Pub Date : 2024-03-29DOI: 10.1097/as9.0000000000000408
Swee H. Teh, Sharon Shiraga, Aaron M. Kellem, Robert A. Li, David M. Le, Said P. Arsalane, Fawzi S. Khayat, Yan Li, I-Yeh Gong, Jessica M. Lee
To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC) pathway, that can significantly reduce hospital stays after laparoscopic gastrectomy without increasing adverse events. Cost-effectiveness and improving patient outcomes are crucial in providing quality gastric cancer care worldwide. To compare the outcomes of gastric cancer surgery using 2 different models of care within an integrated healthcare system from February 2012 to March 2023. The primary endpoint was the length of hospital stay. The secondary endpoints were the need for intensive care unit care, emergency room (ER) visits, readmission, reoperation, and death within 30 days after surgery. There were 553 patients, 167 in the pre-(February 2012–April 2016) and 386 in the post-MIREC period (May 2016–March 2023). Perioperative chemotherapy utilization increased from 31.7% to 76.4% (P < 0.0001). Laparoscopic gastrectomy increased from 17.4% to 97.7% (P < 0.0001). Length of hospitalization decreased from 7 to 2 days (P < 0.0001), with 32.1% and 88% of patients discharged home on postoperative day 1 and postoperative day 2, respectively. When comparing pre- and post-MIREC, intensive care unit utilization (10.8% vs. 2.9%, P < 0.0001), ER visits (34.7% vs. 19.7%, P = 0.0002), and readmission (18.6% vs. 11.1%, P = 0.019) at 30 days were also considerably lower. In addition, more patients received postoperative adjuvant chemotherapy (31.4% to 63.5%, P < 0.0001), and the time between gastrectomy and starting adjuvant chemotherapy was also less (49–41 days; P = 0.002). This comprehensive regional program, which encompasses regionalization care, laparoscopic approach, modern oncologic care, surgical subspecialization, and the MIREC pathway, can potentially improve gastric cancer surgery outcomes. These benefits include reduced hospital stays and lower complication rates. As such, this program can revolutionize how gastric cancer surgery is delivered, leading to a higher quality of care and increased value to patients.
{"title":"A Path to High-Value Gastric Cancer Surgery Care Delivery","authors":"Swee H. Teh, Sharon Shiraga, Aaron M. Kellem, Robert A. Li, David M. Le, Said P. Arsalane, Fawzi S. Khayat, Yan Li, I-Yeh Gong, Jessica M. Lee","doi":"10.1097/as9.0000000000000408","DOIUrl":"https://doi.org/10.1097/as9.0000000000000408","url":null,"abstract":"\u0000 \u0000 To evaluate the feasibility, safety, and effectiveness of a comprehensive regional program, including the Minimally Invasive Recovery and Empowerment Care (MIREC) pathway, that can significantly reduce hospital stays after laparoscopic gastrectomy without increasing adverse events.\u0000 \u0000 \u0000 \u0000 Cost-effectiveness and improving patient outcomes are crucial in providing quality gastric cancer care worldwide.\u0000 \u0000 \u0000 \u0000 To compare the outcomes of gastric cancer surgery using 2 different models of care within an integrated healthcare system from February 2012 to March 2023. The primary endpoint was the length of hospital stay. The secondary endpoints were the need for intensive care unit care, emergency room (ER) visits, readmission, reoperation, and death within 30 days after surgery.\u0000 \u0000 \u0000 \u0000 There were 553 patients, 167 in the pre-(February 2012–April 2016) and 386 in the post-MIREC period (May 2016–March 2023). Perioperative chemotherapy utilization increased from 31.7% to 76.4% (P < 0.0001). Laparoscopic gastrectomy increased from 17.4% to 97.7% (P < 0.0001). Length of hospitalization decreased from 7 to 2 days (P < 0.0001), with 32.1% and 88% of patients discharged home on postoperative day 1 and postoperative day 2, respectively. When comparing pre- and post-MIREC, intensive care unit utilization (10.8% vs. 2.9%, P < 0.0001), ER visits (34.7% vs. 19.7%, P = 0.0002), and readmission (18.6% vs. 11.1%, P = 0.019) at 30 days were also considerably lower. In addition, more patients received postoperative adjuvant chemotherapy (31.4% to 63.5%, P < 0.0001), and the time between gastrectomy and starting adjuvant chemotherapy was also less (49–41 days; P = 0.002).\u0000 \u0000 \u0000 \u0000 This comprehensive regional program, which encompasses regionalization care, laparoscopic approach, modern oncologic care, surgical subspecialization, and the MIREC pathway, can potentially improve gastric cancer surgery outcomes. These benefits include reduced hospital stays and lower complication rates. As such, this program can revolutionize how gastric cancer surgery is delivered, leading to a higher quality of care and increased value to patients.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140367464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.1097/as9.0000000000000404
R. Duhoky, M. Rutgers, T. Burghgraef, S. Stefan, S. Masum, G. Piozzi, Filippos Sagias, Jim S Khan
To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center. Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome. We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes. A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0–13.0) vs 6.0 (4.0–8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010). This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.
