odds ratio: 2.15; 1.42-3.26), abscess size 3 to 4.9 cm (odds ratio: 1.87; 1.06-3.29), abscess size ≥5 cm (odds ratio: 3.62; 2.08-6.32), and use of morphine (odds ratio: 3.68; 2.29-5.92) were associated with emergency surgery. A nomogram was developed with an area under the receiver operating characteristic curve of 0.81 (95% confidence interval: 0.77-0.85). CONCLUSION Percutaneous drainage must be considered in abscesses ≥5 cm to reduce emergency surgery rates; however, there are insufficient data to recommend it in smaller abscesses. The use of the nomogram could help the surgeon develop a targeted approach.
Collapse
|
2
|
A new cardiopulmonary exercise testing score for predicting heart failure events. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiopulmonary exercise test (CPET) provides several variables (V) that are strong predictors of events in patients (pts) with heart failure (HF).
Purpose
Our aim was to develop and evaluate the predictive power (PP) of a CPET-based score, comparing to that of the Heart Failure Survival Score – HFSS.
Methods
Retrospective evaluation of adult pts with HF submitted to CPET in a tertiary center. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation (MTV). The PP of several CPET V's was assessed using ROC curve analysis, which was used to define optimal threshold values for each V. A multiple regression analysis was performed to identify independent prognostic predictors and to determine the regression coefficient (β) for the Vs included in the model, each expressed dichotomously using the threshold value. According to β, a weight was assigned to each V and summed to calculate the composite score. ROC curves were compared using the Hanley and McNeil test.
Results
CPET was performed in 487 HF pts, with a mean age of 56±13 years, 79% were male. 46% of pts were of ischemic etiology, with a mean LVEF of 30±8%, a mean HFSS of 8.6±1.1 and a mean BNP value of 509±668pg/ml. The mortality rate during a mean follow-up of 21 months, was 19% (93pts) with 23 pts (5%) undergoing HT. The primary endpoint was reached by 55 (11%) pts. The variables with higher predictive power were OUES (AUC 0.796), ventilatory power (AUC 0.790), the partial pressure of end-tidal CO2 at the anaerobic threshold (PETCO2L – AUC of 0.787), the pVO2 (AUC 0.767) and heart rhythm (HR) during the test (AUC – 0.640). LVEF also presented a high predictive power with AUC of 0.755. The multivariate analysis revealed that pVO2, PETCO2L, AF, and LVEF were independent prognostic predictors. According to the β of these Vs, the equation was calculated as follows: (pVO2 × 2.194) + (PETCO2L × 1.545) + (LVEF × 1.134) + (HR × 1.055; 0 if AF, 1 if sinus rhythm). The score presented a high PP with an AUC of 0.866. A cut-off of 120 had an 83.6% sensitivity and a 75% specificity for MTV, and pts with a score value of <120 had a markedly lower rate of MTV (log-rank p<0.001). When compared to HFSS, our score presented a higher PP (0.866 vs 0.774, p=0.011).
Conclusion
A multivariable score based on readily available CPET Vs provides a simple, integrated and powerful method to predict HF events.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
3
|
Upfront surgery versus self-expanding metallic stent as bridge to surgery in left-sided colonic cancer obstruction: A multicenter observational study. Surgery 2022; 172:74-82. [PMID: 35168815 DOI: 10.1016/j.surg.2021.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oncological outcomes of self-expanding metallic stent used as a bridge to surgery in potential curative patients with left-sided colonic cancer obstruction remain unclear. The aim of this study was to investigate perioperative and mid-term oncological outcomes of 2 of the currently most commonly performed treatments in left-sided colonic cancer obstruction. METHODS This is a retrospective multicenter study including patients with left-sided colonic cancer obstruction treated with curative intent between 2013 and 2017. The presence of metastasis at diagnosis was an exclusion criterion. The primary outcome was to evaluate the noninferiority, in terms of overall survival, of bridge to surgery strategy compared with emergency colonic resection. The secondary outcomes were perioperative morbimortality, disease free survival, local recurrence, and distant recurrence. RESULTS A total of 564 patients were included, 320 in the emergency colonic resection group and 244 in the bridge to surgery group. Twenty-seven patients of the bridge-to-surgery group needed urgent operation. Postoperative morbidity rates were statistically higher in the emergency colonic resection group (odds ratio [95% confidence interval] 0.37 [0.24-0.55], P < .001). There was no difference in 90-day mortality between groups (odds ratio [95% confidence interval] 0.85 [0.36-1.99], P = .702). The median follow-up was 3.80 years (2.29-4.92). The results show the noninferiority of bridge to surgery versus emergency colonic resection in terms of overall survival (hazard ratio [95% confidence interval) 0.78 [0.56-1.07], P = .127). There were no differences in disease free survival, distant recurrence, and local recurrence rates between bridge to surgery and emergency colonic resection groups. CONCLUSION Self-expanding metallic stent as bridge to surgery might not lead to a negative impact on the long-term prognosis of the tumor compared with emergency colonic resection in expert hands and selected patients.
