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Association between Surgical Patient Selection and Hospital Variation in Failure to Cure in Esophageal Cancer Surgery: A Nationwide Cohort Study. 食管癌手术患者选择与医院治疗失败之间的关系:一项全国性队列研究。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000524999
Daan M Voeten, Pauline A J Vissers, Rob H A Verhoeven, Richard van Hillegersberg, Mark Ivo Van Berge Henegouwen

Introduction: Failure to cure describes: (1) nonresectional ("open-close") surgery, (2) non-radical surgery (R1-R2), and/or (3) postoperative mortality. This study aimed to investigate whether hospitals offering surgery to a large proportion of patients have higher failure-to-cure rates than hospitals operating fewer patients.

Methods: From the Netherlands Cancer Registry, all cT1-cT4a/cTx-any cN-cM0 esophageal cancer patients diagnosed in 2015-2018 were included. For each center, the expected (E) proportion of patients undergoing surgery was established and divided by the observed (O) proportion. Hospitals were categorized into three groups: (1) hospitals treating relatively many patients with surgery, (2) average hospitals, and (3) hospitals treating relatively few patients with surgery. Multilevel multivariable regression investigated the association between these hospital groups and failure to cure.

Results: Some 3,437 (53.2%) of 6,457 patients underwent surgery, ranging from 45 to 64% among 16 hospitals. The failure-to-cure rate was 15.0% (hospital variation [4.6-23.7%]). After categorizing, 1,003 patients underwent surgery in hospitals with low surgery rates (O/E ratio <0.94/corrected percentage <50%), 1,297 patients in average hospitals, and 1,137 patients in hospitals treating many patients surgically (O/E ratio >1.01/corrected percentage >54%). Failure-to-cure rates were 16.8%, 12.2%, and 14.0%, respectively. This was nonsignificant in multilevel analyses (aOR: 0.63, 95% CI: 0.38-1.05; aOR: 0.76, 95% CI: 0.46-1.24).

Discussion/conclusion: Failure-to-cure rates were similar in hospitals with a high surgery rate and hospitals with a low rate. Increasing the proportion of patients undergoing a resection may offer more patients, a chance for cure.

治疗失败描述:(1)非切除(“开合”)手术,(2)非根治性手术(R1-R2),和/或(3)术后死亡率。这项研究的目的是调查是否为大部分患者提供手术的医院比手术患者较少的医院有更高的治愈率。方法:从荷兰癌症登记处纳入2015-2018年诊断的所有cT1-cT4a/cTx-any cN-cM0食管癌患者。对于每个中心,建立接受手术患者的预期(E)比例,并除以观察到的(O)比例。将医院分为三类:(1)手术患者较多的医院,(2)一般医院,(3)手术患者较少的医院。多水平多变量回归研究了这些医院组与治疗失败之间的关系。结果:6457例患者中3437例(53.2%)接受手术治疗,占16家医院的45% ~ 64%。治愈率为15.0%(医院差异[4.6 ~ 23.7%])。经分类,1003例患者在手术率较低的医院接受手术(O/E比1.01/矫正率>54%)。治愈率分别为16.8%、12.2%和14.0%。这在多水平分析中不显著(aOR: 0.63, 95% CI: 0.38-1.05;aOR: 0.76, 95% CI: 0.46-1.24)。讨论/结论:手术率高的医院和手术率低的医院的治愈率相似。增加接受切除手术的患者比例可能会为更多的患者提供治愈的机会。
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引用次数: 0
EDS Society News. EDS社会新闻。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000528742
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引用次数: 0
Front & Back Matter 正面和背面事项
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000521822
S. Paiella
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引用次数: 0
Contents Vol. 38, 2021 目录2021年第38卷
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000521224
S. Paiella
Mustapha Adham – Edouard Herriot Hospital, HCL, Lyon, France Edward Cheong – Norfolk and Norwich University Hospitals, Norwich, UK Marco Del Chiaro – University of Colorado, Aurora, CO, USA Justin Davies – Addenbrooke’s Hospital, Cambridge, UK Matteo Donadon – Humanitas Research Hospital, Milan, Italy Claire L. Donohoe – Trinity College Dublin, Dublin, Ireland Isabella Frigerio – Ospedale P. Pederzoli S.p.A., Peschiera del Garda, Italy Simone Giacopuzzi – Università degli Studi di Verona, Verona, Italy Beat Gloor – University of Bern, Bern, Switzerland Ho-Seong Han – Seoul National University, Seoul, Republic of Korea Daniel Hartmann – Technical University Munich, Munich, Germany Calogero Iacono – University of Verona, Verona, Italy Dara Kavanagh – University of Medicine and Health Sciences, Dublin, Ireland Giuseppe Malleo – University of Verona, Verona, Italy Giovanni Marchegiani – University of Verona Hospital Trust, Verona, Italy John R.T. Monson – Florida Hospital Orlando, Orlando, FL, USA Dermot O’Toole – St James’s Hospital and Trinity College Dublin, Dublin, Ireland European Digestive Surgery (EDS)
Mustapha Adham–Edouard Herriot医院,HCL,法国里昂Edward Cheong–Norfolk and Norwich University Hospitals,Norwich,UK Marco Del Chiaro–科罗拉多大学,Aurora,CO,USA Justin Davies–Addenbrooke医院,Cambridge,UK Matteo Donadon–Humanitas Research Hospital,Milan,Italy Claire L.Donohoe–Trinity College Dublin,Dublin,爱尔兰Isabella Frigerio–Ospedale P.Pederzoli S.P.A.,意大利Peschiera del Garda Simone Giacopuzzi–意大利维罗纳大学Beat Gloor–瑞士伯尔尼伯尔尼大学Ho Seong-Han–韩国首尔国立大学Daniel Hartmann–德国慕尼黑技术大学Calogero Iacono–维罗纳,意大利Dara Kavanagh–医学与健康科学大学,爱尔兰都柏林Giuseppe Malleo–维罗纳大学,意大利维罗纳Giovanni Marchegieni–维罗纳大学医院信托基金会,意大利维ona John R.T.Monson–佛罗里达州奥兰多市佛罗里达医院Dermot O'Toole–圣詹姆斯医院和都柏林三一学院,爱尔兰欧洲消化外科(EDS)
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引用次数: 0
Management Strategy for Gallbladder Polypoid Lesions: Results of a 5-Year Single-Center Cohort Study. 胆囊息肉病的治疗策略:一项5年单中心队列研究的结果。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000529221
Feng Tian, Yu-Xin Ma, Yi-Fan Liu, Wei Liu, Tao Hong, Xiao-Dong He, Qiang Qu