目的：在一家三级医疗中心比较腹腔镜和机器人全直肠系膜切除术（TME）治疗直肠癌的长期疗效。 腹腔镜直肠癌手术的长期疗效与开腹手术不相上下，在短期疗效方面也有一些优势。然而，腹腔镜直肠癌手术在技术上有很大的局限性，而机器人手术正是要克服这些局限性。 我们纳入了2013年至2021年期间接受腹腔镜和机器人TME手术的患者。两组患者经过倾向分数匹配后进行比较。主要结果是5年总生存率（OS）。次要结局为局部复发（LR）、远处复发（DR）、无病生存（DFS）以及短期手术和患者相关结局。 共纳入了 594 名患者，经过倾向分数匹配后，每组仍有 215 名患者。腹腔镜组的5年OS（72.4% vs 81.7%，P = 0.029）有显著差异，但5年LR（4.7% vs 5.2%，P = 0.850）、DR（16.9% vs 13.5%，P = 0.390）或DFS（63.9% vs 74.4%，P = 0.086）无差异。机器人组的转归率明显较低（3.7% vs 0.5%，P = 0.046），住院时间较短[7.0 (6.0-13.0) vs 6.0 (4.0-8.0)，P < 0.001]，术后并发症较少（63.5% vs 50.7%，P = 0.010）。 这项研究表明，与腹腔镜方法相比，机器人TME手术的5年生存率更高，长期肿瘤治疗效果也相当。此外，还观察到较低的转换率、较短的住院时间和较少的术后并发症。与传统方法相比，机器人直肠癌手术是一种安全、有利的替代方法。
{"title":"Long-Term Outcomes of Robotic Versus Laparoscopic Total Mesorectal Excisions: A Propensity-Score Matched Cohort study of 5-year survival outcomes","authors":"R. Duhoky, M. Rutgers, T. Burghgraef, S. Stefan, S. Masum, G. Piozzi, Filippos Sagias, Jim S Khan","doi":"10.1097/as9.0000000000000404","DOIUrl":"https://doi.org/10.1097/as9.0000000000000404","url":null,"abstract":"\u0000 \u0000 To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.\u0000 \u0000 \u0000 \u0000 Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.\u0000 \u0000 \u0000 \u0000 We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.\u0000 \u0000 \u0000 \u0000 A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0–13.0) vs 6.0 (4.0–8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010).\u0000 \u0000 \u0000 \u0000 This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"73 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/as9.0000000000000400
Ajami Gikandi, Z. Fong, M. Qadan, Raja R. Narayan, Thinzar Lwin, C. F. Fernandez-Del Castillo, K. Lillemoe, C. Ferrone
Our aim was to assess whether complications after pancreatoduodenectomy (PD) impact long-term quality of life (QoL) and functional outcomes. There is an increasing number of long-term post-PD survivors, but few studies have evaluated long-term QoL outcomes. The EORTC QLQ-C30 and QLQ-PAN26 questionnaires were administered to patients who survived >5 years post-PD. Clinical relevance (CR) was scored as small (5–10), moderate (10–20), or large (>20). Patients were stratified based on whether they experienced a complication during the index hospitalization. Of 305 patients >5 years post-PD survivors, with valid contact information, 248 completed the questionnaires, and 231 had complication data available. Twenty-nine percent of patients experienced a complication, of which 17 (7.4%) were grade 1, 27 (11.7%) were grade 2, and 25 (10.8%) were grade 3. Global health status and functional domain scores were similar between both groups. Patients experiencing complications reported lower fatigue (21.4 vs 28.1, P < 0.05, CR small) and diarrhea (15.9 vs 23.1, P < 0.05, CR small) symptom scores when compared to patients without complications. Patients experiencing complications also reported lower pancreatic pain (38.2 vs 43.4, P < 0.05, CR small) and altered bowel habits (30.1 vs 40.7, P < 0.01, CR moderate) symptom scores. There was a lower prevalence of worrying (36.2% vs 60.5%, P < 0.05) and bloating (42.0% vs 56.2%, P < 0.05) among PD survivors with complications. Post-PD complication rates were not associated with long-term global QoL or functionality, and may be associated with less severe pancreas-specific symptoms.
