首页 > 最新文献

Digestive Surgery最新文献

英文 中文
Systematic Review and Meta-Analysis of Clinical Outcomes after Enucleation of Pancreatic Metastases from Renal Cell Carcinoma. 肾细胞癌胰腺转移瘤去核后临床结果的系统评价和荟萃分析。
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000528823
Stefania Brozzetti, Mariavittoria Carati, Antonio V Sterpetti

Introduction: A systematic review and meta-analysis of the literature was carried out to determine the clinical and oncological outcome of patients who had enucleation of solitary pancreatic metastases from renal cell carcinoma.

Methods: Operative mortality, postoperative complications, observed survival, and disease-free survival were analyzed. The clinical outcomes of patients who had enucleation were compared to those of 947 patients collected from the literature who had standard or atypical pancreatic resection for the same disease using propensity score matching.

Results: There was no postoperative mortality in the 56 patients who had enucleation of pancreatic metastases from renal cell carcinoma. In 51 patients, postoperative complications could be analyzed. Ten patients (10/51 = 19.6%) had postoperative complications. Three patients (3/51 = 5.9%) had major complications (Clavien-Dindo III or more). Five-year observed survival rates and disease-free survival for patients with enucleation were 92% and 79%, respectively. These results compared favorably with those obtained in patients who had standard resection and other forms of atypical resection (also using propensity score matching). Patients who had partial pancreatic resection (atypical or not) with pancreatic-jejunal anastomosis had increased rates of postoperative complications and local recurrences.

Conclusions: Enucleation of pancreatic metastases offers a valid solution in selected patients.

本研究对文献进行了系统回顾和荟萃分析,以确定肾细胞癌孤立性胰腺转移患者的临床和肿瘤学结果。方法:分析手术死亡率、术后并发症、观察生存率和无病生存率。将去核患者的临床结果与文献中收集的947例因同一疾病行标准或非典型胰腺切除术的患者的临床结果进行倾向评分匹配。结果:56例肾细胞癌胰腺转移瘤行去核手术,无术后死亡。对51例患者进行了术后并发症分析。术后并发症10例(10/51 = 19.6%)。3例(3/51 = 5.9%)出现严重并发症(Clavien-Dindo III及以上)。去核患者的5年观察生存率和无病生存率分别为92%和79%。这些结果与标准切除和其他形式的非典型切除(也使用倾向评分匹配)的患者所获得的结果进行了比较。胰部分切除术(非典型或非典型)合并胰空肠吻合术的患者术后并发症和局部复发率增加。结论:胰腺转移瘤去核治疗是一种有效的治疗方法。
{"title":"Systematic Review and Meta-Analysis of Clinical Outcomes after Enucleation of Pancreatic Metastases from Renal Cell Carcinoma.","authors":"Stefania Brozzetti,&nbsp;Mariavittoria Carati,&nbsp;Antonio V Sterpetti","doi":"10.1159/000528823","DOIUrl":"https://doi.org/10.1159/000528823","url":null,"abstract":"<p><strong>Introduction: </strong>A systematic review and meta-analysis of the literature was carried out to determine the clinical and oncological outcome of patients who had enucleation of solitary pancreatic metastases from renal cell carcinoma.</p><p><strong>Methods: </strong>Operative mortality, postoperative complications, observed survival, and disease-free survival were analyzed. The clinical outcomes of patients who had enucleation were compared to those of 947 patients collected from the literature who had standard or atypical pancreatic resection for the same disease using propensity score matching.</p><p><strong>Results: </strong>There was no postoperative mortality in the 56 patients who had enucleation of pancreatic metastases from renal cell carcinoma. In 51 patients, postoperative complications could be analyzed. Ten patients (10/51 = 19.6%) had postoperative complications. Three patients (3/51 = 5.9%) had major complications (Clavien-Dindo III or more). Five-year observed survival rates and disease-free survival for patients with enucleation were 92% and 79%, respectively. These results compared favorably with those obtained in patients who had standard resection and other forms of atypical resection (also using propensity score matching). Patients who had partial pancreatic resection (atypical or not) with pancreatic-jejunal anastomosis had increased rates of postoperative complications and local recurrences.</p><p><strong>Conclusions: </strong>Enucleation of pancreatic metastases offers a valid solution in selected patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"9-20"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9826791","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
Omentectomy as Part of Radical Surgery for Gastric Cancer: 5-Year Follow-Up Results of a Multicenter Prospective Cohort Study. 网膜切除术作为胃癌根治性手术的一部分:一项多中心前瞻性队列研究的5年随访结果
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000530975
Kammy Keywani, Alexander B J Borgstein, Djamila Boerma, Stijn van Esser, Wietse J Eshuis, Mark I Van Berge Henegouwen, Johanna van Sandick, Suzanne S Gisbertz

Introduction: Curative therapy for gastric cancer usually consists of perioperative chemotherapy combined with a radical (R0) gastrectomy. In addition to a modified D2 lymphadenectomy, a complete omentectomy is recommended. However, there is little evidence for a survival benefit of omentectomy. This study presents the follow-up data of the OMEGA study.

