Pub Date : 2024-09-12DOI: 10.1097/sla.0000000000006532
Joseph R Habib,Ingmar F Rompen,Benedict Kinny-Köster,Brady A Campbell,Paul C M Andel,Greg D Sacks,Adrian T Billeter,Hjalmar C van Santvoort,Lois A Daamen,Ammar A Javed,Beat P Müller-Stich,Marc G Besselink,Markus W Büchler,Jin He,Christopher L Wolfgang,I Quintus Molenaar,Martin Loos
OBJECTIVETo assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section.SUMMARY BACKGROUND DATAThe ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable.METHODSConsecutive patients with resected and histologically confirmed IPMN-derived PDAC (2002-2022) from six international high-volume centers were included. The prognostic relevance of a positive resection margin (R1) and degrees of dysplasia at the pancreatic neck margin were assessed by log-rank test and multivariable Cox-regression for overall survival (OS) and recurrence-free survival (RFS).RESULTSOverall, 832 patients with IPMN-derived PDAC were included with 322 patients (39%) having an R1-resection on final pathology. Median OS (mOS) was significantly longer in patients with an R0 status compared to those with an R1 status (65.8 vs. 26.3 mo P<0.001). Patients without dysplasia at the pancreatic neck margin had similar OS compared to those with low-grade dysplasia (mOS: 78.8 vs. 66.8 months, P=0.344). However, high-grade dysplasia (mOS: 26.1 mo, P=0.001) and invasive cancer (mOS: 25.0 mo, P<0.001) were associated with significantly worse OS compared to no or low-grade dysplasia. Patients who underwent conversion of high-risk margins (high-grade or invasive cancer) to a low-risk margin (low-grade or no dysplasia) after intraoperative frozen section had significantly superior OS compared to those with a high-risk neck margin on final pathology (mOS: 76.9 vs. 26.1 mo P<0.001).CONCLUSIONSIn IPMN-derived PDAC, normal epithelium or low-grade dysplasia at the neck have similar outcomes while pancreatic neck margins with high-grade dysplasia or invasive cancer are associated with poorer outcomes. Conversion of a high-risk to low-risk margin after intraoperative frozen section is associated with survival benefit and should be performed when feasible.
{"title":"Informing Decision-making for Transected Margin Reresection in Intraductal Papillary Mucinous Neoplasm-derived PDAC: An International Multicenter Study.","authors":"Joseph R Habib,Ingmar F Rompen,Benedict Kinny-Köster,Brady A Campbell,Paul C M Andel,Greg D Sacks,Adrian T Billeter,Hjalmar C van Santvoort,Lois A Daamen,Ammar A Javed,Beat P Müller-Stich,Marc G Besselink,Markus W Büchler,Jin He,Christopher L Wolfgang,I Quintus Molenaar,Martin Loos","doi":"10.1097/sla.0000000000006532","DOIUrl":"https://doi.org/10.1097/sla.0000000000006532","url":null,"abstract":"OBJECTIVETo assess the prognostic impact of margin status in patients with resected intraductal papillary mucinous neoplasms (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) and to inform future intraoperative decision-making on handling differing degrees of dysplasia on frozen section.SUMMARY BACKGROUND DATAThe ideal oncologic surgical outcome is a negative transection margin with normal pancreatic epithelium left behind. However, the prognostic significance of reresecting certain degrees of dysplasia or invasive cancer at the pancreatic neck margin during pancreatectomy for IPMN-derived PDAC is debatable.METHODSConsecutive patients with resected and histologically confirmed IPMN-derived PDAC (2002-2022) from six international high-volume centers were included. The prognostic relevance of a positive resection margin (R1) and degrees of dysplasia at the pancreatic neck margin were assessed by log-rank test and multivariable Cox-regression for overall survival (OS) and recurrence-free survival (RFS).RESULTSOverall, 832 patients with IPMN-derived PDAC were included with 322 patients (39%) having an R1-resection on final pathology. Median OS (mOS) was significantly longer in patients with an R0 status compared to those with an R1 status (65.8 vs. 26.3 mo P<0.001). Patients without dysplasia at the pancreatic neck margin had similar OS compared to those with low-grade dysplasia (mOS: 78.8 