Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and the tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.
{"title":"Robotic Spleen-Preserving Distal Pancreatectomy with Preservation of Splenic Vessels Using the Gastrohepatic Ligament Approach: The Superior Window Approach in the Kimura Technique.","authors":"Kosei Takagi, Ryuichi Yoshida, Yuzo Umeda, Tomokazu Fuji, Kazuya Yasui, Takahito Yagi, Toshiyoshi Fujiwara","doi":"10.1159/000527249","DOIUrl":"https://doi.org/10.1159/000527249","url":null,"abstract":"<p><p>Minimally invasive spleen-preserving distal pancreatectomy (SPDP) is technically challenging, and only a few reports have described surgical approaches for minimally invasive SPDP. This report demonstrates our novel gastrohepatic ligament approach in robotic SPDP with preservation of the splenic vessels (the superior window approach in the Kimura technique). Our gastrohepatic ligament approach for robotic SPDP included four steps. First, the gastrohepatic ligament was divided extensively, and the pancreas was confirmed (step 1). In this step, we did not lift the stomach, nor did we divide the gastrocolic ligament. Next, the superior and inferior borders of the pancreas were dissected, and the tunneling of the pancreas on the superior mesenteric vein was performed (step 2). Following the division of the pancreas (step 3), the pancreatic body and tail were dissected from the medial to the lateral side with preservation of the splenic vessels (step 4). Using this approach, the pancreas can be directly accessed via the gastrohepatic ligament route and dissected without division of the gastrocolic ligament or retraction of the stomach. The present approach for robotic SPDP preserves splenic vessels, facilitating easy access to the pancreas with minimal dissection, and may be optional in selected patients, including those with low body mass index.</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":"9121744","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}
Introduction: Although several clinical applications have reported the usefulness of the radical antegrade modular pancreatosplenectomy (RAMPS) procedure for left-sided pancreatic ductal adenocarcinoma, few studies have reported the advantages of RAMPS with respect to the local recurrence (LR) rate.
Methods: As of 2018, 68 and 62 patients underwent RAMPS and standard retrograde pancreatosplenectomy (SRPS). The first recurrence and all subsequent recurrence sites observed on images during a follow-up period and/or chemotherapy. The clinical variables are collected retrospectively.
Results: LR only was found in 5 patients in the RAMPS group (5/68, 7.3%) and in 15 patients in the SRPS group (15/62, 24.2%; p = 0.008) as the first recurrence site. Any chemotherapies were not a risk factor for the incidence of LR. The 5-year cumulative LR rate was significantly lower in patients in the RAMPS group compared with those in the SRPS group (23.6% vs. 49.6%; p = 0.019). The 5-year overall survival was 42.2% in the RAMPS group and 33.0% in the SRPS group (p = 0.251).
Conclusion: The RAMPS procedure for left-sided pancreatic ductal adenocarcinoma may reduce the LR, cumulative LR rates.
