首页 > 最新文献

Ejso最新文献

英文 中文
Patient public perspectives on digital colorectal cancer surgery (DALLAS). 患者和公众对数字化结直肠癌手术(DALLAS)的看法。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-20 DOI: 10.1016/j.ejso.2024.108705
Deirdre M Nally, Emma C Kearns, Jeffrey Dalli, Niamh Moynagh, Kate Hanley, Peter Neary, Ronan A Cahill

Introduction: The importance of patient perspectives is increasingly appreciated in clinical practice and academia with formal engagement processes developing worldwide. Digital surgery encompasses intraoperative patient data (including surgical video) analysis and so requires public-patient involvement (PPI).

Methods: Engagement events were conducted based on NIHR and GRIPP2 LF guidelines. Following informative talks on digital surgery, invited patients and patient relatives were split into focus groups regarding 1) Research; 2) Data; 3) Industry Involvement; and 4) Artificial Intelligence in surgery. Scribed feedback was thematically analysed by two researchers independently. A pre and post event survey was sought voluntarily.

Results: 36 participant perspectives were analysed. In general, patients were enthusiastic about having a voice in surgical research and sharing their journey, with most groups concluding that capturing this was most appropriate after treatment recovery. The use of patient data for surgical development (i.e. research and education) was endorsed unanimously for the purpose of future patient benefit when responsibly and transparently managed and the value of industry was acknowledged. From 30 pre/post surveys (all p > 0.05), participants afforded the greatest data (including video) ownership claim to the surgical team (52 %/48 %) versus patients (32 %/24 %) and the hospital (12 %/24 %). While most (73 %/80 %) agreed that AI should be applied in surgical care, most felt the surgeon most valuable (93 %/80 %) with participants disagreeing that AI should make diagnoses (57 %/64 %) or treat patients (70 %/70 %) without human input.

Conclusion: Patients capably represent stable views and expectations that can strengthen modern and evolving surgical development involving data privacy, ownership and management.

导言:患者观点的重要性在临床实践和学术界日益受到重视,正式的参与过程在全球范围内不断发展。数字化手术包括术中患者数据(包括手术视频)分析,因此需要公众-患者参与(PPI):方法:根据 NIHR 和 GRIPP2 LF 指南开展参与活动。在关于数字化手术的信息讲座之后,受邀患者和患者亲属被分成几个焦点小组,分别讨论 1) 研究;2) 数据;3) 行业参与;4) 手术中的人工智能。两名研究人员分别对记录的反馈意见进行了专题分析。活动前后自愿进行了问卷调查:对 36 位参与者的观点进行了分析。总体而言,患者热衷于在手术研究中发表意见并分享他们的心路历程,大多数小组认为,在治疗恢复后收集这些信息最为合适。大家一致赞同将患者数据用于外科发展(即研究和教育),以便在负责任和透明的管理下为未来的患者造福,并承认了行业的价值。在 30 份前后调查中(P 均大于 0.05),参与者对手术团队(52%/48%)、患者(32%/24%)和医院(12%/24%)的数据(包括视频)所有权要求最高。虽然大多数人(73 %/80 %)同意人工智能应用于外科护理,但大多数人认为外科医生最有价值(93 %/80 %),参与者不同意人工智能在没有人类输入的情况下进行诊断(57 %/64 %)或治疗病人(70 %/70 %):患者有能力代表稳定的观点和期望,这可以加强涉及数据隐私、所有权和管理的现代和不断发展的外科发展。
{"title":"Patient public perspectives on digital colorectal cancer surgery (DALLAS).","authors":"Deirdre M Nally, Emma C Kearns, Jeffrey Dalli, Niamh Moynagh, Kate Hanley, Peter Neary, Ronan A Cahill","doi":"10.1016/j.ejso.2024.108705","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108705","url":null,"abstract":"<p><strong>Introduction: </strong>The importance of patient perspectives is increasingly appreciated in clinical practice and academia with formal engagement processes developing worldwide. Digital surgery encompasses intraoperative patient data (including surgical video) analysis and so requires public-patient involvement (PPI).</p><p><strong>Methods: </strong>Engagement events were conducted based on NIHR and GRIPP2 LF guidelines. Following informative talks on digital surgery, invited patients and patient relatives were split into focus groups regarding 1) Research; 2) Data; 3) Industry Involvement; and 4) Artificial Intelligence in surgery. Scribed feedback was thematically analysed by two researchers independently. A pre and post event survey was sought voluntarily.</p><p><strong>Results: </strong>36 participant perspectives were analysed. In general, patients were enthusiastic about having a voice in surgical research and sharing their journey, with most groups concluding that capturing this was most appropriate after treatment recovery. The use of patient data for surgical development (i.e. research and education) was endorsed unanimously for the purpose of future patient benefit when responsibly and transparently managed and the value of industry was acknowledged. From 30 pre/post surveys (all p > 0.05), participants afforded the greatest data (including video) ownership claim to the surgical team (52 %/48 %) versus patients (32 %/24 %) and the hospital (12 %/24 %). While most (73 %/80 %) agreed that AI should be applied in surgical care, most felt the surgeon most valuable (93 %/80 %) with participants disagreeing that AI should make diagnoses (57 %/64 %) or treat patients (70 %/70 %) without human input.</p><p><strong>Conclusion: </strong>Patients capably represent stable views and expectations that can strengthen modern and evolving surgical development involving data privacy, ownership and management.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108705"},"PeriodicalIF":3.5,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Enhancing vulvar cancer care: Integrating biomarkers and AI for better outcomes. 加强外阴癌护理:整合生物标记物和人工智能,提高疗效。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-19 DOI: 10.1016/j.ejso.2024.108776
Hanzala Ahmed Farooqi, Hamza Bin Ahmed, Rayyan Nabi
{"title":"Enhancing vulvar cancer care: Integrating biomarkers and AI for better outcomes.","authors":"Hanzala Ahmed Farooqi, Hamza Bin Ahmed, Rayyan Nabi","doi":"10.1016/j.ejso.2024.108776","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108776","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108776"},"PeriodicalIF":3.5,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma 肝内胆管癌晚期肺癌炎症指数的预后价值
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-18 DOI: 10.1016/j.ejso.2024.108773
Giovanni Catalano , Laura Alaimo , Odysseas P. Chatzipanagiotou , Andrea Ruzzenente , Federico Aucejo , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Shishir K. Maithel , Minoru Kitago , Itaru Endo , Guillaume Martel , Carlo Pulitano , Feng Shen , Irinel Popescu , Bas Groot Koerkamp , Todd W. Bauer , François Cauchy , George A. Poultsides , Timothy M. Pawlik