vs. 66.8 months, P=0.344). However, high-grade dysplasia (mOS: 26.1 mo, P=0.001) and invasive cancer (mOS: 25.0 mo, P<0.001) were associated with significantly worse OS compared to no or low-grade dysplasia. Patients who underwent conversion of high-risk margins (high-grade or invasive cancer) to a low-risk margin (low-grade or no dysplasia) after intraoperative frozen section had significantly superior OS compared to those with a high-risk neck margin on final pathology (mOS: 76.9 vs. 26.1 mo P<0.001).CONCLUSIONSIn IPMN-derived PDAC, normal epithelium or low-grade dysplasia at the neck have similar outcomes while pancreatic neck margins with high-grade dysplasia or invasive cancer are associated with poorer outcomes. Conversion of a high-risk to low-risk margin after intraoperative frozen section is associated with survival benefit and should be performed when feasible.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVEIn living tissue, it has been difficult to make microscopic-level observations without damaging the tissue.SUMMARY BACKGROUND DATAWe have invented a novel intravital fluorescent observation method (IFOM) for real-time tissue observation, combining multi-photon laser scanning microscopy (MPLSM) with curcumin vital staining (CVS-IFOM). The aim of this study was to use CVS-IFOM to analyze the enteric nervous system (ENS) in mice and human patients with hypoganglionosis and Hirschsprung disease.METHODSIn an initial viability study, we compared live ENS images from non-fluorescent C57BL6 mice stained with curcumin (n=5) and GFP mice (n=5) using MPLSM. We then explored CVS-IFOM for the live examination of resected colon tissues from one hypoganglionosis and three Hirschsprung disease patients.RESULTSIn the viability study, detailed ENS histological features were only observed in the curcumin-stained mice. In the hypoganglionosis patient, CVS-IFOM provided ENS details that were not visualized under H&E staining or calretinin immunohistochemistry, allowing the analysis of ENS size, neural bundle number, and neural cell number per plexus. In Hirschsprung disease patients, CVS-IFOM showed a gradual hypoplastic change in the ENS from the oral wedge to the anal wedge, detecting disproportionate changes in the ENS within the same intestinal level, supporting a circumferentially uneven distribution of the intestinal ENS.CONCLUSIONCVS-IFOM may be supportive for intraoperative pathological diagnosis during surgeries in Hirschsprung disease.
{"title":"Dynamic Pathology of Enteric Neural Network using Curcumin-assisted Multiphoton Laser Imaging in Hirschsprung Disease.","authors":"Yuhki Koike,Akira Mizoguchi,Keiichi Uchida,Yuki Sato,Koki Higashi,Yuka Nagano,Kohei Matsushita,Kousyoku Sai,Aika Kaito-Yamagishi,Shujie Wang,Tetsuro Kayahara,Yoshinaga Okugawa,Kyosuke Tanaka,Mikihiro Inoue,Kazuo Funabiki,Kazushi Kimura,Hidemasa Goto,Mizuki Yuge,Yuhei Nishimura,Hiroto Yuasa,Yuji Toiyama","doi":"10.1097/sla.0000000000006528","DOIUrl":"https://doi.org/10.1097/sla.0000000000006528","url":null,"abstract":"OBJECTIVEIn living tissue, it has been difficult to make microscopic-level observations without damaging the tissue.SUMMARY BACKGROUND DATAWe have invented a novel intravital fluorescent observation method (IFOM) for real-time tissue observation, combining multi-photon laser scanning microscopy (MPLSM) with curcumin vital staining (CVS-IFOM). The aim of this study was to use CVS-IFOM to analyze the enteric nervous system (ENS) in mice and human patients with hypoganglionosis and Hirschsprung disease.METHODSIn an initial viability study, we compared live ENS images from non-fluorescent C57BL6 mice stained with curcumin (n=5) and GFP mice (n=5) using MPLSM. We then explored CVS-IFOM for the live examination of resected colon tissues from one hypoganglionosis and three Hirschsprung disease patients.RESULTSIn the viability study, detailed ENS histological features were only observed in the curcumin-stained mice. In the hypoganglionosis patient, CVS-IFOM provided ENS details that were not visualized under H&E staining or calretinin immunohistochemistry, allowing the analysis of ENS size, neural bundle number, and neural cell number per plexus. In Hirschsprung disease patients, CVS-IFOM showed a gradual hypoplastic change in the ENS from the oral wedge to the anal wedge, detecting disproportionate changes in the ENS within the same intestinal level, supporting a circumferentially uneven distribution of the intestinal ENS.CONCLUSIONCVS-IFOM may be supportive for intraoperative pathological diagnosis during surgeries in Hirschsprung disease.