简介:尽管已有多项临床应用报道了根治性前路模块化胰腺脾切除术(RAMPS)对左侧胰腺导管腺癌的实用性,但很少有研究报道RAMPS在局部复发率(LR)方面的优势:截至2018年,分别有68例和62例患者接受了RAMPS和标准逆行胰腺脾切除术(SRPS)。在随访期间和/或化疗期间,通过图像观察首次复发和所有后续复发部位。回顾性收集临床变量:RAMPS组有5名患者(5/68,7.3%)首次复发部位为LR,SRPS组有15名患者(15/62,24.2%;P = 0.008)首次复发部位为LR。任何化疗都不是LR发生率的风险因素。与SRPS组相比,RAMPS组患者的5年累积LR率明显较低(23.6% vs. 49.6%; p = 0.019)。RAMPS组的5年总生存率为42.2%,SRPS组为33.0%(P = 0.251):结论:RAMPS术治疗左侧胰腺导管腺癌可降低LR和累积LR率。
{"title":"Radical Antegrade Modular Pancreatosplenectomy for Left-Sided Pancreatic Ductal Adenocarcinoma May Reduce the Local Recurrence Rate.","authors":"Sho Kiritani, Junichi Kaneko, Junichi Arita, Takeaki Ishizawa, Nobuhisa Akamatsu, Kiyoshi Hasegawa","doi":"10.1159/000524927","DOIUrl":"10.1159/000524927","url":null,"abstract":"<p><strong>Introduction: </strong>Although several clinical applications have reported the usefulness of the radical antegrade modular pancreatosplenectomy (RAMPS) procedure for left-sided pancreatic ductal adenocarcinoma, few studies have reported the advantages of RAMPS with respect to the local recurrence (LR) rate.</p><p><strong>Methods: </strong>As of 2018, 68 and 62 patients underwent RAMPS and standard retrograde pancreatosplenectomy (SRPS). The first recurrence and all subsequent recurrence sites observed on images during a follow-up period and/or chemotherapy. The clinical variables are collected retrospectively.</p><p><strong>Results: </strong>LR only was found in 5 patients in the RAMPS group (5/68, 7.3%) and in 15 patients in the SRPS group (15/62, 24.2%; p = 0.008) as the first recurrence site. Any chemotherapies were not a risk factor for the incidence of LR. The 5-year cumulative LR rate was significantly lower in patients in the RAMPS group compared with those in the SRPS group (23.6% vs. 49.6%; p = 0.019). The 5-year overall survival was 42.2% in the RAMPS group and 33.0% in the SRPS group (p = 0.251).</p><p><strong>Conclusion: </strong>The RAMPS procedure for left-sided pancreatic ductal adenocarcinoma may reduce the LR, cumulative LR rates.</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":"10563247","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}
Niccolò Surci, Claudio Bassi, Roberto Salvia, Giovanni Marchegiani, Luca Casetti, Giacomo Deiro, Christina Bergmann, Klaus Walenta, Dietmar Tamandl, Martin Schindl, Klaus Sahora, Jakob Mühlbacher
Introduction: The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population.
Materials and methods: Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain.
Results: Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery.
Discussion/conclusion: Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.
手术对慢性胰腺炎(CP)患者的营养状况、胰腺功能和症状的影响尚未明确确定。本研究旨在评估意大利-奥地利人群CP手术后的临床随访。材料和方法:对2000年至2018年在两个大容量中心进行CP手术的患者进行分析。比较术前和术后的营养状况、胰腺内分泌和外分泌功能、慢性疼痛。结果:总体而言,186例患者接受了CP手术。其中68例(40%)回答了特定的随访问卷。体重指数在术前和术后评估之间显著增加(21.1比22.5 p = 0.003)。此外,观察到慢性疼痛患病率降低了60%(81%对21%,p < 0.001)。相反,胰腺的外分泌和内分泌功能在手术后都有恶化的趋势,出现糖尿病的患者比例一直较高,需要胰岛素治疗和口服胰酶的患者比例也较高。对40例(24%)患者进行完整影像学检查后的身体成分分析显示,手术后营养状况没有显著变化。讨论/结论:尽管在疼痛缓解方面观察到良好的结果,手术入路导致整体胰腺功能的持续恶化。未发现手术对患者营养状况有显著影响。
{"title":"Long-Term Follow-Up after Surgery for Chronic Pancreatitis: A Bicentric Retrospective Experience.","authors":"Niccolò Surci, Claudio Bassi, Roberto Salvia, Giovanni Marchegiani, Luca Casetti, Giacomo Deiro, Christina Bergmann, Klaus Walenta, Dietmar Tamandl, Martin Schindl, Klaus Sahora, Jakob Mühlbacher","doi":"10.1159/000526263","DOIUrl":"https://doi.org/10.1159/000526263","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of surgery on nutritional status, pancreatic function, and symptoms of patients affected by chronic pancreatitis (CP) has not been unequivocally determined. This study aimed to evaluate clinical follow-up after surgery for CP in an Italian-Austrian population.</p><p><strong>Materials and methods: </strong>Patients operated for CP at two high-volume centers between 2000 and 2018 were analyzed. The following parameters were compared between the pre- and postoperative period: nutritional status, endocrine and exocrine pancreatic functions, and chronic pain.</p><p><strong>Results: </strong>Overall, 186 patients underwent surgery for CP. Among these, 68 (40%) answered a specific follow-up questionnaire. The body mass index showed a significant increase between pre- and postoperative assessments (21.1 vs. 22.5 p = 0.003). Furthermore, a 60% decrease in the prevalence of chronic pain (81 vs. 21%, p < 0.001) was observed. On the contrary, both exocrine and endocrine pancreatic functions pointed toward a worsening after surgery, with consistent higher rates of patients presenting with diabetes mellitus, as well as patients requiring insulin therapy and oral intake of pancreatic enzymes. The analysis of body composition performed on 40 (24%) patients with a complete imaging pack revealed no significant change in the nutritional status after surgery.