Introduction

The advanced lung cancer inflammation index (ALI), which combines inflammation and nutrition data, was recently proposed as a prognostic biomarker. We assessed the impact of ALI on overall survival (OS) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC).

Methods

Patients who underwent surgery for ICC were identified from an international cohort. ALI was calculated as body-mass index (BMI)∗albumin/neutrophil-to-lymphocyte ratio; patients were categorized into “low-” and “high-ALI” using log-rank statistics. The impact of ALI on OS was compared against other inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII = platelets∗NLR]) using Harrell's Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences, propensity score matching was employed.

Results

Among 1045 patients, more than one-half of individuals underwent major hepatectomy (n = 582, 55.7 %), median tumor size was 5.5 cm (IQR, 3.8–7.8), and median ALI was 38.9 (IQR 26.5–57.2). On multivariate analysis, low ALI was an independent risk factor for worse OS (HR 1.21, 95 % CI 1.01–1.46; p = 0.04). Patients with low ALI had worse 5-year OS (36.9 % vs. 49.9 %; p < 0.001), which remained significant after PSM (36.9 % vs. 41.3 %; p = 0.039). ALI had a comparable discriminatory ability compared with NLR, PLR, and SII (C-index: 0.646 vs. 0.644 vs. 0.640 vs. 0.641, respectively), yet had a lower AIC (5475.31 vs. 5546.80 vs. 5550.45 vs. 5548.62, respectively) suggesting slightly better model fit and accuracy.

Conclusions

ALI was an independent predictor of OS among patients undergoing surgery for ICC. Nutritional and inflammatory markers should be incorporated into predictive models to improve prognostic stratification.
简介晚期肺癌炎症指数(ALI)结合了炎症和营养数据,最近被提出作为预后生物标志物。我们评估了ALI对肝内胆管癌(ICC)手术患者总生存期(OS)的影响:方法:从国际队列中筛选出接受 ICC 手术的患者。ALI以体重指数(BMI)∗白蛋白/中性粒细胞与淋巴细胞比值计算;使用对数秩统计将患者分为 "低ALI "和 "高ALI"。使用哈雷尔一致性指数(C-index)和阿凯克信息标准(AIC)比较了ALI与其他炎症指标(即中性粒细胞与淋巴细胞比值[NLR]、血小板与淋巴细胞比值[PLR]、全身免疫炎症指数[SII=血小板∗NLR])对OS的影响。为尽量减少组间差异,采用了倾向得分匹配法:在 1045 名患者中,超过二分之一的患者接受了大肝切除术(n = 582,55.7%),肿瘤大小中位数为 5.5 厘米(IQR,3.8-7.8),ALI 中位数为 38.9(IQR 26.5-57.2)。多变量分析显示,低ALI是OS恶化的独立风险因素(HR 1.21,95 % CI 1.01-1.46;P = 0.04)。低ALI患者的5年OS较差(36.9%对49.9%;P 结论:低ALI患者的5年OS较差:ALI是ICC手术患者OS的独立预测因子。营养和炎症标记物应纳入预测模型,以改善预后分层。
{"title":"Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma","authors":"Giovanni Catalano ,&nbsp;Laura Alaimo ,&nbsp;Odysseas P. Chatzipanagiotou ,&nbsp;Andrea Ruzzenente ,&nbsp;Federico Aucejo ,&nbsp;Hugo P. Marques ,&nbsp;Vincent Lam ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Shishir K. Maithel ,&nbsp;Minoru Kitago ,&nbsp;Itaru Endo ,&nbsp;Guillaume Martel ,&nbsp;Carlo Pulitano ,&nbsp;Feng Shen ,&nbsp;Irinel Popescu ,&nbsp;Bas Groot Koerkamp ,&nbsp;Todd W. Bauer ,&nbsp;François Cauchy ,&nbsp;George A. Poultsides ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.ejso.2024.108773","DOIUrl":"10.1016/j.ejso.2024.108773","url":null,"abstract":"<div><h3>Introduction</h3><div>The advanced lung cancer inflammation index (ALI), which combines inflammation and nutrition data, was recently proposed as a prognostic biomarker. We assessed the impact of ALI on overall survival (OS) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC).</div></div><div><h3>Methods</h3><div>Patients who underwent surgery for ICC were identified from an international cohort. ALI was calculated as body-mass index (BMI)∗albumin/neutrophil-to-lymphocyte ratio; patients were categorized into “low-” and “high-ALI” using log-rank statistics. The impact of ALI on OS was compared against other inflammatory markers (i.e., neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], systemic immune inflammation index [SII = platelets∗NLR]) using Harrell's Concordance index (C-index) and the Akaike Information Criterion (AIC). To minimize intergroup differences, propensity score matching was employed.</div></div><div><h3>Results</h3><div>Among 1045 patients, more than one-half of individuals underwent major hepatectomy (n = 582, 55.7 %), median tumor size was 5.5 cm (IQR, 3.8–7.8), and median ALI was 38.9 (IQR 26.5–57.2). On multivariate analysis, low ALI was an independent risk factor for worse OS (HR 1.21, 95 % CI 1.01–1.46; p = 0.04). Patients with low ALI had worse 5-year OS (36.9 % vs. 49.9 %; p &lt; 0.001), which remained significant after PSM (36.9 % vs. 41.3 %; p = 0.039). ALI had a comparable discriminatory ability compared with NLR, PLR, and SII (C-index: 0.646 vs. 0.644 vs. 0.640 vs. 0.641, respectively), yet had a lower AIC (5475.31 vs. 5546.80 vs. 5550.45 vs. 5548.62, respectively) suggesting slightly better model fit and accuracy.</div></div><div><h3>Conclusions</h3><div>ALI was an independent predictor of OS among patients undergoing surgery for ICC. Nutritional and inflammatory markers should be incorporated into predictive models to improve prognostic stratification.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"50 12","pages":"Article 108773"},"PeriodicalIF":3.5,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review 胃癌患者肌肉松弛性肥胖的患病率及其对不良预后的影响:荟萃分析和系统综述。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-16 DOI: 10.1016/j.ejso.2024.108772
Bingyan Zhao , Leilei Bao , Tongyu Zhang , Yu Chen , Siai Zhang , Chunmei Zhang