Methods: This multicenter prospective cohort study included 100 consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. Primary outcome of the current study was 5-year overall survival. Patients with or without omental metastases were compared. Pathological factors associated with locoregional recurrence and/or metastases were tested with multivariable regression analysis.

Results: Of 100 included patients, five had metastases in the greater omentum. Five-year overall survival was 0.0% in patients with omental metastases and 44.2% in patients without omental metastases (p = 0.001). Median overall survival time for patients with or without omental metastases was 7 months and 53 months. A (y)pT3-4 stage tumor and vasoinvasive growth were associated with locoregional recurrence and/or metastases in patients without omental metastases.

Conclusion: The presence of omental metastases in gastric cancer patients who underwent potentially curative surgery was associated with impaired overall survival. Omentectomy as part of radical gastrectomy for gastric cancer might not contribute to a survival benefit in case of undetected omental metastases.

导言:胃癌的根治性治疗通常包括围手术期化疗联合根治性胃切除术。除改良D2淋巴结切除术外,建议行全网膜切除术。然而,很少有证据表明网膜切除术对生存有好处。本研究提供OMEGA研究的随访数据。方法:这项多中心前瞻性队列研究包括100例连续接受(亚)全胃切除术、全网膜切除术和改良D2淋巴结切除术的胃癌患者。目前研究的主要终点是5年总生存率。对有或无大网膜转移的患者进行比较。用多变量回归分析检测与局部复发和/或转移相关的病理因素。结果:100例患者中,5例转移至大网膜。大网膜转移患者的5年总生存率为0.0%,无大网膜转移患者的5年总生存率为44.2% (p = 0.001)。有或没有大网膜转移的患者中位总生存时间分别为7个月和53个月。A (y)pT3-4期肿瘤和血管侵袭性生长与没有大网膜转移的患者的局部复发和/或转移有关。结论:在接受有可能治愈的手术的胃癌患者中出现大网膜转移与总生存期受损有关。在未发现大网膜转移的情况下,作为胃癌根治性胃切除术的一部分,大网膜切除术可能不会对生存有利。
{"title":"Omentectomy as Part of Radical Surgery for Gastric Cancer: 5-Year Follow-Up Results of a Multicenter Prospective Cohort Study.","authors":"Kammy Keywani,&nbsp;Alexander B J Borgstein,&nbsp;Djamila Boerma,&nbsp;Stijn van Esser,&nbsp;Wietse J Eshuis,&nbsp;Mark I Van Berge Henegouwen,&nbsp;Johanna van Sandick,&nbsp;Suzanne S Gisbertz","doi":"10.1159/000530975","DOIUrl":"https://doi.org/10.1159/000530975","url":null,"abstract":"<p><strong>Introduction: </strong>Curative therapy for gastric cancer usually consists of perioperative chemotherapy combined with a radical (R0) gastrectomy. In addition to a modified D2 lymphadenectomy, a complete omentectomy is recommended. However, there is little evidence for a survival benefit of omentectomy. This study presents the follow-up data of the OMEGA study.</p><p><strong>Methods: </strong>This multicenter prospective cohort study included 100 consecutive patients with gastric cancer undergoing (sub)total gastrectomy with complete en bloc omentectomy and modified D2 lymphadenectomy. Primary outcome of the current study was 5-year overall survival. Patients with or without omental metastases were compared. Pathological factors associated with locoregional recurrence and/or metastases were tested with multivariable regression analysis.</p><p><strong>Results: </strong>Of 100 included patients, five had metastases in the greater omentum. Five-year overall survival was 0.0% in patients with omental metastases and 44.2% in patients without omental metastases (p = 0.001). Median overall survival time for patients with or without omental metastases was 7 months and 53 months. A (y)pT3-4 stage tumor and vasoinvasive growth were associated with locoregional recurrence and/or metastases in patients without omental metastases.</p><p><strong>Conclusion: </strong>The presence of omental metastases in gastric cancer patients who underwent potentially curative surgery was associated with impaired overall survival. Omentectomy as part of radical gastrectomy for gastric cancer might not contribute to a survival benefit in case of undetected omental metastases.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"76-83"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10206761","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
Computed Tomography-Defined Body Composition as Prognostic Parameter in Acute Mesenteric Ischemia. 将计算机断层扫描确定的身体成分作为急性肠系膜缺血的预后参数
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 Epub Date: 2023-09-14 DOI: 10.1159/000534093
Christoph Schwartner, Matthias Mehdorn, Ines Gockel, Manuel Florian Struck, Jakob Leonhardi, Markus Rositzka, Sebastian Ebel, Timm Denecke, Hans-Jonas Meyer

