Digestive Surgery最新文献_第6页

The "Weekday Effect" on Enhanced Recovery after Surgery Protocol for Gastrectomy. “工作日效应”对胃切除术后增强恢复的影响。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000531022

Jacopo Weindelmayer, Valentina Mengardo, Lorena Torroni, Maria Clelia Gervasi, Selma Hetoja, Carlo Alberto De Pasqual, Davide Simion, Simone Giacopuzzi

{"title":"The \"Weekday Effect\" on Enhanced Recovery after Surgery Protocol for Gastrectomy.","authors":"Jacopo Weindelmayer, Valentina Mengardo, Lorena Torroni, Maria Clelia Gervasi, Selma Hetoja, Carlo Alberto De Pasqual, Davide Simion, Simone Giacopuzzi","doi":"10.1159/000531022","DOIUrl":"https://doi.org/10.1159/000531022","url":null,"abstract":"Introduction: While enhanced recovery after surgery (ERAS) protocol demonstrated to improve outcomes after gastrectomy, some papers evidenced a detrimental effect on postoperative morbidity related to the \"weekday effect.\" We aimed to understand whether the day of gastrectomy could affect postoperative outcomes and compliance with ERAS items.Methods: We included all patients that underwent gastrectomy for cancer between January 2017 and September 2021. Cohort was divided considering the day of surgery: Early group (Monday-Wednesday) and Late group (Thursday-Friday). Compliance with protocol and postoperative outcomes were compared.Results: Two hundred twenty-seven patients were included in Early group, while 154 were in Late group. The groups were comparable in preoperative characteristics. No significant difference in pre/intraoperative and postoperative ERAS items' compliance was apparent between Early and Late groups, with most items exceeding the 70% threshold. Median length of stay was 6.5 days and 6 days in Early and Late groups (p = 0.616), respectively. Morbidity was 50% in both groups, with severe complications that occurred in 13% of Early patients and 15% of Late patients. Ninety-day mortality was 2%, and it was similar between the two groups.Conclusions: In a center with a standardized ERAS protocol, the weekday of gastrectomy has no significant impact on the success of each ERAS item and on postoperative surgical and oncological outcomes.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 3-4","pages":"100-107"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10209083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

External Validation of Two Scoring Tools to Predict the Operative Duration and Open Conversion of Elective Laparoscopic Cholecystectomy in a Mexican Population. 两种评分工具预测墨西哥人群择期腹腔镜胆囊切除术手术时间和开放转换的外部验证。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000531087

Gustavo Martínez-Mier, Daniel Mendez-Rico, José Manuel Reyes-Ruiz, Pedro Ivan Moreno-Ley, Victor Bernal-Dolores, Octavio Avila-Mercado

{"title":"External Validation of Two Scoring Tools to Predict the Operative Duration and Open Conversion of Elective Laparoscopic Cholecystectomy in a Mexican Population.","authors":"Gustavo Martínez-Mier, Daniel Mendez-Rico, José Manuel Reyes-Ruiz, Pedro Ivan Moreno-Ley, Victor Bernal-Dolores, Octavio Avila-Mercado","doi":"10.1159/000531087","DOIUrl":"https://doi.org/10.1159/000531087","url":null,"abstract":"Introduction: This study aimed to evaluate the use of laparoscopic cholecystectomy (LC) operative time (CholeS score) and conversion to an open procedure (CLOC score) outside their validation dataset in Mexican population.Methods: Patients >18 years who underwent elective LC were analyzed in a single-center retrospective chart review study. Association between scores (CholeS and CLOC) with operative time and conversion to open procedures was assessed with Spearman correlation. The predictive accuracy of the CholeS score and CLOC score was evaluated by receiver operator characteristic.Results: 200 patients were included in the study (33 excluded for emergency case or missing data). Spearman coefficient correlations between CholeS or CLOC score and operative time were 0.456 (p < 0.0001) and 0.356 (p < 0.0001), respectively. Area under the curve (AUC) for operative prediction time (>90 min) by CholeS score was 0.786 with a 3.5-point cutoff (80% sensitivity and 63.2% specificity). AUC for open conversion (CLOC score) was 0.78 with a 5-point cutoff (60% sensitivity and 91% specificity). The CLOC score had a 0.740 AUC (64% sensitivity and 72.8% specificity) for operative time >90 min.Conclusions: The CholeS and the CLOC scores predicted LC long operative time and risk for conversion to an open procedure, respectively, outside their original validation set.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 3-4","pages":"108-113"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy. 肥胖对癌症胃切除术后严重并发症的影响。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-08-01 DOI: 10.1159/000531797