Purpose

To assess the prevalence of sarcopenic obesity in patients with gastric cancer and its impact on adverse outcomes.

Methods

A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases was performed to search for articles related to sarcopenic obesity in patients with gastric cancer. The search was conducted until June 16, 2024, from the date of the creation of the database.

Results

A total of sixteen studies were included, including fifteen cohort studies and one cross-sectional study involving 4087 patients. The results of the meta-analysis showed that the prevalence of sarcopenic obesity in gastric cancer patients was 16.3 % (95 % CI: 12.2 %–20.4 %). Sarcopenic obesity significantly shortened the overall survival of gastric cancer patients (HR = 1.64, 95 % CI: 1.20 to 2.25, P = 0.002) and increased the risk of postoperative significant complications (OR = 2.84, 95 % CI: 1.95 to 4.16, P < 0.001), severe complications (OR = 2.60, 95 % CI: 1.45 to 4.64, P = 0.001), surgical site infection (OR = 3.82, 95 % CI: 1.47 to 9.89, P = 0.006), and mortality (OR = 4.84, 95 % CI: 1.38 to 17.02, P = 0.014), but no significant effect on 30-day readmission (OR = 1.90, 95 % CI: 0.31 to 11.84, P = 0.491).

Conclusions

The prevalence of sarcopenic obesity is high in patients with gastric cancer and is strongly associated with poor postoperative outcomes. Healthcare providers should evaluate patients with gastric cancer for sarcopenic obesity early to prevent or reduce the incidence of adverse outcomes.
目的:评估胃癌患者肌肉松弛性肥胖的发生率及其对不良预后的影响:对 PubMed、Embase、Cochrane Library、Web of Science 和 CINAHL 数据库进行计算机检索,搜索与胃癌患者肌松性肥胖相关的文章。检索时间从数据库创建之日起至2024年6月16日:共纳入 16 项研究,包括 15 项队列研究和 1 项横断面研究,涉及 4087 名患者。荟萃分析结果显示,胃癌患者肌肉疏松性肥胖的发生率为 16.3%(95 % CI:12.2%-20.4%)。肌肉疏松性肥胖明显缩短了胃癌患者的总生存期(HR = 1.64,95 % CI:1.20 至 2.25,P = 0.002),并增加了术后重大并发症的风险(OR = 2.84,95 % CI:1.95 至 4.16,P 结论:胃癌患者中肌肉松弛性肥胖的发生率很高,且与术后不良预后密切相关。医疗服务提供者应及早评估胃癌患者是否存在肌肉松弛性肥胖,以预防或减少不良后果的发生。
{"title":"Prevalence of sarcopenic obesity in patients with gastric cancer and effects on adverse outcomes: A meta-analysis and systematic review","authors":"Bingyan Zhao ,&nbsp;Leilei Bao ,&nbsp;Tongyu Zhang ,&nbsp;Yu Chen ,&nbsp;Siai Zhang ,&nbsp;Chunmei Zhang","doi":"10.1016/j.ejso.2024.108772","DOIUrl":"10.1016/j.ejso.2024.108772","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the prevalence of sarcopenic obesity in patients with gastric cancer and its impact on adverse outcomes.</div></div><div><h3>Methods</h3><div>A computerized search of PubMed, Embase, Cochrane Library, Web of Science, and CINAHL databases was performed to search for articles related to sarcopenic obesity in patients with gastric cancer. The search was conducted until June 16, 2024, from the date of the creation of the database.</div></div><div><h3>Results</h3><div>A total of sixteen studies were included, including fifteen cohort studies and one cross-sectional study involving 4087 patients. The results of the meta-analysis showed that the prevalence of sarcopenic obesity in gastric cancer patients was 16.3 % (95 % CI: 12.2 %–20.4 %). Sarcopenic obesity significantly shortened the overall survival of gastric cancer patients (HR = 1.64, 95 % CI: 1.20 to 2.25, <em>P</em> = 0.002) and increased the risk of postoperative significant complications (OR = 2.84, 95 % CI: 1.95 to 4.16, <em>P</em> &lt; 0.001), severe complications (OR = 2.60, 95 % CI: 1.45 to 4.64, <em>P</em> = 0.001), surgical site infection (OR = 3.82, 95 % CI: 1.47 to 9.89, <em>P</em> = 0.006), and mortality (OR = 4.84, 95 % CI: 1.38 to 17.02, <em>P</em> = 0.014), but no significant effect on 30-day readmission (OR = 1.90, 95 % CI: 0.31 to 11.84, <em>P</em> = 0.491).</div></div><div><h3>Conclusions</h3><div>The prevalence of sarcopenic obesity is high in patients with gastric cancer and is strongly associated with poor postoperative outcomes. Healthcare providers should evaluate patients with gastric cancer for sarcopenic obesity early to prevent or reduce the incidence of adverse outcomes.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"50 12","pages":"Article 108772"},"PeriodicalIF":3.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Novel multimodal sensing and machine learning strategies to classify cognitive workload in laparoscopic surgery. 用于腹腔镜手术认知工作量分类的新型多模态传感和机器学习策略。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-15 DOI: 10.1016/j.ejso.2024.108735
Ravi Naik, Adrian Rubio-Solis, Kaizhe Jin, George Mylonas

