Pub Date : 2024-06-10DOI: 10.1097/fs9.0000000000000106
Yu-Ting Huang, Chien-Yu Ou
A 27-year-old man upon quickly turning his head experienced sudden dizziness, unilateral limb weakness, neck pain, and paralysis. He was transported to the emergency department by ambulance. Computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging (MRI) of the brain identified a left vertebral artery dissection with cerebellar infarction without subarachnoid hemorrhage (SAH). The patient’s blood pressure was controlled, and he was placed on bed rest, but no surgical intervention was undertaken. A cerebral angiography performed two months after the dissection found the previously stenosed site fully patent with no further stenosis. Our case suggests that for extracranial vertebral dissection, the patient must be first checked for intracranial SAH, and in its absence, conservative treatment can be considered. Many studies have examined surgical intervention to address vertebral artery dissection; however, our case report presents a literature review regarding suitability for surgery in these patients.
{"title":"Vertebral Artery Dissection with Cerebellar Infarction Due to Sudden Head Turning: Case Report","authors":"Yu-Ting Huang, Chien-Yu Ou","doi":"10.1097/fs9.0000000000000106","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000106","url":null,"abstract":"\u0000 A 27-year-old man upon quickly turning his head experienced sudden dizziness, unilateral limb weakness, neck pain, and paralysis. He was transported to the emergency department by ambulance.\u0000 Computed tomography (CT), computed tomography angiography (CTA), and magnetic resonance imaging (MRI) of the brain identified a left vertebral artery dissection with cerebellar infarction without subarachnoid hemorrhage (SAH).\u0000 The patient’s blood pressure was controlled, and he was placed on bed rest, but no surgical intervention was undertaken. A cerebral angiography performed two months after the dissection found the previously stenosed site fully patent with no further stenosis. Our case suggests that for extracranial vertebral dissection, the patient must be first checked for intracranial SAH, and in its absence, conservative treatment can be considered.\u0000 Many studies have examined surgical intervention to address vertebral artery dissection; however, our case report presents a literature review regarding suitability for surgery in these patients.","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.1097/fs9.0000000000000119
Madhur Anand, Mayank Kesharwani, M. H. Sema, Nitish Dev, Apul Goel
{"title":"Hobnail Shaped primary prostatic urethral calculus due to Urethral stricture disease","authors":"Madhur Anand, Mayank Kesharwani, M. H. Sema, Nitish Dev, Apul Goel","doi":"10.1097/fs9.0000000000000119","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000119","url":null,"abstract":"","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-13DOI: 10.1097/fs9.0000000000000133
S M Nazmuz Sakib
Primary Liver Cancer has become a potent threat to the world due to its high morbidity and mortality rate. Up till now, Liver transplantation is the most suggested treatment but it is not feasible owing to the unavailability of donors and high cost. Hepatectomy provides an alternative treatment to this deadliest disease. Precision hepatectomy is performed with the aid of traditional 2 dimensional technology and image processing such as CT scan and Magnetic Resonance Imaging. However, it requires extensive expertise and pose challenges to the young doctors in decision making. Modern imaging and computer technology has opened the new avenues in medical field with the advent of 3 dimensional Reconstruction and visualization methods. We conducted a cohort retrospective study. In this study, we tried to evaluate the efficacy an impacts of 3 dimensional reconstruction on the preoperative planning of hepatectomy, intraoperative conditions and postoperative complications. We took 95 patients and divided them in two groups A and B. Group A has 67 patients who underwent hepatectomy before the application of 3 dimensional reconstruction and 28 patients on whom hepatectomy was performed according to the planning and methods of 3dimensional reconstruction and results were evaluated. Our study found that 3 dimensional reconstruction can help in better diagnosis, resection planning and reduce the postoperative complication. Results were not significant difference p > 0.05 on the incidence of postoperative complication between group A and B. Results were significant p < 0.05 for the intraoperative blood loss, optimal surgery time and postoperative hospitalization. Hence, 3 dimensional reconstruction is a landmark discovery in medical sciences for the accurate evaluation and resection of complex liver cancers.
