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Predicting the resolution of hypertension following adrenalectomy in primary aldosteronism: Controversies and unresolved issues a narrative review. 原发性醛固酮增多症肾上腺切除术后高血压缓解的预测:争议和悬而未决的问题叙述性综述。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-10-01 DOI: 10.1007/s00423-024-03486-7
Luigi Marzano

Background: Hypertension resolution following adrenalectomy in patients with primary aldosteronism (PA) remains a critical clinical challenge. Identifying preoperatively which patients will become normotensive is both a priority and a point of contention. In this narrative review, we explore the controversies and unresolved issues surrounding the prediction of hypertension resolution after adrenalectomy in PA.

Methods: A comprehensive literature review was conducted, focusing on studies published between 1954 and 2024 that evaluated all studies that discussed predictive models for hypertension resolution post-adrenalectomy in PA patients. Databases searched included MEDLINE®, Ovid Embase, and Web of Science databases.

Results: The review identified several predictors and predictive models of hypertension resolution, including female sex, duration of hypertension, antihypertensive medication, and BMI. However, inconsistencies in study designs and patient populations led to varied conclusions.

Conclusions: Although certain predictors and predictive models of hypertension resolution post-adrenalectomy in PA patients are supported by evidence, significant controversies and unresolved issues remain. While the current predictive models provide valuable insights, there is a clear need for further research in this area. Future studies should focus on validating and refining these models.

背景:原发性醛固酮增多症(PA)患者肾上腺切除术后的高血压缓解仍是一项严峻的临床挑战。术前确定哪些患者的血压会恢复正常既是当务之急,也是争议焦点。在这篇叙述性综述中,我们探讨了有关预测 PA 患者肾上腺切除术后高血压缓解的争议和未决问题:我们进行了全面的文献综述,重点关注 1954 年至 2024 年间发表的研究,评估了所有讨论 PA 患者肾上腺切除术后高血压缓解预测模型的研究。检索的数据库包括 MEDLINE®、Ovid Embase 和 Web of Science 数据库:结果:综述发现了几种高血压缓解的预测因素和预测模型,包括女性性别、高血压持续时间、抗高血压药物和体重指数。然而,研究设计和患者人群的不一致导致了不同的结论:结论:虽然 PA 患者肾上腺切除术后高血压缓解的某些预测因素和预测模型有证据支持,但仍存在重大争议和未解决的问题。虽然目前的预测模型提供了有价值的见解,但该领域显然需要进一步研究。未来的研究应侧重于验证和完善这些模型。
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引用次数: 0
Key points of surgical anatomy for endoscopic thyroidectomy via a gasless unilateral axillary approach. 通过无气单侧腋窝入路进行内窥镜甲状腺切除术的手术解剖要点。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-10-01 DOI: 10.1007/s00423-024-03473-y
Kexin Meng, Ying Xin, Zhuo Tan, Jiajie Xu, Xiaoliang Chen, Jincong Gu, Parikh Nikhilkumar Jagadishbhai, Chuanming Zheng

Purpose: Endoscopic thyroidectomy utilizing the Gasless Unilateral Axillary Approach (GUA) offers distinct advantages including clear visibility, simple manipulation, safe oncological outcomes. This technique eliminates postoperative neck scarring, ensures concealed surgical incisions, and minimizes postoperative swallowing discomfort.

Methods: We retrospectively reviewed 150 surgical videos to document key anatomical features and their variations during this procedure.

Results: The GUA endoscopic thyroidectomy, which approaches from the contralateral side, presents significant difficulties in identifying anatomical structures, especially anatomical abnormalities in the contralateral neck, while constructing feasible operative fields. This article offers an in-depth discussion of the anatomical challenges, pitfalls, and viable strategies associated with this surgery, particularly for less experienced surgeons.

Conclusions: Given the intricate interplay of muscular, vascular, and neural anatomical structures, novices in surgery must be well-acquainted with the underlying anatomy to minimize potential complications.

目的:采用无气单侧腋窝入路(GUA)的内窥镜甲状腺切除术具有清晰可见、操作简单、肿瘤治疗安全等显著优势。该技术可消除术后颈部瘢痕,确保手术切口隐蔽,并将术后吞咽不适降至最低:我们回顾性地查看了 150 个手术视频,记录了该手术过程中的主要解剖特征及其变化:GUA内镜甲状腺切除术从对侧入路,在识别解剖结构,尤其是对侧颈部的解剖异常,同时构建可行的手术野方面存在很大困难。本文深入探讨了与该手术相关的解剖难题、陷阱和可行策略,尤其是对经验不足的外科医生而言:鉴于肌肉、血管和神经解剖结构之间错综复杂的相互作用,手术新手必须熟知基本的解剖结构,以最大限度地减少潜在的并发症。
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引用次数: 0
Prevalence of relevant early complications during the first 24 h on a normal ward in patients following PACU care after medium and major surgery: a monocentric retrospective observational study. 中型和大型手术后在普通病房接受 PACU 护理的患者在最初 24 小时内相关早期并发症的发生率:一项单中心回顾性观察研究。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-30 DOI: 10.1007/s00423-024-03480-z
Anouk Wurth, Thilo Hackert, Dittmar Böckler, Manuel Feisst, Sabine Haag, Markus A Weigand, Thorsten Brenner, Thomas Schmoch

