Journal of Gastrointestinal Surgery最新文献

英文中文

Appendiceal bleeding: a rare cause of lower gastrointestinal bleeding 阑尾出血：下消化道出血的罕见病因。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.011

Congyuan Ma , Yufei Liu , Ping Zhu

引用次数: 0

Different prognostic effect of lymph node metastasis between remnant gastric cancers and primary proximal gastric cancers 淋巴结转移对残胃癌和原发性近端胃癌的预后影响不同

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.06.026

Background

Although the dissected lymph node number in remnant gastric cancer (RGC) may be smaller than in primary proximal gastric cancer (PGC), altered lymphatic flow provides different metastatic patterns in lymph nodes, which could potentially give rise to prognostic differences between RGC and PGC with nodal metastasis.

Methods

Between 1993 and 2020, 2546 consecutive patients with gastric cancer underwent gastrectomy. Of these, 53 patients with RGC and 381 patients with PGC with pathologic TNM stage I-III gastric cancer underwent curative gastrectomy. We reviewed their hospital records retrospectively.

Results

The number of dissected lymph nodes was significantly smaller in patients with RGC than in patients with PGC (P < .001; RGC, 13.0 vs PGC, 34.5). Although the 5-year overall survival (OS) rate did not differ between RGC and PGC in all patients, the prognosis in each pathologic N (pN) stage of RGC was worse than that of PGC, suggesting that each lymph node metastasis has a greater prognostic effect in RGC. In particular, even with patients with pN1 (20.0%) or pN2 RGC (40.0%), their 5-year OS rates were poor and similar to those of patients with pN3 PGC (35.7%). The presence of lymph node metastasis in RGC (hazard ratio [HR], 4.41; 95% CI, 1.02–18.9; P = .045) was an independent and a similar prognostic impact in pN3 PGC (HR, 2.82; 95% CI, 1.57–5.07; P < .001). Lymph node metastasis in RGC more strongly affected peritoneal or lymph node recurrence rather than hematogenous recurrence.

Conclusion

The presence of lymph node metastasis yielded a poorer prognosis in patients with RGC than patients with primary PGC. Patients with RGC with lymph node metastasis should be specifically targeted in an effort to improve their prognosis.

背景：虽然残胃癌（RGC）的切除淋巴结数量可能少于原发性近端胃癌（PGC），但淋巴流的改变提供了不同的淋巴结转移模式，这可能导致有结节转移的残胃癌和原发性近端胃癌在预后上的差异：1993年至2020年间，2546名胃癌患者连续接受了胃切除术。其中，53 例 RGC 和 381 例 PGC 患者均为 p 阶段 I-III 胃癌，接受了根治性胃切除术。我们回顾性地查看了他们的住院记录：结果：RGC 患者切除的淋巴结数量明显少于 PGC 患者（P < 0.001：RGC：13.0 对 PGC：34.5）。虽然所有患者的五年总生存率（OS）在RGC和PGC之间没有差异，但RGC各pN分期的预后均比PGC差，这表明每个淋巴结转移对RGC的预后影响更大。具体而言，即使是pN1（20.0%）或pN2（40.0%）期的RGC患者，其五年生存率也较差，与pN3期的PGC患者（35.7%）相似。RGC淋巴结转移（HR：4.41，95% CI：1.02-18.9，P = 0.045）对pN3 PGC（HR：2.82，95% CI：1.57-5.07，P <0.001）的预后有独立影响，且影响程度相似。RGC淋巴结转移对腹膜或淋巴结复发的影响大于血源性复发：结论：与原发性PGC患者相比，RGC患者出现淋巴结转移的预后较差。有淋巴结转移的RGC患者应作为特定靶点，以改善其预后。

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引用次数: 0

Outcome of a 3-day vs 7-day selective digestive tract decontamination–based regimen for oral antibiotic bowel decontamination in left-sided colorectal surgery: A noninferiority study 左侧结直肠手术中口服抗生素肠道净化 3 天与 7 天 SDD 方案的结果：非劣效性研究。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.031

Ulrich Wirth , Josefine Schardey , Thomas von Ahnen , Alexander Crispin , Alina Kappenberger , Petra Zimmermann , Kühn Florian , Jan G. D‘Haese , Jens Werner , Bettina Rau

Background

Colorectal surgery still experiences high rates of infectious complications, such as anastomotic leakage (AL) and surgical site infections (SSIs). Therefore, oral antibiotic bowel decontamination (OABD) has experienced a renaissance. However, data on perioperative selective digestive tract decontamination (SDD)–based regimens or combined bowel preparation are inconsistent. Nonetheless, with widespread use of Enhanced Recovery After Surgery concepts, the ideal length for perioperative SDD treatment has to be reconsidered.