我们的目的是评估胰十二指肠切除术（PD）后并发症是否会影响长期生活质量（QoL）和功能结果。 胰十二指肠切除术后长期存活者的人数越来越多，但很少有研究对长期 QoL 结果进行评估。 我们对肺结核术后存活超过 5 年的患者进行了 EORTC QLQ-C30 和 QLQ-PAN26 问卷调查。临床相关性（CR）分为小（5-10）、中（10-20）或大（>20）。根据患者在住院期间是否出现并发症对其进行分层。 在305名PD后存活5年以上并提供有效联系方式的患者中，248人完成了问卷调查，231人有并发症数据。29%的患者出现了并发症，其中17人（7.4%）为1级，27人（11.7%）为2级，25人（10.8%）为3级。两组患者的总体健康状况和功能领域得分相似。与无并发症患者相比，出现并发症患者的疲劳（21.4 vs 28.1，P < 0.05，CR 小）和腹泻（15.9 vs 23.1，P < 0.05，CR 小）症状评分较低。出现并发症的患者的胰腺疼痛（38.2 vs 43.4，P < 0.05，CR 小）和排便习惯改变（30.1 vs 40.7，P < 0.01，CR 中）症状评分也较低。在有并发症的腹泻幸存者中，担心（36.2% vs 60.5%，P < 0.05）和腹胀（42.0% vs 56.2%，P < 0.05）的发生率较低。 胰腺癌术后并发症发生率与长期整体质量生活水平或功能无关，可能与较轻的胰腺特异性症状有关。
{"title":"Do Complications After Pancreatoduodenectomy Have an Impact on Long-Term Quality of Life and Functional Outcomes?","authors":"Ajami Gikandi, Z. Fong, M. Qadan, Raja R. Narayan, Thinzar Lwin, C. F. Fernandez-Del Castillo, K. Lillemoe, C. Ferrone","doi":"10.1097/as9.0000000000000400","DOIUrl":"https://doi.org/10.1097/as9.0000000000000400","url":null,"abstract":"\u0000 \u0000 Our aim was to assess whether complications after pancreatoduodenectomy (PD) impact long-term quality of life (QoL) and functional outcomes.\u0000 \u0000 \u0000 \u0000 There is an increasing number of long-term post-PD survivors, but few studies have evaluated long-term QoL outcomes.\u0000 \u0000 \u0000 \u0000 The EORTC QLQ-C30 and QLQ-PAN26 questionnaires were administered to patients who survived >5 years post-PD. Clinical relevance (CR) was scored as small (5–10), moderate (10–20), or large (>20). Patients were stratified based on whether they experienced a complication during the index hospitalization.\u0000 \u0000 \u0000 \u0000 Of 305 patients >5 years post-PD survivors, with valid contact information, 248 completed the questionnaires, and 231 had complication data available. Twenty-nine percent of patients experienced a complication, of which 17 (7.4%) were grade 1, 27 (11.7%) were grade 2, and 25 (10.8%) were grade 3. Global health status and functional domain scores were similar between both groups. Patients experiencing complications reported lower fatigue (21.4 vs 28.1, P < 0.05, CR small) and diarrhea (15.9 vs 23.1, P < 0.05, CR small) symptom scores when compared to patients without complications. Patients experiencing complications also reported lower pancreatic pain (38.2 vs 43.4, P < 0.05, CR small) and altered bowel habits (30.1 vs 40.7, P < 0.01, CR moderate) symptom scores. There was a lower prevalence of worrying (36.2% vs 60.5%, P < 0.05) and bloating (42.0% vs 56.2%, P < 0.05) among PD survivors with complications.\u0000 \u0000 \u0000 \u0000 Post-PD complication rates were not associated with long-term global QoL or functionality, and may be associated with less severe pancreas-specific symptoms.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"124 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/as9.0000000000000407
Xu Wang, Li-Heng Liu, Jin-Kai Feng, Shu-Qun Cheng
{"title":"Comment on “Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma”","authors":"Xu Wang, Li-Heng Liu, Jin-Kai Feng, Shu-Qun Cheng","doi":"10.1097/as9.0000000000000407","DOIUrl":"https://doi.org/10.1097/as9.0000000000000407","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"12 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/as9.0000000000000399
Vincent P. Groot, L. Daamen
{"title":"Response to: Comment on “Dynamics of Serum CA 19-9 in Patients Undergoing Pancreatic Cancer Resection”","authors":"Vincent P. Groot, L. Daamen","doi":"10.1097/as9.0000000000000399","DOIUrl":"https://doi.org/10.1097/as9.0000000000000399","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"107 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/as9.0000000000000406
A. K. Uribe Rivera, Barbara Seeliger, Laurent Goffin, Alain García-Vázquez, D. Mutter, Mariano E. Giménez
The aim of this systematic review and meta-analysis is to identify current robotic assistance systems for percutaneous liver ablations, compare approaches, and determine how to achieve standardization of procedural concepts for optimized ablation outcomes. Image-guided surgical approaches are increasingly common. Assistance by navigation and robotic systems allows to optimize procedural accuracy, with the aim to consistently obtain adequate ablation volumes. Several databases (PubMed/MEDLINE, ProQuest, Science Direct, Research Rabbit, and IEEE Xplore) were systematically searched for robotic preclinical and clinical percutaneous liver ablation studies, and relevant original manuscripts were included according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. The endpoints were the type of device, insertion technique (freehand or robotic), planning, execution, and confirmation of the procedure. A meta-analysis was performed, including comparative studies of freehand and robotic techniques in terms of radiation dose, accuracy, and Euclidean error. The inclusion criteria were met by 33/755 studies. There were 24 robotic devices reported for percutaneous liver surgery. The most used were the MAXIO robot (8/33; 24.2%), Zerobot, and AcuBot (each 2/33, 6.1%). The most common tracking system was optical (25/33, 