Purpose: Even today, it remains a challenge for healthcare professionals to decide whether a clinically stable patient who is recovering from uncomplicated medium or major surgery would benefit from a postoperative intensive care unit (ICU) admission, or whether they would be at least as adequately cared for by a few hours of monitoring in the post-operative care unit (PACU).

Methods: In this monocentric retrospective observational study, all adult patients who (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Anästh Intensivmed (50):S486-S489, 2009) underwent medium or major surgery between 1 January 1 2014 and 31 December 2018 at the Heidelberg University Surgical Center, and (Vimlati et al. in Eur J Anaesthesiol September 26(9):715-721, 2009) were monitored for 1-12 h in the PACU, and then (De Pietri et al. in World J Gastroenterol 20(9):2304-23207, 2014) transferred to a normal ward (NW) immediately thereafter were included. At the end of the PACU stay, each patient was cleared by both a surgeon and an anesthesiologist to be transferred to a NW. The first objective of this study was to determine the prevalence of relevant early complications (RECs) within the first 24 h on a normal ward. The secondary objective was to determine the prevalence of RECs in the subgroup of included patients who underwent partial pancreaticoduodenectomy.

Results: A total of 10,273 patients were included in this study. The prevalence of RECs was 0.50% (confidence interval [CI] 0.40-0.60%), with the median length of stay in the PACU before the patient's first transfer to a NW being 285 min (interquartile range 210-360 min). In the subgroup of patients who underwent partial pancreaticoduodenectomy (n = 740), REC prevalence was 1.1% (CI = 0.55-2.12%).

Conclusion: Based on a medical case-by-case assessment, it is possible to select patients who after a PACU stay of only up to 12 h have a low risk of emergency readmission to an ICU within the 24 h following the transfer to the NW. Continued research will be needed to further improve transfer decisions in such low-risk subgroups.

目的:时至今日,对于医护人员来说,如何决定临床稳定的中型或大型手术后恢复期患者是否需要入住术后重症监护室(ICU),或者是否在术后监护室(PACU)接受数小时的监护至少也能获得同样充分的护理,仍然是一项挑战:在这项单中心回顾性观察研究中,2014年1月1日至2018年12月31日期间在海德堡大学外科中心接受中型或大型手术的所有成人患者(Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Anästh Intensivmed (50):S486-S489, 2009),以及(Vimlati et al.in Eur J Anaesthesiol September 26(9):715-721, 2009)在PACU监护1-12小时,随后(De Pietri et al. in World J Gastroenterol 20(9):2304-23207, 2014)立即转入普通病房(NW)的患者纳入。在 PACU 留观结束时,每位患者均由外科医生和麻醉师批准转入 NW。本研究的首要目标是确定在普通病房的头 24 小时内相关早期并发症 (REC) 的发生率。次要目标是确定接受胰十二指肠部分切除术的亚组患者中相关早期并发症的发生率:本研究共纳入了 10273 名患者。RECs的发生率为0.50%(置信区间[CI] 0.40-0.60%),患者首次转入NW之前在PACU的中位住院时间为285分钟(四分位距为210-360分钟)。在接受胰十二指肠部分切除术的亚组患者(n = 740)中,REC发生率为1.1%(CI = 0.55-2.12%):结论:根据逐个病例的医疗评估,可以选择在PACU停留不超过12小时的患者,这些患者在转入NW后的24小时内再次紧急入住ICU的风险较低。要进一步改进此类低风险亚组的转院决策,还需要继续开展研究。
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引用次数: 0
Day-case laparoscopic cholecystectomy in the management of gallbladder disease: a literature review. 日间病例腹腔镜胆囊切除术治疗胆囊疾病:文献综述。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-28 DOI: 10.1007/s00423-024-03479-6
Mohamed Abuahmed, Rahel Rashid

Background: Day-case laparoscopic cholecystectomy (DCLC) has gained traction globally due to its benefits, including shorter hospital stays, reduced costs, and enhanced patient experience. While concerns about patient safety, particularly related to bleeding and bile duct injury persist, the literature supports the efficacy and advantages of DCLC highlighting the need for its wider adoption in healthcare settings to optimise resources and improve patient outcomes.

