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Proposal of the Second Cutoff of Serum Carcinoembryonic Antigen Levels to Stratify Patients into Low, Intermediate, and High Risks at Recurrences after Curative Resection of Gastric Cancer. 建议用血清癌胚抗原水平的第二个临界值将胃癌根治性切除术后复发的患者分为低、中、高风险。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-09-12 DOI: 10.1159/000533143
Bin Sato, Mitsuro Kanda, Seiji Ito, Yoshinari Mochizuki, Hitoshi Teramoto, Kiyoshi Ishigure, Toshifumi Murai, Takahiro Asada, Akiharu Ishiyama, Hidenobu Matsushita, Koki Nakanishi, Dai Shimizu, Chie Tanaka, Michitaka Fujiwara, Kenta Murotani, Yasuhiro Kodera

Introduction: Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 are widely used for treating various cancers, with cutoff values of 5.0 ng/mL and 37.0 IU/mL, respectively. However, these cutoff values are not for specific diseases or purposes but are uniformly used for any disease and any purpose. It is also unclear as to whether patients are at equal risk of recurrence if they are below the cutoff values. This study aimed to investigate the optimal cutoff of serum tumor markers in the stratification of recurrence risk after curative resection of gastric cancer.

Methods: We constructed a nine-center integrated database of patients who received gastrectomy between January 2010 and December 2014 with a 5-year follow-up period. We determined the cutoff value of preoperative serum tumor marker levels correlated with postoperative recurrences and evaluated its performance in risk stratification for recurrences in 948 patients with stage II/III gastric cancer who underwent radical resection.

Results: The hazard ratio for postoperative recurrences increased at two points of preoperative CEA levels, 3.6 ng/mL and 5.0 ng/mL, which were set as cutoffs. These two cutoffs stratified relapse-free survival into three levels.

Conclusions: By adding a second cutoff value for preoperative serum CEA, which was proposed specifically for the prediction of recurrences, patients can be stratified into low-, intermediate-, and high-risk recurrences after curative resection of gastric cancer.

导言:癌胚抗原(CEA)和碳水化合物抗原 19-9 被广泛用于治疗各种癌症,其临界值分别为 5.0 纳克/毫升和 37.0 IU/毫升。然而,这些临界值并非针对特定疾病或目的,而是统一用于任何疾病和任何目的。此外,目前还不清楚低于临界值的患者是否具有同等的复发风险。本研究旨在探讨血清肿瘤标志物在胃癌根治性切除术后复发风险分层中的最佳临界值:我们建立了一个九个中心的综合数据库,收录了 2010 年 1 月至 2014 年 12 月间接受胃切除术的患者,随访期为 5 年。我们确定了与术后复发相关的术前血清肿瘤标志物水平的临界值,并评估了其在对948例接受根治性切除术的II/III期胃癌患者进行复发风险分层时的表现:术前CEA水平在3.6纳克/毫升和5.0纳克/毫升这两个临界点时,术后复发的危险比增加。这两个临界值将无复发生存率分为三个等级:通过增加术前血清CEA的第二个临界值(该临界值是专门为预测复发而提出的),可将胃癌根治性切除术后复发的患者分为低、中、高三个风险等级。
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引用次数: 0
Pathologic Complete Response after Chemotherapy with Atezolizumab plus Bevacizumab for Hepatocellular Carcinoma with Tumor Thrombus in the Main Portal Trunk. 阿特唑单抗联合贝伐单抗治疗肝细胞癌伴门静脉主干肿瘤血栓后的病理完全缓解
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000529405
Ken Kurisaki, Akihiko Soyama, Takanobu Hara, Hajime Matsushima, Hajime Imamura, Takayuki Tanaka, Tomohiko Adachi, Shinichiro Ito, Kengo Kanetaka, Masaaki Hidaka, Shinji Okano, Susumu Eguchi

We report a case of pathologic complete response after successful treatment for advanced hepatocellular carcinoma (HCC) complicated with portal venous tumor thrombus with atezolizumab and bevacizumab followed by radical resection. The patient was a male in his 60s. During follow-up for chronic hepatitis B, abdominal ultrasonography revealed a huge tumor located in the right lobe of the liver with the portal vein thrombosed by the tumor. The tumor thrombus extended to the proximal side of the left branch of the portal vein. The patient's tumor marker levels were elevated (alpha-phetoprotein, 14,696 ng/mL; PIVKA-II, 2,141 mAU/mL). Liver biopsy revealed poorly differentiated HCC. The lesion was categorized as advanced stage according to the BCLC staging system. As systemic therapy, atezolizumab plus bevacizumab was administered. Imaging showed marked shrinkage of the tumor and portal venous thrombus with a remarkable decrease of tumor marker levels after 2 courses of chemotherapy. After 3 additional courses of chemotherapy, radical resection was considered possible. The patient underwent right hemihepatectomy and portal venous thrombectomy. A pathological examination revealed a complete response. In conclusion, we experienced a case in which advanced HCC was curatively treated with atezolizumab plus bevacizumab, which was administered as systemic therapy with a view to conversion surgery.

