Journal of Gastrointestinal Surgery最新文献

英文中文

Foramen of Winslow hernia initially diagnosed as cecal volvulus

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-26 DOI: 10.1016/j.gassur.2025.101973

Bryan Chen , Matthew Morris , Michael Jureller

引用次数: 0

Textbook Outcomes Among Patients Undergoing CRS+HIPEC for Peritoneal Surface Malignancies in an Eastern European Population.

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-21 DOI: 10.1016/j.gassur.2025.101971

Sebastian Kobiałka, Marcin Kubiak, Katarzyna Sędłak, Radosław Mlak, Zuzanna Pelc, Wojciech Polkowski, Paweł Bogacz, Katarzyna Chawrylak, Katarzyna Mielniczek, Magdalena Leśniewska, Andrew Gumbs, S Vincent Grasso, Timothy M Pawlik, Kamil Torres, Paweł Rybojad, Karol Rawicz-Pruszyński

Background: The preferred treatment option for patients with limited peritoneal metastasis (PM) is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC).While the textbook outcome (TO) concept has been applied to other complex surgeries, its prevalence, determinants, and impact in patients with PM remain unclear. This study sought to identify factors influencing TO among individuals with PM undergoing CRS+HIPEC in an Eastern European population.

Materials and methods: Between 2010 and 2023, 300 patients with PM were treated at the Department of Surgical Oncology, Medical University of Lublin. In this cohort, 155 patients were scheduled for CRS+HIPEC to achieve complete cytoreduction.

Results: Overall, TO achievement in the entire cohort was 56.1%. Patients with gastrointestinal or peritoneal cancers had lower odds of achieving TO compared with individuals with ovarian cancer (51.4% vs. 68.2%; OR 0.49; 95% CI 0.24-1.03). Patients with PCI (Peritoneal Cancer Index) ≥14 had lower odds of achieving TO compared with individuals with PCI <14 (31.4% vs. 63.3%; OR 0.27; 95%CI 0.12-0.59). Achievement of completeness of cytoreduction (CCR 0/1) increased the odds of TO compared with non-completed CRS (CCR≥2, 63.5%vs.0%; OR 64.11; 95%CI 3.78-1086.72). Median overall survival (OS) for the entire cohort was 37.5 months. Achievement of TO was associated with decreased hazards of death among patients with PM undergoing CRS+HIPEC (HR 0.55; 95%CI 0.34-0.88) CONCLUSION: TO achievement improved overall survival (OS) among patients with PM undergoing CRS+HIPEC. Barriers to achieving TO included PCI ≥14, perioperative complications and incomplete cytoreduction.

{"title":"Textbook Outcomes Among Patients Undergoing CRS+HIPEC for Peritoneal Surface Malignancies in an Eastern European Population.","authors":"Sebastian Kobiałka, Marcin Kubiak, Katarzyna Sędłak, Radosław Mlak, Zuzanna Pelc, Wojciech Polkowski, Paweł Bogacz, Katarzyna Chawrylak, Katarzyna Mielniczek, Magdalena Leśniewska, Andrew Gumbs, S Vincent Grasso, Timothy M Pawlik, Kamil Torres, Paweł Rybojad, Karol Rawicz-Pruszyński","doi":"10.1016/j.gassur.2025.101971","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101971","url":null,"abstract":"<p><strong>Background: </strong>The preferred treatment option for patients with limited peritoneal metastasis (PM) is cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS+HIPEC).While the textbook outcome (TO) concept has been applied to other complex surgeries, its prevalence, determinants, and impact in patients with PM remain unclear. This study sought to identify factors influencing TO among individuals with PM undergoing CRS+HIPEC in an Eastern European population.</p><p><strong>Materials and methods: </strong>Between 2010 and 2023, 300 patients with PM were treated at the Department of Surgical Oncology, Medical University of Lublin. In this cohort, 155 patients were scheduled for CRS+HIPEC to achieve complete cytoreduction.</p><p><strong>Results: </strong>Overall, TO achievement in the entire cohort was 56.1%. Patients with gastrointestinal or peritoneal cancers had lower odds of achieving TO compared with individuals with ovarian cancer (51.4% vs. 68.2%; OR 0.49; 95% CI 0.24-1.03). Patients with PCI (Peritoneal Cancer Index) ≥14 had lower odds of achieving TO compared with individuals with PCI <14 (31.4% vs. 63.3%; OR 0.27; 95%CI 0.12-0.59). Achievement of completeness of cytoreduction (CCR 0/1) increased the odds of TO compared with non-completed CRS (CCR≥2, 63.5%vs.0%; OR 64.11; 95%CI 3.78-1086.72). Median overall survival (OS) for the entire cohort was 37.5 months. Achievement of TO was associated with decreased hazards of death among patients with PM undergoing CRS+HIPEC (HR 0.55; 95%CI 0.34-0.88) CONCLUSION: TO achievement improved overall survival (OS) among patients with PM undergoing CRS+HIPEC. Barriers to achieving TO included PCI ≥14, perioperative complications and incomplete cytoreduction.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101971"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028871","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}

