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Results of a German nationwide survey on perioperative cardiac management in vascular surgery. 德国全国血管外科围手术期心脏管理调查结果。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-12 DOI: 10.1007/s00423-024-03523-5
Dmitriy I Dovzhanskiy, Moritz S Bischoff, Karola Passek, Dittmar Böckler

Because of the lack of specific recommendations concerning cardiac risk stratification before vascular surgery, appropriate decisions remain individual. The aim of the present study was to evaluate the perioperative cardiac management in vascular surgery in Germany.

Methods: This article is based on a survey from 2018 of heads of German vascular surgical departments or units regarding their experience with perioperative cardiac management. The questionnaire asked about the experience with preoperative cardiac evaluation and its extension, awareness of perioperative myocardial ischemia, the art of postoperative monitoring and the routine use of the best medical treatment.

Results: In total, 62% of responders agreed that perioperative myocardial ischemia is a relevant postoperative problem in their clinic after open abdominal aortic surgery, while 47% stated the same after vascular surgery (VS) like carotid endarterectomy, peripheral arterial surgery or EVAR. Preoperative cardiological evaluations are performed routinely by 87% of responders before open abdominal aortic surgery and by 42% before VS. Preoperative cardiac evaluation included cardiac echography in 92% and stress diagnostics (stress echography, stress ECG) in 38%. Routine preoperative cardiac catheterisation is performed in 4% before OAS and only 0.5% before VS. In addition, 79% of participants initiate acetylsalicylic acid routinely and 68% use statins preoperatively. The serum troponin diagnostic test in asymptomatic patients was routinely applied by 19% of responders after OAS and by 6% after VS.

Conclusion: Perioperative myocardial ischemia is considered a relevant problem, primarily after aortic surgery. The preoperative cardiac stress diagnostics among vascular surgeons does not seem to be sufficiently widespread. The preoperative initiation of acetylsalicylic acid and statins is not routine in 30% of hospitals.

由于缺乏有关血管手术前心脏风险分层的具体建议,适当的决定仍是个性化的。本研究旨在评估德国血管外科围术期心脏管理情况:本文基于 2018 年对德国血管外科部门或单位负责人关于围术期心脏管理经验的调查。问卷调查内容包括术前心脏评估的经验及其扩展、对围术期心肌缺血的认识、术后监测的艺术以及最佳医疗的常规使用:结果:总共有 62% 的受访者同意围术期心肌缺血是他们在开腹主动脉手术后遇到的相关术后问题,而 47% 的受访者在颈动脉内膜剥脱术、外周动脉手术或 EVAR 等血管手术(VS)后也有同样的看法。87%的应答者在开腹主动脉手术前常规进行术前心脏评估,42%的应答者在血管手术前常规进行术前心脏评估。术前心脏评估包括 92% 的心脏超声检查和 38% 的负荷诊断(负荷超声检查、负荷心电图)。常规术前心导管检查在 OAS 之前进行的占 4%,在 VS 之前进行的仅占 0.5%。此外,79% 的参与者在术前常规使用乙酰水杨酸,68% 使用他汀类药物。在无症状患者中进行血清肌钙蛋白诊断检测,19% 的应答者在 OAS 后常规使用,6% 的应答者在 VS 后常规使用:结论:围术期心肌缺血被认为是一个相关问题,主要是在主动脉手术后。在血管外科医生中,术前心脏负荷诊断似乎还不够普及。在30%的医院中,术前开始使用乙酰水杨酸和他汀类药物并非常规做法。
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引用次数: 0
Spinal analgesia with continuous local wound infusion vs thoracic epidural analgesia after open pancreaticoduodenectomy. 开腹胰十二指肠切除术后局部伤口持续输液脊髓镇痛与胸硬膜外镇痛的对比。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-12 DOI: 10.1007/s00423-024-03534-2
Harrison Davies, Ngee-Soon Lau, Michael Wilson, Sivakumar Gananadha

Background: The current gold standard for postoperative analgesia following a pancreaticoduodenectomy (PD) is a thoracic epidural analgesia (TEA). Spinal analgesia with continuous wound infusion (CWI) of local anaesthetic is an emerging alternative modality. This non-inferiority study aimed to compare CWI with spinal analgesia to TEA and assess its impact on clinical outcomes.

Methods: A retrospective observational analysis of patients undergoing open pancreatoduodenectomy through a midline laparotomy. A total of 74 patients were included in the study forming two groups: CWI (n = 33) and TEA (n = 41).

Results: TEA resulted in lower median pain scores at rest (p = 0.002) and with coughing (p = 0.005) on postoperative day 2. CWI was non-inferior to TEA for all other pain outcomes measures from days 0-5. Patients in the CWI group had a shorter time to first bowel motion (p = 0.001), commencement of a liquid diet (p = 0.04), earlier removal of nasogastric tube (p = 0.005), abdominal drain (p = 0.003) and indwelling catheter (p < 0.001). Analgesic failure and postoperative nausea and vomiting were also less frequent (p = 0.001 and p < 0.001 respectively).