Shunsuke Yamagishi, Yukiyasu Okamura, Woodae Kang, Masataka Shindate, Mitsugu Kochi, Yusuke Mitsuka, Megumu Watabe, Nao Yoshida, Masahito Ikarashi, Shintaro Yamazaki, Osamu Aramaki, Hisashi Nakayama, Masamichi Moriguchi, Tokio Higaki, Hiroharu Yamashita

{"title":"Impact of Sarcopenic Obesity on Severe Postoperative Complications in Patients with Gastric Cancer Undergoing Gastrectomy.","authors":"Shunsuke Yamagishi, Yukiyasu Okamura, Woodae Kang, Masataka Shindate, Mitsugu Kochi, Yusuke Mitsuka, Megumu Watabe, Nao Yoshida, Masahito Ikarashi, Shintaro Yamazaki, Osamu Aramaki, Hisashi Nakayama, Masamichi Moriguchi, Tokio Higaki, Hiroharu Yamashita","doi":"10.1159/000531797","DOIUrl":"10.1159/000531797","url":null,"abstract":"Introduction: Several studies have indicated that sarcopenia affects the short- and long-term outcomes of cancer patients, including those with gastric cancer. In recent years, sarcopenic obesity and its effects have been reported in cancer patients. This study aimed to evaluate the impact of sarcopenic obesity on postoperative complications in patients with gastric cancer undergoing gastrectomy.Methods: This single-center, retrospective study included 155 patients who underwent curative gastrectomy for gastric cancer from January 2015 to July 2021. Sarcopenia was defined by the psoas muscle index (<6.36 cm2/m2 in men and <3.92 cm2/m2 in women), which measures the iliopsoas muscle area at the lumbar L3 level using computed tomography. Obesity was defined by body mass index (≥25). Patients with both sarcopenia and obesity were defined as the sarcopenic obesity group and others as the non-sarcopenic obesity group. Severe postoperative complications were defined as Clavien-Dindo classification grade IIIa or higher.Results: Of the 155 patients, 26 (16.8%) had sarcopenic obesity. The incidence of severe postoperative complications was significantly higher in the sarcopenic obesity group (30.8% vs. 10.9%; p = 0.014). Multivariate analysis indicated that sarcopenic obesity was an independent risk factor for severe postoperative complications (odds ratio, 3.950; 95% confidence interval, 1.390-11.200; p = 0.010).Conclusion: Sarcopenic obesity is an independent risk factor for severe postoperative complications.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"143-152"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10277655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis. 疑似阑尾炎的腹腔镜手术后其他病理很少报道:一项系统回顾和荟萃分析。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000531283

