Pub Date : 2023-03-01DOI: 10.1177/14574969231151379
Francisco Tustumi, Edno T Bianchi, Daniel J Szor
Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Summary
{"title":"Measuring the burden of gastroesophageal reflux after per-oral endoscopic myotomy.","authors":"Francisco Tustumi, Edno T Bianchi, Daniel J Szor","doi":"10.1177/14574969231151379","DOIUrl":"https://doi.org/10.1177/14574969231151379","url":null,"abstract":"Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Summary","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":"112 1","pages":"56-57"},"PeriodicalIF":2.4,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9391717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.1177/14574969221111027
Daniel Mønsted Shabanzadeh, Dorthe Wiinholdt Christensen, Caroline Ewertsen, Hans Friis-Andersen, Frederik Helgstrand, Lars Nannestad Jørgensen, Anders Kirkegaard-Klitbo, Anders Christian Larsen, Jonas Sanberg Ljungdalh, Palle Nordblad Schmidt, Rikke Therkildsen, Peter Vilmann, Jes Sefland Vogt, Lars Tue Sørensen
Background and objective: Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS).
Methods: An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences.
Results: For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation).
Conclusions: Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed.
{"title":"National clinical practice guidelines for the treatment of symptomatic gallstone disease: 2021 recommendations from the Danish Surgical Society.","authors":"Daniel Mønsted Shabanzadeh, Dorthe Wiinholdt Christensen, Caroline Ewertsen, Hans Friis-Andersen, Frederik Helgstrand, Lars Nannestad Jørgensen, Anders Kirkegaard-Klitbo, Anders Christian Larsen, Jonas Sanberg Ljungdalh, Palle Nordblad Schmidt, Rikke Therkildsen, Peter Vilmann, Jes Sefland Vogt, Lars Tue Sørensen","doi":"10.1177/14574969221111027","DOIUrl":"https://doi.org/10.1177/14574969221111027","url":null,"abstract":"<p><strong>Background and objective: </strong>Gallstones are highly prevalent, and more than 9000 cholecystectomies are performed annually in Denmark. The aim of this guideline was to improve the clinical course of patients with gallstone disease including a subgroup of high-risk patients. Outcomes included reduction of complications, readmissions, and need for additional interventions in patients with uncomplicated gallstone disease, acute cholecystitis, and common bile duct stones (CBDS).</p><p><strong>Methods: </strong>An interdisciplinary group of clinicians developed the guideline according to the GRADE methodology. Randomized controlled trials (RCTs) were primarily included. Non-RCTs were included if RCTs could not answer the clinical questions. Recommendations were strong or weak depending on effect estimates, quality of evidence, and patient preferences.</p><p><strong>Results: </strong>For patients with acute cholecystitis, acute laparoscopic cholecystectomy is recommended (16 RCTs, strong recommendation). Gallbladder drainage may be used as an interval procedure before a delayed laparoscopic cholecystectomy in patients with temporary contraindications to surgery and severe acute cholecystitis (1 RCT and 1 non-RCT, weak recommendation). High-risk patients are suggested to undergo acute laparoscopic cholecystectomy instead of drainage (1 RCT and 1 non-RCT, weak recommendation). For patients with CBDS, a one-step procedure with simultaneous laparoscopic cholecystectomy and CBDS removal by laparoscopy or endoscopy is recommended (22 RCTs, strong recommendation). In high-risk patients with CBDS, laparoscopic cholecystectomy is suggested to be included in the treatment (6 RCTs, weak recommendation). For diagnosis of CBDS, the use of magnetic resonance imaging or endoscopic ultrasound prior to surgical treatment is recommended (8 RCTs, strong recommendation). For patients with uncomplicated symptomatic gallstone disease, observation is suggested as an alternative to laparoscopic cholecystectomy (2 RCTs, weak recommendation).</p><p><strong>Conclusions: </strong>Seven recommendations, four weak and three strong, for treating patients with symptomatic gallstone disease were developed. Studies for treatment of high-risk patients are few and more are needed.</p><p><strong>Endorsement: </strong>The Danish Surgical Society.</p>","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":"111 3","pages":"11-30"},"PeriodicalIF":2.4,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10403568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/14574969221102284
Arvid Gustafsson, L. Enochsson, B. Tingstedt, G. Olsson
