Journal of Gastrointestinal Surgery最新文献

Purpose: The incidence of diverticular disease in younger adults has been on the rise over the past decades. This study aims to evaluate the association between age and postoperative outcomes for patients undergoing colectomy for diverticular disease.

Methods: A retrospective analysis was performed using the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files between 2016 and 2020. Adults aged ≥18 years who underwent colectomy for diverticular disease were included. Demographic, perioperative, and postoperative variables were analyzed between patients aged <50 and ≥50 years. A multivariable logistic regression was used to identify independent predictors of major intra-abdominal complication, defined as positive when either anastomotic leak or organ/space surgical site infections were present.

Results: A total of 39,729 patients met inclusion criteria. Younger individuals composed 23% of the cohort, were less often female (36% vs. 61%, p<0.001), had a higher mean BMI (32 vs. 29, p<0.001), and were more likely to be smokers (28% vs. 18%, p<0.001). Readmissions were more frequent in older patients (8.5% vs. 7.5%; p=0.002); however, the median time to first readmission occurred earlier in younger patients (12 vs. 15 days; p<0.001). In multivariable analysis, among other factors, age younger than 50 years independently increased the risk of major intra-abdominal complication (OR 1.14; 95% CI, 1.02-1.27).

Conclusions: Despite their overall healthier profile, younger patients experience comparable postoperative risk rates to older patients and are at increased risk of severe intra-abdominal complications. These findings provide insights that add to patient-physician shared decision-making.

Background: Patients post-gastroesophageal cancer surgery frequently present with clinical features of malabsorption and are often treated empirically with pancreatic enzyme replacement therapy (PERT). Primary aim was to objectify the presence of fat malabsorption in patients after gastroesophageal surgery and, secondary, to measure exocrine pancreatic function.

Methods: Eligible patients were those who underwent gastroesophageal cancer surgery (2017-2021), were at least six months post-operative, maintained an oral diet, and showed no evidence of recurrent disease. Treatment with PERT was ceased prior to this study. Fecal fat balance test (coefficient of fat absorption, CFA (%)) was used to measure absorption of fat. The CFA was determined by collecting feces over three days to measure daily fecal fat excretion (g/d), along with a four-day (weighted) nutritional diary, to establish the average daily fat intake (g/d). Fat malabsorption was defined as a CFA <85%. Exocrine pancreatic function was measured using fecal elastase-1 (FE-1).

Results: We included 90 patients (50 after esophagectomy with gastric tube reconstruction and 40 after (sub)total gastrectomy with Roux-en-Y reconstruction). Fecal analyses were conducted at a median of 17.5 months (IQR 11.3-29.8) post-surgery. A CFA <85% was found in 24% of patients after gastric tube reconstruction, accompanied by low levels of FE-1 in 33%. After Roux-en-Y reconstruction a CFA < 85% was present in 43%, of which 70% had low levels of FE-1.

Conclusion: Fat malabsorption is common after gastrectomy with Roux-en-Y reconstruction and after esophagectomy with gastric tube reconstruction, partly accompanied by reduced FE-1 levels. Clinicians should remain alert to malabsorption during follow-up and an empirical trial with PERT can be considered, although further studies are needed to evaluate its effects on absorption, symptoms, and quality of life.