Introduction: Controversy remains about the classification, differential diagnosis, and treatment strategy for gallbladder polypoid lesions (GPLs). This study sought to explore the individualized treatment strategy for GPLs.

Methods: We retrospectively studied 642 consecutive patients with GPLs from January 2015 to May 2020. Univariate and multivariable analyses were performed to explore the potential risk factors for neoplastic polyps. The outcome of laparoscopic gallbladder-preserving polypectomy (GPP) was evaluated and compared with that of laparoscopic cholecystectomy (LC).

Results: Of 642 enrolled patients, 572 underwent LC, and 70 underwent GPP. Pathologically, the majority of GPLs were cholesterol polyps (68.4%), followed by adenomyomatosis (19.9%), benign adenoma (7.3%), adenocarcinoma (3.6%), and rare pathological types (0.8%). Additionally, 66.3% (379/572) of the LC cases were classified as non-neoplastic, and 33.7% (193/572) neoplastic polyps. Multivariate analysis demonstrated that single polyps (OR 1.956, 95% CI: 1.121-3.412; p = 0.018), polyps located at the gallbladder fundus (OR 4.326, 95% CI: 2.179-8.591; p < 0.001), polyps not less than 14 mm (OR 2.833, 95% CI: 1.614-4.973; p < 0.001), and polyps with a broad base (OR 4.173, 95% CI: 1.743-9.990; p = 0.001) were independent risk factors for neoplastic polyps. The 5-year prospective results after GPP showed that the 1-year and 3-year polyp recurrence rates were 13.2% and 23.4%, respectively.

Conclusion: The majority of GPLs are cholesterol or other benign lesions without malignant potential. LC is the main treatment procedure for GPLs with a high neoplastic risk. GPP is potentially feasible and could be an alternative management strategy for a group of GPLs patients who meet the selection criteria.