Introduction: Body composition comprising low-skeletal muscle mass (LSMM) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed by using cross-sectional imaging modalities. Previous analyses suggest that these parameters harbor prognostic relevance in various diseases. Aim of this study was to analyze possible associations of body composition parameters on mortality in patients with clinically suspected acute mesenteric ischemia (AMI).

Methods: All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. Overall, 137 patients (52 female patients, 37.9%) with a median age of 71 years were included in the present analysis. For all patients, the preoperative abdominal computed tomography (CT) was used to calculate LSMM, VAT, and SAT.

Results: Overall, 94 patients (68.6%) of the patient cohort died within 30 days within a median of 2 days, range 1-39 days. Of these, 27 patients (19.7%) died within 24 h. According to the CT, 101 patients (73.7%) were classified as being visceral obese, 102 patients (74.5%) as being sarcopenic, and 69 patients (50.4%) as being sarcopenic obese. Skeletal muscle index (SMI) was lower in non-survivors compared to survivors (37.5 ± 12.4 cm2/m2 vs. 44.1 ± 13.9 cm2/m2, p = 0.01). There were no associations between body composition parameters with mortality in days (SMI r = 0.07, p = 0.48, SAT r = -0.03, p = 0.77, and VAT r = 0.04, p = 0.68, respectively). In Cox regression analysis, a nonsignificant trend for visceral obesity was observed (HR: 0.62, 95% CI: 0.36-1.05, p = 0.07).

Conclusion: SMI might be a valuable CT-based parameter, which could help discriminate between survivors and non-survivors. Further studies are needed to elucidate the associations between body composition and survival in patients with AMI.

