1
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Farquhar R, Matthews S, Baxter N, Rayers G, Ratnayake CBB, Robertson FP, Nandhra S, Lim WB, Witham M, Pandanaboyana S. Sarcopenia and Sarcopenic Obesity on Body Composition Analysis is a Significant Predictor of Mortality in Severe Acute Pancreatitis: A Longitudinal Observational Study. World J Surg 2023; 47:2825-2833. [PMID: 37541981 PMCID: PMC10545625 DOI: 10.1007/s00268-023-07122-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The prevalence and impact of sarcopenia and sarcopenic obesity noted on body composition analysis in severe acute pancreatitis (SAP) is unknown. This study investigates the prevalence of sarcopenia at different timepoints and its effect on post-pancreatitis complications and mortality. METHODS A prospective database of SAP admissions with organ failure at a single institution from 2015 to 2019 were analysed. Sarcopenia was determined by IMAGE J software on CT. Database was further queried for post-pancreatitis complications and mortality. RESULTS 141 patients with a median age of 59 (range 18-88) and M:F ratio 1.52:1 of were analysed. Sarcopenia was present in 111/141 (79%) patients at admission, 78/79 (99%) at 3 months and 26/36 (72%) at 12 months. 67/111 patients with sarcopenia on admission had sarcopenic obesity. The mortality at 30 days, 3 months and 12 months was 16/141 (11%), 30/141 (21%) and 42/141 (30%) respectively. Mortality was significantly higher in sarcopenic patients at admission (35.14%) compared to the non-sarcopenic group (10%), P = 0.008). Mortality in the sarcopenic obesity group was significantly higher (45%) compared to the sarcopenic non-obese group (20%), P = 0.009) at admission. Multivariate logistic regression identified sarcopenic obesity (OR: 2.880), age (OR: 1.048) and number of organ failures (OR: 3.225) as significant predictors of mortality. CONCLUSIONS Sarcopenia and Sarcopenic obesity are highly prevalent in SAP patients on admission and during follow up. Furthermore, sarcopenic obesity was shown to be a significant predictor of mortality at admission, suggesting that body composition analysis could be a potential predictive marker of mortality in SAP patients.
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Affiliation(s)
- Robert Farquhar
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK.
| | - Scott Matthews
- Department of Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Nesta Baxter
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - George Rayers
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | | | | | - Sandip Nandhra
- HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Wei Boon Lim
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Miles Witham
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
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2
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Ratnayake CBB, Roberts KJ, Pandanaboyana S. Upfront surgery vs. neoadjuvant therapy for resectable pancreatic cancer: a narrative review of available evidence. Chin Clin Oncol 2022; 11:2. [PMID: 35184565 DOI: 10.21037/cco-21-161] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Though the use of neoadjuvant therapy (NAT) is increasing in the setting of borderline resectable (BRPC) and locally advance pancreatic cancer (LAPC), the role of NAT in resectable pancreatic cancer (RPC) remains uncertain. METHODS This is a narrative review, summarising the contemporary evidence and emerging studies comparing neoadjuvant therapy to upfront resection and adjuvant therapy in RPC. KEY AND CONTENT AND FINDINGS Upfront resection followed by adjuvant chemotherapy is currently the standard of care for RPC. Though BRPC and LAPC have reported significant overall survival benefits with NAT, those results have yet to be translated to RPC. Downstaging is only reported in a small proportion of patients who receive NAT; most have stable disease and a small number have progression. Preliminary trial data have largely been consistent with that observed in the past whereby a modest improvement in R0 resection rates and pathological findings is observed with NAT, however rates of distant recurrence and overall survival remain similar to upfront resection. A significant proportion further fail to achieve resection due to the side effects, deconditioning and delays to surgery. Most international recommendations have been guided by non-randomised data sets and long-term data from emerging phase III trials are yet to be published. CONCLUSIONS Although we have observed improved R0 resection rates with NAT, this has yet to translate to a robust improvement in overall survival. Concerns regarding delays to resection, and limited response to NAT remain a topic of ongoing investigation.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith J Roberts
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, UK; Population Health Sciences Institute, Newcastle University, Newcastle, UK
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3
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Lavikainen LI, Guyatt GH, Lee Y, Couban RJ, Luomaranta AL, Sallinen VJ, Kalliala IEJ, Karanicolas PJ, Cartwright R, Aaltonen RL, Ahopelto K, Aro KM, Beilmann-Lehtonen I, Blanker MH, Cárdenas JL, Craigie S, Galambosi PJ, Garcia-Perdomo HA, Ge FZ, Gomaa HA, Huang L, Izett-Kay ML, Joronen KM, Karjalainen PK, Khamani N, Kilpeläinen TP, Kivelä AJ, Korhonen T, Lampela H, Mattila AK, Najafabadi BT, Nykänen TP, Nystén C, Oksjoki SM, Pandanaboyana S, Pourjamal N, Ratnayake CBB, Raudasoja AR, Singh T, Tähtinen RM, Vernooij RWM, Wang Y, Xiao Y, Yao L, Haukka J, Tikkinen KAO. Systematic reviews of observational studies of Risk of Thrombosis and Bleeding in General and Gynecologic Surgery (ROTBIGGS): introduction and methodology. Syst Rev 2021; 10:264. [PMID: 34625092 PMCID: PMC8499502 DOI: 10.1186/s13643-021-01814-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/12/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. METHODS We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. DISCUSSION This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021234119.
