After gastrectomy for gastric cancer, patients often lose significant body weight because of decreased caloric intake and nutrient absorption. Body weight typically requires approximately 1 year to stabilize. This study aimed to examine the changes and predictors of body composition during the first postoperative year.
Methods
A total of 230 patients underwent radical gastrectomy for stage I to III gastric cancers. Body composition was measured using bioelectrical impedance analysis, and changes were analyzed over 1 year. Multiple regression analysis was used to identify predictors of body composition changes.
Results
Body composition changes and significant body weight and body fat mass reductions occurred primarily within the first 6 months postoperatively. Skeletal muscle mass initially decreased but improved after 6 months without significant changes related to adjuvant chemotherapy. Increased edema was observed at 6 and 12 months postoperatively in patients after total gastrectomy and adjuvant chemotherapy. Gastrectomy type and body mass index significantly affected postoperative body weight changes. In addition, gastrectomy type was associated with changes in skeletal muscle mass and bone mineral content. Adjuvant chemotherapy significantly affected the whole-body phase angle at 6 and 12 months.
Conclusion
Our findings emphasized the initial significant reductions postoperatively and subsequent adjustments over time and elucidated the complex interplay between surgical techniques, adjuvant treatment, and patient characteristics and midterm changes in body composition.
{"title":"Change and predictors of body composition after gastrectomy for gastric cancer during first postoperative year","authors":"Tomohiro Osaki , Tomoyuki Matsunaga , Masahiro Makinoya , Shota Shimizu , Yuji Shishido , Kozo Miyatani , Ayumi Tsuda , Kanenori Endo , Keigo Ashida , Shigeru Tatebe , Yoshiyuki Fujiwara","doi":"10.1016/j.gassur.2024.101931","DOIUrl":"10.1016/j.gassur.2024.101931","url":null,"abstract":"<div><h3>Purpose</h3><div>After gastrectomy for gastric cancer, patients often lose significant body weight because of decreased caloric intake and nutrient absorption. Body weight typically requires approximately 1 year to stabilize. This study aimed to examine the changes and predictors of body composition during the first postoperative year.</div></div><div><h3>Methods</h3><div>A total of 230 patients underwent radical gastrectomy for stage I to III gastric cancers. Body composition was measured using bioelectrical impedance analysis, and changes were analyzed over 1 year. Multiple regression analysis was used to identify predictors of body composition changes.</div></div><div><h3>Results</h3><div>Body composition changes and significant body weight and body fat mass reductions occurred primarily within the first 6 months postoperatively. Skeletal muscle mass initially decreased but improved after 6 months without significant changes related to adjuvant chemotherapy. Increased edema was observed at 6 and 12 months postoperatively in patients after total gastrectomy and adjuvant chemotherapy. Gastrectomy type and body mass index significantly affected postoperative body weight changes. In addition, gastrectomy type was associated with changes in skeletal muscle mass and bone mineral content. Adjuvant chemotherapy significantly affected the whole-body phase angle at 6 and 12 months.</div></div><div><h3>Conclusion</h3><div>Our findings emphasized the initial significant reductions postoperatively and subsequent adjustments over time and elucidated the complex interplay between surgical techniques, adjuvant treatment, and patient characteristics and midterm changes in body composition.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101931"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824225","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101925
Juliana Maria Napoli, Felipe Higuera, Fernando Gabriel Wright
{"title":"Gastric metastasis from Merkel cell carcinoma","authors":"Juliana Maria Napoli, Felipe Higuera, Fernando Gabriel Wright","doi":"10.1016/j.gassur.2024.101925","DOIUrl":"10.1016/j.gassur.2024.101925","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101925"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829106","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101884
Ayesha P. Ng, Joseph E. Hadaya, Yas Sanaiha, Nikhil L. Chervu, Mark D. Girgis, Peyman Benharash
Background
Of note, 15% to 20% of patients with duodenal or periampullary malignancies develop gastric outlet obstruction (GOO). Although small randomized trials have reported more rapid recovery and shorter hospital stay with endoscopic stenting (ES), limited studies have evaluated outcomes at a national level. The current study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) vs ES in malignant GOO.