导言:胆囊息肉样病变(GPLs)的分类、鉴别诊断和治疗策略仍有争议。本研究旨在探讨gpl的个体化治疗策略。方法:我们回顾性研究了2015年1月至2020年5月连续642例GPLs患者。通过单因素和多因素分析探讨肿瘤性息肉的潜在危险因素。评价腹腔镜保胆息肉切除术(GPP)与腹腔镜胆囊切除术(LC)的疗效。结果:642例入组患者中,572例行LC, 70例行GPP。病理上以胆固醇息肉为主(68.4%),其次为腺肌瘤病(19.9%)、良性腺瘤(7.3%)、腺癌(3.6%)和罕见病理类型(0.8%)。66.3%(379/572)的LC病例为非肿瘤性息肉,33.7%(193/572)为肿瘤性息肉。多因素分析显示单个息肉(OR 1.956, 95% CI: 1.121-3.412;p = 0.018),胆囊底息肉(OR 4.326, 95% CI: 2.179-8.591;p < 0.001),息肉不小于14 mm (OR 2.833, 95% CI: 1.614-4.973;p < 0.001),息肉基底较宽(OR 4.173, 95% CI: 1.743-9.990;P = 0.001)是肿瘤性息肉的独立危险因素。GPP术后5年前瞻性结果显示,1年和3年息肉复发率分别为13.2%和23.4%。结论:gpl多为胆固醇或其他良性病变,无恶性潜能。LC是具有高肿瘤风险的gpl的主要治疗方法。GPP具有潜在的可行性,对于符合选择标准的一组GPLs患者,GPP可能是一种替代的管理策略。
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引用次数: 0
Safety and Efficacy of Laparoscopic Surgery versus Open Surgery in Elderly Patients with Colon Cancer: A Propensity Score Matching Cohort Study. 老年结肠癌患者腹腔镜手术与开放手术的安全性和有效性:一项倾向评分匹配队列研究
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000529223
Chao Wang, Lin Gan, Kewei Jiang, Zhidong Gao, Yingjiang Ye

Introduction: The safety of laparoscopic surgery (LS) and its effect on survival have not been sufficiently assessed in elderly colon cancer patients.

Methods: Clinicopathologic data of patients aged ≥75 years who underwent colectomy for primary colon cancer, between January 2018 and June 2021, were reviewed. Patients were divided into the LS and open surgery (OS) groups according to the intention-to-treat principle and were compared using propensity score matching. The primary outcomes were differences in surgical safety and 3-year survival.

Results: There were 98 patients with a median age of 82 years and 85 patients with a median age of 80 years assigned to the OS and LS groups, respectively. Propensity score matching revealed that LS did not prolong the operative time (190 vs. 180 min, p = 0.209) and was linked to less intraoperative blood loss (50 vs. 100 mL, p = 0.039) and shorter postoperative hospital stay (8 vs. 10 days, p = 0.005), compared to OS. In addition, LS was not accompanied by more stress response when the variations exhibited in laboratory tests and the Barthel index pre- and postsurgery were considered. There were no significant differences in the adjusted 3-year overall survival (86.0% vs. 81.2%, p = 0.795) and disease-free survival (86.6% vs. 87.9%, p = 0.356) between the groups.

Conclusion: LS enhanced postoperative recovery without increasing surgical risks, compared to OS, in colon cancer patients aged ≥75 years. Furthermore, no significant differences in the 3-year adjusted survival were observed between the groups.

腹腔镜手术(LS)的安全性及其对老年结肠癌患者生存的影响尚未得到充分的评估。方法:回顾2018年1月至2021年6月期间年龄≥75岁的原发性结肠癌结肠切除术患者的临床病理资料。根据意向治疗原则将患者分为LS组和开放手术(OS)组,采用倾向评分匹配进行比较。主要结局是手术安全性和3年生存率的差异。结果:OS组和LS组分别有98例患者,中位年龄82岁和85例患者,中位年龄80岁。倾向评分匹配显示,与OS相比,LS不会延长手术时间(190 vs 180 min, p = 0.209),术中出血量更少(50 vs 100 mL, p = 0.039),术后住院时间更短(8 vs 10天,p = 0.005)。此外,考虑到实验室测试和Barthel指数在术前和术后所表现出的变化,LS并不伴有更多的应激反应。两组间调整后的3年总生存率(86.0% vs. 81.2%, p = 0.795)和无病生存率(86.6% vs. 87.9%, p = 0.356)无显著差异。结论:在年龄≥75岁的结肠癌患者中,与OS相比,LS可提高术后恢复,但不增加手术风险。此外,3年调整生存率在两组间无显著差异。
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引用次数: 0
Hybrid Laparo-Endoscopic Resection of Submucosal Cardial Tumors Assisted by Flexible Articulated Instruments. 柔性关节器械辅助下的混合腹腔镜内镜下心脏粘膜下肿瘤切除术。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 DOI: 10.1159/000527026
Federico Llanos, Matias Turchi, Mauricio Ramirez, Franco Badaloni, Fabio Nachman, Alejandro Nieponice