Conclusion: Local CWI with spinal analgesia was non-inferior to TEA for pain management in open pancreaticoduodenectomy. CWI demonstrated advantages in measures associated with enhanced recovery after surgery programs without disadvantages in terms of analgesia requirements.

背景:目前,胰十二指肠切除术(PD)术后镇痛的金标准是胸硬膜外镇痛(TEA)。通过伤口持续输注(CWI)局麻药进行脊柱镇痛是一种新兴的替代方式。这项非劣效性研究旨在比较脊髓镇痛 CWI 与 TEA,并评估其对临床结果的影响:方法:对通过中线开腹手术进行开腹胰十二指肠切除术的患者进行回顾性观察分析。研究共纳入了 74 名患者,分为两组:结果:结果:术后第 2 天,TEA 可降低静息时(p = 0.002)和咳嗽时(p = 0.005)的中位疼痛评分。在术后第 0-5 天的所有其他疼痛结果测量中,CWI 均不劣于 TEA。CWI 组患者首次排便时间(p = 0.001)、开始流质饮食时间(p = 0.04)、拔除鼻胃管时间(p = 0.005)、腹腔引流管时间(p = 0.003)和留置导尿管时间(p 结论:CWI 组患者在术后第 2 天出现咳嗽(p = 0.005),术后第 3 天出现咳嗽(p = 0.001),术后第 4 天出现咳嗽(p = 0.005),术后第 5 天出现咳嗽(p = 0.005):在开腹胰十二指肠切除术中,局部CWI加脊髓镇痛的镇痛效果并不优于TEA。CWI 在促进术后恢复的相关措施方面具有优势,但在镇痛要求方面没有劣势。
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引用次数: 0
Prognosis analysis and nomogram for predicting lateral lymph node metastasis in Medullary Thyroid Microcarcinoma. 预测甲状腺髓样微癌侧淋巴结转移的预后分析和提名图
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-11 DOI: 10.1007/s00423-024-03538-y
Jinming Zhang, Dongmei Huang, Ming Gao, Xiangqian Zheng

Background: Currently, the incidence rate of Medullary Thyroid Microcarcinoma (micro-MTC) has an increasing trend, but the incidence of LNM and prognosis were still ambiguous. We analyzed the status of neck LNM of micro-MTC patients and created a prognostic nomogram to predict the probability of lateral lymph node metastasis (LLNM) for clinical practice.

Methods: This is a retrospective study included patients with micro-MTC from SEER database for the period from 2004 to 2017 and patients from our medical center for the period from 2011 to 2019. A nomogram was constructed and the accuracy and clinical practicability were separately tested by Harrell's C-indexes, calibration plots, Receiver operating characteristic curve (ROC) and decision curve analyses (DCA).

Results: A total of 413 patients with micro-MTC from SEER database and 64 patients with micro-MTC from our department enrolled in the study. There were 16.0% and 9.4% cases in SEER database and 39.1% and 25.0% cases in our department appeared LNM and LLNM, respectively. Besides, a nomogram was constructed to assess the incidence of LLNM with good C-index, which was 0.850 in training cohort and 0.856 in validation cohort. The results of the area under the curve (AUC) were 0.830 in training cohort, 0.801 in validation cohort and 0.832 in external testing cohort, respectively.

Conclusion: A relatively high rate of LLNM than expected was found, which should be emphasized. The prediction model could facilitate clinicians to assess the probability of LLNM and make a personalized treatment strategy.

研究背景目前,甲状腺髓样微癌(micro-MTC)的发病率呈上升趋势,但LNM的发生率和预后仍不明确。我们分析了微型甲状腺微癌患者颈部淋巴结转移的情况,并创建了一个预后提名图,用于预测侧淋巴结转移(LLNM)的概率,供临床实践使用:这是一项回顾性研究,纳入了2004年至2017年期间SEER数据库中的微小MTC患者和2011年至2019年期间本医疗中心的患者。通过哈雷尔C指数、校准图、接收者工作特征曲线(ROC)和决策曲线分析(DCA)分别检验了其准确性和临床实用性:共有 413 名来自 SEER 数据库的微小 MTC 患者和 64 名来自本部门的微小 MTC 患者参加了研究。SEER数据库中分别有16.0%和9.4%的病例出现LNM和LLNM,而我科分别有39.1%和25.0%的病例出现LNM和LLNM。此外,我们还构建了一个C指数良好的提名图来评估LLNM的发生率,训练队列的C指数为0.850,验证队列的C指数为0.856。训练队列的曲线下面积(AUC)结果为 0.830,验证队列为 0.801,外部测试队列为 0.832:结论:发现 LLNM 的发生率比预期的要高,这一点应引起重视。该预测模型有助于临床医生评估 LLNM 的概率,并制定个性化的治疗策略。
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引用次数: 0
Risk factors and predictive model development for high blood loss in minimally invasive distal pancreatectomy: a retrospective cohort study. 微创远端胰腺切除术中高失血量的风险因素和预测模型开发:一项回顾性队列研究。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-11 DOI: 10.1007/s00423-024-03533-3
Cong Chen, Ronggui Lin, Xianchao Lin, Heguang Huang, Fengchun Lu