Background and objective: The most common way of closing the cystic duct in laparoscopic cholecystectomy is by using metal clips (>80%). Nevertheless, bile leakage occurs in 0.4%–2.0% of cases, and thus causes significant morbidity. However, the optimal number of clips needed to avoid bile leakage has not been determined. The primary aim of this study was to evaluate bile leakage and post-procedural adverse events after laparoscopic cholecystectomy concerning whether two or three clips were used to seal the cystic duct. Methods: Using a retrospective observational design, we gathered data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (ERCP) (GallRiks). From 2006 until 2019, 124,818 patients were eligible for inclusion. These were nested to cohorts of 75,322 (60.3%) for uncomplicated gallstone disease and 49,496 (39.7%) with complicated gallstone disease. The cohorts were grouped by the number (i.e. two or three) of metal clips applied to the proximal cystic duct. The main outcome was 30-day bile leakage and post-procedural adverse events. Results: No significant differences surfaced in the rate of bile leakage (0.8% vs 0.8%; P = .87) or post-procedural adverse events (three clips, 5.7% vs two clips, 5.4%; P = .16) for uncomplicated gallstone disease. However, for complicated disease, bile leakage (1.4% vs 1.0%; P < .001) and post-procedural adverse events (10.2% vs 8.6%; P < .001) significantly increased when the cystic duct was sealed with three clips compared with two. Conclusions: Because no differences in the rates of bile leakage or adverse events emerged in uncomplicated gallstone disease when a third clip was applied, a third clip for additional safety is not recommended in such cases. On the contrary, bile leakage and adverse events increased when a third clip was used in patients with complicated gallstone disease. This finding probably indicates a more difficult cholecystectomy rather than being caused by the third clip itself.
{"title":"Bile leakage and the number of metal clips on the cystic duct during laparoscopic cholecystectomy","authors":"Arvid Gustafsson, L. Enochsson, B. Tingstedt, G. Olsson","doi":"10.1177/14574969221102284","DOIUrl":"https://doi.org/10.1177/14574969221102284","url":null,"abstract":"Background and objective: The most common way of closing the cystic duct in laparoscopic cholecystectomy is by using metal clips (>80%). Nevertheless, bile leakage occurs in 0.4%–2.0% of cases, and thus causes significant morbidity. However, the optimal number of clips needed to avoid bile leakage has not been determined. The primary aim of this study was to evaluate bile leakage and post-procedural adverse events after laparoscopic cholecystectomy concerning whether two or three clips were used to seal the cystic duct. Methods: Using a retrospective observational design, we gathered data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (ERCP) (GallRiks). From 2006 until 2019, 124,818 patients were eligible for inclusion. These were nested to cohorts of 75,322 (60.3%) for uncomplicated gallstone disease and 49,496 (39.7%) with complicated gallstone disease. The cohorts were grouped by the number (i.e. two or three) of metal clips applied to the proximal cystic duct. The main outcome was 30-day bile leakage and post-procedural adverse events. Results: No significant differences surfaced in the rate of bile leakage (0.8% vs 0.8%; P = .87) or post-procedural adverse events (three clips, 5.7% vs two clips, 5.4%; P = .16) for uncomplicated gallstone disease. However, for complicated disease, bile leakage (1.4% vs 1.0%; P < .001) and post-procedural adverse events (10.2% vs 8.6%; P < .001) significantly increased when the cystic duct was sealed with three clips compared with two. Conclusions: Because no differences in the rates of bile leakage or adverse events emerged in uncomplicated gallstone disease when a third clip was applied, a third clip for additional safety is not recommended in such cases. On the contrary, bile leakage and adverse events increased when a third clip was used in patients with complicated gallstone disease. This finding probably indicates a more difficult cholecystectomy rather than being caused by the third clip itself.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45349618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/14574969221102280
D. Fukumori, C. Tschuor, L. Penninga, J. Hillingsø, L. Svendsen, P. N. Larsen
While most centers around the globe still consider open hepatic resection as the standard, innovative centers step in light of future developments of the robotic platform forward and introduce a robotic liver program while skipping the laparoscopic approach for its technological flaws. This applies also for our Department of Surgery and Transplantation at Rigshospitalet, Copenhagen University Hospital in Denmark. We herewith present as—to our best knowledge—the first center in Scandinavia our experience with the initial 50 robotic liver resections.