Collapse
|
4
|
Usefulness of myocardial work to predict long-term hard cardiovascular outcomes after ST-segment elevation acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) predicts long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction.
Methods
A total of 132 consecutive patients admitted with an ST-segment-elevation acute myocardial infarction (mean age 62 ± 12 years; 76% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.9 ± 2.4 days after admission). All patients had at least a two-year follow-up (mean follow-up of 820 ± 155 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization.
Results
In the two-year follow-up, 6 patients died, there were 18 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE and GWI showed better discrimination compared to GLS (Table), with a cut-off of 83% and 1066 mmHg% (log-rank < 0,001) respectively. However, ROC curve comparisons were not significantly different. For MACE, the performance of all methods is suboptimal, with an AUC < 0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the best parameter to predict this event.
Conclusions
LVGWE and GWI are better predictors of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. Abstract Figure.
Collapse
|
5
|
OUP accepted manuscript. BJS Open 2022; 6:6544101. [PMID: 35257139 PMCID: PMC8902345 DOI: 10.1093/bjsopen/zrac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022] Open
|
6
|
What are the predictors of heart failure in patients admitted with acute coronary syndrome? Data from a large national registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is a serious and frequent complication of acute myocardial infarction with important impact in outcome. Early treatment according to contemporaneous guidelines is essential to avoid that complication. Previous ischemic heart disease and HF are important predictors. Our objective is to identify additional predictors of HF in patients admitted with acute coronary syndrome (ACS).
Methods
Analysis of all consecutive patients prospectively included in a large national registry of ACS. Patients with a previous history of ACS, myocardial revascularization or heart failure were excluded from the analysis. The group that developed HF was compared with the group without HF and multivariate logistic regression analysis was performed to identify independent predictors of HF during hospitalization (Killip class >1).
Results
A total of 19,248 patients were included, and 17.3% developed HF during hospitalization. Patients with HF were older, less often males and smokers, and more often with hypertension and diabetes, as well as other comorbidities (p<0.001). ST elevation myocardial infarction (STEMI), atrial fibrillation, mechanical and electrical complications are also more frequent. Patients that developed HF have higher in-hospital mortality (0.9% vs. 12.1%). Independent predictors of HF are female gender (OR 1.64, 95% CI 1.15–2.33), age (1.42, 1.25–1.62, per 10-year increase) diabetes (1.97, 1.44–2.69), atrial fibrillation (2.65,1.66–4.23), STEMI (2.30, 1.70–3.10), multivessel disease (1.52, 1.13–2.05) and initial admission in a hospital without catheterization laboratory as a protective factor (0.71, 0.52–0.96). In STEMI patients, anterior location is also an independent predictor.
Conclusions
In patients admitted with a first ACS and without previous ischemic heart disease or heart failure, female gender, increasing age, diabetes, atrial fibrillation, STEMI and multivessel disease are the main predictors of worst outcome and these patients should be treated more aggressively to avoid HF development.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
7
|
Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction.
Methods
A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization.
Results
In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank <0,001). For MACE, the performance of all methods is suboptimal, with an AUC <0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event.
Conclusions
LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding.
Funding Acknowledgement
Type of funding sources: None. Table 1
Collapse
|
8
|
Predictive ability of cardiopulmonary exercise test parameters in heart failure patients with cardiac resynchronization therapy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
There is evidence suggesting that a peak oxygen uptake (pVO2) cut-off of 10ml/kg/min provides a more precise risk stratification in Cardiac Resynchronization Therapy (CRT) patients. Our aim was to compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in patients with CRT and assess the discriminative ability of the guideline-recommended pVO2 cut-off values.
Methods
Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months and was analyzed by several CPET parameters for the highest area under thecurve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs.
Results
A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p=0.660). End-tidal carbon dioxide pressure at the anaerobic threshold (PETCO2AT) had the highest AUC value, which was significantly higher than that of pVO2 in the CRT group (0.951 vs 0.778, p=0.046). The currently recommended pVO2 cut-off provided accurate risk stratification in this setting (p<0.001),and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p=0.772).