我们报告一个病例的病理完全缓解后成功治疗晚期肝细胞癌(HCC)合并门静脉肿瘤血栓阿特唑单抗和贝伐单抗根治性切除。患者是一名60多岁的男性。在慢性乙型肝炎的随访中,腹部超声检查显示肝脏右叶有一个巨大的肿瘤,肿瘤形成门静脉血栓。肿瘤血栓延伸至门静脉左支近端。患者肿瘤标志物水平升高(α -光蛋白,14,696 ng/mL;PIVKA-II, 2141 mAU/mL)。肝活检显示低分化HCC。根据BCLC分期系统,病变被归类为晚期。作为全身治疗,使用atezolizumab加贝伐单抗。化疗2个疗程后影像学显示肿瘤及门静脉血栓明显缩小,肿瘤标志物水平明显降低。经过3个疗程的化疗后,认为根治性切除是可能的。患者行右半肝切除术及门静脉取栓术。病理检查显示完全反应。总之,我们经历了一例晚期HCC采用atezolizumab + bevacizumab治疗的病例,这是一种全身治疗,目的是进行转换手术。
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引用次数: 0
Treatment of EGJ Cancer within or outside Clinical Trials: Does the Setting Matter? A Monocentric Prospective Observational Study. 临床试验内外EGJ癌的治疗:环境重要吗?单中心前瞻性观察研究。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000529199
Simone Giacopuzzi, Lorena Torroni, Maria Bencivenga, Jacopo Weindelmayer, Maria Clelia Gervasi, Giuseppe Verlato, Michele Pavarana, Gabriella Rossi, Giovanni de Manzoni

Introduction: RCTs support neoadjuvant chemoradiotherapy (nCRT) followed by surgery in locally advanced esophago-gastric junction (LA-EGJ) adenocarcinoma. However, RCTs are performed in highly controlled settings with limited representativeness of real-life patients (RLS). The aim of the study was to compare the outcomes in RLS and clinical trial settings.

Methods: The outcomes of RLS, which comprised 125 patients consequently treated for LA-EGJ adenocarcinoma between 2012 and 2017, were compared with the phase II trial (PIIS), performed on 65 patients from 2003 to 2011.

Results: About half of RLS (51.2%) were treated with nCRT according to VR protocol, 20.8% with standard CRT according to CROSS/Al-Sarraf, 20% with chemotherapy (CT) alone. pCR was 36.8%, 28.6%, and 9.1% after VR protocol, standard CRT, and CT, respectively (p = 0.082), while 3-year overall survival (OS) was 58.6% (95% CI 43.2-71.1%), 32.8% (14.6-52.4%), and 44.8% (21.3-65.9%), respectively (p = 0.030). With respect to PIIS, RLS had a higher proportion of cN+ (94% vs. 54%; p < 0.001) and a lower proportion of pCR after CT/CRT (23% vs. 39%; p = 0.041). Three-year OS was slightly higher, although not significantly, in PIIS (58.9%, 45.1-70.2%) than RLS (47.9%, 37.4-57.7%) and nearly identical to 3-year OS in RLS treated with VR protocol.

Conclusion: Real-life patients with EGJ adenocarcinoma have more advanced cancer at baseline, lower pathologic response to neoadjuvant treatment than patients enrolled in clinical trials, but similar survival.