{"title":"Evaluation of Three-Dimensional Reconstruction Technology in Precision Hepatectomy for Primary Liver Cancer","authors":"S M Nazmuz Sakib","doi":"10.1097/fs9.0000000000000133","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000133","url":null,"abstract":"\u0000 \u0000 \u0000 Primary Liver Cancer has become a potent threat to the world due to its high morbidity and mortality rate. Up till now, Liver transplantation is the most suggested treatment but it is not feasible owing to the unavailability of donors and high cost. Hepatectomy provides an alternative treatment to this deadliest disease. Precision hepatectomy is performed with the aid of traditional 2 dimensional technology and image processing such as CT scan and Magnetic Resonance Imaging. However, it requires extensive expertise and pose challenges to the young doctors in decision making. Modern imaging and computer technology has opened the new avenues in medical field with the advent of 3 dimensional Reconstruction and visualization methods.\u0000 \u0000 \u0000 \u0000 We conducted a cohort retrospective study. In this study, we tried to evaluate the efficacy an impacts of 3 dimensional reconstruction on the preoperative planning of hepatectomy, intraoperative conditions and postoperative complications. We took 95 patients and divided them in two groups A and B. Group A has 67 patients who underwent hepatectomy before the application of 3 dimensional reconstruction and 28 patients on whom hepatectomy was performed according to the planning and methods of 3dimensional reconstruction and results were evaluated.\u0000 \u0000 \u0000 \u0000 Our study found that 3 dimensional reconstruction can help in better diagnosis, resection planning and reduce the postoperative complication. Results were not significant difference p > 0.05 on the incidence of postoperative complication between group A and B. Results were significant p < 0.05 for the intraoperative blood loss, optimal surgery time and postoperative hospitalization.\u0000 \u0000 \u0000 \u0000 Hence, 3 dimensional reconstruction is a landmark discovery in medical sciences for the accurate evaluation and resection of complex liver cancers.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140983847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-09DOI: 10.1097/fs9.0000000000000134
Meng-Hung Shih, Tai‐Lung Cha, Sheng‐Tang Wu, E. Meng, C. Tsao, C. Kao, Chin‐Li Chen, Yu-Ching Juho, Hui-Kung Ting, Guang‐Huan Sun, Sun‐Yran Chang, Dah-Shyong Yu, Ming‐Hsin Yang
To identify the role of plastin3 (PLS3) expression in circulating tumor cells (CTCs) of early stage prostate cancer (PCa). CTCs were collected from 23 prostate cancer patients based on cell surface markers targeting prostate cancer by V-BioChip. Condition of Plastin3 expression and correlations to the prostate cancer were also analyzed. Of the 23 patients with prostate cancer, total CTCs (CK+ or PLS3+) were found in 11 patients and PLS3+ CTCs were detected in 10 patients. When the cohort was stratified by risk group, 90% of the high-risk patients were found to have PLS3+ circulating tumor cells (9/10 patients). However, only 15.4% of low/intermediate-risk patients had PLS3+ circulating tumor cells (2/13 patients). The number of PLS3+ CTCs was higher in the high-risk group. The expression of PLS3 in CTCs is associated with prostate cancer risk. Further study of PLS3+ CTCs for prognosis prediction is required for clinical application in prostate cancer patients.