Methods: This was a literature review that aims to assess the feasibility and safety of day-case laparoscopic cholecystectomy for symptomatic gallstone patients, focusing on incidence and aetiology of unexpected admissions and readmissions, as well as conversion-to-open rates. PubMed was searched for all studies focusing on DCLC between 2014 and 2024. The timeframe was specifically selected to identify recent trends and practices in this evolving field. By focusing on this specific period, the review aims to provide a comprehensive analysis of current practices, emerging trends, and the evolving standard of care in this area.

Results: This review highlights that the main causes of unexpected admission post DCLC were postoperative nausea, vomiting, and pain, while the implementation of anaesthetic pathways notably increased day-case rates. Studies addressing complication rates postoperatively consistently found no significant difference between day-case and in-patient procedures.

Conclusions: DCLC for symptomatic gallstone patients is supported by research as safe and effective, with high success rates and patient satisfaction. Studies show minimal complications and acceptable readmission rates, suggesting that DCLC can be the standard approach for selective patients, improving outcomes and healthcare efficiency.

背景:日间病例腹腔镜胆囊切除术(DCLC)具有缩短住院时间、降低成本和改善患者体验等优点,已在全球范围内得到推广。尽管对患者安全的担忧,特别是与出血和胆管损伤有关的担忧依然存在,但文献支持腹腔镜胆囊切除术的疗效和优势,强调有必要在医疗机构中更广泛地采用腹腔镜胆囊切除术,以优化资源和改善患者预后:这是一项文献综述,旨在评估日间病例腹腔镜胆囊切除术治疗无症状胆结石患者的可行性和安全性,重点关注意外入院和再入院的发生率和病因,以及转开腹率。在PubMed上搜索了2014年至2024年间所有关于DCLC的研究。选择这一时间段是为了确定这一不断发展的领域的最新趋势和实践。通过关注这一特定时期,该综述旨在全面分析该领域的当前实践、新兴趋势和不断发展的护理标准:本综述强调,DCLC 术后意外入院的主要原因是术后恶心、呕吐和疼痛,而麻醉路径的实施明显增加了日间病例率。针对术后并发症发生率的研究一致发现,日间手术和住院手术之间没有显著差异:结论:对有症状的胆结石患者进行DCLC治疗安全有效,成功率高,患者满意度高,这一点得到了研究的支持。研究表明,DCLC 的并发症极少,再入院率也在可接受范围内,这表明 DCLC 可以成为选择性患者的标准方法,从而提高治疗效果和医疗效率。
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引用次数: 0
Knowledge mapping of frailty and surgery: a bibliometric and visualized analysis. 虚弱与外科手术的知识图谱:文献计量与可视化分析。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-27 DOI: 10.1007/s00423-024-03477-8
Zhiwei Guo, Feifei Wang, Jiacheng Xu, Zhonggui Shan

Purpose: Frailty is common in surgical patients and is closely associated with postoperative outcomes.

Aims: This study employed bibliometric methods to summarize and analyze research related to frailty and surgery, comprehensively analyzing the research structure and providing visualized maps.

Methods: This study analyzed the volume of publications, countries, institutions, authors, journals, references, and keywords related to perioperative frailty in the Web of Science Core Collection from 1978 to 2024. Visual bibliometric analyses were conducted from multiple perspectives, including collaboration networks, citation analysis, and keyword clustering.

Results: From 1978 to 2024, 21,879 authors from 95 countries and regions published 4,119 papers on perioperative frailty in 973 journals worldwide. The United States has the most publications, while Italy has the highest degree of international collaboration. The University of California System has the highest number of publications. The University of Kansas Medical Center is the institution with the highest centrality. The top nine authors in terms of publication volume are all from the USA. Bowers Christian A. is the most prolific author. The Journal of Vascular Surgery is the journal with the most publications. Current research directions include preoperative risk assessment of frailty, the relationship between frailty and postoperative complications, elderly frailty, and the relationship between frailty and sarcopenia. Research hotspots include risk stratification, postoperative delirium, the elderly, and sarcopenia.

Conclusion: This study has identified the research hotspots and trends in perioperative frailty. Our findings will enable researchers to understand this field's knowledge structure better and identify future research directions.