Background: Surgeons can experience elevated cognitive workload (CWL) during surgery due to various factors including operative technicalities and the environmental demands of the operating theatre. This can result in poorer outcomes and have a detrimental effect on surgeon well-being. The objective measurement of CWL provides a potential solution to facilitate classification of workload levels, however results are variable when physiological measures are used in isolation. The aim of this study is to develop and propose a multimodal machine learning (ML) approach to classify CWL levels using a bespoke sensor platform and to develop a ML approach to impute missing pupil diameter measures due to the effect of blinking or noise.

Materials and methods: Ten surgical trainees performed a simulated laparoscopic cholecystectomy under cognitive conditions of increasing difficulty, namely a modified auditory N-back task with increasing difficulty and a verbal clinical scenario. Physiological measures were recorded using a novel platform (MAESTRO). Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were used as direct measures of CWL. Indirect measures included electromyography (EMG), electrocardiography (ECG) and pupil diameter (PD). A reference point for validation was provided by subjective assessment of perceived CWL using the SURG-TLX. A multimodal machine learning approach that systematically implements a CNN-BiLSTM, a binary version of the metaheuristic Manta Ray Foraging Optimisation (BMRFO) and a version of Fuzzy C-Means (FCM) called Optimal Completion Strategy (OCS) was used to classify the associated perceived CWL state.

Results: Compared to other state of the art classification techniques, cross-validation results for the classification of CWL levels suggest that the CNN-BLSTM and BMRFO approach provides an average accuracy of 97 % based on the confusion matrix. Additionally, OCS demonstrated a superior average performance of 9.15 % in terms of Root-Mean-Square-Error (RMSE) when compared to other PD imputation methods.

Conclusion: Perceived CWL levels were correctly classified using a multimodal ML approach. This approach provides a potential route to accurately classify CWL levels, which may have application in future surgical training and assessment programs as well as the development of cognitive support systems in the operating room.

背景:由于手术技术和手术室环境要求等各种因素,外科医生在手术过程中会出现认知工作量(CWL)增加的情况。这可能会导致较差的结果,并对外科医生的健康产生不利影响。对 CWL 的客观测量提供了一个潜在的解决方案,便于对工作量水平进行分类,但如果单独使用生理测量方法,结果会有差异。本研究的目的是开发并提出一种多模态机器学习(ML)方法,利用定制的传感器平台对 CWL 水平进行分类,并开发一种 ML 方法来弥补因眨眼或噪音影响而缺失的瞳孔直径测量值:十名外科学员在难度递增的认知条件下进行了模拟腹腔镜胆囊切除术,即难度递增的改良听觉N-back任务和口头临床情景。使用新型平台(MAESTRO)记录生理指标。脑电图(EEG)和功能性近红外光谱(fNIRS)被用作 CWL 的直接测量指标。间接测量包括肌电图(EMG)、心电图(ECG)和瞳孔直径(PD)。使用 SURG-TLX 对感知的 CWL 进行主观评估,为验证提供了参考点。系统实施了 CNN-BiLSTM、二进制版本的元启发式 Manta Ray Foraging Optimisation (BMRFO) 和称为 Optimal Completion Strategy (OCS) 的模糊 C-Means (FCM) 版本的多模态机器学习方法,用于对相关的感知 CWL 状态进行分类:与其他最先进的分类技术相比,CWL 等级分类的交叉验证结果表明,根据混淆矩阵,CNN-BLSTM 和 BMRFO 方法的平均准确率为 97%。此外,与其他 PD 估算方法相比,OCS 的均方根误差(RMSE)为 9.15%,表现更优:结论:使用多模态 ML 方法对感知的 CWL 水平进行了正确分类。这种方法提供了准确分类 CWL 水平的潜在途径,可应用于未来的外科培训和评估计划,以及手术室认知支持系统的开发。
{"title":"Novel multimodal sensing and machine learning strategies to classify cognitive workload in laparoscopic surgery.","authors":"Ravi Naik, Adrian Rubio-Solis, Kaizhe Jin, George Mylonas","doi":"10.1016/j.ejso.2024.108735","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108735","url":null,"abstract":"<p><strong>Background: </strong>Surgeons can experience elevated cognitive workload (CWL) during surgery due to various factors including operative technicalities and the environmental demands of the operating theatre. This can result in poorer outcomes and have a detrimental effect on surgeon well-being. The objective measurement of CWL provides a potential solution to facilitate classification of workload levels, however results are variable when physiological measures are used in isolation. The aim of this study is to develop and propose a multimodal machine learning (ML) approach to classify CWL levels using a bespoke sensor platform and to develop a ML approach to impute missing pupil diameter measures due to the effect of blinking or noise.</p><p><strong>Materials and methods: </strong>Ten surgical trainees performed a simulated laparoscopic cholecystectomy under cognitive conditions of increasing difficulty, namely a modified auditory N-back task with increasing difficulty and a verbal clinical scenario. Physiological measures were recorded using a novel platform (MAESTRO). Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were used as direct measures of CWL. Indirect measures included electromyography (EMG), electrocardiography (ECG) and pupil diameter (PD). A reference point for validation was provided by subjective assessment of perceived CWL using the SURG-TLX. A multimodal machine learning approach that systematically implements a CNN-BiLSTM, a binary version of the metaheuristic Manta Ray Foraging Optimisation (BMRFO) and a version of Fuzzy C-Means (FCM) called Optimal Completion Strategy (OCS) was used to classify the associated perceived CWL state.</p><p><strong>Results: </strong>Compared to other state of the art classification techniques, cross-validation results for the classification of CWL levels suggest that the CNN-BLSTM and BMRFO approach provides an average accuracy of 97 % based on the confusion matrix. Additionally, OCS demonstrated a superior average performance of 9.15 % in terms of Root-Mean-Square-Error (RMSE) when compared to other PD imputation methods.</p><p><strong>Conclusion: </strong>Perceived CWL levels were correctly classified using a multimodal ML approach. This approach provides a potential route to accurately classify CWL levels, which may have application in future surgical training and assessment programs as well as the development of cognitive support systems in the operating room.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108735"},"PeriodicalIF":3.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Risk factors for major complications following pelvic exenteration: A NSQIP study 骨盆外展术后主要并发症的风险因素:一项 NSQIP 研究
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-13 DOI: 10.1016/j.ejso.2024.108761
Gabriel Levin , Brian Slomovitz , Jason D. Wright , Rene Pareja , Kacey M. Hamilton , Rebecca schneyer , Matthew T. Siedhoff , Kelly N. Wright , Yosef Nasseri , Moshe Barnajian , Raanan Meyer