导言:身体成分包括低骨骼肌质量(LSMM)、皮下和内脏脂肪组织(SAT 和 VAT),可通过横断面成像模式进行评估。以往的分析表明,这些参数与各种疾病的预后相关。本研究旨在分析临床疑似急性肠系膜缺血(AMI)患者的身体成分参数与死亡率之间可能存在的关联:对2016年至2020年间所有临床疑似AMI患者进行回顾性评估。本分析共纳入 137 名患者(52 名女性,占 37.9%),中位年龄为 71 岁。所有患者的术前腹部计算机断层扫描(CT)均用于计算LSMM、VAT和SAT:总体而言,94 名患者(68.6%)在 30 天内死亡,死亡时间中位数为 2 天,死亡范围为 1-39 天。根据 CT,101 名患者(73.7%)被归类为内脏肥胖,102 名患者(74.5%)被归类为肌肉松弛型肥胖,69 名患者(50.4%)被归类为肌肉松弛型肥胖。与幸存者相比,非幸存者的骨骼肌指数(SMI)较低(37.5 ± 12.4 cm2/m2 vs. 44.1 ± 13.9 cm2/m2,P = 0.01)。身体成分参数与日死亡率之间没有关联(SMI r = 0.07,p = 0.48;SAT r = -0.03,p = 0.77;VAT r = 0.04,p = 0.68)。在 Cox 回归分析中,观察到内脏肥胖的趋势不明显(HR:0.62,95% CI:0.36-1.05,p = 0.07):SMI可能是一个有价值的基于CT的参数,有助于区分幸存者和非幸存者。还需要进一步的研究来阐明 AMI 患者的身体成分与存活率之间的关系。
{"title":"Computed Tomography-Defined Body Composition as Prognostic Parameter in Acute Mesenteric Ischemia.","authors":"Christoph Schwartner, Matthias Mehdorn, Ines Gockel, Manuel Florian Struck, Jakob Leonhardi, Markus Rositzka, Sebastian Ebel, Timm Denecke, Hans-Jonas Meyer","doi":"10.1159/000534093","DOIUrl":"10.1159/000534093","url":null,"abstract":"<p><strong>Introduction: </strong>Body composition comprising low-skeletal muscle mass (LSMM) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed by using cross-sectional imaging modalities. Previous analyses suggest that these parameters harbor prognostic relevance in various diseases. Aim of this study was to analyze possible associations of body composition parameters on mortality in patients with clinically suspected acute mesenteric ischemia (AMI).</p><p><strong>Methods: </strong>All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. Overall, 137 patients (52 female patients, 37.9%) with a median age of 71 years were included in the present analysis. For all patients, the preoperative abdominal computed tomography (CT) was used to calculate LSMM, VAT, and SAT.</p><p><strong>Results: </strong>Overall, 94 patients (68.6%) of the patient cohort died within 30 days within a median of 2 days, range 1-39 days. Of these, 27 patients (19.7%) died within 24 h. According to the CT, 101 patients (73.7%) were classified as being visceral obese, 102 patients (74.5%) as being sarcopenic, and 69 patients (50.4%) as being sarcopenic obese. Skeletal muscle index (SMI) was lower in non-survivors compared to survivors (37.5 ± 12.4 cm2/m2 vs. 44.1 ± 13.9 cm2/m2, p = 0.01). There were no associations between body composition parameters with mortality in days (SMI r = 0.07, p = 0.48, SAT r = -0.03, p = 0.77, and VAT r = 0.04, p = 0.68, respectively). In Cox regression analysis, a nonsignificant trend for visceral obesity was observed (HR: 0.62, 95% CI: 0.36-1.05, p = 0.07).</p><p><strong>Conclusion: </strong>SMI might be a valuable CT-based parameter, which could help discriminate between survivors and non-survivors. Further studies are needed to elucidate the associations between body composition and survival in patients with AMI.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"225-232"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10716866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10240727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Paratracheal Lymphadenectomy on Lymph Node Yield and Short-Term Outcomes in Esophagectomy for Cancer: A Nation-Wide Propensity Score-Matched Analysis. 气管旁淋巴结切除术对食管癌患者食管切除术中淋巴结产量和短期预后的影响:一项全国性倾向评分匹配分析。
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 DOI: 10.1159/000530019
B Feike Kingma, Eliza R C Hagens, Mark I Van Berge Henegouwen, Alicia S Borggreve, Jelle P Ruurda, Suzanne S Gisbertz, Richard van Hillegersberg

Introduction: The balance between potential oncological merits and surgical risks is unclear for the additional step of performing paratracheal lymphadenectomy during esophagectomy for cancer. This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients who underwent this procedure in the Netherlands.

Methods: Patients who underwent neoadjuvant chemoradiotherapy followed by transthoracic esophagectomy were included from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, lymph node yield and short-term outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not.

Results: Between 2011 and 2017, 2,128 patients were included. Some 770 patients (n = 385 vs. n = 385) and 516 patients (n = 258 vs. n = 258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher lymph node yield in Ivor Lewis (23 vs. 19 nodes, p < 0.001) and McKeown (21 vs. 19 nodes, p = 0.015) esophagectomy. There were no significant differences in complications or mortality. After Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with longer length of stay (12 vs. 11 days, p < 0.048). After McKeown esophagectomy, paratracheal lymphadenectomy was associated with more re-interventions (30% vs. 18%, p = 0.002).

Conclusions: Paratracheal lymphadenectomy resulted in a higher lymph node yield but also in longer length of stay after Ivor Lewis and more re-interventions following McKeown esophagectomy.