{"title":"Plastin 3 Expression in Circulating Tumor Cells as a Predictor of Cancer Status in Patients with Prostate Cancer","authors":"Meng-Hung Shih, Tai‐Lung Cha, Sheng‐Tang Wu, E. Meng, C. Tsao, C. Kao, Chin‐Li Chen, Yu-Ching Juho, Hui-Kung Ting, Guang‐Huan Sun, Sun‐Yran Chang, Dah-Shyong Yu, Ming‐Hsin Yang","doi":"10.1097/fs9.0000000000000134","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000134","url":null,"abstract":"\u0000 \u0000 \u0000 To identify the role of plastin3 (PLS3) expression in circulating tumor cells (CTCs) of early stage prostate cancer (PCa).\u0000 \u0000 \u0000 \u0000 CTCs were collected from 23 prostate cancer patients based on cell surface markers targeting prostate cancer by V-BioChip. Condition of Plastin3 expression and correlations to the prostate cancer were also analyzed.\u0000 \u0000 \u0000 \u0000 Of the 23 patients with prostate cancer, total CTCs (CK+ or PLS3+) were found in 11 patients and PLS3+ CTCs were detected in 10 patients. When the cohort was stratified by risk group, 90% of the high-risk patients were found to have PLS3+ circulating tumor cells (9/10 patients). However, only 15.4% of low/intermediate-risk patients had PLS3+ circulating tumor cells (2/13 patients). The number of PLS3+ CTCs was higher in the high-risk group.\u0000 \u0000 \u0000 \u0000 The expression of PLS3 in CTCs is associated with prostate cancer risk. Further study of PLS3+ CTCs for prognosis prediction is required for clinical application in prostate cancer patients.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140995921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although surgical excisional biopsy provides robust diagnostic results, the ultrasound-assisted vacuum-assisted biopsy (VABB) offers an alternative for Asian candidates with dense breasts and lesions which cannot be approached by stereotactic biopsy. The study aims to investigate the efficacy of the ultrasound-assisted VABB for impalpable mammographic-detected lesions. A retrospective case-control study is conducted in a group of Taiwanese female patients who have impalpable breast lesions such as microcalcifications at screening mammography that are limited to BI-RADS category 4. Specifically, the lesions are categorized into three groups: 4a, 4b, 4c, and the histology from B2 through B5. The cases underwent ultrasound-assisted VABB and the controls had lumpectomies. The diagnostic accuracy, rate of discordance, excited tumor size, and the proportion of cancer cases is evaluated and compared using Fisher’s Exact test, Cohen’s kappa test, Chi-Square test, and the use of IBM SPSS statistical programs. The histology of the majorities of the collected specimen are B2 benign fibrocystic changes (60-70%). In cases of patients who are diagnosed with breast cancer, most are ductal carcinoma in situ and early-stage diseases. The cancer risks for lesions categorized under BI-RADS 4a, 4b, 4c respectively are consistent with clinical practice. Meanwhile, the diagnostic accuracy of VABB is similar to lumpectomy, as the histologic discordance rate did not differ significantly. Ultrasound-assisted VABB does offer an option for patients who are not candidates for stereotactic biopsy, as it has shown to have non-inferior diagnostic values and cosmetic benefits when compared to surgical excision. The use of sonography monitors the biopsy process and guides the needle insertion thus is capable of obtaining samples from multiple directions, without risking the pectoralis muscles underneath. However, VABB may be intended for biopsies in lower-risk findings such as BI-RADS category 4a because doubts persist as complete excisional rates are operator-dependent.
