Pub Date : 2024-03-01DOI: 10.1097/as9.0000000000000405
C. Tinterri, Giuseppe Canavese, D. Gentile
{"title":"To Dissect or Not to Dissect? The Surgeon’s Perspective on the Prediction of Greater Than or Equal to 4 Axillary Lymph Node Metastasis in Early-Stage Breast Cancer: A Comparative Analysis of the Per-Protocol Population of the SINODAR-ONE Clinical Trial","authors":"C. Tinterri, Giuseppe Canavese, D. Gentile","doi":"10.1097/as9.0000000000000405","DOIUrl":"https://doi.org/10.1097/as9.0000000000000405","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"26 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269050","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/as9.0000000000000393
Leo Buhler, Ty Dunn, U. Boggi, C. Vollmer, Jens Werner, Christos Dervenis, Giovanni Marchegiani, Shailesh V Shrikhande, I. Khatkov, Abraham Fingerhut
{"title":"Comment on “Total Pancreatectomy With Islet Autotransplantation as an Alternative to High-Risk Pancreatojejunostomy After Pancreaticoduodenectomy: A Prospective Randomized Trial”","authors":"Leo Buhler, Ty Dunn, U. Boggi, C. Vollmer, Jens Werner, Christos Dervenis, Giovanni Marchegiani, Shailesh V Shrikhande, I. Khatkov, Abraham Fingerhut","doi":"10.1097/as9.0000000000000393","DOIUrl":"https://doi.org/10.1097/as9.0000000000000393","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"7 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140084121","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/as9.0000000000000397
E. M. L. van der Does de Willebois, Vittoria Bellato, M. Duijvestein, Susan van Dieren, S. Danese, Pierpaolo Sileri, C. Buskens, Andrea Vignali, Willem Bemelman
Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications. A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle–Ottawa Quality Assessment Scale and Cochrane Collaboration’s tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208. Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56–44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2–59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0–59.5) and 19.8% to 62.9% (IQR, 37.3–46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively. This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.
{"title":"How Reliable Is Endoscopic Scoring of Postoperative Recurrence in Crohn Disease?: A Systematic Review and Meta-Analysis","authors":"E. M. L. van der Does de Willebois, Vittoria Bellato, M. Duijvestein, Susan van Dieren, S. Danese, Pierpaolo Sileri, C. Buskens, Andrea Vignali, Willem Bemelman","doi":"10.1097/as9.0000000000000397","DOIUrl":"https://doi.org/10.1097/as9.0000000000000397","url":null,"abstract":"\u0000 \u0000 Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications.\u0000 \u0000 \u0000 \u0000 A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle–Ottawa Quality Assessment Scale and Cochrane Collaboration’s tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208.\u0000 \u0000 \u0000 \u0000 Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56–44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2–59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0–59.5) and 19.8% to 62.9% (IQR, 37.3–46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively.\u0000 \u0000 \u0000 \u0000 This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"512 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274897","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/as9.0000000000000403
M. A. Millis, C. Vitous, Cara Ferguson, Maedeh A. Marzoughi, Erin Kim, Sarah E. Bradley, A. Duby, P. Suwanabol
We sought to determine if and how providers use elements of shared decision-making (SDM) in the care of surgical patients in the intensive care unit (ICU). SDM is the gold standard for decision-making in the ICU. However, it is unknown if this communication style is used in caring for critically ill surgical patients. Qualitative interviews were conducted with providers who provide ICU-level care to surgical patients in Veterans Affairs hospitals. Interviews were designed to examine end-of-life care among veterans who have undergone surgery and require ICU-level care. Forty-eight providers across 14 Veterans Affairs hospitals were interviewed. These participants were diverse with respect to age, race, and sex. Participant dialogue was deductively mapped into 8 established SDM components: describing treatment options; determining roles in the decision-making process; fostering partnerships; health care professional preferences; learning about the patient; patient preferences; supporting the decision-making process; and tailoring the information. Within these components, participants shared preferred tools and tactics used to satisfy a given SDM component. Participants also noted numerous barriers to achieving SDM among surgical patients. Providers use elements of SDM when caring for critically ill surgical patients. Additionally, this work identifies facilitators that can be leveraged and barriers that can be addressed to facilitate better communication and decision-making through SDM. These findings are of value for future interventions that seek to enhance SDM among surgical patients both in the ICU and in other settings.