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo compare total mesorectal excision (TME) techniques combined with sphincter-sparing procedure in high-risk patients (HRPs).BACKGROUNDTME is the standard treatment for rectal cancer, but can be challenging in HRPs. The available surgical approaches must be compared, especially in HRPs.METHODSProspective, observational, multicenter trial to compare laparotomy (OTME), laparoscopy (LTME), robotic-assisted surgery (RTME), and transanal surgery (TaTME) in HRPs. The composite primary outcome included circumferential radial margin (CRM) ≥1mm, TME grade II-III, and absence of Clavien-Dindo grade III-IV complications. Three propensity score analyses were performed (LTME vs. RTME, RTME vs. TaTME, LTME vs. TaTME).RESULTS1078 HRPs (75% of men, median body mass index of 27 kg/m2, 50% of tumors in the lower third of the rectum) underwent surgery. The RTME and TaTME groups included patients with more advanced and lower tumors and coloanal anastomosis (P<0.001). Operative time was longer for RTME surgery (P<0.001). Conversion rate was similar for minimally invasive procedures (4.5%). The global R0 resection rate was 96% without difference among techniques. The primary outcome rates were 82.4%, 64.3%, 74.7%, and 80.3% for LTME, OTME, RTME, and TaTME, respectively. None achieved the expected success rate (85%), and propensity score analyses found no differences. Operative results were similar between high- and low-volume inclusion centers only for RTME.CONCLUSIONSThe RESET trial yielded high-quality results despite focusing on HRPs. Minimally invasive procedures showed similar sphincter-sparing procedure outcomes, but LTME included patients with more favorable tumors. Oncologic and functional outcomes will be evaluated at 2 years (ClinicalTrials.gov, ID: NCT03574493).
{"title":"A Prospective European Trial Comparing Laparotomy, Laparoscopy, Robotic-Assisted, and Transanal Total Mesorectal Excision Procedures in High-Risk Patients with Rectal Cancer: The RESET Trial.","authors":"Philippe Rouanet,Mario Guerrieri,Pablo Lemercier,Emre Balik,Eddy Cotte,Antonino Spinelli,Marcos Gómez-Ruiz,Albert Wolthuis,Emilio Bertani,Anne Dubois,","doi":"10.1097/sla.0000000000006534","DOIUrl":"https://doi.org/10.1097/sla.0000000000006534","url":null,"abstract":"OBJECTIVETo compare total mesorectal excision (TME) techniques combined with sphincter-sparing procedure in high-risk patients (HRPs).BACKGROUNDTME is the standard treatment for rectal cancer, but can be challenging in HRPs. The available surgical approaches must be compared, especially in HRPs.METHODSProspective, observational, multicenter trial to compare laparotomy (OTME), laparoscopy (LTME), robotic-assisted surgery (RTME), and transanal surgery (TaTME) in HRPs. The composite primary outcome included circumferential radial margin (CRM) ≥1mm, TME grade II-III, and absence of Clavien-Dindo grade III-IV complications. Three propensity score analyses were performed (LTME vs. RTME, RTME vs. TaTME, LTME vs. TaTME).RESULTS1078 HRPs (75% of men, median body mass index of 27 kg/m2, 50% of tumors in the lower third of the rectum) underwent surgery. The RTME and TaTME groups included patients with more advanced and lower tumors and coloanal anastomosis (P<0.001). Operative time was longer for RTME surgery (P<0.001). Conversion rate was similar for minimally invasive procedures (4.5%). The global R0 resection rate was 96% without difference among techniques. The primary outcome rates were 82.4%, 64.3%, 74.7%, and 80.3% for LTME, OTME, RTME, and TaTME, respectively. None achieved the expected success rate (85%), and propensity score analyses found no differences. Operative results were similar between high- and low-volume inclusion centers only for RTME.CONCLUSIONSThe RESET trial yielded high-quality results despite focusing on HRPs. Minimally invasive procedures showed similar sphincter-sparing procedure outcomes, but LTME included patients with more favorable tumors. Oncologic and functional outcomes will be evaluated at 2 years (ClinicalTrials.gov, ID: NCT03574493).","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/sla.0000000000006531