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Affiliation(s)
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Rachel J Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Anna L Luomaranta
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville J Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka E J Kalliala
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Paul J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rufus Cartwright
- Department of Obstetrics and Gynaecology, LNWH NHS Trust, London, UK
| | - Riikka L Aaltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaisa Ahopelto
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karoliina M Aro
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ines Beilmann-Lehtonen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marco H Blanker
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jovita L Cárdenas
- National Center for Health Technology Excellence (CENETEC) Direction of Health Technologies assessment, Mexico City, Mexico
| | - Samantha Craigie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Päivi J Galambosi
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Herney A Garcia-Perdomo
- Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
| | - Fang Zhou Ge
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Huda A Gomaa
- High Institute of Public Health, Alexandria University, Alexandria, Egypt
- Tanta Chest Hospital, Ministry of Health and Population, Tanta, Egypt
| | - Linglong Huang
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matthew L Izett-Kay
- Urogynaecology Department, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Kirsi M Joronen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Nadina Khamani
- Department of Obstetrics and Gynecology, Institute of Childrens' Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas P Kilpeläinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti J Kivelä
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tapio Korhonen
- Experts by Experience, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lampela
- Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne K Mattila
- Central Finland Central Hospital, Department of Surgery, Jyväskylä, Finland
| | - Borna Tadayon Najafabadi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Carolina Nystén
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Sanjay Pandanaboyana
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Negar Pourjamal
- Laboratory of Molecular Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Chathura B B Ratnayake
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | | | - Tino Singh
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Riikka M Tähtinen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Robin W M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuting Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- West China School of Nursing/Department of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jari Haukka
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Clinicum/Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland.
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4
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Ratnayake CBB, Kamarajah SK, Loveday BPT, Nayar M, Oppong K, White S, French JJ, Windsor JA, Pandanaboyana S. A Network Meta-analysis of Surgery for Chronic Pancreatitis: Impact on Pain and Quality of Life. J Gastrointest Surg 2020; 24:2865-2873. [PMID: 32705610 DOI: 10.1007/s11605-020-04718-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/27/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The surgical operation associated with improved pain and quality of life (QoL) in patients with chronic pancreatitis (CP) is unknown. METHOD The Scopus, EMBASE, Medline and Cochrane databases were systematically searched until May 2019, and all randomised trials (RCTs) comparing surgical operations for CP pain were included in a network meta-analysis (NMA). RESULTS Four surgical operations for treating CP were directly compared in eight RCTs including 597 patients. Patients were mainly male (79%, 474/597) with alcoholic CP (85%, 382/452). Surgical operations included were pancreatoduodenectomy (224, 38%), Berne procedure (168, 28%), Beger procedure (133, 22%) and Frey procedure (72, 12%). The NMA revealed that the Beger procedure ranked best for pain relief, whilst the Frey procedure ranked best for postoperative QoL, postoperative pancreatic fistula rate and postoperative exocrine insufficiency rate during a median follow-up of 26 months (reported range 6-58 months). Overall the Frey procedure ranked best for the combination of primary outcome measures based on surface under cumulative ranking curve scores. CONCLUSIONS Overall the Frey procedure may perform the best for both pain relief and postoperative QoL in patients with CP. Further trials are warranted in defining the role of surgery in relation to endotherapy.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery,, Freeman Hospital, Newcastle upon Tyne, UK
| | - Benjamin P T Loveday
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kofi Oppong
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery,, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jeremy J French
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery,, Freeman Hospital, Newcastle upon Tyne, UK
| | - John A Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery,, Freeman Hospital, Newcastle upon Tyne, UK. .,Population Health Sciences Institute, Newcastle University, Newcastle, UK.