Methods
Adults with malignant GOO treated with ES or GJ were identified in the 2016–2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariate regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission.
Results
Of 8186 patients with GOO, 5603 (68.4%) underwent ES, and 2583 (31.6%) underwent GJ. The cohorts were similar in age, female/male sex, and comorbidities. However, patients who underwent GJ were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between patients who underwent GJ and those who underwent ES. GJ was associated with greater odds of blood transfusion (adjusted odds ratio [AOR], 1.74; 95% CI, 1.37–2.21) and postoperative TPN use (AOR, 3.76; 95% CI, 2.64–5.35). Furthermore, patients who underwent GJ experienced a significant increment of >$15,800 in costs and >6.9 days in LOS. In subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable among palliation strategies.
Conclusion
ES seems to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.
背景：大约 15-20% 的十二指肠或胰腺周围恶性肿瘤患者会出现 GOO。虽然有小型随机试验报告称 ES 可使患者恢复更快、住院时间更短，但在全国范围内对结果进行评估的研究却很有限。本研究对恶性胃出口梗阻（GOO）的胃空肠吻合术（GJ）与内镜支架植入术（ES）的短期临床和经济效果进行了评估：从2016-2020年全国再入院数据库中识别出接受ES或GJ治疗的恶性GOO成人。采用熵平衡法平衡各组间的协变量，并采用多变量回归法评估GJ或ES与院内死亡率、全肠外营养（TPN）使用、并发症、住院时间（LOS）、费用和90天再入院之间的关系：在8186名GOO患者中，68.4%接受了ES治疗，31.6%接受了GJ治疗。两组患者的年龄、性别和合并症相似，而 GJ 患者更常见于体弱者。经过风险调整后，GJ 和 ES 的死亡率、综合并发症和 90 天再入院率相当。GJ 患者输血（AOR 1.74 [95% CI [1.37-2.21]）和术后使用 TPN（AOR 3.76 [95% CI 2.64-5.35]）的几率更高。此外，GJ 患者的费用显著增加了 15,800 美元，LOS 增加了 6.9 天。对患有转移性疾病的患者进行亚组分析后发现，不同缓解策略的死亡率、并发症和再入院率仍然相当：结论：与 GJ 相比，ES 的短期发病率和死亡率与 GJ 相当，且能显著降低成本。增加使用内窥镜技术的机会，并将医疗服务区域化，使其集中在高流量中心，可能有助于改善恶性 GOO 患者的治疗效果。
{"title":"A national perspective on palliative interventions for malignant gastric outlet obstruction","authors":"Ayesha P. Ng, Joseph E. Hadaya, Yas Sanaiha, Nikhil L. Chervu, Mark D. Girgis, Peyman Benharash","doi":"10.1016/j.gassur.2024.101884","DOIUrl":"10.1016/j.gassur.2024.101884","url":null,"abstract":"<div><h3>Background</h3><div>Of note, 15% to 20% of patients with duodenal or periampullary malignancies develop gastric outlet obstruction (GOO). Although small randomized trials have reported more rapid recovery and shorter hospital stay with endoscopic stenting (ES), limited studies have evaluated outcomes at a national level. The current study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) vs ES in malignant GOO.</div></div><div><h3>Methods</h3><div>Adults with malignant GOO treated with ES or GJ were identified in the 2016–2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariate regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission.</div></div><div><h3>Results</h3><div>Of 8186 patients with GOO, 5603 (68.4%) underwent ES, and 2583 (31.6%) underwent GJ. The cohorts were similar in age, female/male sex, and comorbidities. However, patients who underwent GJ were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between patients who underwent GJ and those who underwent ES. GJ was associated with greater odds of blood transfusion (adjusted odds ratio [AOR], 1.74; 95% CI, 1.37–2.21) and postoperative TPN use (AOR, 3.76; 95% CI, 2.64–5.35). Furthermore, patients who underwent GJ experienced a significant increment of >$15,800 in costs and >6.9 days in LOS. In subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable among palliation strategies.</div></div><div><h3>Conclusion</h3><div>ES seems to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101884"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High visceral fat area (VFA), estimated by computed tomography (CT), is reportedly associated with surgical site infection (SSI) in patients who undergo gastrectomy for gastric cancer (GC). Given that fat distributions vary markedly according to sex, sex-specific definitions of visceral obesity should be applied. This study investigated the optimal sex-specific thresholds for VFA at the L3 level to assess the risk of SSI after gastrectomy.