引用次数: 0

You may delay, but time will not

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-21 DOI: 10.1016/j.gassur.2025.101970

Fumihiro Kawano, Claudius Conrad

引用次数: 0

Quality of life and social health in patients after pancreatic surgery

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-21 DOI: 10.1016/j.gassur.2025.101969

Nicholas Galouzis, Maria Khawam, Evelyn V. Alexander, Lusine Mesropyan, Carrie Luu, Mohammad R. Khreiss, Taylor S. Riall

Background

Clinicians lack robust data on quality of life (QOL) and social functioning after pancreatectomy limiting their ability guide patient decision making aligned with patients’ goals of care.

Methods

In this cross-sectional survey study, we administered the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire, pancreas-specific QLQ-PAN26, Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate in Social Roles, and PROMIS activities and social isolation scales to all elective pancreatectomies (2021–2023). Results were compared with both normative data and between groups to determine factors predicting better QOL with a >10–12-point change considered clinically significant.

Results

A total of 143 patients were included; 71 (49.6%) completed the distributed surveys. The average age of responders was 59.9 ± 16.1 years with 56.3% men. Pancreaticoduodenectomy (54.9%) was performed for malignancy in 67.6% of cases. Compared with normative population controls, postpancreatectomy patients reported lower role functioning scores (67.2 ± 28.7 vs 81.7 ± 28.2, 14.5 score difference) but less social isolation (40.6 ± 5.7 vs 50.0 ± 10.0, 9.4 score difference). Compared with patients with benign disease, those with malignancy reported clinically significant worse social functioning; more fatigue, pain, constipation, change in taste, weight loss, weakness, and altered bowel habits; worse body image; and increased worries about the future. Despite more symptoms, they were more satisfied with the healthcare they received (all >10-point score difference).

Conclusion

QOL and social health are affected by pancreatic resection and outcomes differ whether surgery was performed for benign or malignant disease. These issues are largely unaddressed and are potential targets for intervention to improve QOL.

