Journal of Surgical Oncology最新文献

Background and objectives: Parathyroid gland detection is a fundamental skill in endocrine surgery that is enhanced with experience. This study aims to investigate the impact of near-infrared autofluorescence (NIRAF) imaging on a surgical team's ability to recognize parathyroid glands during thyroidectomy and parathyroidectomy procedures across different training levels.

Methods: Patients who underwent thyroidectomy or parathyroidectomy under NIRAF guidance by three surgeons between March and June 2024 were included. Attending surgeons, endocrine surgery fellows, and general surgery residents were assessed regarding their ability to recognize parathyroid glands before and after NIRAF imaging during the procedures. Wilcoxon and Chi-Square tests were used for statistical analyses.

Results: Assessments were made in 32 thyroidectomy and 53 parathyroidectomy procedures, with eventual intraoperative identification of a total of 255 parathyroid glands. A total of 896 collective assessments were made. There were 250 assessments involving junior trainees, 288 involving senior trainees (fellows), and 358 involving the primary surgeon. Parathyroid detection rates for junior trainees, senior trainees, and attending surgeons before versus after NIRAF imaging were 46.5% versus 94.8%, 68% versus 97%, and 80% versus 100%, respectively (p < 0.0001). For the same groups, respectively, NIRAF imaging detected 48.3%, 29%, and 20% of parathyroid glands not initially visible on conventional view (p < 0.0001) and increased the confidence for 51.7%, 71%, and 80% of parathyroid glands that were already recognized on conventional view (p < 0.0001). Overall, for junior trainees, senior trainees, and attending surgeons, NIRAF made a positive impact in the recognition of 82.6% (n = 142/172), 62% (n = 124/200), and 42% (n = 107/255) of the total number parathyroid glands, ultimately identified during the surgical procedures respectively, (p < 0.0001).

Conclusions: Our results show that NIRAF imaging improved the whole surgical team's ability to recognize parathyroid glands, with the degree of impact inversely related to the level of surgical training.

Background: It is unknown if textbook outcomes (TBOs) correlate with patient-reported health-related quality of life (HRQoL) parameters in patients undergoing hepatic resection for colorectal liver metastasises. Understanding this relationship is required to inform treatment decisions and optimise patient care. This single-centre analysis aims to assess this correlation and provide insight into the impact of liver resection on patient well-being in this population.

Methods: Single-centre analysis of all liver resections performed for colorectal liver metastases (CRLM) at our centre from 2018 to 2023. The EuroQol-5D (EQ-5D) validated telephone questionnaire was used to assess HRQoL. The impact of a TBO on overall survival and recurrence-free survival was investigated using Kaplan-Meier curve analysis. A Cox model was used to determine factors associated with improved survival.

Results: 185 patients underwent liver resection for CRLM between 2018 and 2023. 55% of eligible patients completed the EQ-5D telephone questionnaire. TBOs were achieved in 68.2% of CRLM at our institution. Achieving TBOs in this cohort was associated with improved HRQoL (p = 0.061).

Conclusion: This study demonstrates excellent long-term HRQoL in patients who undergo resection for CRLM. Achieving TBO in this cohort is associated with improved patient-reported HRQoL. Our findings strengthen the utility of the previously defined textbook outcomes in CRLM.

Background: Surgical resection for pancreas ductal adenocarcinoma (PDAC) remains the mainstay of treatment. Regardless of enhanced survival rates, disparities in patient outcomes and experiences driven by the social determinants of health (SDH) persist. The area deprivation index (ADI) comprises 17 indicators related to education, employment, housing-quality, and poverty. We sought to examine the impact of ADI on surgical outcomes of PDAC patients.

Methods: Patients who underwent pancreatoduodenectomy or distal pancreatectomy for PDAC between January 2011 and December 2022 were identified. ADI was calculated using patient zip codes and categorized into quartiles, with the highest indicating the most marginalized. The primary outcome was loss to follow-up after surgical resection. To account for confounders, a competing risk multivariable regression analysis was used.

Results: A total of 1001 patients had a mean age of 66.6 (±9.64), with 46.3% (n = 463) of patients being female. A majority, 94.6% (n = 947), identified as white, and 64.1% (n = 641) had at least a college degree. The median length of follow-up after surgery was 1.8 years (interquartile range: 0.9-3.5). Multivariable analysis adjusting for competing risk of death, showed that patients who are least marginalized are 1.57 times more likely to have their follow-up than those most marginalized (hazard ratio: 1.57, 95% confidence interval: 1.08-2.29, p = 0.017).