</p><p><strong>Discussion/conclusion: </strong>Despite the good results observed in terms of pain relief, the surgical approach led to a consistent worsening of the global pancreatic function. No significant influence of surgery on the nutritional status of patients was detected.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9909709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10744208","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}
Pub Date : 2022-01-01Epub Date: 2021-12-07DOI: 10.1159/000521169
Robert Memba, Olga Morató, Laia Estalella, Mihai C Pavel, Erik Llàcer-Millán, Mar Achalandabaso, Elisabet Julià, Erlinda Padilla, Carles Olona, Donal O'Connor, Rosa Jorba
Introduction: Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention.
Methods: Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296).
Results: A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective.
Conclusions: IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.
{"title":"Prevention of Incisional Hernia after Open Hepato-Pancreato-Biliary Surgery: A Systematic Review.","authors":"Robert Memba, Olga Morató, Laia Estalella, Mihai C Pavel, Erik Llàcer-Millán, Mar Achalandabaso, Elisabet Julià, Erlinda Padilla, Carles Olona, Donal O'Connor, Rosa Jorba","doi":"10.1159/000521169","DOIUrl":"https://doi.org/10.1159/000521169","url":null,"abstract":"<p><strong>Introduction: </strong>Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention.</p><p><strong>Methods: </strong>Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296).</p><p><strong>Results: </strong>A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective.</p><p><strong>Conclusions: </strong>IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.</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":"39789565","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}
Marco Milone, Sara Vertaldi, Marie Sophie Alfano, Antonino Agrusa, Gabriele Anania, Gian Luca Baiocchi, Pietro Paolo Bianchi, Alberto Biondi, Umberto Bracale, Salvatore Buscemi, Matteo Chiozza, Francesco Corcione, Domenico D'Ugo, Maurizio Degiuli, Giuseppe De Simone, Ugo Elmore, Federica Galli, Giuseppe Giuliani, Pietro Maida, Francesco Maione, Michele Manigrasso, Giampaolo Marte, Stefano Olmi, Stefano Rausei, Rossella Reddavid, Riccardo Rosati, Matteo Uccelli, Giovanni Domenico De Palma, Elisa Cassinotti, Luigi Boni
Introduction: Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis.
Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread.
Results: Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029).
Conclusions: Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.
{"title":"Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study.","authors":"Marco Milone, Sara Vertaldi, Marie Sophie Alfano, Antonino Agrusa, Gabriele Anania, Gian Luca Baiocchi, Pietro Paolo Bianchi, Alberto Biondi, Umberto Bracale, Salvatore Buscemi, Matteo Chiozza, Francesco Corcione, Domenico D'Ugo, Maurizio Degiuli, Giuseppe De Simone, Ugo Elmore, Federica Galli, Giuseppe Giuliani, Pietro Maida, Francesco Maione, Michele Manigrasso, Giampaolo Marte, Stefano Olmi, Stefano Rausei, Rossella Reddavid, Riccardo Rosati, Matteo Uccelli, Giovanni Domenico De Palma, Elisa Cassinotti, Luigi Boni","doi":"10.1159/000526348","DOIUrl":"https://doi.org/10.1159/000526348","url":null,"abstract":"<p><strong>Introduction: </strong>Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis.</p><p><strong>Methods: </strong>All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread.</p><p><strong>Results: </strong>Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029).</p><p><strong>Conclusions: </strong>Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.</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":"9423304","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}
Introduction: Given that doubling time is an indicator of tumor growth, we assessed the usefulness of carcinoembryonic antigen doubling time (CEA-DT) in prognosis prediction after curative resection for locally recurrent rectal cancer.