导言:对于食管癌患者在食管癌切除术期间进行气管旁淋巴结切除术的额外步骤,潜在的肿瘤学优点和手术风险之间的平衡尚不清楚。本研究旨在探讨荷兰气管旁淋巴结切除术对患者淋巴结产量和短期预后的影响。方法:接受新辅助放化疗后经胸食管切除术的患者来自荷兰上消化道癌症审计(DUCA)。在分别匹配Ivor Lewis和McKeown方法的倾向评分后,比较了行气管旁淋巴结切除术和未行气管旁淋巴结切除术的患者的淋巴结产量和短期结果。结果:2011年至2017年,纳入了2128例患者。分别有770例患者(n = 385 vs. n = 385)和516例患者(n = 258 vs. n = 258)与Ivor Lewis和McKeown方法匹配。Ivor Lewis的气管旁淋巴结切除术与更高的淋巴结产出率相关(23 vs 19个淋巴结,p <0.001)和McKeown (21 vs 19, p = 0.015)食管切除术。并发症和死亡率无显著差异。Ivor Lewis食管切除术后,气管旁淋巴结切除术与更长的住院时间相关(12天vs 11天,p <0.048)。McKeown食管切除术后,气管旁淋巴结切除术与更多的再干预相关(30%对18%,p = 0.002)。结论:气管旁淋巴结切除术导致更高的淋巴结产量,但Ivor Lewis术后住院时间更长,McKeown食管切除术后再次干预次数更多。
{"title":"The Impact of Paratracheal Lymphadenectomy on Lymph Node Yield and Short-Term Outcomes in Esophagectomy for Cancer: A Nation-Wide Propensity Score-Matched Analysis.","authors":"B Feike Kingma,&nbsp;Eliza R C Hagens,&nbsp;Mark I Van Berge Henegouwen,&nbsp;Alicia S Borggreve,&nbsp;Jelle P Ruurda,&nbsp;Suzanne S Gisbertz,&nbsp;Richard van Hillegersberg","doi":"10.1159/000530019","DOIUrl":"https://doi.org/10.1159/000530019","url":null,"abstract":"<p><strong>Introduction: </strong>The balance between potential oncological merits and surgical risks is unclear for the additional step of performing paratracheal lymphadenectomy during esophagectomy for cancer. This study aimed to investigate the impact of paratracheal lymphadenectomy on lymph node yield and short-term outcomes in patients who underwent this procedure in the Netherlands.</p><p><strong>Methods: </strong>Patients who underwent neoadjuvant chemoradiotherapy followed by transthoracic esophagectomy were included from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). After propensity score matching Ivor Lewis and McKeown approaches separately, lymph node yield and short-term outcomes were compared between patients who underwent paratracheal lymphadenectomy versus patients who did not.</p><p><strong>Results: </strong>Between 2011 and 2017, 2,128 patients were included. Some 770 patients (n = 385 vs. n = 385) and 516 patients (n = 258 vs. n = 258) were matched for the Ivor Lewis and McKeown approaches, respectively. Paratracheal lymphadenectomy was associated with a higher lymph node yield in Ivor Lewis (23 vs. 19 nodes, p &lt; 0.001) and McKeown (21 vs. 19 nodes, p = 0.015) esophagectomy. There were no significant differences in complications or mortality. After Ivor Lewis esophagectomy, paratracheal lymphadenectomy was associated with longer length of stay (12 vs. 11 days, p &lt; 0.048). After McKeown esophagectomy, paratracheal lymphadenectomy was associated with more re-interventions (30% vs. 18%, p = 0.002).</p><p><strong>Conclusions: </strong>Paratracheal lymphadenectomy resulted in a higher lymph node yield but also in longer length of stay after Ivor Lewis and more re-interventions following McKeown esophagectomy.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"40 1-2","pages":"58-68"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9830099","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
Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy. 引流管中血清肌酐和淀粉酶预测胰十二指肠切除术后胰瘘风险。
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 Epub Date: 2023-10-20 DOI: 10.1159/000533869
Yunda Song, Subo Zhang

Introduction: The identification of patients with low risk of clinically relevant postoperative pancreatic fistula (CR-POPF) and postoperative hemorrhage (PPH) can guide drain removal after pancreatoduodenectomy (PD). However, drain fluid amylase (DFA) ≤5,000 U/L on postoperative day (POD) 1 does not robustly predict the absence of CR-POPF.

Methods: Consecutive patients undergoing PD at Sun Yat-sen University Cancer Center between July 2018 and October 2021 were analyzed. Recursive partitioning analysis was used to classify patients into groups with different risks of CR-POPF and PPH.

Results: Among 288 consecutive patients included, 99 patients (34.38%) developed CR-POPF (86 grade B and 13 grade C). Patients with CR-POPF had increased levels of preoperative creatinine (CRE) and POD1 CRE. The combination of POD1 CRE (>104 μmol/L or not) and POD1 DFA (>5,000 U/L or not) stratified patients into subgroups with the maximum difference in CR-POPF risk. The CR-POPF rates were 17.82% (36/202) in group A (POD1 CRE ≤104 μmol/L and POD1 DFA ≤5,000 U/L), 53.33% (8/15) in group B (POD1 CRE >104 μmol/L and POD1 DFA ≤5,000 U/L), and 77.46% (55/71) in group C (POD1 DFA >5,000 U/L). The PPH rates were 1.98% (4/202), 20.00% (3/15), and 19.72% (14/71) in groups A, B, and C, respectively.