Objectives

Due to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy.

Method

We used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012–2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration.

Results

Overall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01–1.05)], diabetes [aOR 1.82 95 % CI (1.13–3.22)], low serum albumin [aOR 0.73 95 % CI (0.54–0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05–2.77)].

Conclusions

Major postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable.
目的由于盆腔外扩张手术的罕见性,预测哪些患者术后并发症的风险会增加具有挑战性。我们的目的是研究因妇科恶性肿瘤而接受盆腔外扩张术的女性患者术后并发症的预测因素。方法我们利用国家外科质量改进计划登记册评估了 2012-2022 年期间接受盆腔外扩张术的患者的术后病程和并发症。分析的主要目的是估计盆腔外翻术后的主要并发症。其中,56.5%为前路外展术,43.5%为后路外展术,13.9%为联合外展术。轻微并发症发生率为72.5%(576人),主要并发症发生率为31.5%(250人)。最常见的轻微并发症是输血(538 人,67.8%),其次是浅表手术部位感染(SSI)和尿路感染(分别为 9.8% 和 9.4%)。在主要并发症中,最常见的是器官/空间 SSI(11.2%),其次是败血症(9.2%)、再次手术(8.6%)和伤口开裂(5.2%)。1.5%的患者在30天内死亡。在多变量回归分析中,以下因素与主要并发症独立相关:较高的体重指数(BMI)[调整后的几率比(aOR)为 1.03,95% 置信区间(CI)为(1.01-1.05)]、糖尿病[aOR 为 1.82,95% 置信区间(CI)为(1.13-3.结论约有三分之一的妇科恶性肿瘤盆腔外切手术会出现严重的术后并发症。我们的研究强调了与主要术后并发症相关的独立因素,其中一些因素可能是可以改变的。
{"title":"Risk factors for major complications following pelvic exenteration: A NSQIP study","authors":"Gabriel Levin ,&nbsp;Brian Slomovitz ,&nbsp;Jason D. Wright ,&nbsp;Rene Pareja ,&nbsp;Kacey M. Hamilton ,&nbsp;Rebecca schneyer ,&nbsp;Matthew T. Siedhoff ,&nbsp;Kelly N. Wright ,&nbsp;Yosef Nasseri ,&nbsp;Moshe Barnajian ,&nbsp;Raanan Meyer","doi":"10.1016/j.ejso.2024.108761","DOIUrl":"10.1016/j.ejso.2024.108761","url":null,"abstract":"<div><h3>Objectives</h3><div>Due to the rarity of pelvic exenteration surgery, it is challenging to predict which patients are at an increased risk for postoperative complications. We aimed to study the predictors for postoperative complications among women undergoing pelvic exenteration for gynecologic malignancy.</div></div><div><h3>Method</h3><div>We used the National Surgical Quality Improvement Program registry to evaluate postoperative course and complications of those patients undergoing pelvic exenteration in the period 2012–2022. The primary objective of the analysis was to estimate the major postoperative complications following pelvic exenteration.</div></div><div><h3>Results</h3><div>Overall, 794 pelvic exenterations were included. Of those, 56.5 % were anterior exenteration, 43.5 % were posterior exenteration, and 13.9 % were a combined exenteration. The rate of minor complications was 72.5 % (n = 576), and the rate of major complications was 31.5 % (n = 250). The most common minor complications were blood transfusion (n = 538, 67.8 %), followed by superficial surgical site infections (SSI) and urinary tract infections (9.8 % and 9.4 %, respectively). Among the major complications, the most common was organ/space SSI (11.2 %), followed by sepsis (9.2 %), reoperation (8.6 %), and wound dehiscence (5.2 %). Death within 30 days occurred in 1.5 % of patients. In multivariable regression analysis, the following factors were independently associated with major complications: higher BMI [adjusted odds ratio (aOR) 1.03 95 % confidence interval (CI) (1.01–1.05)], diabetes [aOR 1.82 95 % CI (1.13–3.22)], low serum albumin [aOR 0.73 95 % CI (0.54–0.98)], and high serum creatinine [aOR 1.70 95 % CI (1.05–2.77)].</div></div><div><h3>Conclusions</h3><div>Major postoperative complications occur in approximately one third of pelvic exenterations for gynecologic malignancies. Our study highlights independent factors associated with major postoperative complications, of which some are potentially modifiable.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"50 12","pages":"Article 108761"},"PeriodicalIF":3.5,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142446244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
A scoping review of preoperative weight loss interventions on postoperative outcomes for patients with gastrointestinal cancer 胃肠道癌症患者术前减肥干预对术后效果的影响范围综述。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-11 DOI: 10.1016/j.ejso.2024.108743
Yangyue Zhang , Natalia Tomborelli Bellafronte , Gezal Najafitirehshabankareh , Michelle Huamani Jimenez , Emily Jaeger-McEnroe , Hughes Plourde , Mary Hendrickson , Chelsia Gillis

Background

Obesity is associated with increased risk of surgical complications in some settings.