75.8%). In the meta-analysis, the robotic approach was superior to the freehand technique in terms of individual radiation (0.5582, 95% confidence interval [CI] = 0.0167–1.0996, dose-length product range 79–2216 mGy.cm), accuracy (0.6260, 95% CI = 0.1423–1.1097), and Euclidean error (0.8189, 95% CI = –0.1020 to 1.7399). Robotic assistance in percutaneous ablation for liver tumors achieves superior results and reduces errors compared with manual applicator insertion. Standardization of concepts and reporting is necessary and suggested to facilitate the comparison of the different parameters used to measure liver ablation results. The increasing use of image-guided surgery has encouraged robotic assistance for percutaneous liver ablations. This systematic review analyzed 33 studies and identified 24 robotic devices, with optical tracking prevailing. The meta-analysis favored robotic assessment, showing increased accuracy and reduced errors compared with freehand technique, emphasizing the need for conceptual standardization.
{"title":"Robotic Assistance in Percutaneous Liver Ablation Therapies: A Systematic Review and Meta-Analysis","authors":"A. K. Uribe Rivera, Barbara Seeliger, Laurent Goffin, Alain García-Vázquez, D. Mutter, Mariano E. Giménez","doi":"10.1097/as9.0000000000000406","DOIUrl":"https://doi.org/10.1097/as9.0000000000000406","url":null,"abstract":"\u0000 \u0000 The aim of this systematic review and meta-analysis is to identify current robotic assistance systems for percutaneous liver ablations, compare approaches, and determine how to achieve standardization of procedural concepts for optimized ablation outcomes.\u0000 \u0000 \u0000 \u0000 Image-guided surgical approaches are increasingly common. Assistance by navigation and robotic systems allows to optimize procedural accuracy, with the aim to consistently obtain adequate ablation volumes.\u0000 \u0000 \u0000 \u0000 Several databases (PubMed/MEDLINE, ProQuest, Science Direct, Research Rabbit, and IEEE Xplore) were systematically searched for robotic preclinical and clinical percutaneous liver ablation studies, and relevant original manuscripts were included according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses guidelines. The endpoints were the type of device, insertion technique (freehand or robotic), planning, execution, and confirmation of the procedure. A meta-analysis was performed, including comparative studies of freehand and robotic techniques in terms of radiation dose, accuracy, and Euclidean error.\u0000 \u0000 \u0000 \u0000 The inclusion criteria were met by 33/755 studies. There were 24 robotic devices reported for percutaneous liver surgery. The most used were the MAXIO robot (8/33; 24.2%), Zerobot, and AcuBot (each 2/33, 6.1%). The most common tracking system was optical (25/33, 75.8%). In the meta-analysis, the robotic approach was superior to the freehand technique in terms of individual radiation (0.5582, 95% confidence interval [CI] = 0.0167–1.0996, dose-length product range 79–2216 mGy.cm), accuracy (0.6260, 95% CI = 0.1423–1.1097), and Euclidean error (0.8189, 95% CI = –0.1020 to 1.7399).\u0000 \u0000 \u0000 \u0000 Robotic assistance in percutaneous ablation for liver tumors achieves superior results and reduces errors compared with manual applicator insertion. Standardization of concepts and reporting is necessary and suggested to facilitate the comparison of the different parameters used to measure liver ablation results. The increasing use of image-guided surgery has encouraged robotic assistance for percutaneous liver ablations. This systematic review analyzed 33 studies and identified 24 robotic devices, with optical tracking prevailing. The meta-analysis favored robotic assessment, showing increased accuracy and reduced errors compared with freehand technique, emphasizing the need for conceptual standardization.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"119 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-26DOI: 10.1097/as9.0000000000000409
N. Napoli, E. Kauffmann, M. Ginesini, Armando Di Dato, V. Viti, Cesare Gianfaldoni, Lucrezia Lami, C. Cappelli, Maria Isabella Rotondo, D. Campani, G. Amorese, C. Vivaldi, Silvia Cesario, Laura Bernardini, Enrico Vasile, F. Vistoli, U. Boggi
This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC). Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis. This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011–2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs. Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively (P = 0.759; OR: 1.21 [0.36–4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR (P = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; P < 0.0001), more type 2 vein resection (28.6% vs 5.7%; P = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; P = 0.0008), longer vein occlusion time (30 [25.3–78.3] minutes vs 15 [8–19.5] minutes; P = 0.0098), less blood loss (450 [200–750] mL vs 733 [500–1070.3] mL; P = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; P = 0.0041) (perioperative: 14.3% vs 60.0%; P = 0.0001). In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.