Methods

Perioperative outcome was analyzed in a cohort of patients undergoing minimally invasive surgery for left-sided colorectal cancer in a retrospective study. Additional to usual perioperative outcome measures, including AL, SSIs, and overall infectious complications, the efficacy of a shortened 3-day perioperative OABD treatment was compared with the efficacy of a 7-day perioperative OABD treatment based on a noninferiority analysis.

Results

Overall, 256 patients were included into analysis, of whom 84 and 172 patients were treated by 3-day and 7-day perioperative OABD regimens, respectively. AL occurred in 1.2% of patients in the 3-day group and 5.2% of patients in the 7-day group, and SSIs occurred in 3.6% of patients in the 3-day group and 5.8% of patients in the 7-day group, without significant difference. The shortened 3-day perioperative SDD-based regimen was noninferior to the regular 7-day perioperative SDD-based regimen concerning the rates of AL, SSIs, and infectious complications.

Conclusion

Our data demonstrated noninferiority of a shortened 3-day SDD-based treatment vs a 7-day SDD-based treatment for AL, SSIs, and overall infectious complications.

背景：结肠直肠手术的感染并发症发生率仍然很高，如吻合口漏和手术部位感染。因此，口服抗生素肠道净化疗法重新兴起。但关于围手术期选择性消化道净化（SDD）方案或联合肠道准备的数据并不一致。尽管如此，随着术后增强恢复概念的广泛应用，围手术期选择性消化道净化治疗的理想时间必须重新考虑：方法：在一项回顾性研究中，对一组接受微创手术治疗左侧结直肠癌的患者的围手术期结果进行了分析。除了通常的围手术期结果测量吻合口漏、手术部位感染和总体感染并发症外，还根据非劣效性分析比较了术后3天缩短围手术期口服抗生素肠道净化治疗与术后7天治疗方案的疗效：共有256名患者纳入分析，其中84名患者接受了为期3天的围手术期口服抗生素肠道净化治疗，172名患者接受了为期7天的围手术期口服抗生素肠道净化治疗。3 天组和 7 天组分别有 1.2% 和 5.2% 的患者发生吻合口漏，手术部位感染的比例分别为 3.6% 和 5.8%，差异不大。就吻合口渗漏、手术部位感染和感染性并发症的发生率而言，围手术期缩短 3 天的 SDD 方案不劣于常规的 7 天 SDD 方案：这些数据首次证明，在吻合口渗漏、手术部位感染和总体感染并发症方面，缩短 3 天的围手术期 SDD 治疗方案与 7 天的治疗方案相比并无劣势。

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引用次数: 0

Segment 3 bypass: a long-forgotten option for hilar strictures 第 3 段分流术：被遗忘已久的肝门狭窄治疗方案。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.006

Jon M. Harrison , Jennifer Berumen , Gabriel Schnickel , Bryan Clary

引用次数: 0

C-reactive protein, white blood cells, and neutrophil/lymphocyte ratio for predicting complicated appendicitis: which is more reliable? 预测并发阑尾炎的 C 反应蛋白、白细胞和中性粒细胞/淋巴细胞比值：哪种方法更可靠？

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.021

María A. Casas , Cristian A. Angeramo , Manuela Monrabal Lezama , Nicolas A. Rotholtz , Francisco Schlottmann

引用次数: 0

Outcomes of patients with eosinophilic esophagitis undergoing bariatric surgery 接受减肥手术的嗜酸性粒细胞食管炎患者的疗效。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.029

Nimrod Deiss-Yehiely , Anne Lidor , Luke Hillman

引用次数: 0

Enhancing severe anastomotic leakage prediction after rectal cancer surgery through multimodal data integration. 通过多模态数据整合加强直肠癌术后严重吻合口渗漏预测

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.09.032

Lei Liang, Liu-Yang Yang, Wei-Qing Liu, Hong Zhang, Xin Li, Jun Yang, Ning Xu

引用次数: 0

Optimal radiation dose intensity: low vs high dose in the neoadjuvant treatment of locally advanced esophageal cancer. 最佳放射剂量强度：局部晚期食管腺癌新辅助治疗中的低剂量与高剂量。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.09.029

Robert C G Martin, Nicolas Caminiti, Michael Egger, Charles Scoggins, Prejesh Philips

引用次数: 0

Disparities in esophageal cancer care: a population-based study 食管癌治疗中的差异：一项基于人群的研究。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.004

Francisco Tustumi , Ricardo Yugi Eri , Klaus Werner Wende , Eric Toshiyuki Nakamura , Pedro Luiz Serrano Usón Junior , Daniel José Szor

Background

Vulnerable populations potentially have a worse prognosis for cancer. The present study aimed to identify individual and municipal characteristics of access to health, including education, use of health insurance, gross domestic product per capita (GDPpc), and urban aspects, which could impact the prognosis of patients with esophageal cancer.