Stephen A Stearns,Alexander R Farid,Anupam B Jena
OBJECTIVETo compare divorce prevalence among surgeons with that of non-surgeon physicians.SUMMARY BACKGROUND DATAThe demanding nature of a career in surgery uniquely challenges the social wellbeing of a surgeon; however, its impact on marital health has not yet been well described.METHODSA cross-sectional study was conducted using publicly available U.S. Census data from 2017-2021 to investigate prevalence of divorce across different occupations. Survey respondents were divided into two groups, surgeons and non-surgeon physicians, with the remaining Census participants as a control. All participants under the age of 18 were excluded to focus on the U.S. adult population. Lifetime prevalence of divorce was measured across occupations and multivariable logistic regression analyses were performed to identify factors independently associated with divorce. Secondarily, the occurrence of more than one marriage was used to supplement understanding of marital health.RESULTSA total of 3,171 surgeons and 51,660 non-surgeon physicians were identified, with both groups similarly aged (51.6 and 50.2 y, respectively) and predominately male (82.9% and 61.9%, respectively). In unadjusted analysis, 21.3% (676/3,171) of surgeons had undergone a divorce compared to only 17.9% (9,252/51,660) of non-surgeon physicians, a 19% increase in risk of divorce (Risk ratio [RR]=1.19; 95% confidence interval [95% CI], 1.11-1.28). Both surgeons and non-surgeon physicians were significantly less likely to report being divorced compared with the general population. The increased divorce prevalence among surgeons persisted in multivariable analysis that adjusted for age, age at time of marriage, sex, race, income, hours worked per week, and number of children in the household, with surgeons experiencing a 22% increased prevalence of divorce over non-surgical physicians (adjusted divorce prevalence of 21.8% vs. 18.7%, respectively; odds ratio [OR]=1.22; 95% CI, 1.09-1.35). In subgroup analysis, the finding of higher divorce prevalence for surgeons over non-surgeon physicians was concentrated among men (adjusted divorce prevalence: 22.6% of male surgeons vs. 18.9% of male non-surgeon physicians; adjusted OR 1.26, 95% CI, 1.11-1.42), White (adjusted divorce prevalence: 22.4% of white surgeons vs. 19.1% of white non-surgeons; adjusted OR 1.22, 95% CI, 1.09-1.38) and Asian surgeons (adjusted divorce prevalence: 12.0% of Asian surgeons vs. 8.1% of Asian non-surgeons; adjusted OR 1.55, 95% CI, 1.06-2.26), with the effect not present in other measured subgroups.CONCLUSIONSBoth surgeons and physicians have lower divorce prevalence than the general population. Surgeons exhibit higher prevalence of divorce compared with non-surgeon physicians, with measured demographic and work characteristics insufficient to explain this difference.
{"title":"Divorce Among Surgeons and Other Physicians in the United States.","authors":"Stephen A Stearns,Alexander R Farid,Anupam B Jena","doi":"10.1097/sla.0000000000006531","DOIUrl":"https://doi.org/10.1097/sla.0000000000006531","url":null,"abstract":"OBJECTIVETo compare divorce prevalence among surgeons with that of non-surgeon physicians.SUMMARY BACKGROUND DATAThe demanding nature of a career in surgery uniquely challenges the social wellbeing of a surgeon; however, its impact on marital health has not yet been well described.METHODSA cross-sectional study was conducted using publicly available U.S. Census data from 2017-2021 to investigate prevalence of divorce across different occupations. Survey respondents were divided into two groups, surgeons and non-surgeon physicians, with the remaining Census