{"title":"Robotic Versus Open Pancreatoduodenectomy With Vein Resection and Reconstruction: A Propensity Score-Matched Analysis","authors":"N. Napoli, E. Kauffmann, M. Ginesini, Armando Di Dato, V. Viti, Cesare Gianfaldoni, Lucrezia Lami, C. Cappelli, Maria Isabella Rotondo, D. Campani, G. Amorese, C. Vivaldi, Silvia Cesario, Laura Bernardini, Enrico Vasile, F. Vistoli, U. Boggi","doi":"10.1097/as9.0000000000000409","DOIUrl":"https://doi.org/10.1097/as9.0000000000000409","url":null,"abstract":"\u0000 \u0000 This study aimed to compare robotic pancreatoduodenectomy with vein resection (PD-VR) based on the incidence of severe postoperative complications (SPC).\u0000 \u0000 \u0000 \u0000 Robotic pancreatoduodenectomy has been gaining momentum in recent years. Vein resection is frequently required in this operation, but no study has compared robotic and open PD-VR using a matched analysis.\u0000 \u0000 \u0000 \u0000 This was an intention-to-treat study designed to demonstrate the noninferiority of robotic to open PD-VR (2011–2021) based on SPC. To achieve a power of 80% (noninferiority margin:10%; α error: 0.05; ß error: 0.20), a 1:1 propensity score-matched analysis required 35 pairs.\u0000 \u0000 \u0000 \u0000 Of the 151 patients with PD-VR (open = 115, robotic = 36), 35 procedures per group were compared. Elective conversion to open surgery was required in 1 patient with robotic PD-VR (2.9%). One patient in both groups experienced partial vein thrombosis. SPC occurred in 7 (20.0%) and 6 patients (17.1%) in the robotic and open PD-VR groups, respectively (P = 0.759; OR: 1.21 [0.36–4.04]). Three patients died after robotic PD-VR (8.6%) and none died after open PD-VR (P = 0.239). Robotic PD-VR was associated with longer operative time (611.1 ± 13.9 minutes vs 529.0 ± 13.0 minutes; P < 0.0001), more type 2 vein resection (28.6% vs 5.7%; P = 0.0234) and less type 3 vein resection (31.4% vs 71.4%; P = 0.0008), longer vein occlusion time (30 [25.3–78.3] minutes vs 15 [8–19.5] minutes; P = 0.0098), less blood loss (450 [200–750] mL vs 733 [500–1070.3] mL; P = 0.0075), and fewer blood transfusions (intraoperative: 14.3% vs 48.6%; P = 0.0041) (perioperative: 14.3% vs 60.0%; P = 0.0001).\u0000 \u0000 \u0000 \u0000 In this study, robotic PD-VR was noninferior to open PD-VR for SPC. Robotic and open PD-VR need to be compared in randomized controlled trials.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"124 35","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140380986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1097/as9.0000000000000401
B. Görgec, I. Verpalen, J. Sijberden, M. Abu Hilal, S. Bipat, Cornelis Verhoef, R. Swijnenburg, Marc G Besselink, J. Stoker
Abdominal computed tomography (CT) is the standard imaging modality for detection and staging in patients with colorectal liver metastases (CRLM). Although liver magnetic resonance imaging (MRI) is superior to CT in detecting small lesions, guidelines are ambiguous regarding the added value of an additional liver MRI in the surgical workup of patients with CRLM. Therefore, this systematic review and meta-analysis aimed to evaluate the clinical added value of liver MRI in patients eligible for resection or ablation of CRLM based on CT. A systematic search was performed in the PubMed, Embase, and Cochrane Library databases through June 23, 2023. Studies investigating the impact of additional MRI on local treatment plan following CT in patients with CRLM were included. Risk of bias was assessed using the QUADAS-2 tool. The pooled weighted proportions for the primary outcome were calculated using random effect meta-analysis. Overall, 11 studies with 1440 patients were included, of whom 468 patients (32.5%) were assessed for change in local treatment plan. Contrast-enhanced liver MRI was used in 10 studies, including gadoxetic acid in 9 studies. Liver MRI with diffusion-weighted imaging was used in 8 studies. Pooling of data found a 24.12% (95% confidence interval, 15.58%–32.65%) change in the local treatment plan based on the added findings of liver MRI following CT. Sensitivity analysis including 5 studies (268 patients) focusing on monophasic portal venous CT followed by gadoxetic acid-enhanced liver MRI with diffusion-weighted imaging showed a change of local treatment plan of 17.88% (95% confidence interval, 5.14%–30.62%). This systematic review and meta-analysis found that liver MRI changed the preinterventional local treatment plan in approximately one-fifth of patients eligible for surgical resection or ablation of CRLM based on CT. These findings suggest a clinically relevant added value of routine liver MRI in the preinterventional workup of CRLM, which should be confirmed by large prospective studies.