{"title":"Robotic liver resection in Denmark: Report of the first 50 cases at Rigshospitalet Copenhagen","authors":"D. Fukumori, C. Tschuor, L. Penninga, J. Hillingsø, L. Svendsen, P. N. Larsen","doi":"10.1177/14574969221102280","DOIUrl":"https://doi.org/10.1177/14574969221102280","url":null,"abstract":"While most centers around the globe still consider open hepatic resection as the standard, innovative centers step in light of future developments of the robotic platform forward and introduce a robotic liver program while skipping the laparoscopic approach for its technological flaws. This applies also for our Department of Surgery and Transplantation at Rigshospitalet, Copenhagen University Hospital in Denmark. We herewith present as—to our best knowledge—the first center in Scandinavia our experience with the initial 50 robotic liver resections.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44780025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1177/14574969221096193
Johan Back, V. Sallinen, A. Kokkola, P. Puolakkainen
Introduction: Gastrectomy with D2 lymphadenectomy is considered standard treatment in gastric cancer (GC). Among Western patients, morbidity and mortality seem to increase in D2 relative to D1 lymphadenectomy. As elderly patients with co-morbidities are more prone to possible complications, it is unclear whether they benefit from D2 lymphadenectomy. This study aims to compare the short- and long-term results of D1 and D2 lymphadenectomy in elderly patients undergoing gastrectomy for GC. Methods: All elderly (⩾75 years) patients undergoing gastrectomy with curative intent for GC during 2000–2015 were included and grouped according to the level of lymph node dissection into the D1 or D2 group. Short-term surgical outcome included the Comprehensive Complication Index (CCI) and 30-day mortality. Long-term outcomes comprised overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Cox regression was used in multivariable analyses. Results: In total, 99 elderly patients were included in the study (51 in D1 group, 48 in D2 group). The median follow-up was 32.5 months. Patients in the D1 group were older and had a higher American Society of Anesthesiologist (ASA) score. Both groups had similar burden of postoperative complications (CCI 20.9 versus 22.6, p = 0.26, respectively) and 90-day mortality (2% for both groups). The OS, DSS, and DFS were similar between groups. Multivariable analysis adjusted for potential confounders detected no difference in the survival between the D1 and D2 groups. Conclusions: Gastrectomy with D2 lymphadenectomy can be performed with low postoperative morbidity and mortality suggesting its use also in the elderly. Long-term outcomes seem similar but need further studies.
{"title":"Surgical and oncological outcomes of D1 versus D2 gastrectomy among elderly patients treated for gastric cancer","authors":"Johan Back, V. Sallinen, A. Kokkola, P. Puolakkainen","doi":"10.1177/14574969221096193","DOIUrl":"https://doi.org/10.1177/14574969221096193","url":null,"abstract":"Introduction: Gastrectomy with D2 lymphadenectomy is considered standard treatment in gastric cancer (GC). Among Western patients, morbidity and mortality seem to increase in D2 relative to D1 lymphadenectomy. As elderly patients with co-morbidities are more prone to possible complications, it is unclear whether they benefit from D2 lymphadenectomy. This study aims to compare the short- and long-term results of D1 and D2 lymphadenectomy in elderly patients undergoing gastrectomy for GC. Methods: All elderly (⩾75 years) patients undergoing gastrectomy with curative intent for GC during 2000–2015 were included and grouped according to the level of lymph node dissection into the D1 or D2 group. Short-term surgical outcome included the Comprehensive Complication Index (CCI) and 30-day mortality. Long-term outcomes comprised overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Cox regression was used in multivariable analyses. Results: In total, 99 elderly patients were included in the study (51 in D1 group, 48 in D2 group). The median follow-up was 32.5 months. Patients in the D1 group were older and had a higher American Society of Anesthesiologist (ASA) score. Both groups had similar burden of postoperative complications (CCI 20.9 versus 22.6, p = 0.26, respectively) and 90-day mortality (2% for both groups). The OS, DSS, and DFS were similar between groups. Multivariable analysis adjusted for potential confounders detected no difference in the survival between the D1 and D2 groups. Conclusions: Gastrectomy with D2 lymphadenectomy can be performed with low postoperative morbidity and mortality suggesting its use also in the elderly. Long-term outcomes seem similar but need further studies.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":"242 ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41314941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.1177/14574969221096191