{"title":"Quality of life and social health in patients after pancreatic surgery","authors":"Nicholas Galouzis, Maria Khawam, Evelyn V. Alexander, Lusine Mesropyan, Carrie Luu, Mohammad R. Khreiss, Taylor S. Riall","doi":"10.1016/j.gassur.2025.101969","DOIUrl":"10.1016/j.gassur.2025.101969","url":null,"abstract":"<div><h3>Background</h3><div>Clinicians lack robust data on quality of life (QOL) and social functioning after pancreatectomy limiting their ability guide patient decision making aligned with patients’ goals of care.</div></div><div><h3>Methods</h3><div>In this cross-sectional survey study, we administered the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire, pancreas-specific QLQ-PAN26, Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate in Social Roles, and PROMIS activities and social isolation scales to all elective pancreatectomies (2021–2023). Results were compared with both normative data and between groups to determine factors predicting better QOL with a >10–12-point change considered clinically significant.</div></div><div><h3>Results</h3><div>A total of 143 patients were included; 71 (49.6%) completed the distributed surveys. The average age of responders was 59.9 ± 16.1 years with 56.3% men. Pancreaticoduodenectomy (54.9%) was performed for malignancy in 67.6% of cases. Compared with normative population controls, postpancreatectomy patients reported lower role functioning scores (67.2 ± 28.7 vs 81.7 ± 28.2, 14.5 score difference) but less social isolation (40.6 ± 5.7 vs 50.0 ± 10.0, 9.4 score difference). Compared with patients with benign disease, those with malignancy reported clinically significant worse social functioning; more fatigue, pain, constipation, change in taste, weight loss, weakness, and altered bowel habits; worse body image; and increased worries about the future. Despite more symptoms, they were more satisfied with the healthcare they received (all >10-point score difference).</div></div><div><h3>Conclusion</h3><div>QOL and social health are affected by pancreatic resection and outcomes differ whether surgery was performed for benign or malignant disease. These issues are largely unaddressed and are potential targets for intervention to improve QOL.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101969"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028858","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}

引用次数: 0

Global, regional, and national burden of gallbladder and biliary tract cancer, 1990 to 2021 and predictions to 2045: an analysis of the Global Burden of Disease study 2021

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-21 DOI: 10.1016/j.gassur.2025.101968

Chunlong Liu , Sen Du , Xue Liu , Wang Niu , Kun Song , Jiangtao Yu

Background

Identifying past, present, and future temporal trends in gallbladder and biliary tract cancer (GBTC) can increase public awareness and promote changes in prevention and treatment strategies.

Methods

The incidence and death rates of GBTC between 1990 and 2021 were extracted from the Global Burden of Disease study 2021 and assessed according to country, region, year, age, and sex. Time trends were measured using the average annual percentage change (AAPC) and projections of the burden of disease for 2022 to 2045 were made using the Bayesian age-period-cohort model.

Results

In 2021, there were 216,768.3 new cases (95% uncertainty interval [UI], 181,888.0–245,237.6) and 171,961.2 deaths (95% UI, 142,351.8–194,238.4) in GBTC globally. The increases in incidence and deaths were 101.09% and 74.26%, respectively, compared with 1990. The GBTC burden was higher in females and older adults. However, age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) trended downward from 1990 to 2021, with AAPC at −0.39 (95% CI, −0.52 to −0.26) and −0.88 (95% CI, −0.96 to −0.79), respectively. Although the ASIR and ASDR for both sexes are projected to decline gradually from 2022 to 2045, the incidence and deaths are expected to increase steadily. In addition, the global proportion of GBTC deaths owing to high body mass index in 2021 was 12.66% for females and 10.48% for males, which did not change significantly from 1990.

Conclusion

GBTC is becoming a major global health burden, especially among females and older adults. Given the increasing burden of an aging population, there is a need to reduce the incidence of this disease by adopting effective strategies and measures targeting risk factors.

{"title":"Global, regional, and national burden of gallbladder and biliary tract cancer, 1990 to 2021 and predictions to 2045: an analysis of the Global Burden of Disease study 2021","authors":"Chunlong Liu , Sen Du , Xue Liu , Wang Niu , Kun Song , Jiangtao Yu","doi":"10.1016/j.gassur.2025.101968","DOIUrl":"10.1016/j.gassur.2025.101968","url":null,"abstract":"<div><h3>Background</h3><div>Identifying past, present, and future temporal trends in gallbladder and biliary tract cancer (GBTC) can increase public awareness and promote changes in prevention and treatment strategies.</div></div><div><h3>Methods</h3><div>The incidence and death rates of GBTC between 1990 and 2021 were extracted from the Global Burden of Disease study 2021 and assessed according to country, region, year, age, and sex. Time trends were measured using the average annual percentage change (AAPC) and projections of the burden of disease for 2022 to 2045 were made using the Bayesian age-period-cohort model.</div></div><div><h3>Results</h3><div>In 2021, there were 216,768.3 new cases (95% uncertainty interval [UI], 181,888.0–245,237.6) and 171,961.2 deaths (95% UI, 142,351.8–194,238.4) in GBTC globally. The increases in incidence and deaths were 101.09% and 74.26%, respectively, compared with 1990. The GBTC burden was higher in females and older adults. However, age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) trended downward from 1990 to 2021, with AAPC at −0.39 (95% CI, −0.52 to −0.26) and −0.88 (95% CI, −0.96 to −0.79), respectively. Although the ASIR and ASDR for both sexes are projected to decline gradually from 2022 to 2045, the incidence and deaths are expected to increase steadily. In addition, the global proportion of GBTC deaths owing to high body mass index in 2021 was 12.66% for females and 10.48% for males, which did not change significantly from 1990.</div></div><div><h3>Conclusion</h3><div>GBTC is becoming a major global health burden, especially among females and older adults. Given the increasing burden of an aging population, there is a need to reduce the incidence of this disease by adopting effective strategies and measures targeting risk factors.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101968"},"PeriodicalIF":2.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028884","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}