Siri Rønholdt Henriksen, Jacob Rosenberg, Siv Fonnes

{"title":"Other Pathologies Were Rarely Reported after Laparoscopic Surgery for Suspected Appendicitis: A Systematic Review and Meta-Analysis.","authors":"Siri Rønholdt Henriksen, Jacob Rosenberg, Siv Fonnes","doi":"10.1159/000531283","DOIUrl":"https://doi.org/10.1159/000531283","url":null,"abstract":"Background: Diagnostic laparoscopy is often used when a patient is suspected of having acute appendicitis. The aim of this study was to assess the rate of other pathologies found during diagnostic laparoscopy for suspected acute appendicitis.Methods: This systematic search included studies with ≥100 patients who received laparoscopy for suspected acute appendicitis and reported on the histopathologic and other intra-abdominal findings. We performed a meta-analysis estimating the rate of other pathologies, and a sensitivity analysis excluding smaller cohorts (≤500 patients). Age groups, sex, specific findings, and geographic regions were investigated. Certainty of evidence was assessed with GRADE.Results: A total of 27 studies were included covering 25,547 patients and of these 793 had an unexpected pathology. The findings were benign pathology in the appendix (34%), malignancy (30%), gynecologic pathology (5%), gastrointestinal pathology (4%), or unspecified (27%). Meta-analysis showed an overall rate of unexpected findings of 3.5% (95% CI 2.7-4.3; moderate certainty), and the sensitivity analysis showed similar results. Malignancy found in the appendix when treating suspected acute appendicitis was 1.0% (95% CI 0.8-1.3%; high certainty).Conclusion: The rate of other histopathological findings in patients with suspected acute appendicitis was low and a malignancy in appendix was found in 1% of patients.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 3-4","pages":"91-99"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10567863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Revision of Vertical Banded Gastroplasty to Roux-En-Y Gastric Bypass with 2 Years of Follow-Up]. [垂直带状胃成形术改为Roux-En-Y胃旁路术，随访2年]。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000529603

Medhat Mohamed Helmy Khalil, Gad Behairy, Ahmed Farrag, Mohab G Elbarbary

{"title":"[Revision of Vertical Banded Gastroplasty to Roux-En-Y Gastric Bypass with 2 Years of Follow-Up].","authors":"Medhat Mohamed Helmy Khalil, Gad Behairy, Ahmed Farrag, Mohab G Elbarbary","doi":"10.1159/000529603","DOIUrl":"https://doi.org/10.1159/000529603","url":null,"abstract":"Background: Due to weight regain and GIT symptoms associated with vertical banded gastroplasty (VBG), revisional surgery is necessary. Roux-en-Y gastric bypass (RYGB) is one of the best options as a revision procedure but comes with a high complication rate.Methods: This prospective study included 80 patients undergoing RYGB surgery at Ain Shams University Hospitals after failed VBG surgery, with up to 2 years of follow-up.Results: Eighty patients underwent RYGB correction after VBG. The mean age was 42 ± 6.45 (39-58) years and the mean preoperative body mass index was 45.46 ± 4.135 (38-55) kg/m2. The median length of hospital stay for the patients was 4.78 ± 1.84 days. The early postoperative complication rate was 8.7% and the reoperation rate within 30 days was 3.75%, with no mortality. Leakage and bowel injury were detected in 2 patients. After an average follow-up of 2 years, the percentage of EWL was 64.47 ± 19.3, and complete resolution of VBG-related GIT symptoms was achieved in approximately all patients. Late complications occurred in 7.5% of patients, of whom 3.75% required surgery.Conclusion: Conversion to RYGB is feasible with a limited short-term complication and reoperation rate; long-term results show a nearly complete resolution of VBG-related symptoms and a statistically significant positive impact on weight loss.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"31-38"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9819899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Effects of Hospital Volume on Short-Term Outcomes of Laparoscopic Surgery for Rectal Cancer: A Large-Scale Analysis of 37,821 Cases on a Nationwide Administrative Database. 医院数量对直肠癌腹腔镜手术短期疗效的影响:全国行政数据库37,821例的大规模分析

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000529752

Takuya Oba, Shinichi Tomioka, Norihiro Sato, Makoto Otani, Akiko Sakurai, Yasuki Akiyama, Jun Nagata, Takayuki Torigoe, Shinya Matsuda, Keiji Hirata