目的目的:本研究采用文献计量学方法总结和分析与虚弱和外科手术相关的研究,全面分析研究结构并提供可视化地图:本研究分析了1978年至2024年科学网核心藏书中与围手术期虚弱相关的出版物数量、国家、机构、作者、期刊、参考文献和关键词。从合作网络、引文分析和关键词聚类等多个角度进行了可视化文献计量分析:从1978年到2024年,来自95个国家和地区的21879位作者在全球973种期刊上发表了4119篇关于围手术期虚弱的论文。美国发表的论文最多,而意大利的国际合作程度最高。加利福尼亚大学系统发表的论文数量最多。堪萨斯大学医学中心是中心地位最高的机构。论文发表量排名前九位的作者均来自美国。Bowers Christian A. 是最多产的作者。血管外科杂志》是发表论文最多的杂志。目前的研究方向包括虚弱的术前风险评估、虚弱与术后并发症的关系、老年虚弱以及虚弱与肌肉疏松症的关系。研究热点包括风险分层、术后谵妄、老年人和肌肉疏松症:本研究确定了围手术期虚弱的研究热点和趋势。我们的研究结果将有助于研究人员更好地了解这一领域的知识结构,并确定未来的研究方向。
{"title":"Knowledge mapping of frailty and surgery: a bibliometric and visualized analysis.","authors":"Zhiwei Guo, Feifei Wang, Jiacheng Xu, Zhonggui Shan","doi":"10.1007/s00423-024-03477-8","DOIUrl":"https://doi.org/10.1007/s00423-024-03477-8","url":null,"abstract":"<p><strong>Purpose: </strong>Frailty is common in surgical patients and is closely associated with postoperative outcomes.</p><p><strong>Aims: </strong>This study employed bibliometric methods to summarize and analyze research related to frailty and surgery, comprehensively analyzing the research structure and providing visualized maps.</p><p><strong>Methods: </strong>This study analyzed the volume of publications, countries, institutions, authors, journals, references, and keywords related to perioperative frailty in the Web of Science Core Collection from 1978 to 2024. Visual bibliometric analyses were conducted from multiple perspectives, including collaboration networks, citation analysis, and keyword clustering.</p><p><strong>Results: </strong>From 1978 to 2024, 21,879 authors from 95 countries and regions published 4,119 papers on perioperative frailty in 973 journals worldwide. The United States has the most publications, while Italy has the highest degree of international collaboration. The University of California System has the highest number of publications. The University of Kansas Medical Center is the institution with the highest centrality. The top nine authors in terms of publication volume are all from the USA. Bowers Christian A. is the most prolific author. The Journal of Vascular Surgery is the journal with the most publications. Current research directions include preoperative risk assessment of frailty, the relationship between frailty and postoperative complications, elderly frailty, and the relationship between frailty and sarcopenia. Research hotspots include risk stratification, postoperative delirium, the elderly, and sarcopenia.</p><p><strong>Conclusion: </strong>This study has identified the research hotspots and trends in perioperative frailty. Our findings will enable researchers to understand this field's knowledge structure better and identify future research directions.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"290"},"PeriodicalIF":2.1,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349378","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}
引用次数: 0
Impact of marmara-yegen cuttıng gastrojejunostomy on delayed gastrıc emptyıng after pancreatoduodenectomy: ınıtıal results. 马尔马拉-耶根切胃空肠术对胰十二指肠切除术后延迟胃排空的影响:临床结果。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-27 DOI: 10.1007/s00423-024-03482-x
Ali Emre Atici, Ayşegul Bahar Ozocak, Ayse Eren Kayaci, Ecem Guclu Ozturk, Alper Kararmaz, Sevket Cumhur Yegen

Background: Delayed gastric emptying (DGE) is one of the most common reasons for morbidity after pancreatoduodenectomy. The technical characteristics of anastomosis that could be affected by surgeon may offer a relevant chance to improve postoperative DGE rates. We investigated the effect of a technical modification of gastrojejunostomy after the classical pancreaticoduodenectomy on DGE.

Materials and methods: A total of 161 patients underwent classical pancreaticoduodenectomy (with 20-40 percent antrectomy) due to pancreatic adenocarcinoma at the Department of General Surgery, Marmara University, School of Medicine Hospital, from February 2019 to May 2023, and those who met the inclusion criteria were enrolled. One hundred twenty patients had undergone classical end-to-side gastrojejunostomy (Classical GJ group), and 41 had undergone Marmara-Yegen cutting side-to-side gastrojejunostomy (M-Yc group). DGE was defined according to the International Working Group on Pancreatic Surgery, and postoperative DGE rates of both groups were compared. In addition, multivariate analysis was performed to identify possible independent predictive factors for DGE.

Results: The total incidence of DGE was 31% in the Classical GJ group and 17% in the (M-Yc group). Although there was no significant difference between the groups regarding DGE and DGE grades (p = 0.1), DGE was distinctly lower in the M-Yc GJ group. In multi-variant analysis, Clavien-Dindo grade 3a and above postoperative complication was determined as independent predictors for DGE.

Conclusions: We tried to explain the mechanism of DGE in terms of anatomical configuration. The incidence and severity of DGE decreased in patients who underwent M-Yc GJ.