{"title":"Is Everyone Beating Around the Bush?: A Qualitative Study Examining the Status of Shared Decision-Making Between Veterans Affairs Providers and Surgical Patients in the ICU","authors":"M. A. Millis, C. Vitous, Cara Ferguson, Maedeh A. Marzoughi, Erin Kim, Sarah E. Bradley, A. Duby, P. Suwanabol","doi":"10.1097/as9.0000000000000403","DOIUrl":"https://doi.org/10.1097/as9.0000000000000403","url":null,"abstract":"\u0000 \u0000 We sought to determine if and how providers use elements of shared decision-making (SDM) in the care of surgical patients in the intensive care unit (ICU).\u0000 \u0000 \u0000 \u0000 SDM is the gold standard for decision-making in the ICU. However, it is unknown if this communication style is used in caring for critically ill surgical patients.\u0000 \u0000 \u0000 \u0000 Qualitative interviews were conducted with providers who provide ICU-level care to surgical patients in Veterans Affairs hospitals. Interviews were designed to examine end-of-life care among veterans who have undergone surgery and require ICU-level care.\u0000 \u0000 \u0000 \u0000 Forty-eight providers across 14 Veterans Affairs hospitals were interviewed. These participants were diverse with respect to age, race, and sex. Participant dialogue was deductively mapped into 8 established SDM components: describing treatment options; determining roles in the decision-making process; fostering partnerships; health care professional preferences; learning about the patient; patient preferences; supporting the decision-making process; and tailoring the information. Within these components, participants shared preferred tools and tactics used to satisfy a given SDM component. Participants also noted numerous barriers to achieving SDM among surgical patients.\u0000 \u0000 \u0000 \u0000 Providers use elements of SDM when caring for critically ill surgical patients. Additionally, this work identifies facilitators that can be leveraged and barriers that can be addressed to facilitate better communication and decision-making through SDM. These findings are of value for future interventions that seek to enhance SDM among surgical patients both in the ICU and in other settings.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"29 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269260","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/as9.0000000000000396
Y. Hirata, Heather Lyu, Ahad M. Azimuddin, Pamela Lu, Jeeva Ajith, Jason A. Schmeisser, Elizabeth P. Ninan, Kyung Hyun Lee, B. Badgwell, Paul F. Mansfield, N. Ikoma
To determine the magnitude of the perioperative costs associated with robotic gastrectomy (RG). A robotic surgery platform has a high implementation cost and requires maintenance costs; however, whether the overall cost of RG, including all perioperative costs, is higher than conventional open gastrectomy (OG) remains unknown. Patients who underwent a major gastrectomy during February 2018 through December 2021 were retrospectively identified. We calculated the perioperative costs of RG and OG and compared them overall as well as in different phases, including intraoperative costs and 30-day postsurgery inpatient and outpatient costs. We investigated factors potentially associated with high cost and estimated the likelihood of RG to reduce overall cost under a Bayesian framework. All cost data were converted to ratios to the average cost of all operations performed at our center in year FY2021. We identified 119 patients who underwent gastrectomy. The incidence of postoperative complications (Clavien-Dindo >IIIa; RG, 10% vs OG, 13%) did not significantly differ between approaches. The median length of stay was 3 days shorter for RG versus OG (4 vs 7 days, P < 0.001). Intraoperative cost ratios were significantly higher for RG (RG, 2.6 vs OG, 1.7; P < 0.001). However, postoperative hospitalization cost ratios were significantly lower for RG (RG, 2.8 vs OG, 3.9; P < 0.001). Total perioperative cost ratios were similar between groups (RG, 6.1 vs OG, 6.4; P = 0.534). The multiple Bayesian generalized linear analysis showed RG had 76.5% posterior probability of overall perioperative cost reduction (adjusted risk ratio of 0.95; 95% credible interval, 0.85–1.07). Despite increased intraoperative costs, total perioperative costs in the RG group were similar to those in the OG group because of reduced postoperative hospitalization costs.