Y. Yokoyama, S. Emoto, H. Nozawa, K. Kawai, K. Sasaki, K. Murono, Rei Ishibashi, K. Koike, S. Ishihara
Background and objective: Laparoscopic resection for obstructive colon cancer (CC) after insertion of self-expanding metallic stents (SEMSs) is reportedly difficult. However, this has not yet been thoroughly investigated. Therefore, we investigated the influence of SEMS insertion on laparoscopic resection. Methods: This retrospective comparative study included 87 patients with obstructive left-sided CC (December 2011–December 2019). Patients were assigned to two groups based on elective laparoscopic surgery for (1) obstructive CC necessitating emergent decompression with SEMS insertion (SEMS group) and (2) obstructive CC without emergent decompression (control group). Results: The SEMS group had a longer operation time (283.3 ± 79.3 min vs 222.2 ± 79.4 min, P = 0.002) and greater blood loss (204.8 ± 417.6 mL vs 53.7 ± 166.1 mL, P = 0.029) on univariate analysis; however, in multiple linear regression analysis, SEMS was not an independent risk factor for both operation time (Δ operation time 25.5 min: P = 0.19) and blood loss (Δ blood loss 33.6 mL: P = 0.58). The complication rate based on Clavien−Dindo grade II did not differ significantly (17% vs 20%, P = 1.00), whereas the rates of conversion to laparotomy (17% vs 2%, P = 0.016) and stoma creation (26% vs 2%, P = 0.001) were higher in the SEMS group. In oncological outcomes, there was no intergroup difference in the 5-year disease-free survival (80.0% vs 72.2%, P = 0.76) and overall survival (100% vs 86.3%, P = 0.25). Conclusions: Laparoscopic surgery after SEMS for left-sided CC is demanding due to higher conversion rates to open surgery. However, this study also revealed that it is as safe as laparoscopic surgery for cases without SEMS because of comparable complication rate and long-term outcomes.
背景与目的:据报道，在插入自膨胀金属支架(SEMSs)后，腹腔镜切除梗阻性结肠癌(CC)是困难的。然而，这一点尚未得到彻底的调查。因此，我们研究了SEMS插入对腹腔镜切除的影响。方法:回顾性比较研究纳入87例左侧梗阻性CC患者(2011年12月- 2019年12月)。患者根据选择性腹腔镜手术分为两组(1)梗阻性CC需要紧急减压并插入SEMS (SEMS组)和(2)梗阻性CC无需紧急减压(对照组)。结果:单因素分析显示，SEMS组手术时间更长(283.3±79.3 min vs 222.2±79.4 min, P = 0.002)，出血量更大(204.8±417.6 mL vs 53.7±166.1 mL, P = 0.029);然而，在多元线性回归分析中，SEMS不是手术时间(Δ手术时间25.5 min: P = 0.19)和出血量(Δ出血量33.6 mL: P = 0.58)的独立危险因素。基于Clavien - Dindo II级的并发症发生率无显著差异(17% vs 20%， P = 1.00)，而SEMS组中转开腹率(17% vs 2%， P = 0.016)和造口率(26% vs 2%， P = 0.001)更高。在肿瘤预后方面，5年无病生存率(80.0% vs 72.2%， P = 0.76)和总生存率(100% vs 86.3%， P = 0.25)组间无差异。结论:SEMS后腹腔镜手术治疗左侧CC的要求较高，因为转换率较高。然而，这项研究也表明，由于并发症发生率和长期预后相当，对于没有SEMS的病例，它与腹腔镜手术一样安全。
{"title":"Laparoscopic resection after self-expanding stent insertion for obstructive left-sided colorectal cancer: Clinicopathological features and outcomes","authors":"Y. Yokoyama, S. Emoto, H. Nozawa, K. Kawai, K. Sasaki, K. Murono, Rei Ishibashi, K. Koike, S. Ishihara","doi":"10.1177/14574969221096191","DOIUrl":"https://doi.org/10.1177/14574969221096191","url":null,"abstract":"Background and objective: Laparoscopic resection for obstructive colon cancer (CC) after insertion of self-expanding metallic stents (SEMSs) is reportedly difficult. However, this has not yet been thoroughly investigated. Therefore, we investigated the influence of SEMS insertion on laparoscopic resection. Methods: This retrospective comparative study included 87 patients with obstructive left-sided CC (December 2011–December 2019). Patients were assigned to two groups based on elective laparoscopic surgery for (1) obstructive CC necessitating emergent decompression with SEMS insertion (SEMS group) and (2) obstructive CC without emergent decompression (control group). Results: The SEMS group had a longer operation time (283.3 ± 79.3 min vs 222.2 ± 79.4 min, P = 0.002) and greater blood loss (204.8 ± 417.6 mL vs 53.7 ± 166.1 mL, P = 0.029) on univariate analysis; however, in multiple linear regression analysis, SEMS was not an independent risk factor for both operation time (Δ operation time 25.5 min: P = 0.19) and blood loss (Δ blood loss 33.6 mL: P = 0.58). The complication rate based on Clavien−Dindo grade II did not differ significantly (17% vs 20%, P = 1.00), whereas the rates of conversion to laparotomy (17% vs 2%, P = 0.016) and stoma creation (26% vs 2%, P = 0.001) were higher in the SEMS group. In oncological outcomes, there was no intergroup difference in the 5-year disease-free survival (80.0% vs 72.2%, P = 0.76) and overall survival (100% vs 86.3%, P = 0.25). Conclusions: Laparoscopic surgery after SEMS for left-sided CC is demanding due to higher conversion rates to open surgery. However, this study also revealed that it is as safe as laparoscopic surgery for cases without SEMS because of comparable complication rate and long-term outcomes.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48236722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/14574969221083394