{"title":"Efficacy of the minimal-invasive vacuum-assisted biopsy under direct visualization with ultrasound for impalpable breast lesions in Taiwanese female: A retrospective case-control study","authors":"Sherry Ying-Hsuan Chen, Sin-Hua Moi, Mei-Ren Pan, Chih-Po Chiang, C. Luo, Huei-Shan Lin, Chieh-Ni Kao, Cheng-Che Wu, Chung-Liang Li, J. Shiau, Ping-Fu Yang, Jung-Yu Kan, C. Chuang, Shen-Liang Shih, Fang-Ming Chen, Ming-Feng Hou","doi":"10.1097/fs9.0000000000000130","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000130","url":null,"abstract":"\u0000 \u0000 \u0000 Although surgical excisional biopsy provides robust diagnostic results, the ultrasound-assisted vacuum-assisted biopsy (VABB) offers an alternative for Asian candidates with dense breasts and lesions which cannot be approached by stereotactic biopsy. The study aims to investigate the efficacy of the ultrasound-assisted VABB for impalpable mammographic-detected lesions.\u0000 \u0000 \u0000 \u0000 A retrospective case-control study is conducted in a group of Taiwanese female patients who have impalpable breast lesions such as microcalcifications at screening mammography that are limited to BI-RADS category 4. Specifically, the lesions are categorized into three groups: 4a, 4b, 4c, and the histology from B2 through B5. The cases underwent ultrasound-assisted VABB and the controls had lumpectomies. The diagnostic accuracy, rate of discordance, excited tumor size, and the proportion of cancer cases is evaluated and compared using Fisher’s Exact test, Cohen’s kappa test, Chi-Square test, and the use of IBM SPSS statistical programs.\u0000 \u0000 \u0000 \u0000 The histology of the majorities of the collected specimen are B2 benign fibrocystic changes (60-70%). In cases of patients who are diagnosed with breast cancer, most are ductal carcinoma in situ and early-stage diseases. The cancer risks for lesions categorized under BI-RADS 4a, 4b, 4c respectively are consistent with clinical practice. Meanwhile, the diagnostic accuracy of VABB is similar to lumpectomy, as the histologic discordance rate did not differ significantly.\u0000 \u0000 \u0000 \u0000 Ultrasound-assisted VABB does offer an option for patients who are not candidates for stereotactic biopsy, as it has shown to have non-inferior diagnostic values and cosmetic benefits when compared to surgical excision. The use of sonography monitors the biopsy process and guides the needle insertion thus is capable of obtaining samples from multiple directions, without risking the pectoralis muscles underneath. However, VABB may be intended for biopsies in lower-risk findings such as BI-RADS category 4a because doubts persist as complete excisional rates are operator-dependent.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141010076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1097/fs9.0000000000000131
Fatih Basak
The occurrence of medical illnesses varies with the seasons, which are influenced by the environment. This variation can be valuable for healthcare administrators in effectively allocating resources. While seasonal variation has been extensively studied in infectious and surgical diseases, it has received limited attention in the case of perianal diseases. Therefore, our objective was to investigate the seasonal variation specifically in hemorrhoids and fissures. We conducted a retrospective analysis on patients admitted with hemorrhoids and fissures between January 2010 and December 2019. To assess seasonality, we utilized the chi-square goodness-of-fit test, a statistical method widely recognized for its ability to determine if observed data aligns with expected frequencies. By adjusting for variations in the number of days between seasons, we aimed to ensure accurate and reliable results. Overall, 49,046 patients were admitted with hemorrhoids, and 33,480 patients were admitted with anal fissures during the study period. The frequency of admitted hemorrhoids varied between months (minimum: June, n = 3865; maximum: March, n = 4591; P < 0.001) and seasons (minimum: summer, n = 11771; maximum: spring, n = 12989; P = 0.03). The frequency of admitted anal fissures also varied between months (minimum: June, n = 2356; maximum: March, n = 3244; P < 0.001) and seasons (minimum: summer, n = 7180; maximum: winter, n = 9246; P = 0.04). Age and gender distribution across months and seasons were similar (P > 0.05 for each). Our research findings confirm that there is a seasonal variation in the occurrence of hemorrhoids and fissures. Specifically, we have observed that the spring and winter seasons have the highest number of cases for each condition, while the summer season has the lowest. These results highlight the importance of considering seasonal factors when studying these medical conditions.