确定与机器人胃切除术（RG）相关的围手术期成本的规模。 机器人手术平台的实施成本很高，并且需要维护成本；然而，机器人胃切除术的总体成本（包括所有围手术期成本）是否高于传统的开腹胃切除术（OG）仍是未知数。 我们对 2018 年 2 月至 2021 年 12 月期间接受胃大部切除术的患者进行了回顾性鉴定。我们计算了RG和OG的围手术期成本，并对两者的总体成本以及不同阶段的成本进行了比较，包括术中成本和术后30天的住院和门诊成本。我们研究了可能与高成本相关的因素，并在贝叶斯框架下估计了 RG 降低总体成本的可能性。我们将所有成本数据转换为 2021 财年本中心所有手术平均成本的比率。 我们确定了 119 名接受胃切除术的患者。不同方法的术后并发症发生率（Clavien-Dindo >IIIa；RG，10% vs OG，13%）无显著差异。RG 与 OG 相比，中位住院时间缩短了 3 天（4 天 vs 7 天，P < 0.001）。RG 的术中成本比明显更高（RG 2.6 vs OG 1.7；P < 0.001）。但是，RG 的术后住院费用比明显较低（RG，2.8 vs OG，3.9；P <0.001）。两组的围手术期总成本比相似（RG，6.1 vs OG，6.4；P = 0.534）。多重贝叶斯广义线性分析显示，RG 有 76.5% 的后验概率使围手术期总成本降低（调整风险比为 0.95；95% 可信区间为 0.85-1.07）。 尽管术中费用增加，但由于术后住院费用减少，RG 组的围手术期总费用与 OG 组相似。
{"title":"Cost Analysis for Robotic and Open Gastrectomy","authors":"Y. Hirata, Heather Lyu, Ahad M. Azimuddin, Pamela Lu, Jeeva Ajith, Jason A. Schmeisser, Elizabeth P. Ninan, Kyung Hyun Lee, B. Badgwell, Paul F. Mansfield, N. Ikoma","doi":"10.1097/as9.0000000000000396","DOIUrl":"https://doi.org/10.1097/as9.0000000000000396","url":null,"abstract":"\u0000 \u0000 To determine the magnitude of the perioperative costs associated with robotic gastrectomy (RG).\u0000 \u0000 \u0000 \u0000 A robotic surgery platform has a high implementation cost and requires maintenance costs; however, whether the overall cost of RG, including all perioperative costs, is higher than conventional open gastrectomy (OG) remains unknown.\u0000 \u0000 \u0000 \u0000 Patients who underwent a major gastrectomy during February 2018 through December 2021 were retrospectively identified. We calculated the perioperative costs of RG and OG and compared them overall as well as in different phases, including intraoperative costs and 30-day postsurgery inpatient and outpatient costs. We investigated factors potentially associated with high cost and estimated the likelihood of RG to reduce overall cost under a Bayesian framework. All cost data were converted to ratios to the average cost of all operations performed at our center in year FY2021.\u0000 \u0000 \u0000 \u0000 We identified 119 patients who underwent gastrectomy. The incidence of postoperative complications (Clavien-Dindo >IIIa; RG, 10% vs OG, 13%) did not significantly differ between approaches. The median length of stay was 3 days shorter for RG versus OG (4 vs 7 days, P < 0.001). Intraoperative cost ratios were significantly higher for RG (RG, 2.6 vs OG, 1.7; P < 0.001). However, postoperative hospitalization cost ratios were significantly lower for RG (RG, 2.8 vs OG, 3.9; P < 0.001). Total perioperative cost ratios were similar between groups (RG, 6.1 vs OG, 6.4; P = 0.534). The multiple Bayesian generalized linear analysis showed RG had 76.5% posterior probability of overall perioperative cost reduction (adjusted risk ratio of 0.95; 95% credible interval, 0.85–1.07).\u0000 \u0000 \u0000 \u0000 Despite increased intraoperative costs, total perioperative costs in the RG group were similar to those in the OG group because of reduced postoperative hospitalization costs.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"155 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275932","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 : 2024-02-27DOI: 10.1097/as9.0000000000000382
Raquel Lima Sampaio, G. R. Coelho, D. Mesquita, Carlos Eduardo Lopes Soares, José Huygens Parente Garcia