背景:胃排空延迟(DGE)是胰十二指肠切除术后最常见的发病原因之一。可受外科医生影响的吻合技术特点可能为提高术后 DGE 发生率提供相关机会。我们研究了经典胰十二指肠切除术后胃空肠吻合术的技术改造对 DGE 的影响:2019年2月至2023年5月期间,马尔马拉大学医学院附属医院普外科共对161例因胰腺癌接受经典胰十二指肠切除术(20%-40%反切除)的患者进行了登记,符合纳入标准的患者均被纳入其中。120名患者接受了经典的端侧胃空肠吻合术(经典GJ组),41名患者接受了马尔马拉-耶根切割侧对侧胃空肠吻合术(M-Yc组)。根据国际胰腺外科工作组对 DGE 的定义,比较了两组患者的术后 DGE 发生率。此外,还进行了多变量分析,以确定DGE可能的独立预测因素:经典 GJ 组的 DGE 总发生率为 31%,M-Yc 组为 17%。虽然两组在 DGE 和 DGE 等级方面没有明显差异(P = 0.1),但 M-Yc GJ 组的 DGE 明显较低。在多变量分析中,Clavien-Dindo 3a 级及以上术后并发症被确定为 DGE 的独立预测因素:我们试图从解剖结构的角度来解释 DGE 的机制。结论:我们试图从解剖结构的角度解释 DGE 的机制。接受 M-Yc GJ 的患者 DGE 的发生率和严重程度均有所下降。
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引用次数: 0
Acute cholecystitis diagnosis in the emergency department: an artificial intelligence-based approach. 急诊科的急性胆囊炎诊断:基于人工智能的方法。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-24 DOI: 10.1007/s00423-024-03475-w
Hossein Saboorifar, Mohammad Rahimi, Paria Babaahmadi, Asal Farokhzadeh, Morteza Behjat, Aidin Tarokhian

Objectives: This study aimed to assess the diagnostic performance of a support vector machine (SVM) algorithm for acute cholecystitis and evaluate its effectiveness in accurately diagnosing this condition.

Methods: Using a retrospective analysis of patient data from a single center, individuals with abdominal pain lasting one week or less were included. The SVM model was trained and optimized using standard procedures. Model performance was assessed through sensitivity, specificity, accuracy, and AUC-ROC, with probability calibration evaluated using the Brier score.

Results: Among 534 patients, 198 (37.07%) were diagnosed with acute cholecystitis. The SVM model showed balanced performance, with a sensitivity of 83.08% (95% CI: 71.73-91.24%), a specificity of 80.21% (95% CI: 70.83-87.64%), and an accuracy of 81.37% (95% CI: 74.48-87.06%). The positive predictive value (PPV) was 73.97% (95% CI: 65.18-81.18%), the negative predictive value (NPV) was 87.50% (95% CI: 80.19-92.37%), and the AUC-ROC was 0.89 (95% CI: 0.85 to 0.93). The Brier score indicated well-calibrated probability estimates.

Conclusion: The SVM algorithm demonstrated promising potential for accurately diagnosing acute cholecystitis. Further refinement and validation are needed to enhance its reliability in clinical practice.

研究目的本研究旨在评估支持向量机(SVM)算法对急性胆囊炎的诊断性能,并评价其在准确诊断该病症方面的有效性:方法: 通过对一个中心的患者数据进行回顾性分析,纳入了腹痛持续时间在一周或一周以内的患者。采用标准程序对 SVM 模型进行了训练和优化。通过灵敏度、特异性、准确性和 AUC-ROC 评估模型性能,并使用 Brier 评分评估概率校准:在 534 名患者中,198 人(37.07%)被诊断为急性胆囊炎。SVM 模型表现均衡,灵敏度为 83.08%(95% CI:71.73-91.24%),特异度为 80.21%(95% CI:70.83-87.64%),准确度为 81.37%(95% CI:74.48-87.06%)。阳性预测值(PPV)为 73.97%(95% CI:65.18-81.18%),阴性预测值(NPV)为 87.50%(95% CI:80.19-92.37%),AUC-ROC 为 0.89(95% CI:0.85-0.93)。Brier 评分表明概率估计校准良好:结论:SVM 算法有望准确诊断急性胆囊炎。需要进一步改进和验证,以提高其在临床实践中的可靠性。
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引用次数: 0
Impairment of perioperative activities of daily living is associated with poor prognosis following pancreatectomy for pancreatic cancer. 胰腺癌胰腺切除术后,围手术期日常生活能力受损与预后不良有关。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-24 DOI: 10.1007/s00423-024-03478-7
Takashi Ofuchi, Kosuke Mima, Hiromitsu Hayashi, Yuki Adachi, Kosuke Kanemitsu, Takuya Tajiri, Rumi Itoyama, Shigeki Nakagawa, Hirohisa Okabe, Hideo Baba

Purpose: It has reported that the prevalence of frailty in patients with pancreatic cancer is 45%. The number of patients with pancreatic cancer is increasing, and within this cohort, patients often suffer from impaired activities of daily living (ADLs). This study aimed to examine the association between perioperative Barthel Index (BI) scores, a validated measure of ADLs, and survival outcomes after pancreatectomy for pancreatic cancer.