We report a new surgical method in 10 patients who underwent hybrid laparo-endoscopic resection (HLER) of submucosal tumors with the combination of flexible articulated laparoscopic instruments (FALI). We have assessed technical reproducibility, safety, and morbidity. Resection was completed in all cases. Mean surgical time was 60 min (30-85). Median tumor size was 16 mm (12-30). The more frequent location was the gastroesophageal junction. No complications were observed during the procedure. Length of stay was 1 day in all cases. We have found HLER to be a safe procedure allowing margin resection and organ preservation. The addition of FALI added ease of performance in hard-to-reach tumor locations.

我们报告了一种新的手术方法,10例患者接受混合腹腔镜内镜切除(HLER)粘膜下肿瘤与柔性关节腹腔镜器械(FALI)的组合。我们已经评估了技术可重复性、安全性和发病率。所有病例均完成手术切除。平均手术时间60 min(30-85)。中位肿瘤大小为16 mm(12-30)。最常见的部位是胃食管交界处。手术过程中无并发症发生。所有病例住院时间均为1天。我们发现HLER是一种安全的手术,可以切除边缘并保存器官。FALI的加入增加了在难以到达的肿瘤位置的性能。
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引用次数: 0
Handling of Hilar Vasculature in Living Donor Right Hepatectomy Using Extrahepatic Glissonean Approach. 肝外格利索内入路对活体右肝切除术肝门血管的处理。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 Epub Date: 2021-12-06 DOI: 10.1159/000521240
Naokazu Chiba, Motohide Shimazu, Shigeto Ochiai, Takahiro Gunji, Toshimichi Kobayashi, Toru Sano, Koichi Tomita, Shigeyuki Kawachi

Donor hepatectomy is one of the most important procedures in LDLT because it affects the safety of donors and the outcome of the recipients. We standardized a method of securing the important vessels at the hepatic hilum while advancing the dissection toward the central direction. This research introduces our technique of handling hilar vasculature in living donor hepatectomy, using the extrahepatic Glissonean approach, and discusses its efficacy. At first, after the extrahepatic right Glissonean approach, the resected hepatic artery and portal vein are secured on the same line as with the secured Glisson. The resected hepatic artery and portal vein are followed in the central direction, and the surrounding area is dissected. The dissection is continued up to the main brunch of the hepatic artery and portal vein. The bile duct can be secured by subtracting the hepatic artery and portal vein from the tape that secured the Glissonean pedicle. The bile duct, hepatic artery, and the portal vein are dissected in this order, before dissecting the right hepatic vein, completing the surgery. This method of dissection approaching the extrahepatic Glisson carried out toward the central direction suggests to acquire minimal tissue removal and to shorten operative time. This could result in adequate perfusion to the remaining liver and donor safety, taken together effective results on the recipient.

供体肝切除术是LDLT中最重要的手术之一,因为它影响供体的安全性和受体的预后。我们标准化了一种在肝门处固定重要血管的方法,同时向中心方向推进解剖。本研究介绍在活体供肝切除术中应用肝外格利索内入路处理肝门血管的技术,并讨论其疗效。首先,肝外右Glissonean入路后,将切除的肝动脉和门静脉固定在与固定glissone入路相同的线上。沿中央方向行切除的肝动脉、门静脉,解剖周围区域。分离继续到肝动脉和门静脉的主要部位。从固定Glissonean蒂的胶带上减去肝动脉和门静脉,可以固定胆管。依次解剖胆管、肝动脉、门静脉,然后解剖右肝静脉,完成手术。这种向中心方向接近肝外Glisson的剥离方法建议获得最小的组织切除并缩短手术时间。这可能导致剩余肝脏的充分灌注和供体的安全性,以及对受体的有效效果。
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引用次数: 0
Surgical Resection Is Preferred in Selected Solitary Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis. 选择性单发肝细胞癌合并门静脉肿瘤血栓,首选手术切除。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2022-01-01 Epub Date: 2022-01-11 DOI: 10.1159/000521827
Jaehun Yang, Jong Man Kim, Jinsoo Rhu, Gyu-Seong Choi, Choon Hyuck David Kwon, Jae-Won Joh

Introduction: Sorafenib is the standard care for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT), though it offers limited survival. This study was designed to compare clinical outcomes between liver resection (surgery) and transarterial chemoembolization plus radiotherapy (TACE-RT) as the initial treatment modality for resectable treatment-naïve solitary HCC combined with subsegmental (Vp1), segmental (Vp2), and lobar (Vp3) PVTT.