引用次数: 0

Invited commentary on “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? Intraoperative air leak test matters”

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-21 DOI: 10.1016/j.gassur.2025.101966

Marco E. Allaix, Mario Morino

引用次数: 0

Sarcoidosis of the common bile duct: an uncommon mimicker of biliary malignancy

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.gassur.2025.101967

Giulia Canali, Gerlinde Averous, Pietro Addeo

引用次数: 0

Postoperative outcomes of a pelvic pouch procedure: Lessons learned over 40 years among 5070 patients

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.gassur.2024.101938

Olga Lavryk, Marianna Maspero, Stefan D. Holubar, Arielle Kanters, David Liska, Michael A. Valente, Jeremy M. Lipman, Hermann Kessler, Scott R. Steele, Tracy L. Hull

Background

This study aimed to report the experience over 40 years and outcomes of 5070 patients who underwent a pelvic pouch procedure.

Methods

A retrospective analysis of a prospectively maintained ileal pouch-anal anastomosis (IPAA) database (1983–2022) was performed. Patients were stratified based on the following diagnoses: ulcerative colitis (UC), indeterminate colitis (IC), familial adenomatous polyposis (FAP), inflammatory bowel disease (IBD)-dysplasia, Crohn colitis (CD), and others. The long-term IPAA outcomes, quality of life, and satisfaction with IPAA over time were studied.

Results

The Kaplan-Meier pouch survival rates at 20 years based on the diagnosis were as follows: 92% (95% CI, 90%–94%) for UC, 87% (95% CI, 81%–94%) for CD, 95% (95% CI, 92%–99%) for FAP, and 92% (95% CI, 89%–96%) for IC. Of the patients with UC, 28% developed pouchitis, 12% developed anastomotic stricture, and 13% developed small bowel obstruction. Patients with IC had the highest rate of pouchitis (347 [37%]) and IPAA strictures (154 [17%]). Patients with CD had the highest rate of fistula (26 [15%]). Patients with FAP had the highest rate of obstruction (41 [25%]). The social lifestyle restrictions were predominant among patients with FAP (20%) compared with those with UC (12%) or CD (13%) (P =.004). The median stool frequency was 6 (IQR, 5–8) among the groups (P =.46).

Conclusion

Patients with an IBD diagnosis and IPAA were at an increased risk of pouch-associated complications, such as pouchitis, strictures, and pelvic sepsis. Patients with FAP had the best pouch survival with significantly lower rates of pouch-associated complications.