{"title":"Added Value of Liver MRI in Patients Eligible for Surgical Resection or Ablation of Colorectal Liver Metastases Based on CT: A Systematic Review and Meta-Analysis","authors":"B. Görgec, I. Verpalen, J. Sijberden, M. Abu Hilal, S. Bipat, Cornelis Verhoef, R. Swijnenburg, Marc G Besselink, J. Stoker","doi":"10.1097/as9.0000000000000401","DOIUrl":"https://doi.org/10.1097/as9.0000000000000401","url":null,"abstract":"\u0000 \u0000 Abdominal computed tomography (CT) is the standard imaging modality for detection and staging in patients with colorectal liver metastases (CRLM). Although liver magnetic resonance imaging (MRI) is superior to CT in detecting small lesions, guidelines are ambiguous regarding the added value of an additional liver MRI in the surgical workup of patients with CRLM. Therefore, this systematic review and meta-analysis aimed to evaluate the clinical added value of liver MRI in patients eligible for resection or ablation of CRLM based on CT.\u0000 \u0000 \u0000 \u0000 A systematic search was performed in the PubMed, Embase, and Cochrane Library databases through June 23, 2023. Studies investigating the impact of additional MRI on local treatment plan following CT in patients with CRLM were included. Risk of bias was assessed using the QUADAS-2 tool. The pooled weighted proportions for the primary outcome were calculated using random effect meta-analysis.\u0000 \u0000 \u0000 \u0000 Overall, 11 studies with 1440 patients were included, of whom 468 patients (32.5%) were assessed for change in local treatment plan. Contrast-enhanced liver MRI was used in 10 studies, including gadoxetic acid in 9 studies. Liver MRI with diffusion-weighted imaging was used in 8 studies. Pooling of data found a 24.12% (95% confidence interval, 15.58%–32.65%) change in the local treatment plan based on the added findings of liver MRI following CT. Sensitivity analysis including 5 studies (268 patients) focusing on monophasic portal venous CT followed by gadoxetic acid-enhanced liver MRI with diffusion-weighted imaging showed a change of local treatment plan of 17.88% (95% confidence interval, 5.14%–30.62%).\u0000 \u0000 \u0000 \u0000 This systematic review and meta-analysis found that liver MRI changed the preinterventional local treatment plan in approximately one-fifth of patients eligible for surgical resection or ablation of CRLM based on CT. These findings suggest a clinically relevant added value of routine liver MRI in the preinterventional workup of CRLM, which should be confirmed by large prospective studies.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"188 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1097/as9.0000000000000398
Èva S. Nagy, Mark Westaway, Suzanne Danieletto, Lawrence B. Afrin
To investigate the possible association between breast implant illness (BII) and mast cell activation syndrome (MCAS), which often manifests increased mast cells (MCs) in assorted tissues and may explain BII symptoms. Mechanisms by which implants cause BII symptoms remain unclear, but BII and MCAS symptom profiles heavily overlap, warranting investigation of potential linkage. We retrospectively analyzed 20 implant patients who underwent explantation and total capsulectomy; 15 self-reported preoperatively they had BII (subject group); 5 felt they did not [control group 1 (CG1)]. Five prophylactic mastectomy patients constituted control group 2 (CG2). Subjects and CG1 patients completed BII symptom questionnaires preoperatively and multiple points postoperatively. With CD117 staining, average and maximum mast cell counts (MCCs) in resected tissues were determined. Mean BII symptom score 2 weeks postexplantation was reduced by 77% (P < 0.0001), and 85% by 9 months. Analysis suggested BII in CG1 patients, too, who improved similarly. Among CG2 patients, healthy breast tissue showed mean and maximum MCCs of 5.0/hpf and 6.9/hpf. Mean and maximum MCCs in capsules in BII patients were 11.7/hpf and 16.3/hpf, and 7.6/hpf and 13.3/hpf in CG1 patients. All intergroup comparisons were significantly different (P < 0.0001). MCCs in peri-implant capsules in BII patients are increased; some implanted patients appear to have unrecognized BII. Given that neoantigenic/xenobiotic exposures commonly trigger dysfunctional MCs in MCAS to heighten aberrant mediator expression driving inflammatory and other issues, further investigation of whether BII represents an implant-driven escalation of preexisting MCAS and whether an MCAS diagnosis flags risk for BII seems warranted.