简介:随机对照试验支持局部晚期食管胃结(LA-EGJ)腺癌的新辅助放化疗(nCRT)后手术治疗。然而,随机对照试验是在高度控制的环境中进行的,对现实患者(RLS)的代表性有限。该研究的目的是比较RLS和临床试验环境的结果。方法:将2012年至2017年期间接受LA-EGJ腺癌治疗的125例RLS患者的结果与2003年至2011年进行的65例II期试验(PIIS)患者的结果进行比较。结果:约一半(51.2%)的RLS患者采用VR方案的nCRT治疗,20.8%的RLS患者采用CROSS/Al-Sarraf标准CRT治疗,20%的RLS患者采用单独化疗(CT)治疗。VR方案、标准CRT和CT后的pCR分别为36.8%、28.6%和9.1% (p = 0.082), 3年总生存率(OS)分别为58.6% (95% CI 43.2-71.1%)、32.8%(14.6-52.4%)和44.8% (21.3-65.9%)(p = 0.030)。相对于PIIS, RLS中cN+的比例更高(94% vs. 54%;p < 0.001), CT/CRT后pCR比例较低(23% vs. 39%;P = 0.041)。PIIS的3年OS(58.9%, 45.1-70.2%)略高于RLS(47.9%, 37.4-57.7%),但不显著,与VR方案治疗的RLS的3年OS几乎相同。结论:与临床试验患者相比,现实生活中的EGJ腺癌患者在基线时更晚期,对新辅助治疗的病理反应更低,但生存期相似。
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引用次数: 0
Significantly Lower Physical Activity Participation in Individuals with Chronic Pancreatitis Compared to Controls: An Exploratory Study of Objectively Assessed Physical Activity Levels. 慢性胰腺炎患者体力活动参与明显低于对照组:一项客观评估体力活动水平的探索性研究。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000530543
Brenda Monaghan, Ann Monaghan, Qurat Ul Ain, Sinead N Duggan, Kevin C Conlon, John Gormley

Introduction: The beneficial effects of exercise and physical activity (PA) have been demonstrated in many chronic inflammatory diseases. Knowledge on PA levels is unknown in the chronic pancreatitis population, and there are currently no specific PA recommendations for this condition.

Methods: PA was measured objectively over a 7-day period in 17 individuals with chronic pancreatitis using an accelerometer (ActiGraph) and in 15 controls, matched for age, sex, and body mass index.

Results: Participants with chronic pancreatitis spent a significantly lower amount of time in moderate, light, and moderate/vigorous activity compared to the healthy control group. Mean time in light activity in the chronic pancreatitis group was 825.4 ± 972 (standard deviation [SD]) compared to 1,500 ± 958 (SD) in the healthy control group. Moderate activity mean minutes were 61.6 ± 85 in the chronic pancreatitis group compared to 161.4 ± 131.2 in the healthy control group. Moderate/vigorous mean minutes were 62.1 ± 86 (SD) in the chronic pancreatitis group compared to 164.3 ± 132 (SD) in the healthy control group. There was no significant difference found between the groups for either vigorous activity or time spent sedentary.

Conclusion: This exploratory study offers early objective evidence that activity levels in the chronic pancreatic group are not meeting current international recommendations. Further investigation of this chronic illness population is strongly recommended.

运动和身体活动(PA)的有益作用已经在许多慢性炎症疾病中得到证实。对慢性胰腺炎人群中PA水平的了解尚不清楚,目前对这种情况没有具体的PA建议。方法:使用加速度计(ActiGraph)客观测量17例慢性胰腺炎患者和15例对照组的PA,时间为7天,年龄、性别和体重指数相匹配。结果:与健康对照组相比,慢性胰腺炎患者在中度、轻度和中度/剧烈运动中花费的时间显着减少。慢性胰腺炎组轻度活动的平均时间为825.4±972(标准差[SD]),而健康对照组为1500±958 (SD)。慢性胰腺炎组中度活动平均分钟为61.6±85分钟,健康对照组为161.4±131.2分钟。慢性胰腺炎组中度/剧烈平均分钟为62.1±86 (SD),健康对照组为164.3±132 (SD)。在剧烈运动和久坐的时间上,两组之间没有发现显著差异。结论:这项探索性研究提供了早期客观证据,表明慢性胰腺组的活动水平不符合目前的国际建议。强烈建议对这一慢性疾病人群进行进一步调查。
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引用次数: 0
Society News 社会新闻
3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000531190
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引用次数: 0
The Role of Biologic Mesh and Fundoplication in the Surgical Management of Hiatal Hernias: A Multicenter Evaluation. 生物网状物和底折叠术在先天性疝外科治疗中的作用:多中心评估。
IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 Epub Date: 2023-07-26 DOI: 10.1159/000533186
Cassandra Mohr, Hailie Ciomperlik, Naila Dhanani, Oscar A Olavarria, Craig Hannon, William Hope, Scott Roth, Mike K Liang, Julie L Holihan

Introduction: Hiatal hernia repair is associated with substantial recurrence of both hiatal hernia and symptoms of gastroesophageal reflux (GER). While small randomized controlled trials demonstrate limited differences in outcomes with use of mesh or fundoplication type, uncertainty remains.