Background: High blood loss is an adverse event related to increased morbidity and poorer outcomes in pancreatic surgery patients. The aim of this study was to identify risk factors and establish a predictive model for high perioperative blood loss (HPBL) in minimally invasive distal pancreatectomy (MIDP).

Methods: We collected data from 353 patients who underwent MIDP at a university affiliated tertiary hospital between January 2016 and October 2023. Perioperative blood loss was calculated based on pre- and postoperative hemoglobin concentrations according to a combination of the formulas provided by Nadler and Gross. Multivariate logistic regression analyses were performed for the training cohort to identify the clinical factors independently associated with perioperative blood loss (PBL). A predictive nomogram based on these factors was established and validated.

Results: Weight, imaging findings, serum albumin concentration, MIDP experience, spleen treatment, and operation time were independent predictors for HPBL. The established model for predicting HPBL showed that the area under the curve (AUC) was 0.799 (95% CI = 0.746-0.853) and 0.852 (95% CI = 0.760-0.943) for the training cohort and validation cohort, respectively. When utilized to predict blood transfusion, the AUC was 0.778 (95% CI = 0.691-0.865) in the training cohort and 0.818 (95% CI = 0.681-0.955) in the validation cohort. Patients with a high predicted risk had significantly higher incidences of postoperative pancreatic fistula, intra-abdominal infection, and longer hospital stays than patients with a low risk.

Conclusions: We established and validated a model for predicting HPBL in MIDP patients. This novel model may have future utility when generating surgical strategies.

背景:高失血是与胰腺手术患者发病率增加和预后较差有关的不良事件。本研究旨在确定微创远端胰腺切除术(MIDP)围术期高失血量(HPBL)的风险因素并建立预测模型:我们收集了2016年1月至2023年10月期间在一所大学附属三级医院接受微创胰腺切除术的353名患者的数据。围手术期失血量根据术前和术后血红蛋白浓度计算,计算方法结合了 Nadler 和 Gross 提供的公式。对培训队列进行了多变量逻辑回归分析,以确定与围手术期失血量(PBL)独立相关的临床因素。根据这些因素建立并验证了预测提名图:结果:体重、影像学检查结果、血清白蛋白浓度、MIDP 经验、脾脏治疗和手术时间是 HPBL 的独立预测因素。建立的 HPBL 预测模型显示,训练队列和验证队列的曲线下面积(AUC)分别为 0.799(95% CI = 0.746-0.853)和 0.852(95% CI = 0.760-0.943)。用于预测输血时,训练队列的AUC为0.778(95% CI = 0.691-0.865),验证队列的AUC为0.818(95% CI = 0.681-0.955)。与低风险患者相比,预测风险高的患者术后胰瘘、腹腔内感染的发生率明显更高,住院时间也更长:我们建立并验证了一个用于预测 MIDP 患者 HPBL 的模型。结论:我们建立并验证了预测 MIDP 患者 HPBL 的模型,这一新颖的模型未来可能会在制定手术策略时发挥作用。
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引用次数: 0
Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB). Roux-en-Y胃旁路术(RYGB)、转流单吻合胃旁路术(D-OAGB)和单吻合胃旁路术(OAGB)中期疗效比较研究。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-09 DOI: 10.1007/s00423-024-03525-3
Mohamed Abdul Moneim El Masry, Islam Abdul Rahman, Mohamed Fathy Mahmoud Elshal, Ahmed Maher Abdul Moneim

Purpose: Diverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.

Methods: This is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients' data until 2 years of follow-up were compared.

Results: This study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.

Conclusion: D-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.