I. E. Boukili, A. Flaris, Frédéric Mercier, E. Cotte, V. Kepenekian, D. Vaudoyer, O. Glehen, G. Passot
Background & objective: Major abdominal surgery morbidity can reach 50%. Prehabilitation has shown promising results in decreasing complications. However, it is unknown if prehabilitation can have a positive effect specifically after major abdominal surgery. The goal of this study was to evaluate the feasibility and safety of a prehabilitation program before major abdominal surgery. Methods: All patients evaluated for major abdominal surgery between February and April 2018 were eligible. A 4-week trimodal prehabilitation program combining physical therapy, nutritional support and psychological preparation was set up. Results: Among 106 patients evaluated for major abdominal surgery during the study period, 60 were included in the prehabilitation program. No cardiovascular events occurred during prehabilitation. The 6-min walking distance increased significantly (+45 m, increase of 9.3%, p = 0.008) after prehabilitation (and before the operation). Anxiety, depression, and several quality of life (QoL) items improved. Postoperative 90-day mortality and morbidity were 3.4% and 48%, respectively. Median hospital length of stay, and intensive care unit length of stay were 14 and 6 days, respectively. For 19 patients readmitted, the treatment was medical, radiological, or surgical, for 11, 5, and 3 patients, respectively. Conclusions: Prehabilitation before major abdominal surgery is feasible, safe, and improve patients’ functional reserves, QoL, and psychological status.
{"title":"Prehabilitation before major abdominal surgery: Evaluation of the impact of a perioperative clinical pathway, a pilot study","authors":"I. E. Boukili, A. Flaris, Frédéric Mercier, E. Cotte, V. Kepenekian, D. Vaudoyer, O. Glehen, G. Passot","doi":"10.1177/14574969221083394","DOIUrl":"https://doi.org/10.1177/14574969221083394","url":null,"abstract":"Background & objective: Major abdominal surgery morbidity can reach 50%. Prehabilitation has shown promising results in decreasing complications. However, it is unknown if prehabilitation can have a positive effect specifically after major abdominal surgery. The goal of this study was to evaluate the feasibility and safety of a prehabilitation program before major abdominal surgery. Methods: All patients evaluated for major abdominal surgery between February and April 2018 were eligible. A 4-week trimodal prehabilitation program combining physical therapy, nutritional support and psychological preparation was set up. Results: Among 106 patients evaluated for major abdominal surgery during the study period, 60 were included in the prehabilitation program. No cardiovascular events occurred during prehabilitation. The 6-min walking distance increased significantly (+45 m, increase of 9.3%, p = 0.008) after prehabilitation (and before the operation). Anxiety, depression, and several quality of life (QoL) items improved. Postoperative 90-day mortality and morbidity were 3.4% and 48%, respectively. Median hospital length of stay, and intensive care unit length of stay were 14 and 6 days, respectively. For 19 patients readmitted, the treatment was medical, radiological, or surgical, for 11, 5, and 3 patients, respectively. Conclusions: Prehabilitation before major abdominal surgery is feasible, safe, and improve patients’ functional reserves, QoL, and psychological status.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42606378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/14574969221090056
Ville E.J. Sirviö, J. Räsänen, J. Kauppila
Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Neoadjuvant therapy increases esophageal cancer survival.1 Data on oncological treatments in the Finnish Cancer Registry (FCR) are in research often used to estimate whether patients received neoadjuvant treatment or not. Nordic national registry data are generally valid,2,3 but no studies on using oncological treatment data in the FCR to estimate neoadjuvant treatment exist. The aim was to evaluate the completeness and concordance of FCR data, compared with neoadjuvant treatment according to patient records. This population-based nationwide study in Finland included all patients undergoing esophagectomy for cancer during 2010 to 2016. The ethical committee in Northern Ostrobothnia (EETMK 115/2016), and other relevant bodies and agencies approved the study.4 The FCR maintains an accurate national registry of all cancers in Finland.5 Oncological treatments in the FCR by modality are reported with specifications: “curative, palliative, or unclear intent” and “under or over 4 months from diagnosis.” Whether each modality is neoadjuvant or adjuvant therapy is not specified. Patients receiving any oncological treatment during 4 months from diagnosis in FCR were classified neoadjuvant treated, as all underwent surgery. Neoadjuvant treatment modalities were classified into (1) chemotherapy, (2) radiotherapy, and (3) chemoradiotherapy. The Finnish National Esophago-Gastric Cancer Cohort (FINEGO) was the “gold standard” comparison, described in detail elsewhere.4 The main variable of interest was neoadjuvant therapy (yes/no). Second, modalities were assessed separately. Positive predictive value (PPV), concordance, and completeness were calculated. Of the 562 patients who underwent esophagectomy, 555 (98.8%) had patient records available. Cancer registry record was found for 488 (86.8%) patients. Of the 562 patients, 241 (42.9%) were excluded due to missing FCR data, resulting in 321 (57.1%) patients with complete data on received neoadjuvant treatment. For neoadjuvant treatment modality, there were 306 (54.4%) patients with complete data. The proportions of received neoadjuvant therapy were similar between included patients and those with missing FCR data. For those with FCR record, oncological treatment data completeness was 65.8%. PPV and Research letter: Oncological treatment reported by the Finnish Cancer Registry compared to given neoadjuvant treatment in patients undergoing esophagectomy for cancer—A nationwide study
{"title":"Research letter: Oncological treatment reported by the Finnish Cancer Registry compared to given neoadjuvant treatment in patients undergoing esophagectomy for cancer—A nationwide study","authors":"Ville E.J. Sirviö, J. Räsänen, J. Kauppila","doi":"10.1177/14574969221090056","DOIUrl":"https://doi.org/10.1177/14574969221090056","url":null,"abstract":"Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Neoadjuvant therapy increases esophageal cancer survival.1 Data on oncological treatments in the Finnish Cancer Registry (FCR) are in research often used to estimate whether patients received neoadjuvant treatment or not. Nordic national registry data are generally valid,2,3 but no studies on using oncological treatment data in the FCR to estimate neoadjuvant treatment exist. The aim was to evaluate the completeness and concordance of FCR data, compared with neoadjuvant treatment according to patient records. This population-based nationwide study in Finland included all patients undergoing esophagectomy for cancer during 2010 to 2016. The ethical committee in Northern Ostrobothnia (EETMK 115/2016), and other relevant bodies and agencies approved the study.4 The FCR maintains an accurate national registry of all cancers in Finland.5 Oncological treatments in the FCR by modality are reported with specifications: “curative, palliative, or unclear intent” and “under or over 4 months from diagnosis.” Whether each modality is neoadjuvant or adjuvant therapy is not specified. Patients receiving any oncological treatment during 4 months from diagnosis in FCR were classified neoadjuvant treated, as all underwent surgery. Neoadjuvant treatment modalities were classified into (1) chemotherapy, (2) radiotherapy, and (3) chemoradiotherapy. The Finnish National Esophago-Gastric Cancer Cohort (FINEGO) was the “gold standard” comparison, described in detail elsewhere.4 The main variable of interest was neoadjuvant therapy (yes/no). Second, modalities were assessed separately. Positive predictive value (PPV), concordance, and completeness were calculated. Of the 562 patients who underwent esophagectomy, 555 (98.8%) had patient records available. Cancer registry record was found for 488 (86.8%) patients. Of the 562 patients, 241 (42.9%) were excluded due to missing FCR data, resulting in 321 (57.1%) patients with complete data on received neoadjuvant treatment. For neoadjuvant treatment modality, there were 306 (54.4%) patients with complete data. The proportions of received neoadjuvant therapy were similar between included patients and those with missing FCR data. For those with FCR record, oncological treatment data completeness was 65.8%. PPV and Research letter: Oncological treatment reported by the Finnish Cancer Registry compared to given neoadjuvant treatment in patients undergoing esophagectomy for cancer—A nationwide study","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43959677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.1177/14574969221090487