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5
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Ratnayake CBB, Wells CI, Atherton P, Hammond JS, White S, French JJ, Manas D, Pandanaboyana S. Meta-analysis of survival outcomes following surgical and non surgical treatments for colorectal cancer metastasis to the lung. ANZ J Surg 2020; 91:255-263. [PMID: 33089924 DOI: 10.1111/ans.16383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/09/2020] [Revised: 07/24/2020] [Accepted: 09/20/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Controversy exists regarding the optimal management of colorectal lung metastases (CRLM). This meta-analysis compared surgical (Surg) versus interventional (chemotherapy and/or radiotherapy) and observational non-surgical (NSurg) management of CRLM. METHODS A systematic review of the major databases including Medline, Embase, SCOPUS and the Cochrane library was performed. RESULTS One randomized and nine observational studies including 2232 patients: 1551 (69%) comprised the Surg cohort, 521 (23%) the interventional NSurg group and 160 (7%) the observational NSurg group. A significantly higher overall survival (OS) was observed when Surg was compared to interventional NSurg at 1 year (Surg 88%, 310/352; interventional NSurg 64%, 245/383; odds ratio (OR) 2.77 (confidence interval (CI) 1.94-3.97), P = 0.001), at 3 years (Surg 59%, 857/1444; interventional NSurg 26%, 138/521; OR 2.61 (CI 1.65-4.15), P = 0.002), at 5 years (Surg 47%, 533/1144; interventional NSurg 23%, 45/196; OR 3.24 (CI 1.42-7.39), P = 0.009) and at 10 years (Surg 27%, 306/1122; interventional NSurg 1%, 2/168; OR 15.64 (CI 1.87-130.76), P = 0.031). Surg was associated with a greater OS than observational NSurg at only 1 year (Surg 92%, 98/107; observational NSurg 83%, 133/160; OR 6.69 (CI 1.33-33.58), P = 0.037) and was similar to observational NSurg at all other OS time points. Comparable survival was observed among Surg and overall NSurg cohorts at 3- and 5-year survival in articles published within the last 3 years. CONCLUSIONS Recent evidence suggests comparable survival with Surg and NSurg modalities for CRLM, contrasting to early evidence where Surg had an improved survival. Significant selection bias contributes to this finding, prompting the need for high powered randomized controlled trials and registry data.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Phillip Atherton
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - John S Hammond
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Steve White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jeremy J French
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Derek Manas
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle, UK
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6
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Ratnayake CBB, Wilson CH, Windsor JA, Pandanaboyana S. Re: Management of the pancreatic transection plane after left (distal) pancreatectomy: Expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2020; 169:479-480. [PMID: 32611512 DOI: 10.1016/j.surg.2020.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, New Zealand.
| | - Colin H Wilson
- HPB and Transplant Unit, Freeman Hospital, Newcastle, UK
| | - John A Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, New Zealand; HPB Unit, Department of General Surgery, Auckland City Hospital, New Zealand
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7
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Ratnayake CBB, Shah N, Loveday B, Windsor JA, Pandanaboyana S. The Impact of the Depth of Venous Invasion on Survival Following Pancreatoduodenectomy for Pancreatic Cancer: a Meta-analysis of Available Evidence. J Gastrointest Cancer 2020; 51:379-386. [PMID: 31062188 DOI: 10.1007/s12029-019-00248-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 12/20/2022]
Abstract
PURPOSE The prognostic significance of portal/superior mesenteric vein (PV/SMV) invasion at the time of pancreatoduodenectomy (PD) for pancreatic adenocarcinoma (PDAC) is contentious. The aim of this meta-analysis was to compare the survival outcomes in patients with histologically proven adventitial (superficial) versus media/intimal (deep) PV/SMV invasion at the time of PD for PDAC. METHODS A systematic search of the PubMed, MEDLINE and SCOPUS databases were performed in accordance with PRISMA guidelines. All articles reporting outcomes specific to the depth of PDAC invasion into the PV/SMV wall were included. The primary outcome measure was overall survival. RESULTS Six studies including 310 patients who underwent pancreatic resection with PV/SMV resection for PDAC were included in this meta-analysis. There was no difference in overall survival comparing superficial vs deep invasion at 12 months (64% vs 58% respectively, risk difference, - 0.09; CI, - 0.21-0.04; P = 0.183), 36 months (22% vs 18% respectively, risk difference, - 0.05; CI, - 0.16-0.19; P = 0.857) and mean overall survival (42.8 months vs 25.7 months respectively, standard mean difference, - 0.27; CI, - 0.58, 0.03; P = 0.078). Although larger tumours were seen in those with confirmed deep vein wall invasion (P < 0.001), no difference was observed between the superficial and deep invasion groups with regard to age (P = 0.298), R1 resection (P = 0.896), nodal metastatic disease (P = 0.120) and perineural invasion (P = 0.609). CONCLUSIONS This meta-analysis suggests that the depth of PV/SMV wall invasion by PDAC may not impact survival after PD. However, given the limited sample size, further research is warranted with homogenous cohorts and longer follow-up.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- HPB unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Nehal Shah
- Department of HPB Surgery, Northern General Hospital, Sheffield, UK
| | - Benjamin Loveday
- Department of HPB Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - John A Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- HPB unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Sanjay Pandanaboyana
- HPB and Transplant Unit, Freeman Hospital, High Heaton, Newcastle Upon Tyne, NE7 7DN, UK.