{"title":"Exploring the Seasonal Variation of Anorectal Disease: A Comprehensive Study","authors":"Fatih Basak","doi":"10.1097/fs9.0000000000000131","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000131","url":null,"abstract":"\u0000 \u0000 \u0000 The occurrence of medical illnesses varies with the seasons, which are influenced by the environment. This variation can be valuable for healthcare administrators in effectively allocating resources. While seasonal variation has been extensively studied in infectious and surgical diseases, it has received limited attention in the case of perianal diseases. Therefore, our objective was to investigate the seasonal variation specifically in hemorrhoids and fissures.\u0000 \u0000 \u0000 \u0000 We conducted a retrospective analysis on patients admitted with hemorrhoids and fissures between January 2010 and December 2019. To assess seasonality, we utilized the chi-square goodness-of-fit test, a statistical method widely recognized for its ability to determine if observed data aligns with expected frequencies. By adjusting for variations in the number of days between seasons, we aimed to ensure accurate and reliable results.\u0000 \u0000 \u0000 \u0000 Overall, 49,046 patients were admitted with hemorrhoids, and 33,480 patients were admitted with anal fissures during the study period. The frequency of admitted hemorrhoids varied between months (minimum: June, n = 3865; maximum: March, n = 4591; P < 0.001) and seasons (minimum: summer, n = 11771; maximum: spring, n = 12989; P = 0.03). The frequency of admitted anal fissures also varied between months (minimum: June, n = 2356; maximum: March, n = 3244; P < 0.001) and seasons (minimum: summer, n = 7180; maximum: winter, n = 9246; P = 0.04). Age and gender distribution across months and seasons were similar (P > 0.05 for each).\u0000 \u0000 \u0000 \u0000 Our research findings confirm that there is a seasonal variation in the occurrence of hemorrhoids and fissures. Specifically, we have observed that the spring and winter seasons have the highest number of cases for each condition, while the summer season has the lowest. These results highlight the importance of considering seasonal factors when studying these medical conditions.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1097/fs9.0000000000000132
S. Atamanalp, E. Dişçi, R. Peksoz
Sigmoid volvulus (SV) is common in elders. For this reason, most geriatric comorbidities accompany SV. Additionally, SV may associate with a great number of physiological or pathological entities. The purpose of this review is to evaluate the kind and the incidence of such comorbidities as well as to discuss their pathophysiology. To obtain all SV-related reports in worldwide data, an electronic search of the last 57-years’ literature (from 1967 to date) was made in Web of Science and PubMed databases by using ‘sigmoid volvulus’ heading. Additionally, we evaluated our results including 1,071 patients treated in 57-year period from June 1966 to July 2023. We noted comorbid entities in each case. Tens of physiological or pathological clinical entities may accompany SV. Some entities may be the cause or result of SV, while some others may mimic SV or mimicked by this disease. Moreover, some factors may predispose to SV, while some others may initiate it. Some of these comorbidities have cause and effect relations, while some others are coincidental. However, the relationship between SV and some comorbid entities as well as underlying pathologies are not clear enough.
{"title":"Sigmoid volvulus and concomitant clinical entities","authors":"S. Atamanalp, E. Dişçi, R. Peksoz","doi":"10.1097/fs9.0000000000000132","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000132","url":null,"abstract":"\u0000 Sigmoid volvulus (SV) is common in elders. For this reason, most geriatric comorbidities accompany SV. Additionally, SV may associate with a great number of physiological or pathological entities. The purpose of this review is to evaluate the kind and the incidence of such comorbidities as well as to discuss their pathophysiology. To obtain all SV-related reports in worldwide data, an electronic search of the last 57-years’ literature (from 1967 to date) was made in Web of Science and PubMed databases by using ‘sigmoid volvulus’ heading. Additionally, we evaluated our results including 1,071 patients treated in 57-year period from June 1966 to July 2023. We noted comorbid entities in each case. Tens of physiological or pathological clinical entities may accompany SV. Some entities may be the cause or result of SV, while some others may mimic SV or mimicked by this disease. Moreover, some factors may predispose to SV, while some others may initiate it. Some of these comorbidities have cause and effect relations, while some others are coincidental. However, the relationship between SV and some comorbid entities as well as underlying pathologies are not clear enough.","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141006893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1097/fs9.0000000000000129
Trường Quốc Võ, Tri Phan Minh, Cong Duy Long Tran, Tien My Doan
Grade C pancreatic fistula (PF) is the most dangerous complication after pancreaticoduodenectomy (PD) and had not been identified on the early post-operative day yet. In this study, we aimed to introduce a new approach to distinguish grade C from grade B PF by using features on the 5th post-operative day’s computerized tomography (CT). A bi-centric prospective cohort study was conducted from August 2021 to October 2023 at the University Medical Center (UMC) and Cho Ray Hospital, Viet Nam. Patients who diagnosed pancreatic fistula, underwent a CT scan on the 5th postoperative day were followed - up within 90 days after PD. The characteristics of CT scan images were analyzed to differentiate both grades of PF. During 26 months, 77 patients with periampullary cancer underwent PD and met the criteria of the study (46 males, mean age: 57.1 ± 13.7). Of these, 52 patients had biochemical PF and 25 had CRPF (18 grade B PF and 7 grade C PF). Specifications on the 5th postoperative day’s CT scan that can discriminate grade C from grade B included: fluid diffusing throughout abdomen, retroperitoneal abscess, hematoma beneath the liver, size of the fluid collection next to the pancreas (p = 0.031) and size of pancreatojejunostomy anastomosis dehiscence (p = 0.045). Features on CT scan could be used to identify grade C from the 5th postoperative day. This result can help surgeons to make a plan for carefully follow-up those patients and indicate re-operation at an early stage.