Hamed M. Seleim, A. M. Wishahy, B. Magdy, Mohamed Elseoudi, R. Zakaria, S. Kaddah, M. Elbarbary
Background and objective: There are several forms of relevant epi-aortic branching anomalies, and perhaps that is why different views as to the best approach have been reported. To help resolve this dilemma, we examined the unforeseen arch anomalies found at thoracoscopic repair of esophageal atresia and the outcomes. Methods: In a retrospective cohort, all consecutive patients who were thoracoscopically approached for esophageal atresia over a 5-year period with unforeseen aortic/epi-aortic branching were identified and grouped. Thoracoscopic views, operative interventions, and outcomes were studied. Results: A total of 121 neonates were thoracoscopically approached for EA, of whom 18 cases with aberrant aortic architecture were selected. Four (3%) cases were diagnosed on a preoperative echocardiography as a right-sided aortic arch, whereas unforeseen anomalous anatomies were reported in 14 cases (11.6%): left aortic arch with an aberrant right subclavian artery (ARSA) (n = 10), right-sided aortic arch with an aberrant left subclavian artery (ALSA) (n = 3), and mirror-image right arch (n = 1). Single postoperative mortality was reported among the group with left arch and ARSA (10%), whereas all the cases with right arch and ALSA died. Conclusions: In all, 11.6% of the studied series exhibited unexpected aberrant aortic architecture, with higher complication rates in comparison to the typical thoracoscopic repairs. For EA with left aortic arch and ARSA, the primary esophageal surgery could safely be completed. Meanwhile, curtailing surgery—after ligating the TEF—to get advanced imaging is still advised for both groups with the right arch due to the significant existence of vascular rings.
{"title":"The dilemma after an unforeseen aortic arch anomalies at thoracoscopic repair of esophageal atresia: Is curtailing surgery still a necessity?","authors":"Hamed M. Seleim, A. M. Wishahy, B. Magdy, Mohamed Elseoudi, R. Zakaria, S. Kaddah, M. Elbarbary","doi":"10.1177/14574969221090487","DOIUrl":"https://doi.org/10.1177/14574969221090487","url":null,"abstract":"Background and objective: There are several forms of relevant epi-aortic branching anomalies, and perhaps that is why different views as to the best approach have been reported. To help resolve this dilemma, we examined the unforeseen arch anomalies found at thoracoscopic repair of esophageal atresia and the outcomes. Methods: In a retrospective cohort, all consecutive patients who were thoracoscopically approached for esophageal atresia over a 5-year period with unforeseen aortic/epi-aortic branching were identified and grouped. Thoracoscopic views, operative interventions, and outcomes were studied. Results: A total of 121 neonates were thoracoscopically approached for EA, of whom 18 cases with aberrant aortic architecture were selected. Four (3%) cases were diagnosed on a preoperative echocardiography as a right-sided aortic arch, whereas unforeseen anomalous anatomies were reported in 14 cases (11.6%): left aortic arch with an aberrant right subclavian artery (ARSA) (n = 10), right-sided aortic arch with an aberrant left subclavian artery (ALSA) (n = 3), and mirror-image right arch (n = 1). Single postoperative mortality was reported among the group with left arch and ARSA (10%), whereas all the cases with right arch and ALSA died. Conclusions: In all, 11.6% of the studied series exhibited unexpected aberrant aortic architecture, with higher complication rates in comparison to the typical thoracoscopic repairs. For EA with left aortic arch and ARSA, the primary esophageal surgery could safely be completed. Meanwhile, curtailing surgery—after ligating the TEF—to get advanced imaging is still advised for both groups with the right arch due to the significant existence of vascular rings.","PeriodicalId":49566,"journal":{"name":"Scandinavian Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44547408","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：