The most relevant limiting factor for performing end-to-end anastomosis is portal vein thrombosis (PVT), which leads to challenging vascular reconstructions. This study aimed to analyze a single center’s experience using the left gastric vein (LGV) for portal flow reconstruction in liver transplantation (LT). This retrospective observational study reviewed laboratory and imaging tests, a description of the surgical technique, and outpatient follow-up of patients with portal system thrombosis undergoing LT with portal flow reconstruction using the LGV. This study was conducted at a single transplant reference center in the northeast region of Brazil from January 2016 to December 2021. Between January 2016 and December 2021, 848 transplants were performed at our center. Eighty-two patients (9.7%) presented with PVT, most of whom were treated with thrombectomy. Nine patients (1.1% with PVT) had extensive thrombosis of the portal system (Yerdel III or IV), which required end-to-side anastomosis between the portal vein and the LGV without graft, and had no intraoperative complications. All patients had successful portal flow in Doppler ultrasound control evaluations. The goal was to reestablish physiological flow to the graft. A surgical strategy includes using the LGV graft. According to our reports, using LGV fulfilled the requirements for excellent vascular anastomosis and even allowed the dispensing of venous grafts. This is the largest case series in a single center of reconstruction of portal flow with direct anastomosis with the LGV without needing a vascular graft.
{"title":"Left Gastric Vein Direct Anastomosis as Alternative to Portal Flow Reconstruction in Liver Transplantation","authors":"Raquel Lima Sampaio, G. R. Coelho, D. Mesquita, Carlos Eduardo Lopes Soares, José Huygens Parente Garcia","doi":"10.1097/as9.0000000000000382","DOIUrl":"https://doi.org/10.1097/as9.0000000000000382","url":null,"abstract":"\u0000 \u0000 The most relevant limiting factor for performing end-to-end anastomosis is portal vein thrombosis (PVT), which leads to challenging vascular reconstructions. This study aimed to analyze a single center’s experience using the left gastric vein (LGV) for portal flow reconstruction in liver transplantation (LT).\u0000 \u0000 \u0000 \u0000 This retrospective observational study reviewed laboratory and imaging tests, a description of the surgical technique, and outpatient follow-up of patients with portal system thrombosis undergoing LT with portal flow reconstruction using the LGV. This study was conducted at a single transplant reference center in the northeast region of Brazil from January 2016 to December 2021.\u0000 \u0000 \u0000 \u0000 Between January 2016 and December 2021, 848 transplants were performed at our center. Eighty-two patients (9.7%) presented with PVT, most of whom were treated with thrombectomy. Nine patients (1.1% with PVT) had extensive thrombosis of the portal system (Yerdel III or IV), which required end-to-side anastomosis between the portal vein and the LGV without graft, and had no intraoperative complications. All patients had successful portal flow in Doppler ultrasound control evaluations.\u0000 \u0000 \u0000 \u0000 The goal was to reestablish physiological flow to the graft. A surgical strategy includes using the LGV graft. According to our reports, using LGV fulfilled the requirements for excellent vascular anastomosis and even allowed the dispensing of venous grafts. This is the largest case series in a single center of reconstruction of portal flow with direct anastomosis with the LGV without needing a vascular graft.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"14 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140426022","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 : 2024-02-22DOI: 10.1097/as9.0000000000000381
Robert E. George, Caroline C. Bay, E. Shaffrey, Peter J. Wirth, Venkat K. Rao
Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.