Methods: A multicenter, retrospective review of patients undergoing surgical treatment of hiatal hernias between 2015 and 2020 was performed. Patients with mesh and with suture-only repair were compared, and partial versus complete fundoplication was compared. Primary outcomes were hernia recurrence and occurrence of postoperative GER symptoms and dysphagia. Multivariable regression was performed to assess the effect of each intervention on clinical outcomes.

Results: A total of 453 patients from four sites were followed for a median (IQR) of 17 (13) months. On multivariate analysis, mesh had no impact on hernia recurrence (odds ratio 0.993, 95% CI: 0.53-1.87, p = 0.982), and fundoplication type did not impact recurrence of postoperative GER symptoms (complete: odds ratio 0.607, 95% CI: 0.33-1.12, p = 0.112) or dysphagia (complete: odds ratio 1.17, 95% CI: 0.56-2.43, p = 0.677).

Conclusion: During hiatal hernia repair, mesh and fundoplication type do not appear to have substantial impact on GER symptoms, dysphagia, or hernia recurrence. This multicenter study provides real-world evidence to support the findings of small RCTs.

引言:裂孔疝修补术与裂孔疝和胃食管反流(GER)症状的大量复发有关。虽然小型随机对照试验表明,使用网状物或胃底折叠术类型的结果差异有限,但仍存在不确定性。方法:对2015年至2020年间接受裂孔疝手术治疗的患者进行多中心回顾性审查。比较网状和仅缝合修复的患者,并比较部分和完全胃底折叠术。主要结果是疝复发、术后GER症状和吞咽困难的发生。进行多变量回归以评估每种干预措施对临床结果的影响。结果:来自四个部位的453名患者接受了中位(IQR)17(13)个月的随访。在多变量分析中,网状物对疝复发没有影响(比值比0.993,95%CI:0.53-1.87,p=0.982),而胃底折叠术类型对术后GER症状的复发也没有影响(完全:比值比0.607,95%CI:0.33-1.12,p=0.112)或吞咽困难(完全:优势比1.17,95%CI:0.56-2.43,p=0.677),网状物和胃底折叠类型似乎对GER症状、吞咽困难或疝复发没有实质性影响。这项多中心研究提供了真实世界的证据来支持小型随机对照试验的发现。
{"title":"The Role of Biologic Mesh and Fundoplication in the Surgical Management of Hiatal Hernias: A Multicenter Evaluation.","authors":"Cassandra Mohr, Hailie Ciomperlik, Naila Dhanani, Oscar A Olavarria, Craig Hannon, William Hope, Scott Roth, Mike K Liang, Julie L Holihan","doi":"10.1159/000533186","DOIUrl":"10.1159/000533186","url":null,"abstract":"<p><strong>Introduction: </strong>Hiatal hernia repair is associated with substantial recurrence of both hiatal hernia and symptoms of gastroesophageal reflux (GER). While small randomized controlled trials demonstrate limited differences in outcomes with use of mesh or fundoplication type, uncertainty remains.</p><p><strong>Methods: </strong>A multicenter, retrospective review of patients undergoing surgical treatment of hiatal hernias between 2015 and 2020 was performed. Patients with mesh and with suture-only repair were compared, and partial versus complete fundoplication was compared. Primary outcomes were hernia recurrence and occurrence of postoperative GER symptoms and dysphagia. Multivariable regression was performed to assess the effect of each intervention on clinical outcomes.</p><p><strong>Results: </strong>A total of 453 patients from four sites were followed for a median (IQR) of 17 (13) months. On multivariate analysis, mesh had no impact on hernia recurrence (odds ratio 0.993, 95% CI: 0.53-1.87, p = 0.982), and fundoplication type did not impact recurrence of postoperative GER symptoms (complete: odds ratio 0.607, 95% CI: 0.33-1.12, p = 0.112) or dysphagia (complete: odds ratio 1.17, 95% CI: 0.56-2.43, p = 0.677).</p><p><strong>Conclusion: </strong>During hiatal hernia repair, mesh and fundoplication type do not appear to have substantial impact on GER symptoms, dysphagia, or hernia recurrence. This multicenter study provides real-world evidence to support the findings of small RCTs.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10013964","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 Role of Hepatobiliary Scintigraphy as the Initial Investigative Modality for Significant Bile Leak following Laparoscopic Cholecystectomy. 肝胆闪烁扫描作为腹腔镜胆囊切除术后显著胆汁渗漏的初步研究手段的作用。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 Epub Date: 2023-09-25 DOI: 10.1159/000533794
Amitai Bickel, Ron Lagrissi, Jacqueline Jerushalmi, Wisam Sbeit, Michael Weiss, Moshe Shiller, Samer Ganam, Eli Kakiashvili