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8
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Ratnayake CBB, Wells CI, Kamarajah SK, Loveday B, Sen G, French JJ, White S, Pandanaboyana S. Critical appraisal of the techniques of pancreatic anastomosis following pancreaticoduodenectomy: A network meta-analysis. Int J Surg 2020; 73:72-77. [PMID: 31843679 DOI: 10.1016/j.ijsu.2019.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/22/2019] [Revised: 11/22/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains a major cause of morbidity following pancreaticoduodenectomy (PD). This network meta-analysis (NMA) compared techniques of pancreatic anastomosis following PD to determine the technique with the best outcome profile. METHODS A systematic literature search was performed on the Scopus, EMBASE, Medline and Cochrane databases to identify RCTs employing the international study group of pancreatic fistula (ISGPF) definition of POPF. The primary outcome was clinically relevant POPF. RESULTS Five techniques of pancreatic anastomosis following PD were directly compared in 15 RCTs comprising 2428 patients. Panreatojejunostomy (PJ) end-to-side invagination vs. PJ end-to-side duct-to-mucosa was the most frequent comparison (n = 7). Overall, 971 patients underwent PJ end-to-side duct-to-mucosa, 791 patients PJ end-to-side invagination, 505 patients pancreatogastrostomy (PG) end-to-side invagination, 98 patients PG end-to-side duct-to-mucosa, and 63 patients PJ end-to-side single layer. PG duct-to-mucosa was associated with the lowest rates of clinically relevant POPF, delayed gastric emptying, intra-abdominal abscess, all postoperative morbidity and postoperative mortality, the shortest operative time and postoperative hospital stay and the lowest volume of intra-operative blood loss. CONCLUSION Duct-to-mucosa pancreaticogastrostomy was associated with the lowest rates of clinically relevant POPF and had the best outcome profile among all techniques of pancreatico-anastomosis following PD.
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Affiliation(s)
- Chathura B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sivesh K Kamarajah
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Benjamin Loveday
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia; Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gourab Sen
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Jeremy J French
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Steve White
- Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Sanjay Pandanaboyana
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Hepatobiliary, Pancreatic and Transplant Surgery, Department of Surgery, Freeman Hospital, Newcastle Upon Tyne, Tyne and Wear, UK.
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9
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Ratnayake CBB, Wells C, Hammond J, French JJ, Windsor JA, Pandanaboyana S. Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy. Br J Surg 2019; 106:1580-1589. [DOI: 10.1002/bjs.11291] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/27/2019] [Accepted: 05/30/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Background
The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy remains high, and different pancreatic stump closure techniques have been used to reduce the incidence. A network meta-analysis was undertaken to compare the most frequently performed pancreatic stump closure techniques after distal pancreatectomy and determine the technique associated with the lowest POPF rate.
Methods
A systematic search of the Scopus, PubMed, MEDLINE and Embase databases was conducted to identify eligible RCTs. The primary outcome was the occurrence of clinically relevant POPF. Secondary outcomes were duration of operation, blood loss, intrabdominal collections, postoperative complications and 30-day mortality.