Methods: We analyzed the data of 201 patients who underwent pancreatectomy for pancreatic cancer between 2010 and 2020. Preoperative and postoperative ADLs were assessed using the BI (range: 0-100; higher scores indicated greater independence). A preoperative or postoperative BI score ≤ 85 was defined as an impairment of perioperative ADLs. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) after adjusting for potential confounders.

Results: Among the 201 patients, 14 (7.0%) had a preoperative BI score ≤ 85 and 50 (25%) had a postoperative BI score ≤ 85. Impairment of perioperative ADLs was independently associated with shorter overall survival (multivariable HR: 2.66, 95% confidence interval [95%CI]: 1.75-4.03, P < 0.001), cancer-specific survival (multivariable HR: 2.64, 95%CI: 1.15-4.25, P < 0.001), and recurrence-free survival (multivariable HR: 1.94, 95%CI: 1.08-3.50, P = 0.021).

Conclusion: Impairment of perioperative ADLs is associated with poor prognosis following pancreatectomy for pancreatic cancer. The maintenance and improvement of perioperative ADLs could play an important role in providing favorable long-term outcomes in patients with pancreatic cancer.

目的:据报道,胰腺癌患者体弱的发生率为 45%。胰腺癌患者的人数在不断增加,而在这一群体中,患者的日常生活能力(ADLs)往往受到损害。本研究旨在探讨胰腺癌胰腺切除术后围手术期巴特尔指数(Barthel Index,BI)评分(ADLs的有效测量指标)与生存结果之间的关系:我们分析了2010年至2020年间接受胰腺癌胰腺切除术的201名患者的数据。使用BI(范围:0-100;分数越高表示独立性越强)对术前和术后ADL进行评估。术前或术后 BI 得分≤85 分定义为围术期 ADL 能力受损。在对潜在的混杂因素进行调整后,采用考克斯比例危险回归法计算危险比(HRs):201名患者中,14人(7.0%)术前BI评分≤85分,50人(25%)术后BI评分≤85分。围手术期日常活动能力受损与总生存期缩短密切相关(多变量 HR:2.66,95% 置信区间 [95%CI]:1.75-4.03,P<0.05):1.75-4.03, P 结论:胰腺癌胰腺切除术后,围手术期ADL受损与预后不良有关。维持和改善围手术期 ADLs 可在为胰腺癌患者提供良好的长期预后方面发挥重要作用。
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引用次数: 0
Application of machine learning for predicting lymph node metastasis in T1 colorectal cancer: a systematic review and meta-analysis. 应用机器学习预测 T1 结直肠癌淋巴结转移:系统综述和荟萃分析。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-23 DOI: 10.1007/s00423-024-03476-9
Chinock Cheong, Na Won Kim, Hye Sun Lee, Jeonghyun Kang

Background: We review and analyze research on the application of machine learning (ML) and deep learning (DL) models to lymph node metastasis (LNM) prediction in patients with T1 colorectal cancer (CRC). Predicting LNM before radical surgery is important in patients with T1 CRC. However, current surgical treatment guidelines are limited. LNM prediction using ML or DL may improve predictive accuracy. The diagnostic accuracy of LNM prediction using ML- and DL-based models for patients with CRC was assessed.

Methods: We performed a comprehensive search of the PubMed, Embase, and Cochrane databases (inception to April 30th of 2022) for studies that applied ML or DL to LNM prediction in T1 CRC patients specifically to compare with histopathological findings and not related to radiological aspects.

Results: 33,199 T1 CRC patients enrolled across seven studies with a retrospective design were included. LNM was observed in 3,173 (9.6%) patients. Overall, the ML- and DL-based model exhibited a sensitivity of 0.944 and specificity of 0.877 for the prediction of LNM in patients with T1 CRC. Six different types of ML and DL models were used across the studies included in this meta-analysis. Therefore, a high degree of heterogeneity was observed.

Conclusions: The ML and DL models provided high sensitivity and specificity for predicting LNM in patients with T1 CRC, and the heterogeneity between studies was significant. These results suggest the potential of ML or DL as diagnostic tools. However, more reliable algorithms should be developed for predicting LNM before surgery in patients with T1 CRC.