{"title":"The Effects of Hospital Volume on Short-Term Outcomes of Laparoscopic Surgery for Rectal Cancer: A Large-Scale Analysis of 37,821 Cases on a Nationwide Administrative Database.","authors":"Takuya Oba, Shinichi Tomioka, Norihiro Sato, Makoto Otani, Akiko Sakurai, Yasuki Akiyama, Jun Nagata, Takayuki Torigoe, Shinya Matsuda, Keiji Hirata","doi":"10.1159/000529752","DOIUrl":"https://doi.org/10.1159/000529752","url":null,"abstract":"Introduction: Laparoscopic low anterior resection (L-LAR) has become widely accepted for the treatment of rectal cancer. However, little is known about the superiority of L-LAR in a real-world setting (including low-volume hospitals) and the association between the short-term outcomes and hospital volume focusing on L-LAR.Methods: This is a retrospective cohort study. A total of 37,821 patients who underwent LAR for rectal cancer were analyzed using the Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. The short-term surgical outcomes were analyzed using a multilevel analysis. Hospital volumes were divided into quartiles, including low (1-31), middle (32-55), high (56-91), and very-high volume (92-444 resections per 4 years). The effects of hospital volume on the outcomes were investigated.Results: The study population included 8,335 patients (22%) who underwent open low anterior resection (O-LAR) and 29,486 patients (78%) who underwent L-LAR. The in-hospital mortality and morbidity were consistent with previous reports. In patients who underwent L-LAR, the in-hospital mortality (0.12% vs. 0.41%; OR: 0.33; p = 0.005), the rate of reoperation (3.76% vs. 6.48%; OR: 0.67; p < 0.001), and the perioperative transfusion rate (3.81% vs. 5.90%; OR: 0.66; p < 0.001) were significantly lower in very-high-volume hospitals than in low-volume hospitals. These effects of hospital volume were not observed in O-LAR.Conclusions: Our present study demonstrates that high volume improves outcomes in patients who underwent L-LAR in a real-world setting.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"39-47"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepatic Artery Anomalies in Pancreaticoduodenectomy: Outcomes from a High-Volume Center. 胰十二指肠切除术中的肝动脉异常：来自一个高容量中心的结果。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-09-12 DOI: 10.1159/000533619

Isabella Frigerio, Giulia Capelli, Valentina Chiminazzo, Gaya Spolverato, Giulia Lorenzoni, Silvia Mancini, Alessandro Giardino, Paolo Regi, Roberto Girelli, Giovanni Butturini

{"title":"Hepatic Artery Anomalies in Pancreaticoduodenectomy: Outcomes from a High-Volume Center.","authors":"Isabella Frigerio, Giulia Capelli, Valentina Chiminazzo, Gaya Spolverato, Giulia Lorenzoni, Silvia Mancini, Alessandro Giardino, Paolo Regi, Roberto Girelli, Giovanni Butturini","doi":"10.1159/000533619","DOIUrl":"10.1159/000533619","url":null,"abstract":"Introduction: Hepatic artery anomalies (HAA) may have an impact on surgical and oncological outcomes of patients undergoing pancreaticoduodenectomy (PD).Methods: Patients who underwent PD at our institution between July 2015 and January 2020 were retrospectively reviewed and classified into two groups: group 1, with presence of HAA, and group 2, with no HAA. A weighted logistic regression model was employed to assess the association between HAA and postoperative complications, and to assess the association between HAA and R status in patients with pancreatic cancer.Results: 502 patients were considered for analysis, with 75 (15%) of them in group 1. They had either an accessory (n = 28, 40.8%) or replaced (n = 26, 36.6%) right hepatic artery. Most patients underwent surgery for a malignancy (n = 451; 90%); among them, vascular resection was performed in 69 cases (15%). The presence of a HAA was reported at preoperative imaging only in 4 cases (5%) and the aberrant vessel was preserved in 72% of patients. At weighted multivariable logistic regression analysis, HAA were not associated to higher odds of morbidity (odds ratio [OR]: 0.753, 95% confidence interval [CI]: 0.543-1.043) nor to R1 status in case of pancreatic cancer (OR: 1.583, 95% CI: 0.979-2.561).Conclusion: At our institution, the presence of HAA does not have an impact on postoperative outcomes or affects oncological clearance after PD. Hospitals', surgeons', volume and systematic review of preoperative imaging are all factors that help reduce possible adverse events.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"196-204"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10277630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