Objective

As a precursor to a systematic review, we conducted a scoping review of intentional preoperative weight loss to describe these interventions, their feasibility and effectiveness for patients with gastrointestinal cancer.

Methods

In April 2024, Ovid MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for primary studies of intentional weight loss before elective gastrointestinal cancer surgery. Extracted data encompassed recruitment and attrition, intervention types, adherence, anthropometric and body composition changes, and surgical outcomes. Study quality was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool.

Results

The search produced 7 articles (4 non-randomized clinical trials), which were all conducted in Japan, and involved 258 participants with a baseline BMI ≥25 kg/m2. Weight loss interventions included dietary modification (n = 3), exercise (n = 1), and combination (n = 3). None of the articles reported rates of recruitment, 2 adherence (97–100 %), and 4 reported attrition rates (0–18 %). All reported weight reductions of −1.3 to −6 kg and 4.5–6.9 % (n = 7), compared to baseline. Three of four non-randomized trials observed a reduction in postoperative complications, as compared to control; yet all trials were at critical risk of bias.

Conclusion

Strong conclusions could not be made due to the limited reporting and critical risk of bias; further systematic review is not recommended at this time. To establish more robust evidence, there is a clear need for high-quality trials.
背景:肥胖与某些情况下手术并发症的风险增加有关:在某些情况下,肥胖与手术并发症风险增加有关:作为系统性综述的前奏,我们对有意进行的术前减重进行了范围界定,以描述这些干预措施及其对胃肠道癌症患者的可行性和有效性:2024 年 4 月,我们在 Ovid MEDLINE、EMBASE、CINAHL 和 Google Scholar 中检索了有关胃肠道癌症择期手术前有意减重的主要研究。提取的数据包括招募和减员情况、干预类型、坚持情况、人体测量和身体成分变化以及手术结果。研究质量采用非随机干预研究中的偏倚风险工具进行评估:检索结果显示,共有7篇文章(4项非随机临床试验),均在日本进行,涉及258名基线体重指数≥25 kg/m2的参与者。减肥干预措施包括饮食调整(3 篇)、运动(1 篇)和综合疗法(3 篇)。没有一篇文章报告了招募率,2 篇报告了坚持率(97%-100%),4 篇报告了减员率(0%-18%)。与基线相比,所有文章均报告体重减轻了-1.3 至-6 千克和 4.5-6.9 %(n = 7)。四项非随机试验中有三项观察到,与对照组相比,术后并发症有所减少;但所有试验都存在严重的偏倚风险:由于报告有限且存在严重的偏倚风险,因此无法得出有力的结论;目前不建议进行进一步的系统性审查。要建立更可靠的证据,显然需要进行高质量的试验。
{"title":"A scoping review of preoperative weight loss interventions on postoperative outcomes for patients with gastrointestinal cancer","authors":"Yangyue Zhang ,&nbsp;Natalia Tomborelli Bellafronte ,&nbsp;Gezal Najafitirehshabankareh ,&nbsp;Michelle Huamani Jimenez ,&nbsp;Emily Jaeger-McEnroe ,&nbsp;Hughes Plourde ,&nbsp;Mary Hendrickson ,&nbsp;Chelsia Gillis","doi":"10.1016/j.ejso.2024.108743","DOIUrl":"10.1016/j.ejso.2024.108743","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is associated with increased risk of surgical complications in some settings.</div></div><div><h3>Objective</h3><div>As a precursor to a systematic review, we conducted a scoping review of intentional preoperative weight loss to describe these interventions, their feasibility and effectiveness for patients with gastrointestinal cancer.</div></div><div><h3>Methods</h3><div>In April 2024, Ovid MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for primary studies of intentional weight loss before elective gastrointestinal cancer surgery. Extracted data encompassed recruitment and attrition, intervention types, adherence, anthropometric and body composition changes, and surgical outcomes. Study quality was assessed using the Risk of Bias In Non-randomized Studies of Interventions tool.</div></div><div><h3>Results</h3><div>The search produced 7 articles (4 non-randomized clinical trials), which were all conducted in Japan, and involved 258 participants with a baseline BMI ≥25 kg/m<sup>2</sup>. Weight loss interventions included dietary modification (n = 3), exercise (n = 1), and combination (n = 3). None of the articles reported rates of recruitment, 2 adherence (97–100 %), and 4 reported attrition rates (0–18 %). All reported weight reductions of −1.3 to −6 kg and 4.5–6.9 % (n = 7), compared to baseline. Three of four non-randomized trials observed a reduction in postoperative complications, as compared to control; yet all trials were at critical risk of bias.</div></div><div><h3>Conclusion</h3><div>Strong conclusions could not be made due to the limited reporting and critical risk of bias; further systematic review is not recommended at this time. To establish more robust evidence, there is a clear need for high-quality trials.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"50 12","pages":"Article 108743"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis. 面神经切除术对术前无面神经麻痹的腮腺癌的影响:基于倾向评分的多中心分析。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1016/j.ejso.2024.108746
Florian Chatelet, Sylvie Chevret, Nicolas Fakhry, Caroline Even, Olivier Malard, Erwan de Monès, Nicolas Saroul, François Mouawad, Marie de Boutray, Olivier Mauvais, Sébastien Vergez, Diane Evrard, Christian Righini, Philippe Schultz, Robin Baudouin, Gilles Poissonnet, Sarah Atallah, Fabienne Haroun, Sylvain Morinière, Camille Evrard, Pierre Philouze, Agnès Paasche, Maria Lesnik, Yann Lelonge, Philippe Herman, Benjamin Verillaud

Objectives: The management of the facial nerve (FN) is a major issue in parotid cancer, especially when there is no preoperative facial palsy and FN invasion is discovered intraoperatively. The aim of this study was to assess the impact of FN resection in patients with parotid cancer abutting the FN, without pretreatment facial palsy, using a propensity score matching.