{"title":"Postoperative outcomes of a pelvic pouch procedure: Lessons learned over 40 years among 5070 patients","authors":"Olga Lavryk, Marianna Maspero, Stefan D. Holubar, Arielle Kanters, David Liska, Michael A. Valente, Jeremy M. Lipman, Hermann Kessler, Scott R. Steele, Tracy L. Hull","doi":"10.1016/j.gassur.2024.101938","DOIUrl":"10.1016/j.gassur.2024.101938","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to report the experience over 40 years and outcomes of 5070 patients who underwent a pelvic pouch procedure.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively maintained ileal pouch-anal anastomosis (IPAA) database (1983–2022) was performed. Patients were stratified based on the following diagnoses: ulcerative colitis (UC), indeterminate colitis (IC), familial adenomatous polyposis (FAP), inflammatory bowel disease (IBD)-dysplasia, Crohn colitis (CD), and others. The long-term IPAA outcomes, quality of life, and satisfaction with IPAA over time were studied.</div></div><div><h3>Results</h3><div>The Kaplan-Meier pouch survival rates at 20 years based on the diagnosis were as follows: 92% (95% CI, 90%–94%) for UC, 87% (95% CI, 81%–94%) for CD, 95% (95% CI, 92%–99%) for FAP, and 92% (95% CI, 89%–96%) for IC. Of the patients with UC, 28% developed pouchitis, 12% developed anastomotic stricture, and 13% developed small bowel obstruction. Patients with IC had the highest rate of pouchitis (347 [37%]) and IPAA strictures (154 [17%]). Patients with CD had the highest rate of fistula (26 [15%]). Patients with FAP had the highest rate of obstruction (41 [25%]). The social lifestyle restrictions were predominant among patients with FAP (20%) compared with those with UC (12%) or CD (13%) (<em>P</em> =.004). The median stool frequency was 6 (IQR, 5–8) among the groups (<em>P</em> =.46).</div></div><div><h3>Conclusion</h3><div>Patients with an IBD diagnosis and IPAA were at an increased risk of pouch-associated complications, such as pouchitis, strictures, and pelvic sepsis. Patients with FAP had the best pouch survival with significantly lower rates of pouch-associated complications.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 4","pages":"Article 101938"},"PeriodicalIF":2.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023364","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}

引用次数: 0

Bowel function and quality-of-life outcomes in locally advanced rectal cancer: watch-and-wait vs total mesorectal excision

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.gassur.2025.101972

Tapas N. Parikh , Kent J. Peterson , Ruta Brazauskas , Jed F. Calata , Carrie Y. Peterson , Kirk A. Ludwig , Timothy J. Ridolfi

引用次数: 0

Association of care fragmentation and hospital cancer designation with survival in gastroesophageal junction cancer: a statewide study 一项全国范围的研究：胃食管结癌患者护理分散和医院肿瘤类型与生存的关系。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-16 DOI: 10.1016/j.gassur.2025.101962

Rejoice F. Ngongoni , Hester C. Timmerhuis , Amy Y. Li , Heather Day , Jon Harrison , Brendan C. Visser

Background

Fragmentation of care (FC) refers to healthcare provided by different providers and facilities. FC has been associated with inferior outcomes. However, it improves access to specialized cancer care. This study aimed to identify the association between fragmented gastroesophageal junction (GEJ) cancer care and survival.

Methods

In this retrospective cohort study, adults diagnosed with primary GEJ cancer between January 1, 2007, and December 31, 2017, were identified in the California Cancer Registry (patient data) and merged with the California Department of Healthcare Access and Information database (facility-level data for each patient encounter). FC was measured by quantity, defined as the number of facilities a patient visited within 1 year after diagnosis, and FC directionality, defined by how patients transitioned across different healthcare facilities (with/without cancer center designation). Multivariate time-varying Cox regression models were used to determine the association between FC and survival, which was expressed as hazard ratios (HRs).

Results

Overall, 6025 patients were identified. Of the 2919 patients (48.4%) who experienced FC, 1979 (67.8%) were observed at 2 facilities. Time-varying Cox regression for FC quantity showed that FC quantity was associated with higher mortality (2 facilities: HR, 1.21; 95% CI, 1.12–1.31; P <.001, 3 facilities: HR, 1.47; 95% CI, 1.31–1.65; P <.001; ≥4 facilities: HR, 2.34; 95% CI, 1.93–2.82; P <.001). Upgrading care received from a non-designated center to a designated center was associated with a higher survival than patients who received unfragmented non-designated care (HR: 1.40 [95% CI, 1.16–1.70; P=.001] vs 1.48 [95% CI, 1.29–1.70; P <.001] respectively).