目的:分流单吻合胃旁路术(D-OAGB)是一种新的手术方法,需要在OAGB期间进行Roux-en-Y分流,以防止OAGB术后胆汁反流。本研究旨在比较 Roux-en-Y 胃旁路术 (RYGB) 和 OAGB 与 D-OAGB 的中期疗效:这是一项回顾性研究,分析了 2015 年至 2021 年 5 月期间接受胃旁路手术患者的数据。对患者随访两年前的数据进行比较:该研究纳入了 140 名患者,他们分别接受了 OAGB(64 人)、RYGB(24 人)和 D-OAGB(52 人)手术。在 OAGB、RYGB 和 D-OAGB 组中,并发症发生率分别为 3.1%、8.3% 和 5.8%。在 3 个月和 6 个月的随访中,OAGB 组和 D-OAGB 组的超重率(EWL%)明显高于其他组,差异有统计学意义。在其他随访中,三组的体重测量和体重减轻结果相当(P > 0.05)。OAGB组的胃食管反流病(GERD)缓解病例明显较少,而新发胃食管反流病病例较多:结论:与 RYGB 相比,D-OAGB 显示出良好的疗效,包括较低的早期不良反应和术后前 6 个月较好的体重减轻效果。与 OAGB 相比,D-OAGB 组的胃食管反流缓解率更高,新发胃食管反流率更低。我们需要进一步研究来验证这些发现,并加深对这种创新手术方法的理解。
{"title":"Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB).","authors":"Mohamed Abdul Moneim El Masry, Islam Abdul Rahman, Mohamed Fathy Mahmoud Elshal, Ahmed Maher Abdul Moneim","doi":"10.1007/s00423-024-03525-3","DOIUrl":"10.1007/s00423-024-03525-3","url":null,"abstract":"<p><strong>Purpose: </strong>Diverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.</p><p><strong>Methods: </strong>This is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients' data until 2 years of follow-up were compared.</p><p><strong>Results: </strong>This study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.</p><p><strong>Conclusion: </strong>D-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"340"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11550272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623268","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
Ghost-ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer: results of a randomised controlled multicentre pilot trial (DRKS00013997). 在接受直肠癌低位前切除术的患者中采用幽灵回肠造口术与传统环形回肠造口术:随机对照多中心试点试验的结果(DRKS00013997)。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-09 DOI: 10.1007/s00423-024-03530-6
Felix J Hüttner, Pascal Probst, André L Mihaljevic, Lukas D Sauer, Colette Doerr-Harim, Alexis Ulrich, Samira Stratmeyer, Rosa Klotz, Markus K Diener, Phillip Knebel

Purpose: The objective of the current pilot trial was to evaluate whether ghost ileostomy is a safe alternative to the current standard of care in terms of a conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision (LAR/TME) for rectal cancer.

Methods: This randomized controlled pilot trial included patients undergoing LAR/TME, randomly assigning them to ghost ileostomy or conventional loop ileostomy intraoperatively. Follow-up spanned 6 months, evaluating the following endpoints: comprehensive complication index (CCI), postoperative morbidity, transformation of ghost ileostomy, presence of ostomy at 6 months, Wexner score, and quality of life (EORTC QLQ-C30 & CR29). Exploratory statistical analysis based on the intention-to-treat principle was conducted.

Results: Recruiting 30 patients from May 2018 to September 2022, the trial was prematurely stopped due to slow recruitment. The mean CCI was comparable between groups at any point of time (at 6 months: 30.7 vs. 29.7, p = 0.889). There was no mortality and no need for creation of a terminal ostomy. Anastomotic leakage rates were similar in ghost ileostomy and loop ileostomy groups (p > 0.99). The ghost ileostomy was converted into a conventional loop ileostomy in 6 of 15 (40.0%) patients. Neither postoperative function, nor the overall quality of life showed significant differences.

Conclusion: Ghost ileostomy appears as a viable and safe option for selectively deciding ileostomy creation in LAR/TME for rectal cancer. However, challenges in patient selection, excluding those at high risk for anastomotic leakage, limit widespread application and call for optimization in future research.

Trial-registration: German Clinical Trials Register ( https://drks.de/ ): DRKS00013997; date of registration: April 9th 2018.

目的:本次试验的目的是评估在接受直肠癌低位前切除术和全直肠系膜切除术(LAR/TME)的患者中,"幽灵回肠造口术 "是否是传统环状回肠造口术的安全替代方案:这项随机对照试验纳入了接受 LAR/TME 手术的患者,术中随机分配他们接受 ghost 回肠造口术或常规环状回肠造口术。随访时间为 6 个月,评估终点如下:综合并发症指数 (CCI)、术后发病率、幽闭回肠造口术的转变、6 个月时是否存在造口、Wexner 评分和生活质量(EORTC QLQ-C30 和 CR29)。根据意向治疗原则进行了探索性统计分析:2018年5月至2022年9月共招募30名患者,由于招募缓慢,试验提前结束。两组患者在任何时间点的平均 CCI 都相当(6 个月时:30.7 vs. 29.7,p = 0.889)。无死亡病例,也无需进行末端造口术。ghost 回肠造口术组和环状回肠造口术组的吻合口漏率相似(p > 0.99)。15 位患者中有 6 位(40.0%)将幽闭回肠造口术转化为传统的环状回肠造口术。术后功能和整体生活质量均无明显差异:结论:幽灵回肠造口术似乎是在直肠癌 LAR/TME 中选择性决定回肠造口的一种可行且安全的方案。然而,排除吻合口漏高风险患者,在患者选择方面的挑战限制了其广泛应用,需要在未来的研究中加以优化:德国临床试验注册中心 ( https://drks.de/ ):DRKS00013997;注册日期:2018年4月9日。
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引用次数: 0
Ideal outcome post-pancreatoduodenectomy: a comprehensive healthcare system analysis. 胰十二指肠切除术后的理想结果:医疗保健系统综合分析。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-09 DOI: 10.1007/s00423-024-03532-4
Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis

Introduction: Indicators, such as mortality and complications, are commonly used to measure the quality of care. However, a more comprehensive assessment of surgical quality is captured using composite outcome measures such as Textbook Outcome (TO), Optimal Pancreatic Surgery, and a newer 'Ideal Outcome' (IO) measure. We reviewed our institutional experience to assess the impact of demographics, comorbidities, and operative variables on IO after pancreatoduodenectomy (PD).

Methods: A retrospective study was conducted on PD patients at Northwell Health between 2009 and 2023. IO was determined by the absence of six adverse outcomes, including in-hospital mortality, Clavien-Dindo ≥ III complications, clinically-relevant postoperative pancreatic fistula, reoperation, hospital stay > 75th percentile, and readmission within 30 days. Logistic regression analyzed the effects of various factors on achieving IO.

Results: Of the 578 patients who underwent PD, 248 (42.91%) achieved the IO. On multivariable analysis, factors associated with increased odds of achieving IO included neoadjuvant chemotherapy (OR 1.30, 95% CI 1.05-1.62) and the presence of neuroendocrine tumors (OR 3.37, 95% CI 1.35-8.41). Percutaneous transhepatic biliary drainage (PTBD) (OR 0.34, 95% CI 0.14-0.80) and older age (≥ 70 years) (OR 0.48, 95% CI 0.32-0.74) were associated with decreased odds of achieving IO. Patients with IO had significantly improved survival on Kaplan-Meier log-rank test (p = 0.001) as well as adjusted Cox analysis (HR 0.62 95% CI: 0.39-0.97).

Conclusion: IO may offer a comprehensive metric for assessing PD outcomes, highlighting the impact of age, chemotherapy, biliary drainage, and tumor types. These findings suggest targeted interventions and quality improvements could enhance PD outcomes by addressing modifiable factors and refining clinical strategies.

导言:死亡率和并发症等指标通常用于衡量医疗质量。然而,更全面的手术质量评估是采用综合结果衡量标准,如教科书结果(TO)、最佳胰腺手术和较新的 "理想结果"(IO)衡量标准。我们回顾了本机构的经验,以评估人口统计学、合并症和手术变量对胰十二指肠切除术(PD)后 IO 的影响:我们对 2009 年至 2023 年期间诺斯韦尔健康医院的胰十二指肠切除术患者进行了一项回顾性研究。IO以无六种不良后果为标准,包括院内死亡率、Clavien-Dindo≥III并发症、临床相关的术后胰瘘、再次手术、住院时间大于第75百分位数以及30天内再次入院。逻辑回归分析了各种因素对实现 IO 的影响:结果:在接受腹腔镜手术的578名患者中,有248人(42.91%)实现了IO。多变量分析显示,新辅助化疗(OR 1.30,95% CI 1.05-1.62)和存在神经内分泌肿瘤(OR 3.37,95% CI 1.35-8.41)等因素增加了实现 IO 的几率。经皮经肝胆道引流术(PTBD)(OR 0.34,95% CI 0.14-0.80)和年龄较大(≥ 70 岁)(OR 0.48,95% CI 0.32-0.74)与达到 IO 的几率降低有关。根据卡普兰-米尔对数秩检验(P = 0.001)和调整后的考克斯分析(HR 0.62 95% CI:0.39-0.97),IO患者的生存率明显提高:IO可为评估肺结核预后提供一个综合指标,突出年龄、化疗、胆道引流和肿瘤类型的影响。这些研究结果表明,有针对性的干预措施和质量改进可以通过解决可改变的因素和完善临床策略来提高 PD 的预后。
{"title":"Ideal outcome post-pancreatoduodenectomy: a comprehensive healthcare system analysis.","authors":"Abdullah Khalid, Shamsher A Pasha, Lyudmyla Demyan, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis","doi":"10.1007/s00423-024-03532-4","DOIUrl":"https://doi.org/10.1007/s00423-024-03532-4","url":null,"abstract":"<p><strong>Introduction: </strong>Indicators, such as mortality and complications, are commonly used to measure the quality of care. However, a more comprehensive assessment of surgical quality is captured using composite outcome measures such as Textbook Outcome (TO), Optimal Pancreatic Surgery, and a newer 'Ideal Outcome' (IO) measure. We reviewed our institutional experience to assess the impact of demographics, comorbidities, and operative variables on IO after pancreatoduodenectomy (PD).</p><p><strong>Methods: </strong>A retrospective study was conducted on PD patients at Northwell Health between 2009 and 2023. IO was determined by the absence of six adverse outcomes, including in-hospital mortality, Clavien-Dindo ≥ III complications, clinically-relevant postoperative pancreatic fistula, reoperation, hospital stay > 75th percentile, and readmission within 30 days. Logistic regression analyzed the effects of various factors on achieving IO.</p><p><strong>Results: </strong>Of the 578 patients who underwent PD, 248 (42.91%) achieved the IO. On multivariable analysis, factors associated with increased odds of achieving IO included neoadjuvant chemotherapy (OR 1.30, 95% CI 1.05-1.62) and the presence of neuroendocrine tumors (OR 3.37, 95% CI 1.35-8.41). Percutaneous transhepatic biliary drainage (PTBD) (OR 0.34, 95% CI 0.14-0.80) and older age (≥ 70 years) (OR 0.48, 95% CI 0.32-0.74) were associated with decreased odds of achieving IO. Patients with IO had significantly improved survival on Kaplan-Meier log-rank test (p = 0.001) as well as adjusted Cox analysis (HR 0.62 95% CI: 0.39-0.97).</p><p><strong>Conclusion: </strong>IO may offer a comprehensive metric for assessing PD outcomes, highlighting the impact of age, chemotherapy, biliary drainage, and tumor types. These findings suggest targeted interventions and quality improvements could enhance PD outcomes by addressing modifiable factors and refining clinical strategies.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"339"},"PeriodicalIF":2.1,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623271","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
Comparison of robot-assisted, open, and laparoscopic-assisted surgery for cholangiocarcinoma: a network meta-analysis. 胆管癌机器人辅助手术、开腹手术和腹腔镜辅助手术的比较:网络荟萃分析。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1007/s00423-024-03541-3
Sifan Dong, An Jiang, Shiqi An, Junzhi Xiao