Methods
This study included 828 patients (564 males and 264 females) who underwent curative gastrectomy. Intra-abdominal or incisional infectious complications with Clavien-Dindo scores ≥ 2 were defined as SSIs. Receiver operating characteristic (ROC) analyses were used to determine the optimal sex-specific VFA cutoffs to extract patients with obesity who are at risk of developing SSI. In addition, logistic regression analyses were performed, and the corrected Akaike information criterion (AICc) was calculated to compare the capability to evaluate the possibility of SSI of our sex-specific VFA-based criteria vs the conventional VFA-based or body mass index (BMI)-based criterion.
Results
SSI developed in 59 males and 16 females. Optimal VFA thresholds were 119.3 cm2 for males and 57.2 cm2 for females. Multivariate analyses revealed visceral obesity, as defined by the sex-specific criteria, to be an independent risk factor for SSI (odds ratio, 2.74; 95% CI, 1.62–4.66; P <.01). The logistic regression model with our sex-specific criteria yielded a better AICc (456.4) than the conventional (461.8) or BMI-based (467.0) criterion for obesity.
Conclusion
Sex-specific criteria can enhance the capability of VFA to assess the risk of SSI after gastrectomy, compared with the non–sex-specific criterion.
{"title":"Association between sex-specific criteria for visceral obesity and surgical site infection after gastrectomy","authors":"Shinichiro Shiomi , Wataru Gonoi , Kotaro Sugawara , Satoru Taguchi , Shouhei Hanaoka , Mariko Kurokawa , Nobuhiko Akamatsu , Shohei Inui , Koichi Yagi , Haruki Kume , Osamu Abe , Yasuyuki Seto","doi":"10.1016/j.gassur.2024.101919","DOIUrl":"10.1016/j.gassur.2024.101919","url":null,"abstract":"<div><h3>Background</h3><div>High visceral fat area (VFA), estimated by computed tomography (CT), is reportedly associated with surgical site infection (SSI) in patients who undergo gastrectomy for gastric cancer (GC). Given that fat distributions vary markedly according to sex, sex-specific definitions of visceral obesity should be applied. This study investigated the optimal sex-specific thresholds for VFA at the L3 level to assess the risk of SSI after gastrectomy.</div></div><div><h3>Methods</h3><div>This study included 828 patients (564 males and 264 females) who underwent curative gastrectomy. Intra-abdominal or incisional infectious complications with Clavien-Dindo scores ≥ 2 were defined as SSIs. Receiver operating characteristic (ROC) analyses were used to determine the optimal sex-specific VFA cutoffs to extract patients with obesity who are at risk of developing SSI. In addition, logistic regression analyses were performed, and the corrected Akaike information criterion (AICc) was calculated to compare the capability to evaluate the possibility of SSI of our sex-specific VFA-based criteria vs the conventional VFA-based or body mass index (BMI)-based criterion.</div></div><div><h3>Results</h3><div>SSI developed in 59 males and 16 females. Optimal VFA thresholds were 119.3 cm<sup>2</sup> for males and 57.2 cm<sup>2</sup> for females. Multivariate analyses revealed visceral obesity, as defined by the sex-specific criteria, to be an independent risk factor for SSI (odds ratio, 2.74; 95% CI, 1.62–4.66; <em>P</em> <.01). The logistic regression model with our sex-specific criteria yielded a better AICc (456.4) than the conventional (461.8) or BMI-based (467.0) criterion for obesity.</div></div><div><h3>Conclusion</h3><div>Sex-specific criteria can enhance the capability of VFA to assess the risk of SSI after gastrectomy, compared with the non–sex-specific criterion.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101919"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769554","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101920