Conclusion
PETCO2AT outperforms pVO2's prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
9
|
Can we simplify or improve long-term risk stratification for patients with ST-segment elevation myocardial infarction undergoing primary intervention? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Various scores have been developed to predict early to mid-term prognosis after ST-elevation myocardial infarction (STEMI). The aim of this study was to compare the predictive value of 7 popular risks scores for the long-term outcome of STEMI patients undergoing primary intervention, and to find an easy model with similar or superior predictive and discriminative ability.
Methods
Patients who underwent primary PCI from January 2003 through August 2007 in a single tertiary-center were analysed (n=665) using a dedicated prospective registry. Global Registry for Acute Coronary Events (GRACE), GRACE 6 months, Thrombolysis In Myocardial Infarction (TIMI) STEMI, dynamic TIMI, TIMI risk index, Primary Angioplasty in Myocardial Infarction (PAMI) and Zwolle primary percutaneous coronary intervention (PCI) index were calculated for each patient. We assessed, through the C statistic in receiver-operating characteristic analysis, the predictive accuracy of these scores using all-cause mortality at 5 year as an endpoint. With multivariate regression analysis the variables with highest predictive ability were applied to build a model.
Results
All-cause mortality at 5 years after primary PCI was 22.1%. The risk scores showed moderate predictive ability, GRACE (0.759, 95% confidence interval (CI) 0.712–0.805), GRACE 6 months (0.802, 95% CI 0.759–0.845), TIMI STEMI (0.744, 95% CI 0.696–0.791), dynamic TIMI (0.774, 95% CI 0.727–0.820), TIMI risk index (0.757, 95% CI 0.710–0.803), PAMI (0.753, 95% CI 0.707–0.800) and Zwolle index (0.749, 95% CI 0.703–0.795). Six independent predictors of 5-year mortality were identified (age >70 years, history of MI, history of stroke, heart tare above 85 beats per min, 3-vessel disease and in-hospital adverse events) and the model built had similar discriminative performance in estimation of probabilities of death (0.804, 95% CI 0.762–0.846, p=0.953 for difference with GRACE score).
Conclusions
The prediction values of currently recommended risk scores are moderate for long-term perspective (5-year). The simplified risk stratification score for STEMI and primary angioplasty using only six variables demonstrates accuracy similar to the more advanced risk scores.
Funding Acknowledgement
Type of funding sources: None.
Collapse
|
10
|
Is Metformin Associated With Improved Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer? J Surg Res 2021; 268:465-473. [PMID: 34418650 DOI: 10.1016/j.jss.2021.06.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 01/26/2023]
Abstract
Efforts to determine whether metformin can increase the effectiveness of neoadjuvant chemoradiotherapy in rectal cancer have increased in recent years. However, retrospective studies have yielded inconclusive results. OBJECTIVES The aim of this study was to compare oncological outcomes and survival after neoadjuvant chemoradiotherapy in patients with rectal cancer taking metformin versus in those not taking metformin. METHODS This study analyzed 423 consecutive patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy and curative surgery between January 2010 and May 2020; of these, 59 were taking metformin and 364 were not taking metformin. RESULTS Patients taking metformin had a lower proportion of tumor regression (6.8% versus 22.0%, P = 0.012) as well as a lower proportion of patients achieving a pathological complete response (6.8% versus 20.6%, P = 0.011). In the multivariate analysis, independent predictors of pathologic complete response were not taking metformin (OR: 5.26, 95% CI: 1.12-24.85, P= 0.035) and cT2 stage (OR: 3.49, 95% CI: 1.10-11.07, P= 0.034); the interval was also an independent predictor of tumor regression (OR: 1.78, 95% CI: 1.06-2.96, P= 0.028). No differences were observed in survival between groups. CONCLUSION Metformin was not associated with better tumor responses or survival after neoadjuvant treatment.
Collapse
|
11
|
Abstract
Abstract
Background
Peak oxygen consumption (pVO2) is a key parameter in assessing the prognosis of heart failure with reduced ejection fraction (HFrEF) patients (pts). However, it is a less reliable parameter when the cardiopulmonary exercise test (CPET) is not maximal. It is crucial to identify the submaximal exercise variables with the best prognostic power (PP), in order to improve the management of pts that cannot attain a maximal CPET.
Purpose
The aim of this study was to evaluate and compare the PP of several exercise parameters in submaximal CPET for risk stratification in pts with HFrEF.