Methods: During January 1986-December 2016, 33 patients with locally recurrent rectal cancer who underwent curative resection at our hospital were retrospectively reviewed. The primary endpoint was the 3-year recurrence-free survival (RFS) rate. The Kaplan-Meier method was used to compare RFS rates and evaluate univariate and multivariate analyses for factors associated with oncologic outcomes, including CEA-DT. CEA-DT was classified into 2 groups: the short and long CEA-DT groups.
Results: The 3-year overall survival and RFS rates were 62.6% and 42.4%, respectively. In multivariate analyses, CEA-DT was an independent risk factor for poor RFS. The 3-year RFS rate was significantly better in the long CEA-DT group than in the short CEA-DT group (58.8% vs. 25.0%, p = 0.0063).
Conclusion: CEA-DT is a useful prognostic factor that can be assessed before surgery for locally recurrent rectal cancer. Long CEA-DT may indicate a favorable prognosis. Contrarily, short CEA-DT is associated with poor prognosis; therefore, further treatment intervention is necessary for patients with short CEA-DT.
鉴于倍增时间是肿瘤生长的一个指标,我们评估了癌胚抗原倍增时间(CEA-DT)在局部复发直肠癌根治性切除后预后预测中的作用。方法:对1986年1月~ 2016年12月在我院行根治性切除术的局部复发直肠癌患者33例进行回顾性分析。主要终点是3年无复发生存率(RFS)。Kaplan-Meier方法用于比较RFS率,并评估与肿瘤预后相关因素的单因素和多因素分析,包括CEA-DT。CEA-DT分为2组:短组和长组。结果:3年总生存率和RFS分别为62.6%和42.4%。在多变量分析中,CEA-DT是RFS差的独立危险因素。长CEA-DT组3年RFS率明显优于短CEA-DT组(58.8% vs. 25.0%, p = 0.0063)。结论:CEA-DT是局部复发直肠癌术前评估的有效预后因素。长CEA-DT可能预示预后良好。相反,CEA-DT短与预后差相关;因此,对于短CEA-DT患者,需要进一步的治疗干预。
{"title":"Usefulness of Carcinoembryonic Antigen Doubling Time in Prognosis Prediction after Curative Resection of Locally Recurrent Rectal Cancer: A Retrospective Study.","authors":"Junichi Sakamoto, Heita Ozawa, Hiroki Nakanishi, Shin Fujita","doi":"10.1159/000520694","DOIUrl":"https://doi.org/10.1159/000520694","url":null,"abstract":"<p><strong>Introduction: </strong>Given that doubling time is an indicator of tumor growth, we assessed the usefulness of carcinoembryonic antigen doubling time (CEA-DT) in prognosis prediction after curative resection for locally recurrent rectal cancer.</p><p><strong>Methods: </strong>During January 1986-December 2016, 33 patients with locally recurrent rectal cancer who underwent curative resection at our hospital were retrospectively reviewed. The primary endpoint was the 3-year recurrence-free survival (RFS) rate. The Kaplan-Meier method was used to compare RFS rates and evaluate univariate and multivariate analyses for factors associated with oncologic outcomes, including CEA-DT. CEA-DT was classified into 2 groups: the short and long CEA-DT groups.</p><p><strong>Results: </strong>The 3-year overall survival and RFS rates were 62.6% and 42.4%, respectively. In multivariate analyses, CEA-DT was an independent risk factor for poor RFS. The 3-year RFS rate was significantly better in the long CEA-DT group than in the short CEA-DT group (58.8% vs. 25.0%, p = 0.0063).</p><p><strong>Conclusion: </strong>CEA-DT is a useful prognostic factor that can be assessed before surgery for locally recurrent rectal cancer. Long CEA-DT may indicate a favorable prognosis. Contrarily, short CEA-DT is associated with poor prognosis; therefore, further treatment intervention is necessary for patients with short CEA-DT.</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":"39854504","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}
Pub Date : 2022-01-01Epub Date: 2022-05-17DOI: 10.1159/000524575
Oonagh M Griffin, Yasir Bashir, Donal O'Connor, Joseph Peakin, Jean McMahon, Sinead Noelle Duggan, Justin Geoghegan, Kevin C Conlon
Background/objectives: Sarcopenia in pancreatic cancer may increase the risk of chemotherapy-related toxicity and post-operative morbidity. This systematic review and meta-analysis aimed to quantify the prevalence of sarcopenia in early stage pancreatic cancer.