participants as a control. All participants under the age of 18 were excluded to focus on the U.S. adult population. Lifetime prevalence of divorce was measured across occupations and multivariable logistic regression analyses were performed to identify factors independently associated with divorce. Secondarily, the occurrence of more than one marriage was used to supplement understanding of marital health.RESULTSA total of 3,171 surgeons and 51,660 non-surgeon physicians were identified, with both groups similarly aged (51.6 and 50.2 y, respectively) and predominately male (82.9% and 61.9%, respectively). In unadjusted analysis, 21.3% (676/3,171) of surgeons had undergone a divorce compared to only 17.9% (9,252/51,660) of non-surgeon physicians, a 19% increase in risk of divorce (Risk ratio [RR]=1.19; 95% confidence interval [95% CI], 1.11-1.28). Both surgeons and non-surgeon physicians were significantly less likely to report being divorced compared with the general population. The increased divorce prevalence among surgeons persisted in multivariable analysis that adjusted for age, age at time of marriage, sex, race, income, hours worked per week, and number of children in the household, with surgeons experiencing a 22% increased prevalence of divorce over non-surgical physicians (adjusted divorce prevalence of 21.8% vs. 18.7%, respectively; odds ratio [OR]=1.22; 95% CI, 1.09-1.35). In subgroup analysis, the finding of higher divorce prevalence for surgeons over non-surgeon physicians was concentrated among men (adjusted divorce prevalence: 22.6% of male surgeons vs. 18.9% of male non-surgeon physicians; adjusted OR 1.26, 95% CI, 1.11-1.42), White (adjusted divorce prevalence: 22.4% of white surgeons vs. 19.1% of white non-surgeons; adjusted OR 1.22, 95% CI, 1.09-1.38) and Asian surgeons (adjusted divorce prevalence: 12.0% of Asian surgeons vs. 8.1% of Asian non-surgeons; adjusted OR 1.55, 95% CI, 1.06-2.26), with the effect not present in other measured subgroups.CONCLUSIONSBoth surgeons and physicians have lower divorce prevalence than the general population. Surgeons exhibit higher prevalence of divorce compared with non-surgeon physicians, with measured demographic and work characteristics insufficient to explain this difference.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/sla.0000000000006533
Abraham J Matar,Elissa Falconer,Michelle LaBella,Muneera R Kapadia,Carla F Justiniano,Kinga Skowron Olortegui,Randolph Steinhagen,Kurt Schultz,Anurag Pratap,Ira Leeds,Lauren Weaver,Wolfgang Gaertner,Erik B Finger,Mary Thompson,Lucas Fair,Alessandro Fichera,Brendan P Lovasik,William C Chapman,Catherine Lb McGeoch,Mary Catherine Camacho,Marwan Kazimi,Steven C Kim,Virginia O Shaffer,Jahnavi K Srinivasan
OBJECTIVETo investigate the long-term outcomes of patients with combined primary sclerosing cholangitis/inflammatory bowel disease (PSC-IBD) undergoing both liver transplantation (LT) and total abdominal colectomy (TAC).SUMMARY BACKGROUND DATAThe fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes.METHODSAdult and pediatric patients from nine centers from the US IBD Surgery Collaborative who underwent staged LT and TAC for PSC-IBD were included. Long-term outcomes, including survival, were assessed.RESULTSAmong 127 patients, 66 underwent TAC-before-LT, with a median time from TAC to LT of 7.9 yrs, while 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival post TAC was significantly worse in those undergoing LT-before-TAC (16.0 yrs vs. 42.6 yrs, P=0.007), while post LT survival was not impacted by the order of TAC and LT (21.6 yrs vs. 22.0 yrs, P=0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC (rPSC) (P=0.02) and biliary complications (0.09) compared to those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis (IPAA) did not impact post-LT or post-TAC outcomes.CONCLUSIONSLong term survival in PSC-IBD was contingent upon progression to LT and was not impacted by the need for TAC. PSC-IBD patients undergoing TAC for medically refractory disease had a higher incidence of rPSC and biliary complications. The use of IPAA in PSC-IBD was a viable alternative to end ileostomy.