C 级胰瘘（PF）是胰十二指肠切除术（PD）后最危险的并发症，但尚未在术后早期发现。在这项研究中，我们旨在引入一种新方法，利用术后第 5 天计算机断层扫描（CT）的特征来区分 C 级和 B 级胰瘘。 2021 年 8 月至 2023 年 10 月，我们在越南大学医疗中心（UMC）和赵雷医院开展了一项双中心前瞻性队列研究。确诊为胰瘘的患者在术后第 5 天接受了 CT 扫描，并在胰瘘术后 90 天内接受了随访。通过分析 CT 扫描图像的特征来区分两种级别的胰瘘。 在 26 个月内，77 名胰周癌症患者接受了腹腔镜手术，并符合研究标准（46 名男性，平均年龄：57.1 ± 13.7）。其中，52 名患者为生化性 PF，25 名患者为 CRPF（18 名 B 级 PF，7 名 C 级 PF）。术后第 5 天 CT 扫描中可区分 C 级和 B 级的特征包括：整个腹部弥漫的液体、腹膜后脓肿、肝脏下方的血肿、胰腺旁积液的大小（P = 0.031）和胰空肠吻合口裂开的大小（P = 0.045）。 CT扫描的特征可用于从术后第5天起确定C级。这一结果有助于外科医生制定计划，仔细随访这些患者，并及早提示再次手术。
{"title":"Computerized tomography on the 5th postoperative day helps distinguish grade C from grade B pancreatic fistula after pancreaticoduodenectomy for periampullary cancer","authors":"Trường Quốc Võ, Tri Phan Minh, Cong Duy Long Tran, Tien My Doan","doi":"10.1097/fs9.0000000000000129","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000129","url":null,"abstract":"\u0000 \u0000 \u0000 Grade C pancreatic fistula (PF) is the most dangerous complication after pancreaticoduodenectomy (PD) and had not been identified on the early post-operative day yet. In this study, we aimed to introduce a new approach to distinguish grade C from grade B PF by using features on the 5th post-operative day’s computerized tomography (CT).\u0000 \u0000 \u0000 \u0000 A bi-centric prospective cohort study was conducted from August 2021 to October 2023 at the University Medical Center (UMC) and Cho Ray Hospital, Viet Nam. Patients who diagnosed pancreatic fistula, underwent a CT scan on the 5th postoperative day were followed - up within 90 days after PD. The characteristics of CT scan images were analyzed to differentiate both grades of PF.\u0000 \u0000 \u0000 \u0000 During 26 months, 77 patients with periampullary cancer underwent PD and met the criteria of the study (46 males, mean age: 57.1 ± 13.7). Of these, 52 patients had biochemical PF and 25 had CRPF (18 grade B PF and 7 grade C PF). Specifications on the 5th postoperative day’s CT scan that can discriminate grade C from grade B included: fluid diffusing throughout abdomen, retroperitoneal abscess, hematoma beneath the liver, size of the fluid collection next to the pancreas (p = 0.031) and size of pancreatojejunostomy anastomosis dehiscence (p = 0.045).\u0000 \u0000 \u0000 \u0000 Features on CT scan could be used to identify grade C from the 5th postoperative day. This result can help surgeons to make a plan for carefully follow-up those patients and indicate re-operation at an early stage.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141008320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06DOI: 10.1097/fs9.0000000000000127
Trường Quốc Võ, Minh Tri Phan, Cong Duy Long Tran, Tien My Doan
Clinically relevant postoperative pancreatic fistula (CRPF) is considered the most dangerous morbidity associated with pancreaticoduodenectomy (PD). The purpose of this study is to evaluate the risk factors and to construct a predicted model for CRPF after PD. Consecutive patients who underwent pancreaticoduodenectomy between August 2021 and October 2023 at Cho Ray Hospital and University Medical Center were included in a multicenter cohort research. Multivariate logistic regression analyses was used to identify the risk factors of CRPF, and a nomogram was built based on these factors. The value of the nomogram in predicting CRPF was evaluated using the area under the receiver operating characteristic (ROC) curve. There were 183 eligible patients in this study (mean age: 57.5 ± 12.6 years; 101 males), and the prevalence of CRPF was 13,7% overall. Multivariate analyses showed that, four risk factors related to CRPF, including preoperative serum albumin <3.5 g/dl, body