{"title":"A Day in the Life of a Surgical Instrument: The Cycle of Sterilization","authors":"Robert E. George, Caroline C. Bay, E. Shaffrey, Peter J. Wirth, Venkat K. Rao","doi":"10.1097/as9.0000000000000381","DOIUrl":"https://doi.org/10.1097/as9.0000000000000381","url":null,"abstract":"Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"24 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441078","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 : 2024-02-22DOI: 10.1097/as9.0000000000000383
Grant Patrick, Brian Hickner, Karthik Goli, Liam D. Ferreira, John A Goss, Abbas Rana
Intent-to-treat analysis follows patients from listing to death, regardless of their transplant status, and aims to provide a more holistic scope of the progress made in adult solid-organ transplantation. Many studies have shown progress in waitlist and post-transplant survival for adult kidney, liver, heart, and lung transplants, but there is a need to provide a more comprehensive perspective of transplant outcomes for patients and their families. Univariable and multivariable Cox regression analyses were used to analyze factors contributing to intent-to-treat survival in 813,862 adults listed for kidney, liver, heart, and lung transplants. The Kaplan–Meier method was used to examine changes in waitlist, post-transplant, and intent-to-treat survival. Transplantation rates were compared using χ2 tests. Intent-to-treat survival has steadily increased for liver, heart, and lung transplants. The percentage of patients transplanted within 1 year significantly increased for heart (57.4% from 52.9%) and lung (73.5% from 33.2%). However, the percentage of patients transplanted within 1 year significantly decreased from 35.8% to 21.2% for kidney transplant. Notably, intent-to-treat survival has decreased for kidneys despite increases in waitlist and post-transplant survival, likely because of the decreased transplant rate. Intent-to-treat survival steadily improved for liver, heart, and lung transplant over the 30-year study period. Continued advancements in allocation policy, immunosuppression, and improved care of patients on the waitlist may contribute to further progress in outcomes of all organs, but the increasing discrepancy in supply and demand of donor kidneys is alarming and has impeded the progress of kidney intent-to-treat survival.
{"title":"Trends in Survival for Adult Organ Transplantation","authors":"Grant Patrick, Brian Hickner, Karthik Goli, Liam D. Ferreira, John A Goss, Abbas Rana","doi":"10.1097/as9.0000000000000383","DOIUrl":"https://doi.org/10.1097/as9.0000000000000383","url":null,"abstract":"\u0000 \u0000 Intent-to-treat analysis follows patients from listing to death, regardless of their transplant status, and aims to provide a more holistic scope of the progress made in adult solid-organ transplantation.\u0000 \u0000 \u0000 \u0000 Many studies have shown progress in waitlist and post-transplant survival for adult kidney, liver, heart, and lung transplants, but there is a need to provide a more comprehensive perspective of transplant outcomes for patients and their families.\u0000 \u0000 \u0000 \u0000 Univariable and multivariable Cox regression analyses were used to analyze factors contributing to intent-to-treat survival in 813,862 adults listed for kidney, liver, heart, and lung transplants. The Kaplan–Meier method was used to examine changes in waitlist, post-transplant, and intent-to-treat survival. Transplantation rates were compared using χ2 tests.\u0000 \u0000 \u0000 \u0000 Intent-to-treat survival has steadily increased for liver, heart, and lung transplants. The percentage of patients transplanted within 1 year significantly increased for heart (57.4% from 52.9%) and lung (73.5% from 33.2%). However, the percentage of patients transplanted within 1 year significantly decreased from 35.8% to 21.2% for kidney transplant. Notably, intent-to-treat survival has decreased for kidneys despite increases in waitlist and post-transplant survival, likely because of the decreased transplant rate.\u0000 \u0000 \u0000 \u0000 Intent-to-treat survival steadily improved for liver, heart, and lung transplant over the 30-year study period. Continued advancements in allocation policy, immunosuppression, and improved care of patients on the waitlist may contribute to further progress in outcomes of all organs, but the increasing discrepancy in supply and demand of donor kidneys is alarming and has impeded the progress of kidney intent-to-treat survival.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"15 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140441122","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 : 2024-02-19DOI: 10.1097/as9.0000000000000374