目的研究同时接受肝移植（LT）和全腹结肠切除术（TAC）的合并原发性硬化性胆管炎/炎症性肠病（PSC-IBD）患者的长期预后。方法纳入了来自美国 IBD 外科协作组 9 个中心的成人和儿童患者，他们都接受了分期 LT 和 TAC 治疗 PSC-IBD。结果127例患者中，66例在LT前接受了TAC，从TAC到LT的中位时间为7.9年，61例在TAC前接受了LT，从LT到TAC的中位时间为4.4年。接受LT-before-TAC的患者在TAC后的中位生存期明显较差（16.0年 vs. 42.6年，P=0.007），而LT后的生存期不受TAC和LT顺序的影响（21.6年 vs. 22.0年，P=0.81）。与因肿瘤适应症接受TAC治疗的患者相比，因药物难治性疾病接受TAC治疗的患者复发性PSC（rPSC）（P=0.02）和胆道并发症（0.09）的发生率更高。结论PSC-IBD患者的长期生存取决于LT的进展情况，并不受TAC需求的影响。因药物难治性疾病而接受TAC治疗的PSC-IBD患者的rPSC和胆道并发症发生率较高。在PSC-IBD患者中使用IPAA是一种替代末端回肠造口术的可行方法。
{"title":"Long-term Outcomes Following Colectomy and Liver Transplantation for Inflammatory Bowel Disease with Primary Sclerosing Cholangitis.","authors":"Abraham J Matar,Elissa Falconer,Michelle LaBella,Muneera R Kapadia,Carla F Justiniano,Kinga Skowron Olortegui,Randolph Steinhagen,Kurt Schultz,Anurag Pratap,Ira Leeds,Lauren Weaver,Wolfgang Gaertner,Erik B Finger,Mary Thompson,Lucas Fair,Alessandro Fichera,Brendan P Lovasik,William C Chapman,Catherine Lb McGeoch,Mary Catherine Camacho,Marwan Kazimi,Steven C Kim,Virginia O Shaffer,Jahnavi K Srinivasan","doi":"10.1097/sla.0000000000006533","DOIUrl":"https://doi.org/10.1097/sla.0000000000006533","url":null,"abstract":"OBJECTIVETo investigate the long-term outcomes of patients with combined primary sclerosing cholangitis/inflammatory bowel disease (PSC-IBD) undergoing both liver transplantation (LT) and total abdominal colectomy (TAC).SUMMARY BACKGROUND DATAThe fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes.METHODSAdult and pediatric patients from nine centers from the US IBD Surgery Collaborative who underwent staged LT and TAC for PSC-IBD were included. Long-term outcomes, including survival, were assessed.RESULTSAmong 127 patients, 66 underwent TAC-before-LT, with a median time from TAC to LT of 7.9 yrs, while 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival post TAC was significantly worse in those undergoing LT-before-TAC (16.0 yrs vs. 42.6 yrs, P=0.007), while post LT survival was not impacted by the order of TAC and LT (21.6 yrs vs. 22.0 yrs, P=0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC (rPSC) (P=0.02) and biliary complications (0.09) compared to those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis (IPAA) did not impact post-LT or post-TAC outcomes.CONCLUSIONSLong term survival in PSC-IBD was contingent upon progression to LT and was not impacted by the need for TAC. PSC-IBD patients undergoing TAC for medically refractory disease had a higher incidence of rPSC and biliary complications. The use of IPAA in PSC-IBD was a viable alternative to end ileostomy.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142171008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/sla.0000000000006530
Hye-Sol Jung,Youngmin Han,Yoon Soo Chae,Won-Gun Yun,Young Jae Cho,Younsoo Seo,Go Won Choi,Haeryoung Kim,Kyoung Bun Lee,Dong Ho Lee,Wooil Kwon,Joon Seong Park,Jin-Young Jang
OBJECTIVETo evaluate the diagnostic performance of surgical indications of the revised International Association of Pancreatology (IAP) 2023 guidelines compared to the IAP 2017 and European 2018 guidelines.SUMMARY BACKGROUND DATAThe revised IAP guidelines for surgical indications for branch duct (BD) intraductal papillary mucinous neoplasms (IPMN) include the presence of at least two worrisome features without mandatory endoscopic ultrasound.METHODSAmong 663 patients who underwent resection for pathologically confirmed IPMN in a tertiary hospital between 2013 and 2023, 556 patients with BD or mixed-type IPMN were retrospectively reviewed. Diagnostic performances of the three guidelines for predicting high-grade dysplasia or IPMN with invasive carcinoma were compared. The primary outcome was the malignancy rate. Clinicopathological and radiological imaging data were analyzed.RESULTSA total of 540, 451, and 490 patients met the surgical indications of the IAP, 2017, 2023, and European guidelines, respectively. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia, n=99; invasive carcinoma, n=130). Surgical indication by the IAP 2023 guidelines showed higher specificity (29.1 vs. 4.9%, P<0.001), positive predictive value (48.6 vs. 42.4%, P=0.031), and accuracy (55.5 vs. 44.1%, P<0.001) than the IAP 2017 guidelines. It also had higher specificity than the European guidelines (18.7%, P=0.024). The IAP 2023 guidelines showed a superior AUC of surgical indication (0.623 vs. 0.582 for the European guidelines, P<0.001; and 0.524 for the IAP guidelines, P=0.008).CONCLUSIONSThe IAP 2023 guidelines showed better malignancy prediction than the IAP 2017 and European guidelines, potentially reducing unnecessary surgeries.
