British Journal of Surgery最新文献

Background: Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal cancer treatment with poor health-related quality of life and to assess its clinical utility.

Methods: Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life.

Results: A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life.

Conclusion: The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services.

Background: Venous thrombosis represents a significant complication after deceased-donor liver transplantation, yet there are currently no established protocols for thromboprophylaxis after deceased-donor liver transplantation. The aim of this study was to evaluate the efficacy and safety of prophylactic anticoagulation in patients undergoing deceased-donor liver transplantation.

Methods: A dual-centre RCT of patients assigned to receive either enoxaparin or normal saline after liver transplantation was conducted. The primary efficacy outcome was the incidence of venous thrombosis (portal vein thrombosis and deep vein thrombosis) and the primary safety outcome was the incidence of major bleeding.

Results: A total of 462 patients were recruited. In the intention-to-treat analysis, 89 patients (19.3%) experienced venous thrombosis and 141 patients (30.5%) experienced major bleeding within 90 days after transplantation. No significant differences were observed in the incidence of venous thrombosis, portal vein thrombosis, or deep vein thrombosis between the two groups in the intention-to-treat cohort. The anticoagulant group demonstrated a markedly elevated incidence of major bleeding (35.5% versus 25.5%, P = 0.020). Subgroup analysis revealed that anticoagulation was associated with a lower risk of deep vein thrombosis in hepatocellular carcinoma patients (HR 0.44 (95% c.i. 0.23 to 0.86), P = 0.016), without a significantly higher risk of major bleeding.

Conclusion: Use of prophylactic anticoagulation with enoxaparin is associated with a significantly higher incidence of major bleeding in patients undergoing deceased-donor liver transplantation, rather than a lower likelihood of venous thrombosis.

Registration number: ChiCTR2000032441 (www.chictr.org.cn).