Introduction: Currently, the rate of bile duct injury and leak following laparoscopic cholecystectomy (LC) is still higher than for open surgery. Diverse investigative algorithms were suggested for bile leak, shifting from hepatobiliary scintigraphy (HBS) toward invasive and more sophisticated means. We aimed to analyze the use of biliary scan as the initial modality to investigate significant bile leak in the drain following LC, attempting to avoid potential unnecessary invasive means when the scan demonstrate fair passage of nuclear substance to the intestine, without leak.

Methods: We have conducted a prospective non-randomized study, mandating hepatobiliary scintigraphy first, for asymptomatic patients harboring drain in the gallbladder fossa, leaking more than 50 mL/day following LC. Analysis was done based on medical data from the surgical, gastroenterology, and the nuclear medicine departments.

Results: Among 3,124 patients undergoing LC, significant bile leak in the drain was seen in 67 subjects, of whom we started with HBS in 50 patients, presenting our study group. In 27 of whom, biliary scan was the only investigative modality, showing fair passage of the nuclear isotope to the duodenum and absence of leak in the majority. The leak stopped spontaneously within a mean of 3.6 days, and convalescence as well as outpatient clinic follow-up was uneventful. In 23 patients, biliary scan that was interpreted as abnormal was followed by endoscopic retrograde cholangio-pancreatography (ERCP). However, ERCP did not demonstrate any bile leak in 13 subjects. In 17 patients, ERCP was used initially, without biliary scan, suggesting the possibility of avoiding invasive modalities in 7 patients.

Conclusions: Based on a negative predictive value of 91%, we suggest that in cases of asymptomatic significant bile leak through a drain following LC, a normal HBS as the initial modality can safely decrease the rate of using invasive modalities.

引言:目前,腹腔镜胆囊切除术后胆管损伤和渗漏的发生率仍然高于开放手术。胆汁渗漏的研究算法多种多样,从肝胆闪烁扫描(HBS)转向侵入性和更复杂的方法。我们的目的是分析使用胆道扫描作为研究LC后引流管中显著胆汁泄漏的初始模式,试图避免在扫描显示核物质公平通过肠道而没有泄漏时潜在的不必要的侵入性手段。方法:我们进行了一项前瞻性非随机研究,要求首先对胆囊窝有引流管、LC后渗漏超过50mL/天的无症状患者进行肝胆闪烁扫描。根据外科、胃肠科和核医学部门的医学数据进行分析。结果:在3124名接受LC的患者中,67名受试者的引流管中出现了严重的胆汁泄漏,其中50名患者开始接受HBS治疗,这是我们的研究组。在其中27例患者中,胆道扫描是唯一的研究方式,显示核同位素可以顺利进入十二指肠,大多数患者没有渗漏。泄漏在平均3.6天内自动停止,恢复期和门诊随访都很顺利。在23例患者中,胆道扫描被解释为异常,随后进行内镜逆行胰胆管造影(ERCP)。然而,在13名受试者中,ERCP未显示任何胆汁渗漏。在17名患者中,最初使用ERCP,没有进行胆道扫描,这表明7名患者有可能避免采用侵入性方法。结论:基于91%的阴性预测值,我们建议,在LC后无症状显著胆汁通过引流管泄漏的病例中,正常的HBS作为初始模式可以安全地降低使用侵入性模式的比率。
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引用次数: 0
Pancreatic Anastomosis in Robotic-Assisted Pancreaticoduodenectomy: Different Surgical Techniques. 机器人辅助胰十二指肠切除术中的胰腺吻合:不同的手术技术。
IF 2.7 3区 医学 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000528646
Matteo De Pastena, Elisa Bannone, Elena Andreotti, Chiara Filippini, Marco Ramera, Alessandro Esposito, Roberto Salvia