Methods: Relevant studies were identified using Ovid Medline and Elsevier Embase. Pooled estimates of prevalence rates (percentages) and corresponding 95% confidence interval (CI) were computed using a random-effects model to allow for heterogeneity between studies.
Results: The majority of the 33 studies (n = 5,593 patients) included in this meta-analysis utilized computed tomography (CT)-derived measures for body composition assessment in patients undergoing pancreatic resection. Reported prevalence of sarcopenia varied between 14 and 74%, and the pooled prevalence was 39% (95% CI: 38-40%) Heterogeneity was considerable, however, (I2 = 93%) and did not improve significantly when controlling for assessment method, and use of pre-defined cut-offs for sarcopenia, limiting potential to evaluate the true impact of sarcopenia.
Conclusion: The ready availability of sequential CT offers a valuable opportunity for body composition assessment, but the quality of assessment and interpretation must improve before the impact of body composition on treatment-related outcomes and survival can be assessed. We suggest recommendations for the assessment of body composition for the design of future studies.
{"title":"Measurement of Body Composition in Pancreatic Cancer: A Systematic Review, Meta-Analysis, and Recommendations for Future Study Design.","authors":"Oonagh M Griffin, Yasir Bashir, Donal O'Connor, Joseph Peakin, Jean McMahon, Sinead Noelle Duggan, Justin Geoghegan, Kevin C Conlon","doi":"10.1159/000524575","DOIUrl":"10.1159/000524575","url":null,"abstract":"<p><strong>Background/objectives: </strong>Sarcopenia in pancreatic cancer may increase the risk of chemotherapy-related toxicity and post-operative morbidity. This systematic review and meta-analysis aimed to quantify the prevalence of sarcopenia in early stage pancreatic cancer.</p><p><strong>Methods: </strong>Relevant studies were identified using Ovid Medline and Elsevier Embase. Pooled estimates of prevalence rates (percentages) and corresponding 95% confidence interval (CI) were computed using a random-effects model to allow for heterogeneity between studies.</p><p><strong>Results: </strong>The majority of the 33 studies (n = 5,593 patients) included in this meta-analysis utilized computed tomography (CT)-derived measures for body composition assessment in patients undergoing pancreatic resection. Reported prevalence of sarcopenia varied between 14 and 74%, and the pooled prevalence was 39% (95% CI: 38-40%) Heterogeneity was considerable, however, (I2 = 93%) and did not improve significantly when controlling for assessment method, and use of pre-defined cut-offs for sarcopenia, limiting potential to evaluate the true impact of sarcopenia.</p><p><strong>Conclusion: </strong>The ready availability of sequential CT offers a valuable opportunity for body composition assessment, but the quality of assessment and interpretation must improve before the impact of body composition on treatment-related outcomes and survival can be assessed. We suggest recommendations for the assessment of body composition for the design of future studies.</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":"10563664","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}
Leilei Zhu, Jingyi Shen, Rongrong Fu, Xiaozhen Lu, Liwen Du, Ruihao Jiang, Mengting Zhang, Yetan Shi, Ke Jiang, Yongwei Shi
Background: Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP.
Methods: Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications.
Results: Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention.
Conclusions: Early intervention is safe and recommended only for patients with indications for intervention, such as infection.