High Preoperative Platelet to Lymphocyte Ratio Is Associated with a Greater Risk of Postoperative Complications and Hematogenous Recurrences in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Treatment. 在接受新辅助治疗的食管鳞状细胞癌患者中，术前血小板与淋巴细胞比例高与术后并发症和血液复发的高风险相关。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000530018

Masahiro Sasahara, Mitsuro Kanda, Dai Shimizu, Hideki Takami, Yoshikuni Inokawa, Norifumi Hattori, Masamichi Hayashi, Chie Tanaka, Michitaka Fujiwara, Goro Nakayama, Yasuhiro Kodera

{"title":"High Preoperative Platelet to Lymphocyte Ratio Is Associated with a Greater Risk of Postoperative Complications and Hematogenous Recurrences in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Treatment.","authors":"Masahiro Sasahara, Mitsuro Kanda, Dai Shimizu, Hideki Takami, Yoshikuni Inokawa, Norifumi Hattori, Masamichi Hayashi, Chie Tanaka, Michitaka Fujiwara, Goro Nakayama, Yasuhiro Kodera","doi":"10.1159/000530018","DOIUrl":"https://doi.org/10.1159/000530018","url":null,"abstract":"Introduction: Neoadjuvant treatment is currently the gold standard for advanced esophageal squamous cell carcinoma (ESCC). Several studies have examined the value of blood count-based indexes for predicting short- and long-term outcomes after esophagectomy for ESCC, but the relative predictive value of pretreatment, preoperative, and postoperative indexes has not yet been examined.Methods: This study included 320 patients with thoracic ESCC who underwent subtotal esophagectomy after neoadjuvant chemotherapy or chemoradiotherapy at our institution. A total of 19 candidate blood parameters were measured before neoadjuvant treatment as well as preoperatively and postoperatively. The ability of the parameters to predict postoperative complications, overall survival (OS), and relapse-free survival (RFS) was assessed using receiver operating characteristic (ROC) curve analysis and Cox regression analysis.Results: ROC curve analysis indicated that preoperative platelet to lymphocyte ratio (PLR) had the best predictive value with an optimal cutoff value of 166. Patients with high preoperative PLR (≥166) had significantly shorter OS and RFS and significantly higher incidences of hematogenous recurrence and postoperative pneumonia compared with patients with low preoperative PLR (<166). In multivariate analysis, high preoperative PLR and high preoperative serum carcinoembryonic antigen level were independent predictors of poor prognosis.Conclusion: Preoperative PLR is a good predictor of short- and long-term prognosis in patients with advanced ESCC who receive neoadjuvant treatment followed by radical resection.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"48-57"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identifying Risk Factors of Complications following Total Gastrectomy for Gastric Cancer: Comparison between Splenectomy and Spleen-Preserving Surgery - A Supplementary Analysis of JCOG0110. 胃癌全胃切除术后并发症的危险因素分析:脾切除术与保脾手术的比较——JCOG0110的补充分析

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000531192

Seiji Ito, Takeshi Sano, Junki Mizusawa, Masanori Tokunaga, Tadayoshi Hashimoto, Hiroshi Imamura, Shin Teshima, Koei Nihei, Makoto Yamada, Yasuhiro Choda, Kazuhiro Imamura, Shinji Hato, Masanori Terashima, Mitsuru Sasako