Mohammad S. Farooq , Valentina Mattfeld , Neha Shafique , Gracia M. Vargas , John T. Miura , Giorgos C. Karakousis
{"title":"Laparoscopic surgery for gastric gastrointestinal stromal tumor in the age of Enhanced Recovery After Surgery","authors":"Mohammad S. Farooq , Valentina Mattfeld , Neha Shafique , Gracia M. Vargas , John T. Miura , Giorgos C. Karakousis","doi":"10.1016/j.gassur.2024.101920","DOIUrl":"10.1016/j.gassur.2024.101920","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101920"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780342","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101928
Andrea Costantini , Matteo Pittacolo , Giulia Nezi , Giovanni Capovilla , Mario Costantini , Arianna Vittori , Matteo Santangelo , Luca Provenzano , Loredana Nicoletti , Francesca Forattini , Lucia Moletta , Michele Valmasoni , Edoardo V. Savarino , Renato Salvador
Background
There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score is used to define clinical outcomes. However, objective metrics are lacking. This study aimed to identify whether any high-resolution manometry (HRM) parameters may be useful in predicting a positive outcome after laparoscopic Heller-Dor (LHD).
Methods
Patients who underwent LHD between 2012 and 2022 were enrolled. The patients were divided according to the outcome: the success group (SG) and the failure group (FG). In addition to the common HRM parameters, we measured the difference between pre- and postoperative integrated relaxation pressures (∆-IRPs). A receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of each HRM parameter.
Results
Of note, 336 patients (92.3%) were classified in the SG, and 28 patients (7.7%) were classified in the FG. No difference was found in terms of manometric types, symptom duration, and history of previous treatments. Preoperative lower esophageal sphincter (LES) pressure and IRP were higher in the SG than in the FG (41 vs 35 mm Hg [P =.03] and 33 vs 26 mm Hg [P =.002], respectively). The postoperative LES metrics were similar between the 2 groups, except for the ∆-IRP that was higher in the SG (23 mm Hg [IQR, 15–31]) than in the FG (14 mm Hg [IQR, 9–17]) (P =.0002). In the univariate analysis, age, LES preoperative pressure, IRP, and ∆-IRP were factors able to predict a positive clinical outcome. In the multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (odds ratio, 0.94; 5%–95% CI, 0.89–0.99). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.5 mm Hg (sensibility of 71% and specificity of 70%).
Conclusion
Our data showed that the ∆-IRP with a threshold of 16.5 mm Hg could represent a new objective tool for predicting the long-term positive outcome of LHD in patients with esophageal achalasia.
对贲门失弛缓症患者治疗后失败的定义尚无共识。Eckardt评分（ES）用于定义临床结果，但缺乏客观指标。本研究的目的是确定是否有任何高分辨率测压（HRM）参数可能有助于预测腹腔镜Heller-Dor （LHD）后的阳性结果。方法：纳入2012-2022年间接受LHD的患者。根据治疗结果分为成功组（SG）和失败组（FG）。除了常见的HRM参数外，我们还测量了术前和术后综合松弛压力（∆- irp）之间的差异。应用ROC曲线分析来评估每个HRM参数的准确性。结果：336例患者（92.3%）分为SG组，28例（7.7%）分为FG组。两组在测压类型、症状持续时间和既往治疗史方面均无差异；术前食管下括约肌（LES）压力和IRP在SG组高于FG组（41 vs 35mmHg, p=0.03和33 vs 26mmHg， p=0.002）。两组术后LES指标相似，但SG组（23mmHg, IQR:15-31）的∆-IRP高于FG组（14mmHg, IQR:9-17, p=0.0002）。在单变量分析中，年龄、LES术前压力、IRP和∆-IRP是能够预测阳性临床结果的因素。在多变量分析中，∆-IRP是唯一与临床成功独立相关的参数(p)结论：我们的数据表明，阈值为16.5mmHg的∆-IRP可以作为预测食管贲门失弛缓症患者LHD长期阳性结果的一种新的客观工具。