Conclusion: Patients with POD1 DFA ≤5,000 U/L and POD1 CRE >104 μmol/L have a high risk of CR-POPF and may not benefit from early drain removal. Patients with POD1 DFA ≤5,000 U/L and POD1 CRE ≤104 μmol/L have low risk of CR-POPF and PPH.

引言:识别临床相关的术后胰瘘(CR-POPF)和术后出血(PPH)的低风险患者可以指导胰十二指肠切除术(PD)后的引流管移除。然而,术后第1天引流液淀粉酶(DFA)≤5000U/L(POD)并不能有力地预测CR-POPF的缺失。方法:分析2018年7月至2021年10月在中山大学癌症中心连续接受PD的患者。采用递归划分分析将患者分为不同CR-POPF和PPH风险的组。结果:在288名连续患者中,99名患者(34.38%)出现CR-POPF。CR-POPF患者术前肌酸酐(CRE)和POD1 CRE水平升高。POD1 CRE(>104μmol/L或否)和POD1 DFA(>5000 U/L或否)的组合将患者分为CR-POPF风险差异最大的亚组。CR-POPF发生率A组为17.82%(36/202)(POD1 CRE≤104μmol/L,POD1 DFA≤5000U/L),B组为53.33%(8/15)(POD1CRE>104μmol/L,且POD1DFA≤5000 U/L)。A、B和C组的PPH发生率分别为1.98%(4/202)、20.00%(3/15)和19.72%(14/71)。结论:POD1-DFA≤5000U/L和POD1-CRE>104μmol/L的患者发生CR-POPF的风险较高,可能不会从早期引流中获益。POD1 DFA≤5000 U/L和POD1 CRE≤104μmol/L的患者发生CR-POPF和PPH的风险较低。
{"title":"Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy.","authors":"Yunda Song, Subo Zhang","doi":"10.1159/000533869","DOIUrl":"10.1159/000533869","url":null,"abstract":"<p><strong>Introduction: </strong>The identification of patients with low risk of clinically relevant postoperative pancreatic fistula (CR-POPF) and postoperative hemorrhage (PPH) can guide drain removal after pancreatoduodenectomy (PD). However, drain fluid amylase (DFA) ≤5,000 U/L on postoperative day (POD) 1 does not robustly predict the absence of CR-POPF.</p><p><strong>Methods: </strong>Consecutive patients undergoing PD at Sun Yat-sen University Cancer Center between July 2018 and October 2021 were analyzed. Recursive partitioning analysis was used to classify patients into groups with different risks of CR-POPF and PPH.</p><p><strong>Results: </strong>Among 288 consecutive patients included, 99 patients (34.38%) developed CR-POPF (86 grade B and 13 grade C). Patients with CR-POPF had increased levels of preoperative creatinine (CRE) and POD1 CRE. The combination of POD1 CRE (&gt;104 μmol/L or not) and POD1 DFA (&gt;5,000 U/L or not) stratified patients into subgroups with the maximum difference in CR-POPF risk. The CR-POPF rates were 17.82% (36/202) in group A (POD1 CRE ≤104 μmol/L and POD1 DFA ≤5,000 U/L), 53.33% (8/15) in group B (POD1 CRE &gt;104 μmol/L and POD1 DFA ≤5,000 U/L), and 77.46% (55/71) in group C (POD1 DFA &gt;5,000 U/L). The PPH rates were 1.98% (4/202), 20.00% (3/15), and 19.72% (14/71) in groups A, B, and C, respectively.</p><p><strong>Conclusion: </strong>Patients with POD1 DFA ≤5,000 U/L and POD1 CRE &gt;104 μmol/L have a high risk of CR-POPF and may not benefit from early drain removal. Patients with POD1 DFA ≤5,000 U/L and POD1 CRE ≤104 μmol/L have low risk of CR-POPF and PPH.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"205-215"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10716868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49689233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Thyroid Incidentalomas: Incidence and Oncological Implication in Patients with Esophageal Cancer. 甲状腺偶发瘤:食管癌患者的发病率和肿瘤学意义
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 Epub Date: 2023-09-07 DOI: 10.1159/000534027
Jasmijn R van Doesburg, Marianne C Kalff, Daan M Voeten, Anton F Engelsman, Saskia Jol, Mark I van Berge Henegouwen, Freek Daams, Suzanne S Gisbertz

Introduction: Thyroid incidentalomas are often encountered during imaging performed for the workup of esophageal cancer. Their oncological significance is unknown. This study aimed to establish incidence and etiology of thyroid incidentalomas found during the diagnostic workup of esophageal cancer.