V. Doğru, Jean H. Ashburn, Umut Akova, A. Sutter, E. Esen, E. M. Gardner, A. da Luz Moreira, A. Erkan, John Kirat, M. Grieco, F. Remzi
Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis. The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn’s disease affects surgical outcomes and recurrence. Yet, despite heterogeneous data from different anastomotic configurations, there remains no clear guidance as to the optimal technique. In a retrospective cohort design, patients undergoing ileocolic anastomosis in the setting of Crohn’s disease between 2016 and 2021 at two institutions were identified. Patient characteristics and surgical outcomes in terms of recurrence (surgical, clinical, and endoscopic) were studied. In total, 211 patients were included. Before surgery, 80% were exposed to at least 1 cycle of systemic steroids and 71% had at least 1 biologic agent; 60% exhibited penetrating disease and 38% developed an intra-abdominal abscess. After surgery, one anastomosis leaked (0.5%). Over 2.4 years of follow-up (IQR = 1.3–3.9), surgical recurrence was 0.9%. Two-year overall recurrence-free and endoscopic recurrence-free survivals were 74% and 85% (95% CI = 68–81 and 80–91), respectively. The adjusted hazard ratio of endoscopic recurrence was 3.0 (95% CI = 1.4–6.2) for males and 5.2 (1.2–22) for patients who received systemic steroids before the surgery. The stapled end-to-side anastomosis is an efficient, reliable, and reproducible approach to maintain bowel continuity after ileocecal resection with durable outcomes. Our outcomes demonstrate low rates of disease recurrence and stand favorably in comparison to other more technically complex or protracted anastomotic approaches. This anastomosis is an ideal reconstructive approach after ileocecal resection for Crohn’s disease.
{"title":"Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study","authors":"V. Doğru, Jean H. Ashburn, Umut Akova, A. Sutter, E. Esen, E. M. Gardner, A. da Luz Moreira, A. Erkan, John Kirat, M. Grieco, F. Remzi","doi":"10.1097/as9.0000000000000374","DOIUrl":"https://doi.org/10.1097/as9.0000000000000374","url":null,"abstract":"\u0000 \u0000 Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis.\u0000 \u0000 \u0000 \u0000 The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn’s disease affects surgical outcomes and recurrence. Yet, despite heterogeneous data from different anastomotic configurations, there remains no clear guidance as to the optimal technique.\u0000 \u0000 \u0000 \u0000 In a retrospective cohort design, patients undergoing ileocolic anastomosis in the setting of Crohn’s disease between 2016 and 2021 at two institutions were identified. Patient characteristics and surgical outcomes in terms of recurrence (surgical, clinical, and endoscopic) were studied.\u0000 \u0000 \u0000 \u0000 In total, 211 patients were included. Before surgery, 80% were exposed to at least 1 cycle of systemic steroids and 71% had at least 1 biologic agent; 60% exhibited penetrating disease and 38% developed an intra-abdominal abscess. After surgery, one anastomosis leaked (0.5%). Over 2.4 years of follow-up (IQR = 1.3–3.9), surgical recurrence was 0.9%. Two-year overall recurrence-free and endoscopic recurrence-free survivals were 74% and 85% (95% CI = 68–81 and 80–91), respectively. The adjusted hazard ratio of endoscopic recurrence was 3.0 (95% CI = 1.4–6.2) for males and 5.2 (1.2–22) for patients who received systemic steroids before the surgery.\u0000 \u0000 \u0000 \u0000 The stapled end-to-side anastomosis is an efficient, reliable, and reproducible approach to maintain bowel continuity after ileocecal resection with durable outcomes. Our outcomes demonstrate low rates of disease recurrence and stand favorably in comparison to other more technically complex or protracted anastomotic approaches. This anastomosis is an ideal reconstructive approach after ileocecal resection for Crohn’s disease.\u0000","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"3 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139958763","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 : 2024-02-19DOI: 10.1097/as9.0000000000000392
Yanfei Yang, Ziqiang Du, Rui Du
{"title":"Comment on Article “Risk Models for Developing Pancreatic Fistula After Pancreatoduodenectomy: Validation in a Nationwide Prospective Cohort”","authors":"Yanfei Yang, Ziqiang Du, Rui Du","doi":"10.1097/as9.0000000000000392","DOIUrl":"https://doi.org/10.1097/as9.0000000000000392","url":null,"abstract":"","PeriodicalId":503165,"journal":{"name":"Annals of Surgery Open","volume":"23 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140450643","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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