背景:目前,在急性坏死性胰腺炎(ANP)中,微创介入治疗(MII)已在很大程度上取代了延迟开放手术。然而,信息产业部的上市时间仍不明朗。本研究探讨了早期与延迟MII对ANP并发症的影响。方法:全面检索PubMed、Embase、Cochrane Library和Web of Science自成立至2022年6月期间评估MII时机对ANP患者并发症影响的研究。研究的主要结局是死亡率。次要结局是并发症的发生率。结果:9项研究报告了870例因ANP接受MII治疗的患者。早期干预组和延迟干预组的死亡率没有显著差异。此外,MII的时间与新发呼吸衰竭、新发心血管衰竭、新发肾功能衰竭、新发多器官功能衰竭、胃肠道瘘或穿孔、胰瘘、支架移位、出血、静脉血栓形成、新发胰腺内分泌功能不全的发生率无关。值得注意的是,在胆道和亚洲ANP患者的亚组分析中,早期干预与新发肾衰竭的风险显著高于延迟干预。结论:早期干预是安全的,建议仅对有指征的患者进行干预,如感染。
{"title":"Early versus Delayed Minimally Invasive Intervention for Acute Necrotizing Pancreatitis: An Updated Systematic Review and Meta-Analysis.","authors":"Leilei Zhu, Jingyi Shen, Rongrong Fu, Xiaozhen Lu, Liwen Du, Ruihao Jiang, Mengting Zhang, Yetan Shi, Ke Jiang, Yongwei Shi","doi":"10.1159/000529465","DOIUrl":"https://doi.org/10.1159/000529465","url":null,"abstract":"<p><strong>Background: </strong>Nowadays, minimally invasive intervention (MII) has largely replaced delayed open surgery in acute necrotizing pancreatitis (ANP). However, the timing of MII remains unclear. The present study investigated the effect of early versus delayed MII on complications in ANP.</p><p><strong>Methods: </strong>Studies evaluating the impact of the timing of MII on complications in ANP patients were thoroughly searched on PubMed, Embase, Cochrane Library, and Web of Science from inception to June 2022. The primary outcome of interest was mortality. Secondary outcomes were the incidence of complications.</p><p><strong>Results: </strong>Nine studies reporting 870 patients undergoing MII for ANP were included. No significant difference was found in mortality between the early and delayed intervention groups. In addition, the timing of MII was not associated with the incidence of new-onset respiratory failure, new-onset cardiovascular failure, new-onset renal failure, new-onset multiple organ failure, gastrointestinal fistula or perforation, pancreatic fistula, stent migration, bleeding, venous thrombosis, and new-onset pancreatic endocrine insufficiency. Notably, in the subgroup analysis of biliary and Asian ANP patients, early intervention was associated with a significantly higher risk of new-onset renal failure than delayed intervention.</p><p><strong>Conclusions: </strong>Early intervention is safe and recommended only for patients with indications for intervention, such as infection.</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":"9366651","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}
Pub Date : 2022-01-01Epub Date: 2022-10-31DOI: 10.1159/000527660
Naru Kondo
{"title":"Reply to Letter to the Editor \"Re: Identification of Preoperative Risk Factors for Poor Survival in Patients with Resectable Pancreatic Cancer Treated with Upfront Surgery\".","authors":"Naru Kondo","doi":"10.1159/000527660","DOIUrl":"10.1159/000527660","url":null,"abstract":"","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":"10198394","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}
Christoph G Dietrich, Tanja Kottmann, Annette Holtdirk, Joachim W Heise
Introduction: In 15% of patients with iron deficiency anemia, large diaphragmatic hernias are found as the cause of chronic iron loss. Conversely, iron deficiency anemia is present in 10-40% of diaphragmatic hernia patients. However, it is unclear why some patients with large diaphragmatic hernias develop anemia and others do not.
Methods: We retrospectively analyzed 116 patients with diaphragmatic hernias larger than 5 cm for the presence of anemia and the effect of surgery on this anemia, dividing these patients into 4 groups (group A: 21 patients with anemia/surgery, group B: 27 patients without anemia but with surgery, group C: 34 patients with anemia but without surgery, and group D: 34 patients without anemia/surgery).