Methods: From the institutional HCC registry, we identified 116 patients diagnosed with resectable treatment-naïve HCC with Vp1-Vp3 PVTT based on radiologic images who received surgery (n = 44) or TACE-RT (n = 72) as a primary treatment between 2010 and 2015. A propensity score matching (PSM) model was created.

Results: The TACE-RT group had a higher tumor burden (tumor size, extent, and markers) than the surgery group. Cumulative patient survival curve in the surgery group was significantly higher than that in the TACE-RT group before and after PSM. Liver function was relatively well preserved in the surgery group compared with the TACE-RT group. TACE-RT group, male, increased alkaline phosphatase, and increased platelet count were predisposing factors for patient death in resectable treatment-naïve solitary HCC with PVTT.

Discussion/conclusion: The present study suggests that surgery is considered as an initial treatment in selectively resectable treatment-naïve solitary HCC with Vp1-Vp3 PVTT.

索拉非尼(Sorafenib)是肝细胞癌(HCC)合并门静脉肿瘤血栓形成(PVTT)患者的标准治疗,尽管它的生存率有限。本研究旨在比较肝切除(手术)和经动脉化疗栓塞加放疗(TACE-RT)作为可切除的treatment-naïve孤立性HCC合并亚节段(Vp1)、节段(Vp2)和大叶(Vp3) PVTT的初始治疗方式的临床结果。方法:从机构HCC注册表中,我们确定了116例可切除的treatment-naïve HCC患者,根据放射图像诊断为Vp1-Vp3 PVTT,并在2010年至2015年期间接受手术(n = 44)或TACE-RT (n = 72)作为主要治疗。建立了倾向得分匹配(PSM)模型。结果:TACE-RT组肿瘤负荷(肿瘤大小、范围、标志物)高于手术组。PSM前后,手术组患者累积生存曲线明显高于TACE-RT组。与TACE-RT组相比,手术组肝功能保存相对较好。TACE-RT组、男性、碱性磷酸酶升高和血小板计数升高是可切除treatment-naïve孤立性HCC合并PVTT患者死亡的易感因素。讨论/结论:目前的研究表明,手术被认为是选择性切除treatment-naïve孤立性HCC伴Vp1-Vp3 PVTT的初始治疗。
{"title":"Surgical Resection Is Preferred in Selected Solitary Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis.","authors":"Jaehun Yang,&nbsp;Jong Man Kim,&nbsp;Jinsoo Rhu,&nbsp;Gyu-Seong Choi,&nbsp;Choon Hyuck David Kwon,&nbsp;Jae-Won Joh","doi":"10.1159/000521827","DOIUrl":"https://doi.org/10.1159/000521827","url":null,"abstract":"<p><strong>Introduction: </strong>Sorafenib is the standard care for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT), though it offers limited survival. This study was designed to compare clinical outcomes between liver resection (surgery) and transarterial chemoembolization plus radiotherapy (TACE-RT) as the initial treatment modality for resectable treatment-naïve solitary HCC combined with subsegmental (Vp1), segmental (Vp2), and lobar (Vp3) PVTT.</p><p><strong>Methods: </strong>From the institutional HCC registry, we identified 116 patients diagnosed with resectable treatment-naïve HCC with Vp1-Vp3 PVTT based on radiologic images who received surgery (n = 44) or TACE-RT (n = 72) as a primary treatment between 2010 and 2015. A propensity score matching (PSM) model was created.</p><p><strong>Results: </strong>The TACE-RT group had a higher tumor burden (tumor size, extent, and markers) than the surgery group. Cumulative patient survival curve in the surgery group was significantly higher than that in the TACE-RT group before and after PSM. Liver function was relatively well preserved in the surgery group compared with the TACE-RT group. TACE-RT group, male, increased alkaline phosphatase, and increased platelet count were predisposing factors for patient death in resectable treatment-naïve solitary HCC with PVTT.</p><p><strong>Discussion/conclusion: </strong>The present study suggests that surgery is considered as an initial treatment in selectively resectable treatment-naïve solitary HCC with Vp1-Vp3 PVTT.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39811103","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: 2
Front & Back Matter 正面和背面
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2021-09-01 DOI: 10.1159/000519733
D. O’Toole
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引用次数: 0
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Digestive Surgery
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