Methods: All esophageal cancer patients referred to or diagnosed at the Amsterdam UMC between January 2012 and December 2016 were included. Radiology and multidisciplinary team meeting reports were reviewed for presence of thyroid incidentalomas. When present, the fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) or CT was reassessed by a radiologist. Primary outcome was the incidence and etiology of thyroid incidentalomas.

Results: In total, 1,110 esophageal cancer patients were included. Median age was 66 years, most were male (77.2%) and had an adenocarcinoma (69.4%). For 115 patients (10.4%), a thyroid incidentaloma was reported. Two thyroidal lesions proved malignant. One was an esophageal cancer metastasis (0.9%) and one was a primary thyroid carcinoma (0.9%). Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of disseminated esophageal disease and ineligible for curative treatment.

Conclusion: In this study, thyroid incidentalomas were only very rarely oncologically significant. Further etiological examination should only be considered in accordance with the TI-RADS classification system and when clinical consequences are to be expected.

简介甲状腺偶发瘤经常在食管癌的造影检查中遇到。它们的肿瘤学意义尚不清楚。本研究旨在确定在食管癌诊断过程中发现的甲状腺偶发瘤的发病率和病因:方法:纳入2012年1月至2016年12月期间转诊至阿姆斯特丹联合医疗中心或在该中心确诊的所有食管癌患者。对放射学和多学科小组会议报告进行审查,以确定是否存在甲状腺偶发瘤。如果存在甲状腺偶发瘤,则由放射科医生重新评估氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18FDG-PET/CT)或计算机断层扫描。主要结果是甲状腺偶发瘤的发生率和病因:共纳入1110名食管癌患者。中位年龄为 66 岁,大多数为男性(77.2%),腺癌患者占 69.4%。115名患者(10.4%)报告了甲状腺偶发瘤。有两个甲状腺病变被证实为恶性。一个是食管癌转移灶(0.9%),一个是原发性甲状腺癌(0.9%)。只有原发性甲状腺癌导致了治疗方法的改变。另一个恶性甲状腺偶发瘤是在食管播散性疾病的背景下出现的,不符合根治性治疗的条件:在这项研究中,甲状腺偶发瘤很少具有肿瘤学意义。结论:在这项研究中,甲状腺偶发瘤极少具有肿瘤学意义,只有根据TI-RADS分类系统并预计会产生临床后果时,才应考虑进一步的病因学检查。
{"title":"Thyroid Incidentalomas: Incidence and Oncological Implication in Patients with Esophageal Cancer.","authors":"Jasmijn R van Doesburg, Marianne C Kalff, Daan M Voeten, Anton F Engelsman, Saskia Jol, Mark I van Berge Henegouwen, Freek Daams, Suzanne S Gisbertz","doi":"10.1159/000534027","DOIUrl":"10.1159/000534027","url":null,"abstract":"<p><strong>Introduction: </strong>Thyroid incidentalomas are often encountered during imaging performed for the workup of esophageal cancer. Their oncological significance is unknown. This study aimed to establish incidence and etiology of thyroid incidentalomas found during the diagnostic workup of esophageal cancer.</p><p><strong>Methods: </strong>All esophageal cancer patients referred to or diagnosed at the Amsterdam UMC between January 2012 and December 2016 were included. Radiology and multidisciplinary team meeting reports were reviewed for presence of thyroid incidentalomas. When present, the fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) or CT was reassessed by a radiologist. Primary outcome was the incidence and etiology of thyroid incidentalomas.</p><p><strong>Results: </strong>In total, 1,110 esophageal cancer patients were included. Median age was 66 years, most were male (77.2%) and had an adenocarcinoma (69.4%). For 115 patients (10.4%), a thyroid incidentaloma was reported. Two thyroidal lesions proved malignant. One was an esophageal cancer metastasis (0.9%) and one was a primary thyroid carcinoma (0.9%). Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of disseminated esophageal disease and ineligible for curative treatment.</p><p><strong>Conclusion: </strong>In this study, thyroid incidentalomas were only very rarely oncologically significant. Further etiological examination should only be considered in accordance with the TI-RADS classification system and when clinical consequences are to be expected.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"216-224"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10182823","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 Evaluation of Sarcopenia before Neoadjuvant Chemotherapy Is Important for Predicting Postoperative Pneumonia in Patients with Esophageal Cancer. 新辅助化疗前对肉瘤的评估对预测癌症患者术后肺炎有重要意义。
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-01-01 Epub Date: 2023-07-27 DOI: 10.1159/000533185
Satoshi Nishi, Yuichiro Miki, Takumi Imai, Mikio Nambara, Hironari Miyamoto, Tatsuro Tamura, Mami Yoshii, Takahiro Toyokawa, Hiroaki Tanaka, Shigeru Lee, Kiyoshi Maeda

Introduction: Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy.