背景:我们回顾并分析了机器学习(ML)和深度学习(DL)模型在 T1 结直肠癌(CRC)患者淋巴结转移(LNM)预测中的应用研究。在根治性手术前预测淋巴结转移对 T1 结直肠癌患者非常重要。然而,目前的手术治疗指南却很有限。使用 ML 或 DL 预测 LNM 可以提高预测准确性。我们评估了使用基于 ML 和 DL 的模型对 CRC 患者进行 LNM 预测的诊断准确性:我们对 PubMed、Embase 和 Cochrane 数据库(从开始到 2022 年 4 月 30 日)进行了全面检索,以寻找将 ML 或 DL 应用于 T1 CRC 患者 LNM 预测的研究,这些研究专门与组织病理学结果进行比较,而与放射学方面无关:共纳入了 7 项采用回顾性设计的研究中的 33199 例 T1 CRC 患者。3173例(9.6%)患者观察到LNM。总体而言,基于 ML 和 DL 的模型预测 T1 CRC 患者 LNM 的灵敏度为 0.944,特异度为 0.877。本次荟萃分析所纳入的研究中使用了六种不同类型的 ML 和 DL 模型。因此,观察到了高度的异质性:结论:ML 和 DL 模型在预测 T1 CRC 患者的 LNM 方面具有较高的灵敏度和特异性,而不同研究之间的异质性非常明显。这些结果表明,ML 或 DL 具有作为诊断工具的潜力。不过,应开发更可靠的算法,用于在 T1 CRC 患者手术前预测 LNM。
{"title":"Application of machine learning for predicting lymph node metastasis in T1 colorectal cancer: a systematic review and meta-analysis.","authors":"Chinock Cheong, Na Won Kim, Hye Sun Lee, Jeonghyun Kang","doi":"10.1007/s00423-024-03476-9","DOIUrl":"10.1007/s00423-024-03476-9","url":null,"abstract":"<p><strong>Background: </strong>We review and analyze research on the application of machine learning (ML) and deep learning (DL) models to lymph node metastasis (LNM) prediction in patients with T1 colorectal cancer (CRC). Predicting LNM before radical surgery is important in patients with T1 CRC. However, current surgical treatment guidelines are limited. LNM prediction using ML or DL may improve predictive accuracy. The diagnostic accuracy of LNM prediction using ML- and DL-based models for patients with CRC was assessed.</p><p><strong>Methods: </strong>We performed a comprehensive search of the PubMed, Embase, and Cochrane databases (inception to April 30th of 2022) for studies that applied ML or DL to LNM prediction in T1 CRC patients specifically to compare with histopathological findings and not related to radiological aspects.</p><p><strong>Results: </strong>33,199 T1 CRC patients enrolled across seven studies with a retrospective design were included. LNM was observed in 3,173 (9.6%) patients. Overall, the ML- and DL-based model exhibited a sensitivity of 0.944 and specificity of 0.877 for the prediction of LNM in patients with T1 CRC. Six different types of ML and DL models were used across the studies included in this meta-analysis. Therefore, a high degree of heterogeneity was observed.</p><p><strong>Conclusions: </strong>The ML and DL models provided high sensitivity and specificity for predicting LNM in patients with T1 CRC, and the heterogeneity between studies was significant. These results suggest the potential of ML or DL as diagnostic tools. However, more reliable algorithms should be developed for predicting LNM before surgery in patients with T1 CRC.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"287"},"PeriodicalIF":2.1,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290331","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
Modified 5-Item Frailty Index (mFI-5) may predict postoperative outcomes after pancreatoduodenectomy for pancreatic Cancer. 改良五项虚弱指数(mFI-5)可预测胰腺癌胰十二指肠切除术后的预后。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-09-21 DOI: 10.1007/s00423-024-03483-w
Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Oliver Standring, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis

Background: Pancreatic Ductal Adenocarcinoma (PDAC) primarily affects older individuals with diminished physiological reserves. The Modified 5-Item Frailty Index (mFI-5) is a novel risk stratification tool proposed to predict postoperative morbidity and mortality. This study aimed to validate the mFI-5 for predicting surgical outcomes in patients undergoing pancreatoduodenectomy (PD) for PDAC.

Methods: Our retrospective PDAC database included patients who underwent PD between 2014 and 2023. Patients were stratified by mFI-5 scores (0 best - 5 worst), which assess preoperative CHF, diabetes mellitus, history of COPD or pneumonia, functional health status, and hypertension requiring medication. Associations between mFI-5 scores and outcomes, including postoperative complications and mortality, were analyzed using logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis.