Methods

Data on urban concentration, administrative hierarchy, GDPpc, individual patient characteristics, and access to healthcare were collected from national and state public databases spanning between 2013 and 2022. The study included cities in the state of Sao Paulo, Brazil. Independent variables such as GDPpc, urban concentration, municipal administrative hierarchy, health insurance status, education level, and individual cancer and patient characteristics were evaluated against the outcomes of overall survival (OS), likelihood of undergoing surgical treatment, and time-to-treatment initiation.

Results

A total of 9280 patients with esophageal cancer (85% squamous cell carcinoma and 15% adenocarcinoma) treated in 42 cities were included in the study. In univariate analysis, higher education (hazard ratio [HR] = 0.6; P < .001), female gender (HR = 0.85; P < .001), and having private health insurance (HR = 0.65; P < .001) were identified as protective factors for OS in esophageal cancer. After adjusting for other variables in multivariate analysis, higher education (HR = 0.77; P = .009), female gender (HR = 0.82; P < .001), and private insurance (HR = 0.65; P < .001) remained protective factors. GDPpc was not associated with OS. Urban concentration and hierarchy influenced the likelihood of receiving surgical treatment. Patients from high urban concentrations had shorter time-to-treatment initiation intervals.

Conclusion

Populations at risk, particularly those with limited access to education and healthcare, face a worse prognosis for esophageal cancer.

背景：弱势群体的癌症预后可能较差。本研究旨在确定获得医疗服务的个人和城市特征，包括教育、医疗保险的使用、人均国内生产总值（GDPpc）和城市方面，这些可能会影响食管癌患者的预后：从 2013 年至 2022 年期间的国家和州公共数据库中收集了有关城市集中度、行政等级、GDPpc、患者个人特征和医疗服务获得情况的数据。研究对象包括巴西圣保罗州的城市。针对总生存率（OS）、接受手术治疗的可能性和开始治疗的时间等结果，对国内生产总值（GDP）、城市集中度、市政管理等级、医疗保险状况、教育水平、癌症个体特征和患者特征等自变量进行了评估：共有 9280 名在 42 个城市接受治疗的食管癌患者（85% 为鳞癌，15% 为腺癌）被纳入研究。在单变量分析中，教育程度较高（危险比 [HR] = 0.6；P 结论：教育程度越高，危险越大：高危人群，尤其是教育和医疗条件有限的人群，食管癌的预后较差。

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引用次数: 0

An evaluation of patient experience before and after elective colectomy for diverticulitis between patients older and younger than 65 years: A pilot feasibility study in mobile health use 评估 65 岁以上和 65 岁以下憩室炎患者在选择性结肠切除术前后的体验：移动医疗使用的试点可行性研究。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2024-10-01 DOI: 10.1016/j.gassur.2024.07.024

Numa Perez , Prabh Pannu , Hiroko Kunitake , David Berger , Rocco Ricciardi , Mary Brindle , Zara Cooper , Christine Ritchie , Liliana Bordeianou , Christy E. Cauley

Background

Mobile health (mHealth) platforms are being used to understand patient-reported experiences before and after surgery. Currently, there is limited literature describing the feasibility of using mHealth to evaluate patient experience among older adults. The objective of this study was to determine the feasibility of using mHealth to evaluate patient-reported outcomes among patients older and younger than 65 years undergoing elective colectomy for diverticulitis.

Methods

A prospective pilot study was performed between June 1, 2020 and August 31, 2021, enrolling patients aged > 18 years undergoing elective colectomy for diverticulitis at a single academic center (n = 62). A Health Insurance Portability and Accountability Act-compliant mHealth platform was used to deliver patient-reported quality-of-life surveys at 3 time points: preoperatively, 3 months postoperatively, and 6 months postoperatively. The primary outcome was the feasibility of using mHealth in patients older and younger than 65 years to collect outcomes using recruitment, engagement, and survey completion rates. Preliminary findings of patient experiences were evaluated for patients older and younger than 65 years as secondary outcomes.