Purpose: The aim of this study is to compare the efficacy of robot-assisted, laparoscopic-assisted and open surgery in the treatment of cholangiocarcinoma, and to evaluate the clinical effect of three surgical methods in the treatment of cholangiocarcinoma by network Meta-analysis.

Methods: A systematical retrieval in PubMed and Web of Science was performed for relative literature on the effects of robot-assisted(RA), laparoscopy-assisted(LA), and open surgery(OA) for cholangiocarcinoma in treating cholangiocarcinoma. A literature search updated to September 1st, 2024, was performed.

Results: Studies have shown that the length of R0 resection, complication rate, 30-day mortality, Transfusion rate, Lymph Node Metastasis Rate, and hospital stay in RA are superior to LA and open surgery. The relative effectiveness of the three surgical methods in terms of operation time were: open surgery, laparoscope-assisted surgery, and robot-assisted surgery, and there was no significant difference among the three groups.

Conclusion: Robot-assisted surgery is safe and feasible in the treatment of cholangiocarcinoma, but more clinical evidence is needed to confirm these findings.

目的:本研究旨在比较机器人辅助手术、腹腔镜辅助手术和开腹手术治疗胆管癌的疗效,并通过网络Meta分析评价三种手术方法治疗胆管癌的临床效果:在PubMed和Web of Science中系统检索了机器人辅助(RA)、腹腔镜辅助(LA)和开腹手术(OA)治疗胆管癌效果的相关文献。文献检索更新至2024年9月1日:研究表明,RA手术的R0切除时间、并发症发生率、30天死亡率、输血率、淋巴结转移率和住院时间均优于LA手术和开放手术。三种手术方式在手术时间上的相对效果分别为:开腹手术、腹腔镜辅助手术和机器人辅助手术,三组之间无显著差异:结论:机器人辅助手术治疗胆管癌安全可行,但还需要更多临床证据来证实这些结论。
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引用次数: 0
Acute diverticulitis requiring hospitalization according to regional discrepancies in France between 2013 and 2022: a nationwide study. 2013年至2022年法国各地区需要住院治疗的急性憩室炎:一项全国性研究。
IF 4.6 3区 医学 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1007/s00423-024-03536-0
C Saint-Dizier, J F Hamel, A Lamer, A Venara, M Levaillant, Aurélien Venara

Purpose: The prevention of colon diverticulitis tends to be tailored according to the patients. In order to improve the public health policy to prevent diverticulitis, the influence of regional parameters at a department scale has to be assessed.

Objective: This analysis aimed to assess the occurrence of acute diverticulitis in France in general and according to environmental factors suspected to affect such diseases.