Results: Among 250 PDAC patients undergoing PD, 142 (56.8%) had mFI-5 scores ≤ 1, and 25 (10%) had scores ≥ 3. No patients had scores > 4. Higher mFI-5 scores correlated with older age (p < 0.001) and tobacco use (p = 0.036). Multivariate analysis identified age (RR 1.02, p = 0.038), ASA class (ASA III; RR 2.61, p < 0.001; ASA IV; RR 2.63, p = 0.026), and moderate alcohol consumption (RR 0.56, p = 0.038) as frailty predictors. An mFI-5 score > 2 independently associated with higher mortality (HR 2.08, p = 0.026). Median overall survival was significantly lower for patients with mFI-5 scores > 2 than for those with scores ≤ 2 (21.3 vs. 42.1 months, p = 0.022).

Conclusions: The mFI-5 is a valuable tool for predicting postoperative morbidity and mortality in PDAC patients undergoing PD. Integrating frailty assessment into preoperative evaluations can enhance patient selection and surgical outcomes. Future research should focus on incorporating frailty assessments into surgical planning and patient management to improve outcomes in this vulnerable population.

背景:胰腺导管腺癌(PDAC)主要影响生理储备减少的老年人。改良五项虚弱指数(mFI-5)是一种新型风险分层工具,用于预测术后发病率和死亡率。本研究旨在验证 mFI-5 预测因 PDAC 而接受胰十二指肠切除术(PD)患者的手术结果:我们的回顾性 PDAC 数据库包括 2014 年至 2023 年间接受胰十二指肠切除术的患者。根据 mFI-5 评分(0 分最好 - 5 分最差)对患者进行分层,mFI-5 评分可评估术前慢性阻塞性肺病、糖尿病、慢性阻塞性肺病或肺炎病史、功能性健康状况以及需要药物治疗的高血压。采用逻辑回归、Cox比例危险模型和卡普兰-梅尔生存分析法分析了mFI-5评分与术后并发症和死亡率等结果之间的关系:在接受腹腔镜手术的250名PDAC患者中,142人(56.8%)的mFI-5评分≤1,25人(10%)的评分≥3。没有患者的评分大于 4。mFI-5 评分越高,年龄越大(p 2),死亡率越高(HR 2.08,p = 0.026)。mFI-5评分大于2的患者的中位总生存期明显低于评分小于2的患者(21.3个月 vs. 42.1个月,p = 0.022):mFI-5是预测PDAC患者术后发病率和死亡率的重要工具。将体弱评估纳入术前评估可提高患者选择和手术效果。未来的研究应侧重于将体弱评估纳入手术计划和患者管理,以改善这一弱势群体的预后。
{"title":"Modified 5-Item Frailty Index (mFI-5) may predict postoperative outcomes after pancreatoduodenectomy for pancreatic Cancer.","authors":"Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Oliver Standring, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis","doi":"10.1007/s00423-024-03483-w","DOIUrl":"10.1007/s00423-024-03483-w","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic Ductal Adenocarcinoma (PDAC) primarily affects older individuals with diminished physiological reserves. The Modified 5-Item Frailty Index (mFI-5) is a novel risk stratification tool proposed to predict postoperative morbidity and mortality. This study aimed to validate the mFI-5 for predicting surgical outcomes in patients undergoing pancreatoduodenectomy (PD) for PDAC.</p><p><strong>Methods: </strong>Our retrospective PDAC database included patients who underwent PD between 2014 and 2023. Patients were stratified by mFI-5 scores (0 best - 5 worst), which assess preoperative CHF, diabetes mellitus, history of COPD or pneumonia, functional health status, and hypertension requiring medication. Associations between mFI-5 scores and outcomes, including postoperative complications and mortality, were analyzed using logistic regression, Cox proportional hazards models, and Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>Among 250 PDAC patients undergoing PD, 142 (56.8%) had mFI-5 scores ≤ 1, and 25 (10%) had scores ≥ 3. No patients had scores > 4. Higher mFI-5 scores correlated with older age (p < 0.001) and tobacco use (p = 0.036). Multivariate analysis identified age (RR 1.02, p = 0.038), ASA class (ASA III; RR 2.61, p < 0.001; ASA IV; RR 2.63, p = 0.026), and moderate alcohol consumption (RR 0.56, p = 0.038) as frailty predictors. An mFI-5 score > 2 independently associated with higher mortality (HR 2.08, p = 0.026). Median overall survival was significantly lower for patients with mFI-5 scores > 2 than for those with scores ≤ 2 (21.3 vs. 42.1 months, p = 0.022).</p><p><strong>Conclusions: </strong>The mFI-5 is a valuable tool for predicting postoperative morbidity and mortality in PDAC patients undergoing PD. Integrating frailty assessment into preoperative evaluations can enhance patient selection and surgical outcomes. Future research should focus on incorporating frailty assessments into surgical planning and patient management to improve outcomes in this vulnerable population.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"286"},"PeriodicalIF":2.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290332","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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Langenbeck's Archives of Surgery
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