{"title":"Breast Implant Illness May Be Rooted in Mast Cell Activation: A Case-Controlled Retrospective Analysis","authors":"Èva S. Nagy, Mark Westaway, Suzanne Danieletto, Lawrence B. Afrin","doi":"10.1097/as9.0000000000000398","DOIUrl":"https://doi.org/10.1097/as9.0000000000000398","url":null,"abstract":"\u0000 \u0000 To investigate the possible association between breast implant illness (BII) and mast cell activation syndrome (MCAS), which often manifests increased mast cells (MCs) in assorted tissues and may explain BII symptoms.\u0000 \u0000 \u0000 \u0000 Mechanisms by which implants cause BII symptoms remain unclear, but BII and MCAS symptom profiles heavily overlap, warranting investigation of potential linkage.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed 20 implant patients who underwent explantation and total capsulectomy; 15 self-reported preoperatively they had BII (subject group); 5 felt they did not [control group 1 (CG1)]. Five prophylactic mastectomy patients constituted control group 2 (CG2). Subjects and CG1 patients completed BII symptom questionnaires preoperatively and multiple points postoperatively. With CD117 staining, average and maximum mast cell counts (MCCs) in resected tissues were determined.\u0000 \u0000 \u0000 \u0000 Mean BII symptom score 2 weeks postexplantation was reduced by 77% (P < 0.0001), and 85% by 9 months. Analysis suggested BII in CG1 patients, too, who improved similarly. Among CG2 patients, healthy breast tissue showed mean and maximum MCCs of 5.0/hpf and 6.9/hpf. Mean and maximum MCCs in capsules in BII patients were 11.7/hpf and 16.3/hpf, and 7.6/hpf and 13.3/hpf in CG1 patients. All intergroup comparisons were significantly different (P < 0.0001).\u0000 \u0000 \u0000 \u0000 MCCs in peri-implant capsules in BII patients are increased; some implanted patients appear to have unrecognized BII. Given that neoantigenic/xenobiotic exposures commonly trigger dysfunctional MCs in MCAS to heighten aberrant mediator expression driving inflammatory and other issues, further investigation of whether BII represents an implant-driven escalation of preexisting MCAS and whether an MCAS diagnosis flags risk for BII seems warranted.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"178 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140283593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1097/as9.0000000000000402
C. Kosugi, Keiji Koda, Hiroaki Shimizu, M. Yamazaki, K. Shuto, M. Mori, Akihiro Usui, Hiroyuki Nojima, Satoshi Endo, H. Yanagibashi, H. Arimitsu, Toru Tochigi, T. Sazuka, Mihono Hirota, Hideyuki Kuboki
To determine whether Aquacel Ag Hydrofiber dressings containing ionic silver are superior to film dressings for preventing superficial surgical site infections (SSI) in patients undergoing elective gastrointestinal surgery. Multiple clinical trials have assessed the effectiveness of silver-containing wound dressings; however, systematic reviews failed to find any advantages of these dressings and concluded that there was insufficient evidence to indicate that they prevented wound infections. This study aimed to evaluate the efficacy of Aquacel Ag Hydrofiber dressings for preventing superficial SSIs in patients undergoing gastrointestinal surgery. Patients undergoing elective gastrointestinal surgery were randomly assigned to receive either Aquacel Ag Hydrofiber (study group) or film dressings (control group). The primary end point was superficial SSI within 30 days after surgery (UMIN Clinical Trials Registry ID: 000043081). A total of 865 patients (427 study group, 438 control group) were qualified for primary end-point analysis. The overall rate of superficial SSIs was significantly lower in the study group than in the control group (6.8% vs 11.4%, P = 0.019). There was no significant difference in superficial SSI rates between the groups in patients undergoing upper gastrointestinal surgery; however, the rate was significantly lower in the study group in patients undergoing lower gastrointestinal surgery (P = 0.042). Multivariate analysis identified Aquacel Ag Hydrofiber dressings as an independent factor for reducing superficial SSIs (odds ratio, 0.602; 95% confidence interval, 0.367–0.986; P = 0.044). Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.