{"title":"Delta-integrated relaxation pressures as a new high-resolution manometry metric to predict the positive outcome of laparoscopic Heller-Dor in patients with achalasia","authors":"Andrea Costantini , Matteo Pittacolo , Giulia Nezi , Giovanni Capovilla , Mario Costantini , Arianna Vittori , Matteo Santangelo , Luca Provenzano , Loredana Nicoletti , Francesca Forattini , Lucia Moletta , Michele Valmasoni , Edoardo V. Savarino , Renato Salvador","doi":"10.1016/j.gassur.2024.101928","DOIUrl":"10.1016/j.gassur.2024.101928","url":null,"abstract":"<div><h3>Background</h3><div>There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score is used to define clinical outcomes. However, objective metrics are lacking. This study aimed to identify whether any high-resolution manometry (HRM) parameters may be useful in predicting a positive outcome after laparoscopic Heller-Dor (LHD).</div></div><div><h3>Methods</h3><div>Patients who underwent LHD between 2012 and 2022 were enrolled. The patients were divided according to the outcome: the success group (SG) and the failure group (FG). In addition to the common HRM parameters, we measured the difference between pre- and postoperative integrated relaxation pressures (∆-IRPs). A receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of each HRM parameter.</div></div><div><h3>Results</h3><div>Of note, 336 patients (92.3%) were classified in the SG, and 28 patients (7.7%) were classified in the FG. No difference was found in terms of manometric types, symptom duration, and history of previous treatments. Preoperative lower esophageal sphincter (LES) pressure and IRP were higher in the SG than in the FG (41 vs 35 mm Hg [<em>P</em> =.03] and 33 vs 26 mm Hg [<em>P</em> =.002], respectively). The postoperative LES metrics were similar between the 2 groups, except for the ∆-IRP that was higher in the SG (23 mm Hg [IQR, 15–31]) than in the FG (14 mm Hg [IQR, 9–17]) (<em>P</em> =.0002). In the univariate analysis, age, LES preoperative pressure, IRP, and ∆-IRP were factors able to predict a positive clinical outcome. In the multivariate analysis, the ∆-IRP was the only parameter independently related to clinical success (odds ratio, 0.94; 5%–95% CI, 0.89–0.99). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.5 mm Hg (sensibility of 71% and specificity of 70%).</div></div><div><h3>Conclusion</h3><div>Our data showed that the ∆-IRP with a threshold of 16.5 mm Hg could represent a new objective tool for predicting the long-term positive outcome of LHD in patients with esophageal achalasia.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101928"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101899
Sami Alahmadi , David L. Berger , Christy E. Cauley , Robert N. Goldstone , William V. Kastrinakis , Marc Rubin , Hiroko Kunitake , Rocco Ricciardi , Grace C. Lee
Background
Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.
Methods
This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.
Results
Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (P >.05) or rates of incomplete donuts (P =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; P =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; P =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; P =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; P =.94).
Conclusion
EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.