Methods: All patients above 18 years old admitted to a general hospital with a diverticulitis diagnosis between 2013 and 2022 in France were included. Data were extracted from the French national hospital discharge database. The primary outcome was the occurrence of diverticulitis according to French territories and known risk factors.

Results: In this nationwide cohort study, the 10-years cumulative occurrence of diverticulitis in France was 3.45% (n = 2 0.248.099 patients). Diverticulitis was influenced by older age and male gender but was not significantly associated with ecological parameters (obesity, alcohol consumption, smoking or economic discrepancies) at a departmental scale. Of all patients diagnosed with diverticulitis, 5% had at least one surgical intervention. The surgical management of diverticulitis was associated with an increased number of surgeons in the department, even after adjustment for age and sex.

Conclusions: Except for smoking, the frequency of diverticulitis requiring an hospitalization was independent of regional parameters (nor alcohol intake, nor obesity nor the economic discrepancies).

目的:结肠憩室炎的预防往往根据患者的具体情况而定。为了改善预防憩室炎的公共卫生政策,必须评估地区参数对省一级的影响:本分析旨在评估法国急性憩室炎的总体发生率,以及疑似影响此类疾病的环境因素:方法:纳入2013年至2022年期间在法国综合医院住院并确诊为憩室炎的所有18岁以上患者。数据来自法国国家医院出院数据库。主要结果是根据法国领土和已知风险因素得出的憩室炎发生率:在这项全国性队列研究中,法国憩室炎的10年累计发病率为3.45%(n = 2 0.248.099名患者)。憩室炎受年龄和性别的影响,但与生态参数(肥胖、饮酒、吸烟或经济差异)的关系不大。在所有确诊为憩室炎的患者中,5%的患者至少接受过一次手术治疗。即使在对年龄和性别进行调整后,憩室炎的手术治疗仍与科室外科医生人数的增加有关:结论:除吸烟外,憩室炎需要住院治疗的频率与地区参数(酒精摄入量、肥胖或经济差异)无关。
{"title":"Acute diverticulitis requiring hospitalization according to regional discrepancies in France between 2013 and 2022: a nationwide study.","authors":"C Saint-Dizier, J F Hamel, A Lamer, A Venara, M Levaillant, Aurélien Venara","doi":"10.1007/s00423-024-03536-0","DOIUrl":"10.1007/s00423-024-03536-0","url":null,"abstract":"<p><strong>Purpose: </strong>The prevention of colon diverticulitis tends to be tailored according to the patients. In order to improve the public health policy to prevent diverticulitis, the influence of regional parameters at a department scale has to be assessed.</p><p><strong>Objective: </strong>This analysis aimed to assess the occurrence of acute diverticulitis in France in general and according to environmental factors suspected to affect such diseases.</p><p><strong>Methods: </strong>All patients above 18 years old admitted to a general hospital with a diverticulitis diagnosis between 2013 and 2022 in France were included. Data were extracted from the French national hospital discharge database. The primary outcome was the occurrence of diverticulitis according to French territories and known risk factors.</p><p><strong>Results: </strong>In this nationwide cohort study, the 10-years cumulative occurrence of diverticulitis in France was 3.45% (n = 2 0.248.099 patients). Diverticulitis was influenced by older age and male gender but was not significantly associated with ecological parameters (obesity, alcohol consumption, smoking or economic discrepancies) at a departmental scale. Of all patients diagnosed with diverticulitis, 5% had at least one surgical intervention. The surgical management of diverticulitis was associated with an increased number of surgeons in the department, even after adjustment for age and sex.</p><p><strong>Conclusions: </strong>Except for smoking, the frequency of diverticulitis requiring an hospitalization was independent of regional parameters (nor alcohol intake, nor obesity nor the economic discrepancies).</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"337"},"PeriodicalIF":4.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11549154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604912","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
The impact of preoperative renal insufficiency on the outcomes of patients with pancreatic cancer undergoing pancreaticoduodenectomy. 术前肾功能不全对接受胰十二指肠切除术的胰腺癌患者预后的影响。
IF 2.1 3区 医学 Q2 SURGERY Pub Date : 2024-11-08 DOI: 10.1007/s00423-024-03531-5
Shunsuke Tamura, Hideyuki Kanemoto, Akitsugu Fujita, Satoshi Tokuda, Akihiko Takagi, Eiji Nakatani, Keisei Taku, Noriyuki Oba

Purpose: This study evaluated the impact of renal function impairment on long-term survival outcomes and adjuvant therapy in patients with pancreatic cancer undergoing pancreaticoduodenectomy (PD).