Results

Overall, 33.9% of participants were older than 65 years with a median age of 59.8 years (IQR, 53.3–67.9). mHealth enrollment was high (100%) with survey response rates of 79% preoperatively, 64.5% at 3 months postoperatively, and 17.7% at 6 months postoperatively. Response rates were similar among patients older and younger than 65 years (P = .79 preoperatively and P = .39 at 3 months postoperatively).

Conclusion

Utilization of mHealth to evaluate patient-reported outcomes is feasible in the preoperative and early postoperative settings, including older adults undergoing elective surgery for diverticulitis. Future work will focus on improving long-term outcomes to better examine potential differences when considering patient-centered outcomes among older adult patients.

背景：人们正在利用移动医疗（mHealth）平台来了解手术前后患者报告的经历。目前，描述使用移动医疗评估老年人患者体验的可行性的文献还很有限。本研究的目的是确定使用移动医疗评估65岁以上和65岁以下接受选择性结肠切除术治疗憩室炎患者的患者报告结果的可行性：2020年6月1日至2021年8月31日期间进行了一项前瞻性试验研究，在一个学术中心招募了年龄大于18岁、因憩室炎接受择期结肠切除术的患者（n=62）。使用符合 HIPPA 标准的移动医疗平台，在术前、术后 3 个月和 6 个月三个时间点提供患者报告的生活质量调查。主要结果是在 65 岁以上和 65 岁以下的患者中使用移动医疗的可行性，通过招募率、参与率和调查完成率来收集结果。作为次要结果，对65岁以上和65岁以下患者的患者体验进行了初步评估：33.9%的参与者年龄超过 65 岁，中位年龄为 59.8 岁（IQR-53.3-67.9）。总体而言，移动医疗的注册率很高（100%），调查回复率分别为术前 79%、术后 3 个月 64.5%、术后 6 个月 17.7%。65岁以上和65岁以下患者的回复率相似（术前p=0.79，术后3个月p=0.39）：结论：利用移动医疗来评估患者报告的结果在术前和术后早期是可行的，包括接受憩室炎择期手术的老年人。未来的工作将侧重于改善长期疗效，以更好地研究在考虑以患者为中心的疗效时，老年患者之间可能存在的差异。

{"title":"An evaluation of patient experience before and after elective colectomy for diverticulitis between patients older and younger than 65 years: A pilot feasibility study in mobile health use","authors":"Numa Perez , Prabh Pannu , Hiroko Kunitake , David Berger , Rocco Ricciardi , Mary Brindle , Zara Cooper , Christine Ritchie , Liliana Bordeianou , Christy E. Cauley","doi":"10.1016/j.gassur.2024.07.024","DOIUrl":"10.1016/j.gassur.2024.07.024","url":null,"abstract":"<div><h3>Background</h3><div>Mobile health (mHealth) platforms are being used to understand patient-reported experiences before and after surgery. Currently, there is limited literature describing the feasibility of using mHealth to evaluate patient experience among older adults. The objective of this study was to determine the feasibility of using mHealth to evaluate patient-reported outcomes among patients older and younger than 65 years undergoing elective colectomy for diverticulitis.</div></div><div><h3>Methods</h3><div>A prospective pilot study was performed between June 1, 2020 and August 31, 2021, enrolling patients aged > 18 years undergoing elective colectomy for diverticulitis at a single academic center (n = 62). A Health Insurance Portability and Accountability Act-compliant mHealth platform was used to deliver patient-reported quality-of-life surveys at 3 time points: preoperatively, 3 months postoperatively, and 6 months postoperatively. The primary outcome was the feasibility of using mHealth in patients older and younger than 65 years to collect outcomes using recruitment, engagement, and survey completion rates. Preliminary findings of patient experiences were evaluated for patients older and younger than 65 years as secondary outcomes.</div></div><div><h3>Results</h3><div>Overall, 33.9% of participants were older than 65 years with a median age of 59.8 years (IQR, 53.3–67.9). mHealth enrollment was high (100%) with survey response rates of 79% preoperatively, 64.5% at 3 months postoperatively, and 17.7% at 6 months postoperatively. Response rates were similar among patients older and younger than 65 years (<em>P =</em> .79 preoperatively and <em>P</em> = .39 at 3 months postoperatively).</div></div><div><h3>Conclusion</h3><div>Utilization of mHealth to evaluate patient-reported outcomes is feasible in the preoperative and early postoperative settings, including older adults undergoing elective surgery for diverticulitis. Future work will focus on improving long-term outcomes to better examine potential differences when considering patient-centered outcomes among older adult patients.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"28 10","pages":"Pages 1639-1645"},"PeriodicalIF":2.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875029","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}

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