背景：结直肠切除术后吻合口漏与发病率、死亡率和肠功能不良有关。关于吻合技术、术中泄漏试验和随后的临床泄漏之间关系的数据很少，特别是关于端到端与非端到端吻合以避免术后泄漏的效用。本研究的目的是分析吻合口构造、术中吻合口评估和临床泄漏之间的潜在关联。方法：我们对某三级保健中心的结肠直肠癌患者进行了一项回顾性队列研究，这些患者接受了左侧结肠直肠切除术并进行了结肠直肠或结肠直肠吻合术，比较了吻合技术。结果为术中漏气率、吻合口不完整甜甜圈率和术后临床漏气率。进行单因素和多因素分析以评估吻合技术与术中吻合口评估和随后的吻合口泄漏之间的潜在关联。结果/结局：844例患者中，27例（3.2%）患者术中漏气，6例（0.7%）患者甜甜圈不完整，27例（3.2%）患者临床漏气。端到端吻合500例（59.2%），非端到端吻合344例（40.7%）。两组在人口统计学、合并症和不完整甜甜圈率方面均无显著差异（p < 0.05）。单因素分析（4.9% vs 1.2%, p=0.005）和多因素分析(OR 3.6；95% CI 1.01-12.5, p= 0.049)。单因素分析（3.0% vs 3.5%, p=0.69）和多因素分析(or: 0.97；95% ci: 0.40-2.34；p = 0.94)。结论：端到端吻合术中漏气率高于非端到端吻合术，即使在调整潜在混杂因素后也是如此。
{"title":"Is end-to-end or side-to-end anastomotic configuration associated with risk of positive intraoperative air leak test in left-sided colon and rectal resections for colon and rectal cancers?","authors":"Sami Alahmadi , David L. Berger , Christy E. Cauley , Robert N. Goldstone , William V. Kastrinakis , Marc Rubin , Hiroko Kunitake , Rocco Ricciardi , Grace C. Lee","doi":"10.1016/j.gassur.2024.101899","DOIUrl":"10.1016/j.gassur.2024.101899","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leak after colorectal resection is associated with morbidity, mortality, and poor bowel function. Minimal data exist on the relationship between anastomotic technique, intraoperative leak test, and subsequent clinical leak, particularly on the utility of performing end-to-end anastomosis (EEA) vs non–EEA (NEEA) to avoid postoperative leaks. This study aimed to analyze potential associations between anastomotic construction, intraoperative anastomotic assessments, and clinical leak.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study comparing anastomotic techniques used in patients with colorectal cancer who underwent left-sided colorectal resections with colorectal or coloanal anastomoses at a tertiary care center. The outcomes were rates of intraoperative air leak, incomplete anastomotic donuts, and postoperative clinical leak. Univariate and multivariate analyses were performed to evaluate the potential association between anastomotic technique and intraoperative anastomotic assessments and subsequent leak.</div></div><div><h3>Results</h3><div>Among 844 patients, 27 (3.2%) had intraoperative leak, 6 (0.7%) had incomplete donuts, and 27 (3.2%) experienced clinical leak. Of note, 500 patients (59.2%) had EEAs, and 344 patients (40.7%) had NEEAs. There were no significant differences in demographics or comorbidities between groups (<em>P</em> >.05) or rates of incomplete donuts (<em>P</em> =.07). EEA was associated with significantly more intraoperative air leaks than NEEA on univariate analysis (4.9% vs 1.2%, respectively; <em>P</em> =.005) and multivariate analysis (odds ratio [OR], 3.6; 95% CI, 1.01–12.50; <em>P</em> =.049). There was no difference in postoperative clinical leak between the groups on univariate analysis (3.0% in EEA vs 3.5% in NEEA; <em>P</em> =.69) or multivariate analysis (OR, 0.97; 95% CI, 0.40–2.34; <em>P</em> =.94).</div></div><div><h3>Conclusion</h3><div>EEA is associated with higher rates of intraoperative air leak than NEEA, even after adjusting for potential confounders.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101899"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750972","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101929
John H. Marks , Hye Jin Kim , Gyu-Seog Choi , Luis Andres Idrovo , Suraj Chetty , Thais Reif De Paula , Deborah Keller
<div><h3>Background</h3><div>Rectal cancer surgery remains a significant technical challenge. The development and implementation of a new technology offer hope for more accurate and precise surgery. To evaluate whether single-port robotic (SPr) technology helps achieve this goal, an international SPr registry was established. This study reported short-term clinical and oncologic outcomes from an international SPr registry for rectal cancer.</div></div><div><h3>Methods</h3><div>A review of a prospective international registry of SPr technology approved for colorectal surgery with an investigational design exemption was conducted. Patients with rectal adenocarcinoma who had resection for curative intent using the SPr platform between November 2018 and September 2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncologic, and clinical outcome variables. The main outcome measure was the quality of the total mesorectal excision (TME) specimen. The secondary outcome measures were intraoperative conversion and 30-day postoperative morbidity and mortality.