Methods: In this study, 264 patients who underwent PD for pancreatic head cancer between 2011 and 2021 were retrospectively analyzed. The patients were subsequently categorized into three groups according to the estimated glomerular filtration rate: normal group (> 90 mL/min/1.73 m2, n = 73), moderate group (45-90 mL/min/1.73 m2, n = 176), and severe group (< 45 mL/min/1.73 m2, n = 15). The primary outcomes evaluated were postoperative complications, overall survival (OS), and relapse-free survival (RFS). Additionally, the completion of adjuvant therapy and risk factors for adjuvant therapy discontinuation were analyzed.

Results: The total proportion of patients with complications was significantly higher in the severe group (p = 0.008). The proportion of patients with severe complications (Clavien-Dindo classification ≥ IIIa) did not significantly differ between the chronic kidney disease (CKD) groups (p = 0.730). The proportion of patients in whom adjuvant therapy was completed was notably lower in the severe group (p = 0.011). Multiple logistic regression analysis revealed that CKD groups and hemoglobin levels ≤ 11.5 g/dL were independent predictors of adjuvant therapy completion failure (p = 0.016 and p = 0.016). There was no significant difference in the OS and RFS rates between the CKD groups (p = 0.499, p = 0.688).

Conclusions: In patients with pancreatic cancer and CKD, performing PD safely may be feasible; however, adjuvant therapy completion is challenging.

目的:本研究评估了肾功能损伤对接受胰十二指肠切除术(PD)的胰腺癌患者长期生存结果和辅助治疗的影响:本研究对 2011 年至 2021 年间接受胰头切除术的 264 例胰腺癌患者进行了回顾性分析。随后根据估计肾小球滤过率将患者分为三组:正常组(> 90 mL/min/1.73 m2,n = 73)、中度组(45-90 mL/min/1.73 m2,n = 176)和重度组(2,n = 15)。评估的主要结果是术后并发症、总生存期(OS)和无复发生存期(RFS)。此外,还分析了辅助治疗的完成情况和停止辅助治疗的风险因素:结果:严重组患者出现并发症的总比例明显更高(P = 0.008)。严重并发症(Clavien-Dindo 分级≥ IIIa)患者的比例在慢性肾脏病(CKD)组之间没有显著差异(p = 0.730)。严重组完成辅助治疗的患者比例明显较低(p = 0.011)。多元逻辑回归分析显示,CKD 组和血红蛋白水平≤ 11.5 g/dL 是辅助治疗失败的独立预测因素(p = 0.016 和 p = 0.016)。CKD组之间的OS和RFS率无明显差异(p = 0.499,p = 0.688):结论:对于胰腺癌合并慢性肾功能衰竭的患者,安全地进行胰腺癌根治术是可行的;但是,完成辅助治疗具有挑战性。
{"title":"The impact of preoperative renal insufficiency on the outcomes of patients with pancreatic cancer undergoing pancreaticoduodenectomy.","authors":"Shunsuke Tamura, Hideyuki Kanemoto, Akitsugu Fujita, Satoshi Tokuda, Akihiko Takagi, Eiji Nakatani, Keisei Taku, Noriyuki Oba","doi":"10.1007/s00423-024-03531-5","DOIUrl":"https://doi.org/10.1007/s00423-024-03531-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluated the impact of renal function impairment on long-term survival outcomes and adjuvant therapy in patients with pancreatic cancer undergoing pancreaticoduodenectomy (PD).</p><p><strong>Methods: </strong>In this study, 264 patients who underwent PD for pancreatic head cancer between 2011 and 2021 were retrospectively analyzed. The patients were subsequently categorized into three groups according to the estimated glomerular filtration rate: normal group (> 90 mL/min/1.73 m<sup>2</sup>, n = 73), moderate group (45-90 mL/min/1.73 m<sup>2</sup>, n = 176), and severe group (< 45 mL/min/1.73 m<sup>2</sup>, n = 15). The primary outcomes evaluated were postoperative complications, overall survival (OS), and relapse-free survival (RFS). Additionally, the completion of adjuvant therapy and risk factors for adjuvant therapy discontinuation were analyzed.</p><p><strong>Results: </strong>The total proportion of patients with complications was significantly higher in the severe group (p = 0.008). The proportion of patients with severe complications (Clavien-Dindo classification ≥ IIIa) did not significantly differ between the chronic kidney disease (CKD) groups (p = 0.730). The proportion of patients in whom adjuvant therapy was completed was notably lower in the severe group (p = 0.011). Multiple logistic regression analysis revealed that CKD groups and hemoglobin levels ≤ 11.5 g/dL were independent predictors of adjuvant therapy completion failure (p = 0.016 and p = 0.016). There was no significant difference in the OS and RFS rates between the CKD groups (p = 0.499, p = 0.688).</p><p><strong>Conclusions: </strong>In patients with pancreatic cancer and CKD, performing PD safely may be feasible; however, adjuvant therapy completion is challenging.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"409 1","pages":"338"},"PeriodicalIF":2.1,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604915","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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