{"title":"Identifying Risk Factors of Complications following Total Gastrectomy for Gastric Cancer: Comparison between Splenectomy and Spleen-Preserving Surgery - A Supplementary Analysis of JCOG0110.","authors":"Seiji Ito, Takeshi Sano, Junki Mizusawa, Masanori Tokunaga, Tadayoshi Hashimoto, Hiroshi Imamura, Shin Teshima, Koei Nihei, Makoto Yamada, Yasuhiro Choda, Kazuhiro Imamura, Shinji Hato, Masanori Terashima, Mitsuru Sasako","doi":"10.1159/000531192","DOIUrl":"https://doi.org/10.1159/000531192","url":null,"abstract":"Introduction: Splenectomy for proximal gastric cancer was found to offer no survival benefit in a randomized trial clarifying the role of splenectomy (JCOG0110 study). Although many studies have explored risk factors for morbidities following total gastrectomy, none have assessed the risk factors for postoperative complications in spleen-preserving total gastrectomy.Methods: Using data from 505 patients enrolled in a previous randomized trial, risk factors for postoperative complications were identified by multivariable logistic regression analysis. Then, the risk factors were assessed separately between splenectomy and spleen-preserving total gastrectomy.Results: Postoperative complications were identified in 119 patients (23.6%) and were more common following splenectomy than following spleen-preserving surgery (30.7% and 16.1%, respectively, p < 0.01). Multivariable analysis revealed that age ≥65 years (p = 0.032), body mass index ≥25 (p = 0.003), and blood loss ≥350 (p = 0.019) were independent risk factors for postoperative complications in the entire cohort. Among them, only body mass index was a significant independent risk factor for complications in both spleen preservation (p = 0.047) and splenectomy groups (p = 0.017).Conclusion: Risk factors for postoperative complications were essentially the same between splenectomy and spleen preservation. Being overweight increased the risk of postoperative complications.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 3-4","pages":"114-120"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10209119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Updating the Predictive Models for Mortality and Morbidity after Low Anterior Resection Based on the National Clinical Database. 基于国家临床数据库的前低位切除术后死亡率和发病率预测模型的更新。

IF 2.7 3区医学

Digestive Surgery Pub Date : 2023-01-01 DOI: 10.1159/000531370

Kazushige Kawai, Shinya Hirakawa, Hisateru Tachimori, Taro Oshikiri, Hiroaki Miyata, Yoshihiro Kakeji, Yuko Kitagawa

{"title":"Updating the Predictive Models for Mortality and Morbidity after Low Anterior Resection Based on the National Clinical Database.","authors":"Kazushige Kawai, Shinya Hirakawa, Hisateru Tachimori, Taro Oshikiri, Hiroaki Miyata, Yoshihiro Kakeji, Yuko Kitagawa","doi":"10.1159/000531370","DOIUrl":"https://doi.org/10.1159/000531370","url":null,"abstract":"Introduction: We previously developed risk models for mortality and morbidity after low anterior resection using a nationwide Japanese database. However, the milieu of low anterior resection in Japan has undergone drastic changes since then. This study aimed to construct risk models for 6 short-term postoperative outcomes after low anterior resection, i.e., in-hospital mortality, 30-day mortality, anastomotic leakage, surgical site infection except for anastomotic leakage, overall postoperative complication rate, and 30-day reoperation rate.Methods: This study enrolled 120,912 patients registered with the National Clinical Database, who underwent low anterior resection between 2014 and 2019. Multiple logistic regression analyses were performed to generate predictive models of mortality and morbidity using preoperative information, including the TNM stage.Results: We developed new risk prediction models for the overall postoperative complication and 30-day reoperation rates for low anterior resection, which were absent from the previous version. The concordance indices for each endpoint were 0.82 for in-hospital mortality, 0.79 for 30-day mortality, 0.64 for anastomotic leakage, 0.62 for surgical site infection besides anastomotic leakage, 0.63 for complications, and 0.62 for reoperation. The concordance indices of all four models included in the previous version showed improvement.Conclusion: This study successfully updated the risk calculators for predicting mortality and morbidity after low anterior resection using a model based on vast nationwide Japanese data.","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 3-4","pages":"130-142"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10272068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0