Methods
Prospective evaluation of adult pts with HFrEF submitted to CPET in a tertiary center. A submaximal CPET was defined by a respiratory exchange ratio (RER) ≤1.10. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation. Several CPET parameters were analyzed as potential predictors of the combined endpoint and their PP (area under the curve - AUC) was compared to that of pVO2, using the Hanley and McNeil test.
Results
CPET was performed in 487 HF pts, of which 317 (66%) performed a submaximal CPET. Pts averaged 57±12 years of age, 77% were male, 45.7% had ischemic cardiomyopathy, with a mean LVEF of 30.4±7.6%, a mean heart failure survival score of 8.6±1.1. The mean pVO2 was 17.1±5.5 ml/kg/min and the mean RER 1.01±0.08. During a mean follow-up (FU) time of 11±1 months, 18 pts (6%) met the primary endpoint. Cardiorespiratory optimal point (OP - VE/VO2) had the highest AUC value (0.915, p=0.001), followed by the partial pressure of end-tidal CO2 at the anaerobic threshold - PETCO2L (0.814, p<0.001). pVO2 presented an AUC of 0.730 (p=0.001). OP≥31 and PETCO2L ≤37mmHg had a sensitivity of 100 and 76.9% and a specificity of 71.1 and 67%, respectively, for the primary outcome. OP presented a significantly higher PP than pVO2 (p=0.048), whether PETCO2L didn't achieve any statistical significance (p=0.164). Pts with anOP≥31 presented a significantly lower survival free of HT during FU (log rank p=0.002).
Conclusion
OP had the highest PP for HF events of all parameters analyzed for a submaximal CPET. This parameter can help stratify the HF pts physiologically unable to reach a peak level of exercise.
Funding Acknowledgement
Type of funding source: None
Collapse
|
12
|
Randomized clinical trial comparing side to end vs end to end techniques for colorectal anastomosis. Int J Surg 2020; 83:220-229. [PMID: 33038521 DOI: 10.1016/j.ijsu.2020.09.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low anterior resection syndrome affects 60%-90% of patients with anastomoses after colorectal resection. Consensus regarding the best anastomosis is lacking. OBJECTIVE To compare outcomes after end-to-end versus side-to-end anastomoses. DESIGN Randomized clinical trial. SETTINGS University hospital (April 2016-October 2017). PATIENTS Patients aged ≥18 years with rectal or sigmoid adenocarcinoma. INTERVENTIONS Patients were randomized to undergo mechanical end-to-end or side-to-end (n = 33) anastomosis after laparoscopic resection. MAIN OUTCOME MEASURES Primary outcome was to assess intestinal function (COREFO and LARS questionnaires) 12 months after surgery or ileostomy closure. Secondary outcomes were postoperative complications and intestinal function and quality of life (SF-36® questionnaire) at different time points after surgery or ileostomy closure. RESULTS No significant differences in intestinal function were observed between the two groups 12 months after surgery. Subanalysis of low-mid rectum tumors with end-to-end anastomosis yielded better function at 12 months. Postoperative complications did not differ between the two groups (p = 0.070), but reinterventions were more common in the side-to-end group (p = 0.040). Multivariate analysis found neoadjuvant treatment was independently associated with intestinal dysfunction at 12 months (β = 0.41, p = 0.033, COREFO; β = 0.41, p = 0.024, LARS). CONCLUSIONS End-to-end anastomosis yielded low rates of severe complications and reintervention, as well as better intestinal function at 12 months in the subgroup with tumors in the low-mid rectum. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT02746224.