Conclusion: SDH impact many aspects of patient's care including a higher risk of loss to follow-up for marginalized patients after surgery for PDAC. Future efforts should seek to identify and lower barriers faced by marginalized patients with system-level changes to ensure equitable access.

Introduction: Malignant bowel obstructions (MBO) are complex, heterogeneous disease processes which can be managed with surgical or endoscopic interventions. Patients with MBO often have advanced metastatic disease and poor functional status, which makes it difficult for providers to determine the best treatment strategy.

Methods: Patients with urgent or emergent admissions and a primary or secondary ICD-9/ICD-10 diagnosis of bowel obstruction with an additional diagnosis of disseminated cancer were identified from the National Inpatient Sample (2000-2017). Patients were stratified into operative and non-operative intervention groups. Multivariate regression determined factors associated with surgical treatment of MBO based on significant factors on univariate analysis. Trends in treatment over time were calculated using log-linear regression to determine the annual percent change (APC).

Results: Of 1118 patients, 18% underwent surgery and 7% underwent endoscopic intervention. From 2000 to 2017, a decreasing proportion of patients underwent surgery (APC -2.4, p = 0.023) with a commensurate increase in endoscopic interventions (APC 5.3, p = 0.042). There was also a decrease in the proportion of patients who died during hospitalization (APC -4.3, p = 0.029). Surgery was associated with longer mean lengths of stay (13 days vs. 7 days, p < 0.001) and higher rates of in-hospital mortality (13% vs. 6%, p = 0.001) compared to non-operative management.

Conclusion: The proportion of patients receiving surgery for MBO is decreasing and that receiving endoscopic interventions is increasing. In-hospital mortality is also decreasing proportionately, suggesting an improvement in patient selection.

Background and objectives: Although resection of colorectal liver metastases (CRLM) improves survival, factors including race and health insurance are associated with disparities in care. The aim of this study was to evaluate the effect of health insurance on racial disparities in CRLM resection.

Methods: A retrospective study of patients with CRC with synchronous CRLM was performed using the National Cancer Database (2004-2020). The primary outcome was resection liver resection. Multivariable logistic regression (MVR) was performed to evaluate the association of race and insurance with the odds of resection.

Results: Forty-four thousand and six hundred sixteen patients were included. Resection rates were lower among Blacks compared to White patients (12.9% vs. 17.3%). By MVR, Black patients (OR 0.76 vs. White), uninsured and Medicaid-insured patients (OR 0.49 and OR 0.71 vs. private insurance) were less likely to undergo resection. On MVR of race stratified by insurance, Black patients with private and Medicare insurance had decreased odds of resection compared to White (OR 0.71 and OR 0.64).

Conclusions: Although Black patients with CRLM have lower odds of hepatic resection compared to White, when stratified by insurance, this was only present among private- and Medicare-insured. Further investigation is warranted to understand other factors associated with racial disparities in this population.

Background and objectives: Pancreatoduodenectomy (PD) has been associated with significant morbidity and mortality. To reduce morbidity, minimally invasive pancreatoduodenectomies (MIPD) have become more prevalent. We aimed to compare short-term survival and complications for open (OPD) versus MIPD and to assess the relationship between operative approach and operative time on outcomes.

Methods: Patients undergoing PD between 2017 and 2020 were identified within the National Surgical Quality Improvement Program (NSQIP). The primary outcome was operative time, and the secondary outcomes were death at 30 days, reoperation, readmission, and NSQIP-identified 30-day postoperative complications. A multivariable logistic regression was performed.

Results: A total of 14 977 PDs were performed from 2017 to 2020. MIPD increased from less than 8% of pancreatoduodenectomies performed in 2017 to over 10% of PD by 2020. Of the MIPD cohort, 62% were robotic, and 38% were laparoscopic, with robotic surgery becoming most prevalent by the end of the study period. MIPD was associated with significantly longer operative times than OPD (p < 0.01). MIPD was associated with decreased odds of postoperative bleeding and surgical site infection (p < 0.01), but higher odds of death at 30 days.

Conclusions: MIPD has been shown to have improved postoperative outcomes compared to OPD but is associated with longer operative times, which can be associated with increased complications.