Results: Women significantly predominated in the patient population (76%). Patients with iron deficiency anemia tended to be significantly older than patients without iron deficiency anemia (74.7 ± 12.2 vs. 69.6 ± 14.8 years, p = 0.08). The proportion of patients taking ASA was significantly higher in the anemia collective (41.8% vs. 9.8%, p < 0.001). Regression analysis further confirmed that higher age and ASA intake correlated significantly with lower hemoglobin in anemic patients. Performing hernia repair significantly decreased anemia rates and PPI use in the anemia patients, while both remained almost the same in the non-operated anemia patients.
Conclusion: ASA use and advanced age are risk factors for the presence of iron deficiency anemia in patients with large diaphragmatic hernias. Surgical hernia repair is suitable to reduce anemia.
在15%的缺铁性贫血患者中,发现大膈疝是慢性铁流失的原因。相反,10-40%的膈疝患者存在缺铁性贫血。然而,目前尚不清楚为什么有些大膈疝患者会发生贫血,而另一些则不会。方法:回顾性分析116例大于5 cm膈疝存在贫血及手术治疗对贫血的影响,将患者分为4组(A组:有贫血/手术21例,B组:无贫血但手术27例,C组:有贫血但不手术34例,D组:无贫血/手术34例)。结果:女性在患者群体中占明显优势(76%)。缺铁性贫血患者明显大于无缺铁性贫血患者(74.7±12.2∶69.6±14.8岁,p = 0.08)。在贫血组中,服用ASA的患者比例明显高于对照组(41.8% vs. 9.8%, p < 0.001)。回归分析进一步证实,年龄增大和ASA摄入与贫血患者血红蛋白降低显著相关。行疝修补术显著降低贫血患者的贫血率和PPI的使用,而在未手术的贫血患者中两者几乎保持不变。结论:ASA的使用和高龄是大膈疝患者缺铁性贫血的危险因素。外科疝修补术适合减少贫血。
{"title":"Intake of Acetylsalicylic Acid and High Age Are Risk Factors for Iron Deficiency Anemia in Patients with Large Diaphragmatic Hernias.","authors":"Christoph G Dietrich, Tanja Kottmann, Annette Holtdirk, Joachim W Heise","doi":"10.1159/000529326","DOIUrl":"https://doi.org/10.1159/000529326","url":null,"abstract":"<p><strong>Introduction: </strong>In 15% of patients with iron deficiency anemia, large diaphragmatic hernias are found as the cause of chronic iron loss. Conversely, iron deficiency anemia is present in 10-40% of diaphragmatic hernia patients. However, it is unclear why some patients with large diaphragmatic hernias develop anemia and others do not.</p><p><strong>Methods: </strong>We retrospectively analyzed 116 patients with diaphragmatic hernias larger than 5 cm for the presence of anemia and the effect of surgery on this anemia, dividing these patients into 4 groups (group A: 21 patients with anemia/surgery, group B: 27 patients without anemia but with surgery, group C: 34 patients with anemia but without surgery, and group D: 34 patients without anemia/surgery).</p><p><strong>Results: </strong>Women significantly predominated in the patient population (76%). Patients with iron deficiency anemia tended to be significantly older than patients without iron deficiency anemia (74.7 ± 12.2 vs. 69.6 ± 14.8 years, p = 0.08). The proportion of patients taking ASA was significantly higher in the anemia collective (41.8% vs. 9.8%, p < 0.001). Regression analysis further confirmed that higher age and ASA intake correlated significantly with lower hemoglobin in anemic patients. Performing hernia repair significantly decreased anemia rates and PPI use in the anemia patients, while both remained almost the same in the non-operated anemia patients.</p><p><strong>Conclusion: </strong>ASA use and advanced age are risk factors for the presence of iron deficiency anemia in patients with large diaphragmatic hernias. Surgical hernia repair is suitable to reduce anemia.</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":"9366653","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}