mass index (BMI) ≥ 25 kg/m2, soft texture of the pancreas and estimated blood loss ≥400 ml were prognostic factors for CRPF (p < 0.05). We built a nomogram based on four variables to predict CRPF, and the area under the ROC curve for this nomogram was 0.855 (95% CI: 0,768 – 0,933). Nomogram developed from four risk factors shows good performance to predict CRPF after PD. The clinical findings of this study will help surgeons identify perioperative risk factors for high-risk patients with pancreatic fistula who should be managed differently from other patients. Clinical Trial Registry number: ClinicalTrials.gov NCT05017207. We successfully developed a nomogram to predict the risk of pancreatic fistula using four perioperative factors. By incorporating these risk factors into clinical practice, surgeons can develop appropriate treatment plans and interventions for high-risk patient populations, potentially reducing the morbidity associated with CRPF.
{"title":"Risk factors and nomogram of clinically relevant pancreatic fistula after pancreaticoduodenectomy for periampullary cancer: A prospective multicenter cohort study","authors":"Trường Quốc Võ, Minh Tri Phan, Cong Duy Long Tran, Tien My Doan","doi":"10.1097/fs9.0000000000000127","DOIUrl":"https://doi.org/10.1097/fs9.0000000000000127","url":null,"abstract":"\u0000 \u0000 \u0000 Clinically relevant postoperative pancreatic fistula (CRPF) is considered the most dangerous morbidity associated with pancreaticoduodenectomy (PD). The purpose of this study is to evaluate the risk factors and to construct a predicted model for CRPF after PD.\u0000 \u0000 \u0000 \u0000 Consecutive patients who underwent pancreaticoduodenectomy between August 2021 and October 2023 at Cho Ray Hospital and University Medical Center were included in a multicenter cohort research. Multivariate logistic regression analyses was used to identify the risk factors of CRPF, and a nomogram was built based on these factors. The value of the nomogram in predicting CRPF was evaluated using the area under the receiver operating characteristic (ROC) curve.\u0000 \u0000 \u0000 \u0000 There were 183 eligible patients in this study (mean age: 57.5 ± 12.6 years; 101 males), and the prevalence of CRPF was 13,7% overall. Multivariate analyses showed that, four risk factors related to CRPF, including preoperative serum albumin <3.5 g/dl, body mass index (BMI) ≥ 25 kg/m2, soft texture of the pancreas and estimated blood loss ≥400 ml were prognostic factors for CRPF (p < 0.05). We built a nomogram based on four variables to predict CRPF, and the area under the ROC curve for this nomogram was 0.855 (95% CI: 0,768 – 0,933).\u0000 \u0000 \u0000 \u0000 Nomogram developed from four risk factors shows good performance to predict CRPF after PD. The clinical findings of this study will help surgeons identify perioperative risk factors for high-risk patients with pancreatic fistula who should be managed differently from other patients.\u0000 \u0000 \u0000 Clinical Trial Registry number:\u0000 \u0000 ClinicalTrials.gov NCT05017207.\u0000 \u0000 \u0000 \u0000 We successfully developed a nomogram to predict the risk of pancreatic fistula using four perioperative factors. By incorporating these risk factors into clinical practice, surgeons can develop appropriate treatment plans and interventions for high-risk patient populations, potentially reducing the morbidity associated with CRPF.\u0000","PeriodicalId":12390,"journal":{"name":"Formosan Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141010797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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