</div></div><div><h3>Results</h3><div>A total of 113 SPr procedures for rectal cancer were performed at 2 centers by 4 colorectal surgeons. Of note, 9 local excisions were excluded, leaving 104 cases analyzed. The cohort consisted of 53 men (50.96%), had a mean age of 60.00 years (SD, 11.29), and had a body mass index of 25.80 kg/m<sup>2</sup> (SD, 6.18). The most common T stage was 3 (55 [52.8%]), followed by 2 (19 [18.26%]). More than 60% of patients had preoperative neoadjuvant chemoradiation. The mean tumor distance from the anorectal ring was 2.90 cm (SD, 2.62), and the mean tumor size was 4.52 cm (SD, 1.82). The procedures performed included transanal abdominal transanal/transanal TME (52 [46%]), low anterior resection (49 [43.3%]), and abdominoperineal resection (3 [2.7%]). The mean operating time was 168.0 min (SD, 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.30 cm (SD, 1.31). The TME specimens were complete in 101 cases (97.1%) and near complete in 3 cases (2.9%). The R1 rate was 3.8%, with 3 positive distal margins and 1 positive circumferential margin. Postoperatively, there were 15 total complications, of which 4 were major complications and 11 were minor complications. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.</div></div><div><h3>Conclusion</h3><div>This early international experience with the SPr procedure showed that it is a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates observed with other techniques and platforms used in rectal cancer surgery were not demonstrated. An international registry was used to better understand the opportunities and limitations of SPr technology in rectal cancer surgery as the tec
{"title":"First clinical report of the international single-port robotic rectal cancer registry","authors":"John H. Marks , Hye Jin Kim , Gyu-Seog Choi , Luis Andres Idrovo , Suraj Chetty , Thais Reif De Paula , Deborah Keller","doi":"10.1016/j.gassur.2024.101929","DOIUrl":"10.1016/j.gassur.2024.101929","url":null,"abstract":"<div><h3>Background</h3><div>Rectal cancer surgery remains a significant technical challenge. The development and implementation of a new technology offer hope for more accurate and precise surgery. To evaluate whether single-port robotic (SPr) technology helps achieve this goal, an international SPr registry was established. This study reported short-term clinical and oncologic outcomes from an international SPr registry for rectal cancer.</div></div><div><h3>Methods</h3><div>A review of a prospective international registry of SPr technology approved for colorectal surgery with an investigational design exemption was conducted. Patients with rectal adenocarcinoma who had resection for curative intent using the SPr platform between November 2018 and September 2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncologic, and clinical outcome variables. The main outcome measure was the quality of the total mesorectal excision (TME) specimen. The secondary outcome measures were intraoperative conversion and 30-day postoperative morbidity and mortality.</div></div><div><h3>Results</h3><div>A total of 113 SPr procedures for rectal cancer were performed at 2 centers by 4 colorectal surgeons. Of note, 9 local excisions were excluded, leaving 104 cases analyzed. The cohort consisted of 53 men (50.96%), had a mean age of 60.00 years (SD, 11.29), and had a body mass index of 25.80 kg/m<sup>2</sup> (SD, 6.18). The most common T stage was 3 (55 [52.8%]), followed by 2 (19 [18.26%]). More than 60% of patients had preoperative neoadjuvant chemoradiation. The mean tumor distance from the anorectal ring was 2.90 cm (SD, 2.62), and the mean tumor size was 4.52 cm (SD, 1.82). The procedures performed included transanal abdominal transanal/transanal TME (52 [46%]), low anterior resection (49 [43.3%]), and abdominoperineal resection (3 [2.7%]). The mean operating time was 168.0 min (SD, 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.30 cm (SD, 1.31). The TME specimens were complete in 101 cases (97.1%) and near complete in 3 cases (2.9%). The R1 rate was 3.8%, with 3 positive distal margins and 1 positive circumferential margin. Postoperatively, there were 15 total complications, of which 4 were major complications and 11 were minor complications. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.</div></div><div><h3>Conclusion</h3><div>This early international experience with the SPr procedure showed that it is a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates observed with other techniques and platforms used in rectal cancer surgery were not demonstrated. An international registry was used to better understand the opportunities and limitations of SPr technology in rectal cancer surgery as the tec","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101929"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824230","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}
Pub Date : 2025-02-01DOI: 10.1016/j.gassur.2024.101935
Ran He , Jianxiong Lai , Ou Jiang , Jian Li
Background
Challenges persist in the management of appendicitis in children, but its incidence and temporal trends have been reported in only a few developed countries. This study aimed to comprehensively investigate the incidence and temporal trends of appendicitis in children at the global, regional, and national levels, providing evidence for implementing and scaling up intervention services to reduce adverse health outcomes.