Conclusion

Fragmented GEJ cancer care was associated with decreased survival rates. However, upgrading care from a nondesignated cancer facility to a designated cancer facility could mitigate the deleterious association between FC and decreased survival rates.

背景：分散护理（FC）是由不同的提供者和/或设施提供的医疗保健。FC与预后较差有关，但它改善了获得专门癌症治疗的机会。我们的目的是确定碎片性胃食管结癌（GEJ）护理与生存的关系。方法：在这项回顾性队列研究中，在2007年1月1日至2017年12月31日期间被诊断为原发性GEJ癌的成年人，在加州癌症登记处（患者数据）中被确定，并与加州医疗保健访问和信息数据库（每个患者就诊的设施级数据）合并。FC通过数量来衡量，定义为患者在诊断后1年内访问的设施数量，以及FC方向性，定义为患者如何在不同的医疗保健设施（有/没有癌症中心指定）之间转换。采用多变量时变Cox回归模型确定FC与生存率的关系，以风险比（HR）表示。结果：共发现6025例患者。2919例（48.4%）FC患者中，1979例（67.8%）在两家医院就诊。FC数量的时变Cox回归显示FC数量与较高的死亡率相关（2个设施：HR:1.21,(1.12-1.31)）。结论：碎片化的GEJ癌症治疗与生存率降低相关。然而，将护理升级到指定的癌症设施可以减轻碎片化与生存率降低的有害关联。

{"title":"Association of care fragmentation and hospital cancer designation with survival in gastroesophageal junction cancer: a statewide study","authors":"Rejoice F. Ngongoni , Hester C. Timmerhuis , Amy Y. Li , Heather Day , Jon Harrison , Brendan C. Visser","doi":"10.1016/j.gassur.2025.101962","DOIUrl":"10.1016/j.gassur.2025.101962","url":null,"abstract":"<div><h3>Background</h3><div>Fragmentation of care (FC) refers to healthcare provided by different providers and facilities. FC has been associated with inferior outcomes. However, it improves access to specialized cancer care. This study aimed to identify the association between fragmented gastroesophageal junction (GEJ) cancer care and survival.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, adults diagnosed with primary GEJ cancer between January 1, 2007, and December 31, 2017, were identified in the California Cancer Registry (patient data) and merged with the California Department of Healthcare Access and Information database (facility-level data for each patient encounter). FC was measured by quantity, defined as the number of facilities a patient visited within 1 year after diagnosis, and FC directionality, defined by how patients transitioned across different healthcare facilities (with/without cancer center designation). Multivariate time-varying Cox regression models were used to determine the association between FC and survival, which was expressed as hazard ratios (HRs).</div></div><div><h3>Results</h3><div>Overall, 6025 patients were identified. Of the 2919 patients (48.4%) who experienced FC, 1979 (67.8%) were observed at 2 facilities. Time-varying Cox regression for FC quantity showed that FC quantity was associated with higher mortality (2 facilities: HR, 1.21; 95% CI, 1.12–1.31; <em>P</em> <.001, 3 facilities: HR, 1.47; 95% CI, 1.31–1.65; <em>P</em> <.001; ≥4 facilities: HR, 2.34; 95% CI, 1.93–2.82; <em>P</em> <.001). Upgrading care received from a non-designated center to a designated center was associated with a higher survival than patients who received unfragmented non-designated care (HR: 1.40 [95% CI, 1.16–1.70; <em>P</em>=.001] vs 1.48 [95% CI, 1.29–1.70; <em>P</em> <.001] respectively).</div></div><div><h3>Conclusion</h3><div>Fragmented GEJ cancer care was associated with decreased survival rates. However, upgrading care from a nondesignated cancer facility to a designated cancer facility could mitigate the deleterious association between FC and decreased survival rates.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101962"},"PeriodicalIF":2.2,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006612","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}

引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of Gastrointestinal Surgery

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