Methods: We retrospectively reviewed 113 patients. The skeletal muscle mass index (SMI) was evaluated by bioelectrical impedance analysis and/or computed tomography. Patients were diagnosed with sarcopenia at pre-NAC and preoperative timing. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with the best PP predictability.

Results: Fifteen (13.2%) patients developed grade III or higher PP. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the highest sensitivity (100%) and acceptable specificity (75.8%) for predicting PP. Low pre-NAC body mass index and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria.

Conclusion: Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.

简介:在食管癌症(EC)患者中经常观察到Sarcopenia。然而,新辅助化疗期间少肌症对并发症的影响尚未得到充分研究。因此,我们旨在研究评估肌减少症的最佳方法,以预测接受NAC和食管切除术的EC患者的并发症,特别是术后肺炎(PP)。方法:对113例患者进行回顾性分析。骨骼肌质量指数(SMI)通过生物电阻抗分析和/或计算机断层扫描进行评估。患者在NAC前和术前被诊断为少肌症。在PP的可预测性方面,比较了不同的标准。接下来,我们评估了哪些因素与少肌症相关,PP可预测性最好。结果:15名(13.2%)患者出现III级或更高的PP。NAC前修正的欧洲老年人少肌症工作组(EWGSOP)标准在预测PP方面显示出最高的敏感性(100%)和可接受的特异性(75.8%)。通过修正的EWGSOP标准,低NAC前体重指数和%VC与少肌症显著相关。结论:改良EWGSOP治疗NAC前少肌症是食管切除术后PP的重要预测指标。应对这些患者进行适当的干预,以预防PP。
{"title":"The Evaluation of Sarcopenia before Neoadjuvant Chemotherapy Is Important for Predicting Postoperative Pneumonia in Patients with Esophageal Cancer.","authors":"Satoshi Nishi,&nbsp;Yuichiro Miki,&nbsp;Takumi Imai,&nbsp;Mikio Nambara,&nbsp;Hironari Miyamoto,&nbsp;Tatsuro Tamura,&nbsp;Mami Yoshii,&nbsp;Takahiro Toyokawa,&nbsp;Hiroaki Tanaka,&nbsp;Shigeru Lee,&nbsp;Kiyoshi Maeda","doi":"10.1159/000533185","DOIUrl":"10.1159/000533185","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed 113 patients. The skeletal muscle mass index (SMI) was evaluated by bioelectrical impedance analysis and/or computed tomography. Patients were diagnosed with sarcopenia at pre-NAC and preoperative timing. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with the best PP predictability.</p><p><strong>Results: </strong>Fifteen (13.2%) patients developed grade III or higher PP. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the highest sensitivity (100%) and acceptable specificity (75.8%) for predicting PP. Low pre-NAC body mass index and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria.</p><p><strong>Conclusion: </strong>Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"153-160"},"PeriodicalIF":2.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10253117","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: 1
HBPD Table of Contents HBPD目录
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2022-06-01 DOI: 10.1159/000525285
{"title":"HBPD Table of Contents","authors":"","doi":"10.1159/000525285","DOIUrl":"https://doi.org/10.1159/000525285","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 1","pages":"134 - 136"},"PeriodicalIF":2.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43687098","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
Front & Back Matter 正面和背面
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2022-06-01 DOI: 10.1159/000525469
D. O’Toole
{"title":"Front & Back Matter","authors":"D. O’Toole","doi":"10.1159/000525469","DOIUrl":"https://doi.org/10.1159/000525469","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42004122","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
EDS Society News EDS社新闻
IF 2.7 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2022-06-01 DOI: 10.1159/000525286
{"title":"EDS Society News","authors":"","doi":"10.1159/000525286","DOIUrl":"https://doi.org/10.1159/000525286","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":"39 1","pages":"133 - 133"},"PeriodicalIF":2.7,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42953513","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
期刊
Digestive Surgery
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1