Methods
This study downloaded incidence data on appendicitis in children from the Global Burden of Disease 2021. Data on number and rate of appendicitis in children were analyzed at the global, sex, age, sociodemographic, regional, and national levels. The percentage changes and average annual percentage changes were calculated. The association between the sociodemographic index (SDI) and incidence of appendicitis in children was also determined by Pearson correlation analysis.
Results
In 2021, the newly diagnosed appendicitis in children was estimated to be 2,193,020, accounting for 12.93% of all cases of appendicitis in the general population. The corresponding incidence rate was estimated to be 109 per 100,000. From 1990 to 2021, the incidence of appendicitis in children increased by 0.3% annually. The incidence varied widely across regions and countries, whereas there was a significant positive association between the incidence rates (R = 0.6620, P <.001) and its percentage changes (R = 0.2234, P =.0013) of appendicitis in children and the SDI.
Conclusion
Appendicitis will continue to be a major public health challenge in children worldwide, especially in transitioning countries and regions. A comprehensive description of the incidence and its changing patterns, increasing awareness, and rational resource allocation are needed to reduce the burden of pediatric appendicitis.
{"title":"The incidence and temporal trend of appendicitis in children: An analysis from the Global Burden of Disease Study 2021","authors":"Ran He , Jianxiong Lai , Ou Jiang , Jian Li","doi":"10.1016/j.gassur.2024.101935","DOIUrl":"10.1016/j.gassur.2024.101935","url":null,"abstract":"<div><h3>Background</h3><div>Challenges persist in the management of appendicitis in children, but its incidence and temporal trends have been reported in only a few developed countries. This study aimed to comprehensively investigate the incidence and temporal trends of appendicitis in children at the global, regional, and national levels, providing evidence for implementing and scaling up intervention services to reduce adverse health outcomes.</div></div><div><h3>Methods</h3><div>This study downloaded incidence data on appendicitis in children from the Global Burden of Disease 2021. Data on number and rate of appendicitis in children were analyzed at the global, sex, age, sociodemographic, regional, and national levels. The percentage changes and average annual percentage changes were calculated. The association between the sociodemographic index (SDI) and incidence of appendicitis in children was also determined by Pearson correlation analysis.</div></div><div><h3>Results</h3><div>In 2021, the newly diagnosed appendicitis in children was estimated to be 2,193,020, accounting for 12.93% of all cases of appendicitis in the general population. The corresponding incidence rate was estimated to be 109 per 100,000. From 1990 to 2021, the incidence of appendicitis in children increased by 0.3% annually. The incidence varied widely across regions and countries, whereas there was a significant positive association between the incidence rates (R = 0.6620, <em>P</em> <.001) and its percentage changes (R = 0.2234, <em>P</em> =.0013) of appendicitis in children and the SDI.</div></div><div><h3>Conclusion</h3><div>Appendicitis will continue to be a major public health challenge in children worldwide, especially in transitioning countries and regions. A comprehensive description of the incidence and its changing patterns, increasing awareness, and rational resource allocation are needed to reduce the burden of pediatric appendicitis.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 2","pages":"Article 101935"},"PeriodicalIF":2.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864557","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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