Collapse
|
13
|
HIT Poster session 2P479Strain concordance in a real-world setting: experience in our laboratory after equipment upgradeP4803D echocardiography is a fast-learning and reliable method for the measurements of left atrial volumesP481Echocardiographic parameters associated with long-term appropriate antiarrhythmic therapies in cardiac resynchronization therapy defibrillator patientsP482Noninvasively measured global wasted myocardial work allows for quantitative assessment of typical left ventricular mechanical dyssynchrony pattern in patients with left bundle branch blockP483The impact of adherence to physical exercise on the improvement of cardiovascular remodeling and metabolic status in healthy untrained postmenopausal womenP484The impact of the latest chamber quantification recommendations on the prediction of left atrial appendage thrombus presenceP485The cardiac-enriched miRNAs plasma levels (miR-1, miR-133a, miR-499) reflect the impaired left ventricular systolic function and correlate with cardiac necrosis markers in early phase of NSTE-ACSP486Acute regional myocardial deformation changes in patients with severe aortic stenosis and preserved ejection fraction after isolated aortic valve replacementP487Left ventricular rotational deformation in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction P488The appropriate use of transthoracic echocardiography for the exclusion of infective endocarditisP489In patients with hypertrophic cardiomyopathy, left ventricular mass and shape by three-dimensional echocardiography are related with dynamic obstruction and functional capacityP490Mitral leaflet sizing in hypertrophic cardiomyopathy: impact of method and timingP491Echocardiographic predictors of atrial fibrillation in obese womenP492Echocardiographic risk factors for 30 day mortality after the hybrid procedure for hypoplastic left heart syndromeP493Left ventricular mass is an independent predictor of coronary flow reserve: insights from a single centre stress echo cohortP494Transesophageal echocardigoraphy uner conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP495Transesophageal echocardigoraphy under conscious sedation for guiding cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation - the safety and feasibility studyP496Three-dimensional trans-esophageal echocardiography assessment of the immediate morphological changes of the mitral annulus after percutaneous mitral edge-to-edge repairP497Clinical value of global and regional longitudinal strain in prediction of myocardial ischemia in asymptomatic diabetes type 2 patientsP499Comparison of prognostic operative risk impact on the global longitudinal strain right ventricle (GLS RV) and tricuspid annular plane systolic excursion (TAPSE) values in patients with ischemic cardioP498Right heart function in early diastolic dysfunction: 2D speckle-tracking echocardiography-based assessment of right atrial and right ventricular functionP500 Comparison of 2D, 3D transesophageal echocardiography and computed tomography during the assessment of left atrial appendage closure. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Rehabilitación multimodal y cirugía intestinal por enfermedad de Crohn: Factores asociados a estancia hospitalaria prolongada. Cir Esp 2016; 94:531-536. [DOI: 10.1016/j.ciresp.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/01/2016] [Accepted: 09/11/2016] [Indexed: 12/23/2022]
|
15
|
Incidence and characterization of the anterior resection syndrome through the use of the LARS scale (low anterior resection score). Cir Esp 2016; 94:137-43. [PMID: 26796026 DOI: 10.1016/j.ciresp.2015.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Recently a score (LARS) has been internationally validates that quantifies the anterior resection syndrome (ARS). The objective of this study is to know the incidence and severity of the ARS using LARS and its correlation with selected variables or risk factors. METHODS All operated patients with anterior resection for rectal cancer between October 2007 and February 2014, with curative intention and at least one year of functionality, were sent a LARS questionnaire. The variables studied were: Age sex, time elapsed since surgery, type of surgical approach, type of anastomosis, derivative ileostomy, postoperative pelvic complication, and radiotherapy regimen. RESULTS Out of 195 patients, 136 (70%) responded, and 132 responded properly. A total of 47% of the patients presented "severe" LARS and 34% did not develop quantifiable ARS. Quality of life was worse in the highest LARS scores (P=.002). In the univariate analysis, total mesorectal excision, long radiotherapy regimen and derivative stoma were associated to "severe" LARS and the use of a reservoir was associated with minor LARS. In multivariate analysis only the type of resection (P<.001) and the use of a reservoir (P=.002) were individual factors related to LARS. CONCLUSIONS Half of the operated patients presented high LARS score and only a third did not provide a quantifiable ARS. The overall perception of quality of life was significantly worse in patients with more severe LARS. The absence of the rectum (total mesorectal excision) and the type of anastomosis were the main factors associated with the LARS score.
Collapse
|
16
|
Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
17
|
Exenteración pélvica total en el tratamiento de las neoplasias avanzadas, primarias o recurrentes, de vísceras pélvicas. Cir Esp 2015; 93:174-80. [DOI: 10.1016/j.ciresp.2014.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 07/18/2014] [Accepted: 07/22/2014] [Indexed: 11/26/2022]
|
18
|
Poster session Thursday 12 December - AM: 12/12/2013, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Club35 Poster Session Thursday 12 December: 12/12/2013, 08:30-18:00 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
20
|
Value of echocardiography in predicting super-response to cardiac resynchronisation therapy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Impact of antithrombotic strategy in patients with atrial fibrillation and acute coronary syndrome. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
22
|
Poster Session 2. Europace 2011. [DOI: 10.1093/europace/eur222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
23
|
P-333 Linear ablation for the treatment of typical atrial flutter: Should the inferior and the septal isthmus be both blocked? Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b144-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|