Robot-assisted pancreatoduodenectomy (R-PD) may provide challenges but potential benefits for pancreatic-enteric anastomosis fashioning. Despite numerous trials comparing different pancreatic-enteric anastomosis techniques, an ideal method is still missing. This study aims to describe different management strategies and surgical techniques of standardized pancreatic-enteric anastomoses during an R-PD. This study reported the robotic technical steps of the modified end-to-side Blumgart pancreaticojejunostomy, the Cattel-Warren duct-to-mucosa pancreatojejunostomy, with internal or external pancreatic duct stent, and the modified end-to-side, double-layer pancreogastrostomy. A dual-console da Vinci Xi Surgical System® (Intuitive Surgical Xi, Sunnyvale, CA) was used to perform all the R-PD. Different robotic pancreatic-enteric anastomosis techniques can be used during the reconstruction phase, possibly reproducing the open technique. The type of anastomosis and applied mitigation strategies should balance surgical strategy adaptability and operative technique standardization. R-PD should be performed in high-volume centers by surgeons with extensive experience in pancreatic and advanced MI surgery, enabling different but standardized anastomotic techniques based on patients' risk factors and intraoperative findings. Future studies on robotic pancreatic anastomosis should focus on personalized approaches after adequate risk stratification.

机器人辅助胰十二指肠切除术(R-PD)可能会给胰肠吻合形成带来挑战,但也有潜在的好处。尽管许多试验比较了不同的胰肠吻合技术,但仍缺乏理想的方法。本研究旨在描述在R-PD期间标准化胰肠吻合术的不同管理策略和手术技术。本研究报道了改良的端侧Blumgart胰空肠吻合术、Cattel-Warren胰空肠导管到粘膜胰空肠吻合术(胰管内支架或胰管外支架)和改良的端侧双层胰胃吻合术的机器人技术步骤。在重建阶段可以使用不同的机器人胰肠吻合技术,可能复制开放技术。吻合方式和采用的缓解策略应兼顾手术策略的适应性和手术技术的规范化。R-PD应在大容量中心由具有丰富胰腺和晚期心肌梗死手术经验的外科医生进行,根据患者的危险因素和术中发现,采用不同但标准化的吻合技术。未来对机器人胰腺吻合术的研究应侧重于在充分的风险分层后的个性化方法。
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引用次数: 0
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 Q1 Medicine 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

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.

导论:虽然ERAS方案被证明可以改善胃切除术后的预后,但一些论文证明了与“工作日效应”相关的对术后发病率的不利影响。我们的目的是了解胃切除术的日期是否会影响术后结果和ERAS项目的依从性。方法:我们纳入了2017年1月至2021年9月期间因癌症接受胃切除术的所有患者。根据手术日期将队列分为早组(周一-周三)和晚组(周四-周五)。比较方案依从性和术后结果。结果:早期组227例,晚期组154例。两组术前特征具有可比性。早期组和晚期组术前/术中及术后ERAS项目的依从性无明显差异,多数项目超过70%阈值。早期组和晚期组的中位住院时间分别为6.5 d和6 d (p = 0.616)。两组的发病率均为50%,早期和晚期患者中分别有13%和15%出现严重并发症。90天死亡率为2%,两组之间相似。结论:在采用标准化ERAS方案的中心,胃切除术的工作日对ERAS各项目的成功及术后手术和肿瘤预后无显著影响。
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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 Q1 Medicine Pub Date : 2023-01-01 DOI: 10.1159/000531283
Siri Rønholdt Henriksen, Jacob Rosenberg, Siv Fonnes

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.

背景:诊断性腹腔镜检查常用于怀疑患有急性阑尾炎的患者。本研究的目的是评估在疑似急性阑尾炎的诊断性腹腔镜检查中发现的其他病理的比率。方法:本系统检索纳入了≥100例因疑似急性阑尾炎接受腹腔镜检查并报告了组织病理学和其他腹腔内发现的患者。我们进行了一项荟萃分析,估计了其他病理的发生率,并进行了敏感性分析,排除了较小的队列(≤500例患者)。调查了年龄组、性别、具体结果和地理区域。用GRADE评价证据的确定性。结果:共纳入27项研究,涵盖25,547例患者,其中793例患者有意想不到的病理。结果为阑尾良性病理(34%)、恶性病理(30%)、妇科病理(5%)、胃肠道病理(4%)或未明确病理(27%)。meta分析显示意外发现的总发生率为3.5% (95% CI 2.7-4.3;中等确定性),敏感性分析也显示了类似的结果。疑似急性阑尾炎治疗时阑尾肿瘤发生率为1.0% (95% CI 0.8-1.3%;高确定性)。结论:疑似急性阑尾炎患者其他病理表现的发生率较低,阑尾恶性肿瘤发生率为1%。
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引用次数: 0
期刊
Digestive Surgery
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