Results
Sixteen RCTs including 1984 patients and eight different pancreatic stump closure techniques were included in the network meta-analysis. Patch coverage of the pancreatic stump (round ligament or seromuscular patch) after stapler or suture closure ranked best, with the lowest rates of clinically relevant POPF, lowest volume of intraoperative blood loss, fewer intra-abdominal abscesses, and lower rates of overall complications and 30-day mortality. Round ligament patch closure outperformed seromuscular patch closure in preventing clinically relevant POPF with a significantly larger cohort for comparative analysis. Pancreaticoenteric anastomotic closure consistently ranked poorly for most reported postoperative outcomes.
Conclusion
Patch coverage after stapler or suture closure has the lowest POPF rate and best outcomes among stump closure techniques after distal pancreatectomy.
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Affiliation(s)
- C B B Ratnayake
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Hepatopancreatobiliary Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - C Wells
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Hepatopancreatobiliary Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - J Hammond
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - J J French
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - J A Windsor
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Hepatopancreatobiliary Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - S Pandanaboyana
- Hepatopancreatobiliary and Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK
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10
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Ratnayake CBB, Wells C, Olsson M, Windsor JA, Pandanaboyana S. Sarcopenic obesity and post‐operative morbidity after pancreatic surgery: a cohort study. ANZ J Surg 2019; 89:1587-1592. [DOI: 10.1111/ans.15431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Chathura B. B. Ratnayake
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HPB Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
| | - Cameron Wells
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HPB Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
| | - Magda Olsson
- Institute of MedicineGothenburg University Gothenburg Sweden
| | - John A. Windsor
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HPB Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
| | - Sanjay Pandanaboyana
- Department of Surgery, Faculty of Medical and Health SciencesThe University of Auckland Auckland New Zealand
- HPB Unit, Department of General SurgeryAuckland City Hospital Auckland New Zealand
- HPB and Transplant UnitFreeman Hospital Newcastle Upon Tyne UK
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11
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Ratnayake CBB, Fles R, Tan IB, Baijens LWJ, Pilz W, Meeuwis CA, Janssen-van Det PHE, van Son R, Van den Brekel MWM. Multicenter randomized crossover trial evaluating the provox luna in laryngectomized subjects. Laryngoscope 2019; 129:2354-2360. [PMID: 30786030 PMCID: PMC6790615 DOI: 10.1002/lary.27839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/26/2018] [Revised: 12/08/2018] [Accepted: 01/02/2019] [Indexed: 11/25/2022]
Abstract
Objectives The aim of this study was to compare the relative compliance and the dermatological and pulmonary outcomes when the Provox Luna system (Atos Medical, Malmö, Sweden) is added during the night to the usual tracheastoma care of laryngectomized subjects. Methods This was a multicenter randomized crossover trial conducted in the Netherlands Cancer Institute, Erasmus Medical Center, and Maastricht University Medical Center in The Netherlands. The study included 46 laryngectomized subjects with prior heat and moisture exchanger (HME) and adhesive experience. Results A significant improvement in the number of compliant individuals was found: Luna: n = 43 of 45 (96%); usual care: n = 35 of 46 (76%), P = 0.02. The Luna period was associated with longer intervals of daily HME use (Luna 23.2 hours [range: 15.6–24.0 hours], usual care [UC]: 21.5 hours [range: 6.0–24.0 hours], P = 0.003) and an increased frequency of skin improvement overnight (Luna 3.9 days [standard deviation (SD)]: 7.0 days), Usual Care: 8.1 days ([SD: 10.8 days], P = 0.008). Fifty‐six percent (n = 26) of participants wanted to continue using the Provox Luna system at the conclusion of the study. Conclusion An improvement in compliance and skin recovery overnight was observed when the Provox Luna was added to the usual adhesive and HME use. Therefore, there is utility in supplementing the usual post‐total laryngectomy care with the Provox Luna system at night, particularly in the setting of compliance concerns and in subjects who desire dermatological relief overnight. Level of Evidence 1b Laryngoscope, 129:2354–2360, 2019
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Affiliation(s)
- Chathura B B Ratnayake
- University of Auckland, Auckland, New Zealand.,Netherlands Cancer Institute, Amsterdam, New Zealand
| | - Renske Fles
- Netherlands Cancer Institute, Amsterdam, New Zealand
| | - I Bing Tan
- Netherlands Cancer Institute, Amsterdam, New Zealand.,Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Oncology and Developmental Biology-GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,School for Oncology and Developmental Biology-GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Rob van Son
- Netherlands Cancer Institute, Amsterdam, New Zealand
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