Materials and methods: Data from all patients treated between 2009 and 2020 for a primary parotid cancer abutting or invading the FN but without pretreatment facial palsy were extracted from the national multicentric REFCOR database. Three different definitions of tumors abutting the FN were used for sensitivity analyses, in a retrospective setting. Propensity score matching was used to assess the impact of FN resection on disease-free survival (DFS), overall survival (OS) and locoregional recurrence-free survival (LRRFS).

Results: A total of 163 patients with parotid cancer abutting or invading the FN without pretreatment facial palsy were included. Among them, 99 patients (61 %) underwent FN resection. After overlap weighting and multiple imputation, no benefit of FN resection over preservation was found in terms of OS (HR = 1.21, p = 0.6), DFS (HR = 0.88, p = 0.5) and LRRFS (HR = 0.99, p = 1). Sensitivity analyses revealed similar results, and no significant efficacy was found in the subgroup analyses.

Conclusion: In this retrospective study with propensity score analysis, FN resection did not improve survival outcomes in patients without preoperative facial palsy treated surgically for a primary parotid cancer abutting the FN. In line with recent guidelines, the results of this study suggest that FN preservation should be considered whenever possible in this specific group of patients.

目的:面神经(FN)的管理是腮腺癌的一个主要问题,尤其是当术前无面瘫而术中发现FN侵犯时。本研究旨在采用倾向评分匹配法,评估面神经邻近腮腺癌且术前无面瘫的患者接受面神经切除术的影响:从全国多中心 REFCOR 数据库中提取了 2009 年至 2020 年期间因原发性腮腺癌与 FN 相连或侵犯 FN 但治疗前无面部麻痹的所有患者的数据。在回顾性分析中,采用了三种不同的与FN相邻的肿瘤定义进行敏感性分析。倾向评分匹配用于评估FN切除对无病生存期(DFS)、总生存期(OS)和无局部复发生存期(LRRFS)的影响:结果:共纳入163例腮腺癌毗邻或侵犯FN且治疗前无面瘫的患者。其中99名患者(61%)接受了FN切除术。经过重叠加权和多重归因后,发现在OS(HR = 1.21,P = 0.6)、DFS(HR = 0.88,P = 0.5)和LRRFS(HR = 0.99,P = 1)方面,切除FN比保留FN更无益处。敏感性分析显示了相似的结果,在亚组分析中未发现显著疗效:在这项带有倾向评分分析的回顾性研究中,对于术前无面瘫的腮腺原发癌患者,FN切除并不能改善其生存预后。与最新指南一致,本研究结果表明,对于这类特殊患者,应尽可能考虑保留 FN。
{"title":"Impact of facial nerve resection in parotid cancer abutting the facial nerve without preoperative paralysis: A multicentric propensity score-based analysis.","authors":"Florian Chatelet, Sylvie Chevret, Nicolas Fakhry, Caroline Even, Olivier Malard, Erwan de Monès, Nicolas Saroul, François Mouawad, Marie de Boutray, Olivier Mauvais, Sébastien Vergez, Diane Evrard, Christian Righini, Philippe Schultz, Robin Baudouin, Gilles Poissonnet, Sarah Atallah, Fabienne Haroun, Sylvain Morinière, Camille Evrard, Pierre Philouze, Agnès Paasche, Maria Lesnik, Yann Lelonge, Philippe Herman, Benjamin Verillaud","doi":"10.1016/j.ejso.2024.108746","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108746","url":null,"abstract":"<p><strong>Objectives: </strong>The management of the facial nerve (FN) is a major issue in parotid cancer, especially when there is no preoperative facial palsy and FN invasion is discovered intraoperatively. The aim of this study was to assess the impact of FN resection in patients with parotid cancer abutting the FN, without pretreatment facial palsy, using a propensity score matching.</p><p><strong>Materials and methods: </strong>Data from all patients treated between 2009 and 2020 for a primary parotid cancer abutting or invading the FN but without pretreatment facial palsy were extracted from the national multicentric REFCOR database. Three different definitions of tumors abutting the FN were used for sensitivity analyses, in a retrospective setting. Propensity score matching was used to assess the impact of FN resection on disease-free survival (DFS), overall survival (OS) and locoregional recurrence-free survival (LRRFS).</p><p><strong>Results: </strong>A total of 163 patients with parotid cancer abutting or invading the FN without pretreatment facial palsy were included. Among them, 99 patients (61 %) underwent FN resection. After overlap weighting and multiple imputation, no benefit of FN resection over preservation was found in terms of OS (HR = 1.21, p = 0.6), DFS (HR = 0.88, p = 0.5) and LRRFS (HR = 0.99, p = 1). Sensitivity analyses revealed similar results, and no significant efficacy was found in the subgroup analyses.</p><p><strong>Conclusion: </strong>In this retrospective study with propensity score analysis, FN resection did not improve survival outcomes in patients without preoperative facial palsy treated surgically for a primary parotid cancer abutting the FN. In line with recent guidelines, the results of this study suggest that FN preservation should be considered whenever possible in this specific group of patients.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108746"},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Fluorescent probe applications and prospects in gastrointestinal cancer: A correspondence of bibliometric analysis. 荧光探针在胃肠癌中的应用和前景:文献计量分析的对应关系。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1016/j.ejso.2024.108752
Heng Bai, Si-Yang Liu, Yu Li, Jie Tian
{"title":"Fluorescent probe applications and prospects in gastrointestinal cancer: A correspondence of bibliometric analysis.","authors":"Heng Bai, Si-Yang Liu, Yu Li, Jie Tian","doi":"10.1016/j.ejso.2024.108752","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108752","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108752"},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Appendiceal adenocarcinoma-patterns of tumor spread and prognosis. 阑尾腺癌--肿瘤扩散模式和预后。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2024-10-10 DOI: 10.1016/j.ejso.2024.108755
D Madonia, P Cashin, W Graf, L Ghanipour