目的：确定 Aquacel Ag Hydrofiber 含离子银敷料在预防接受择期胃肠道手术的患者浅表手术部位感染 (SSI) 方面是否优于薄膜敷料。 多项临床试验对含银伤口敷料的有效性进行了评估；然而，系统性综述未能发现这些敷料的任何优点，并得出结论认为没有足够的证据表明它们能预防伤口感染。本研究旨在评估 Aquacel Ag Hydrofiber 敷料对胃肠道手术患者预防浅表 SSI 的疗效。 接受择期胃肠道手术的患者被随机分配到 Aquacel Ag Hydrofiber（研究组）或薄膜敷料（对照组）。主要终点是术后 30 天内的表皮 SSI（UMIN 临床试验注册编号：000043081）。 共有 865 名患者（研究组 427 人，对照组 438 人）符合主要终点分析条件。研究组的浅表 SSI 总发生率明显低于对照组（6.8% vs 11.4%，P = 0.019）。在接受上消化道手术的患者中，研究组与对照组的浅表 SSI 感染率无明显差异；但在接受下消化道手术的患者中，研究组的感染率明显较低（P = 0.042）。多变量分析发现，Aquacel Ag 水纤维敷料是减少浅表 SSI 的一个独立因素（几率比 0.602；95% 置信区间 0.367-0.986；P = 0.044）。 与薄膜敷料相比，Aquacel Ag 水纤维敷料可减少接受择期胃肠道手术（尤其是下胃肠道手术）患者的浅表 SSI。
{"title":"A Randomized Trial of Ionic Silver Dressing to Reduce Surgical Site Infection After Gastrointestinal Surgery","authors":"C. Kosugi, Keiji Koda, Hiroaki Shimizu, M. Yamazaki, K. Shuto, M. Mori, Akihiro Usui, Hiroyuki Nojima, Satoshi Endo, H. Yanagibashi, H. Arimitsu, Toru Tochigi, T. Sazuka, Mihono Hirota, Hideyuki Kuboki","doi":"10.1097/as9.0000000000000402","DOIUrl":"https://doi.org/10.1097/as9.0000000000000402","url":null,"abstract":"\u0000 \u0000 To determine whether Aquacel Ag Hydrofiber dressings containing ionic silver are superior to film dressings for preventing superficial surgical site infections (SSI) in patients undergoing elective gastrointestinal surgery.\u0000 \u0000 \u0000 \u0000 Multiple clinical trials have assessed the effectiveness of silver-containing wound dressings; however, systematic reviews failed to find any advantages of these dressings and concluded that there was insufficient evidence to indicate that they prevented wound infections. This study aimed to evaluate the efficacy of Aquacel Ag Hydrofiber dressings for preventing superficial SSIs in patients undergoing gastrointestinal surgery.\u0000 \u0000 \u0000 \u0000 Patients undergoing elective gastrointestinal surgery were randomly assigned to receive either Aquacel Ag Hydrofiber (study group) or film dressings (control group). The primary end point was superficial SSI within 30 days after surgery (UMIN Clinical Trials Registry ID: 000043081).\u0000 \u0000 \u0000 \u0000 A total of 865 patients (427 study group, 438 control group) were qualified for primary end-point analysis. The overall rate of superficial SSIs was significantly lower in the study group than in the control group (6.8% vs 11.4%, P = 0.019). There was no significant difference in superficial SSI rates between the groups in patients undergoing upper gastrointestinal surgery; however, the rate was significantly lower in the study group in patients undergoing lower gastrointestinal surgery (P = 0.042). Multivariate analysis identified Aquacel Ag Hydrofiber dressings as an independent factor for reducing superficial SSIs (odds ratio, 0.602; 95% confidence interval, 0.367–0.986; P = 0.044).\u0000 \u0000 \u0000 \u0000 Aquacel Ag Hydrofiber dressings can reduce superficial SSIs compared to film dressings in patients undergoing elective gastrointestinal surgery, especially lower gastrointestinal surgery.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"52 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140279216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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