Introduction: Appendiceal adenocarcinoma represents a diagnostic and therapeutic challenge since it is prone to early lymphatic and peritoneal spread. We aimed to analyze the proportion of lymph node metastases in completion right hemicolectomy specimens, risk factors for peritoneal metastases (PM), and prognosis after definitive treatment.

Methods: Ninety-three patients with appendiceal adenocarcinoma scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in Uppsala 2004-2020 were identified from a prospectively maintained registry. Risk factors for PM were assessed based on the presence (CT + group, n = 55) or absence (CT - group, n = 37) of visible PM at baseline CT scan. Prognostic factors were analyzed based on the actual presence (PM group, n = 66) or absence (no PM group, n = 27) of PM.

Results: The median age was 60 (26-78). Forty-eight patients were women. Resection of PM at initial surgery indicated an 80 % risk of finding PM at a follow-up exploration. R1 appendectomy and perforated appendix had a similar risk for PM (24 %,26 %) which increased to 38 % if both were present. Regional lymph node metastases occurred in 31 % in the CT + group vs. 14 % in the CT - group (p = 0.005) and was associated with poor survival HR 5.16 (1.49-17.81). The 5-year OS and DFS rates were 54 % and 29 % in the PM group.

Conclusions: Patients with certain risk factors have a high likelihood of PM despite a normal CT scan, which justifies selective exploration at a HIPEC center. Regional lymph node spread supports the current practice of completion right hemicolectomy and is a significant prognostic factor.

简介:阑尾腺癌容易发生早期淋巴和腹膜扩散,因此是诊断和治疗的难题。我们旨在分析右半结肠切除术标本中淋巴结转移的比例、腹膜转移(PM)的风险因素以及明确治疗后的预后:方法:从乌普萨拉2004-2020年的一项前瞻性登记中确定了93名阑尾腺癌患者,这些患者计划接受囊肿切除手术和腹腔内热化疗(CRS + HIPEC)。根据基线 CT 扫描时可见 PM 的存在(CT + 组,n = 55)或不存在(CT - 组,n = 37)评估 PM 的风险因素。预后因素根据实际存在(PM 组,n = 66)或不存在(无 PM 组,n = 27)PM 进行分析:中位年龄为 60 岁(26-78 岁)。48名患者为女性。初次手术切除原发性阑尾炎表明,在后续检查中发现原发性阑尾炎的风险为 80%。R1阑尾切除术和阑尾穿孔发生阑尾炎的风险相似(分别为24%和26%),如果两者同时存在,则发生阑尾炎的风险增至38%。CT+组发生区域淋巴结转移的比例为31%,而CT-组为14%(P = 0.005),且与不良生存率HR 5.16(1.49-17.81)相关。PM组的5年OS和DFS率分别为54%和29%:结论:尽管CT扫描结果正常,但具有某些危险因素的患者极有可能患有原发性淋巴瘤,因此有必要在HIPEC中心进行选择性检查。区域淋巴结扩散支持目前的右半结肠切除术,也是一个重要的预后因素。
{"title":"Appendiceal adenocarcinoma-patterns of tumor spread and prognosis.","authors":"D Madonia, P Cashin, W Graf, L Ghanipour","doi":"10.1016/j.ejso.2024.108755","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.108755","url":null,"abstract":"<p><strong>Introduction: </strong>Appendiceal adenocarcinoma represents a diagnostic and therapeutic challenge since it is prone to early lymphatic and peritoneal spread. We aimed to analyze the proportion of lymph node metastases in completion right hemicolectomy specimens, risk factors for peritoneal metastases (PM), and prognosis after definitive treatment.</p><p><strong>Methods: </strong>Ninety-three patients with appendiceal adenocarcinoma scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in Uppsala 2004-2020 were identified from a prospectively maintained registry. Risk factors for PM were assessed based on the presence (CT + group, n = 55) or absence (CT - group, n = 37) of visible PM at baseline CT scan. Prognostic factors were analyzed based on the actual presence (PM group, n = 66) or absence (no PM group, n = 27) of PM.</p><p><strong>Results: </strong>The median age was 60 (26-78). Forty-eight patients were women. Resection of PM at initial surgery indicated an 80 % risk of finding PM at a follow-up exploration. R1 appendectomy and perforated appendix had a similar risk for PM (24 %,26 %) which increased to 38 % if both were present. Regional lymph node metastases occurred in 31 % in the CT + group vs. 14 % in the CT - group (p = 0.005) and was associated with poor survival HR 5.16 (1.49-17.81). The 5-year OS and DFS rates were 54 % and 29 % in the PM group.</p><p><strong>Conclusions: </strong>Patients with certain risk factors have a high likelihood of PM despite a normal CT scan, which justifies selective exploration at a HIPEC center. Regional lymph node spread supports the current practice of completion right hemicolectomy and is a significant prognostic factor.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108755"},"PeriodicalIF":3.5,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142516356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Ejso
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