目的评估修订后的国际胰腺学会（IAP）2023年指南与IAP 2017年指南和欧洲2018年指南相比在手术指征方面的诊断性能。摘要背景资料修订后的国际胰腺学会（IAP）分支导管（BD）内乳头状黏液瘤（IPMN）手术指征指南包括至少存在两个令人担忧的特征，而无需进行强制性内镜超声检查。方法回顾性研究了2013年至2023年期间在一家三级医院接受病理确诊IPMN切除术的663例患者，其中556例为BD或混合型IPMN患者。比较了三种指南在预测高级别发育不良或浸润癌 IPMN 方面的诊断性能。主要结果是恶变率。结果共有 540、451 和 490 例患者分别符合 IAP、2017、2023 和欧洲指南的手术指征。229例（41.2%）患者出现恶性IPMN（高级别发育不良，n=99；浸润癌，n=130）。与 IAP 2017 指南相比，IAP 2023 指南的手术指征显示出更高的特异性（29.1 vs. 4.9%，P<0.001）、阳性预测值（48.6 vs. 42.4%，P=0.031）和准确性（55.5 vs. 44.1%，P<0.001）。其特异性也高于欧洲指南（18.7%，P=0.024）。IAP 2023指南显示出更高的手术指征AUC（欧洲指南为0.623 vs. 0.582，P<0.001；IAP指南为0.524，P=0.008）。结论IAP 2023指南比IAP 2017和欧洲指南显示出更好的恶性肿瘤预测，可能会减少不必要的手术。
{"title":"Diagnostic Performance of Surgical Indication for Branch-duct or Mixed-type Intraductal Papillary Mucinous Neoplasms of the Revised International Association of Pancreatology (IAP) 2023 Guidelines.","authors":"Hye-Sol Jung,Youngmin Han,Yoon Soo Chae,Won-Gun Yun,Young Jae Cho,Younsoo Seo,Go Won Choi,Haeryoung Kim,Kyoung Bun Lee,Dong Ho Lee,Wooil Kwon,Joon Seong Park,Jin-Young Jang","doi":"10.1097/sla.0000000000006530","DOIUrl":"https://doi.org/10.1097/sla.0000000000006530","url":null,"abstract":"OBJECTIVETo evaluate the diagnostic performance of surgical indications of the revised International Association of Pancreatology (IAP) 2023 guidelines compared to the IAP 2017 and European 2018 guidelines.SUMMARY BACKGROUND DATAThe revised IAP guidelines for surgical indications for branch duct (BD) intraductal papillary mucinous neoplasms (IPMN) include the presence of at least two worrisome features without mandatory endoscopic ultrasound.METHODSAmong 663 patients who underwent resection for pathologically confirmed IPMN in a tertiary hospital between 2013 and 2023, 556 patients with BD or mixed-type IPMN were retrospectively reviewed. Diagnostic performances of the three guidelines for predicting high-grade dysplasia or IPMN with invasive carcinoma were compared. The primary outcome was the malignancy rate. Clinicopathological and radiological imaging data were analyzed.RESULTSA total of 540, 451, and 490 patients met the surgical indications of the IAP, 2017, 2023, and European guidelines, respectively. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia, n=99; invasive carcinoma, n=130). Surgical indication by the IAP 2023 guidelines showed higher specificity (29.1 vs. 4.9%, P<0.001), positive predictive value (48.6 vs. 42.4%, P=0.031), and accuracy (55.5 vs. 44.1%, P<0.001) than the IAP 2017 guidelines. It also had higher specificity than the European guidelines (18.7%, P=0.024). The IAP 2023 guidelines showed a superior AUC of surgical indication (0.623 vs. 0.582 for the European guidelines, P<0.001; and 0.524 for the IAP guidelines, P=0.008).CONCLUSIONSThe IAP 2023 guidelines showed better malignancy prediction than the IAP 2017 and European guidelines, potentially reducing unnecessary surgeries.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/sla.0000000000006535
Charnwit Assawasirisin,Peter Fagenholz,Motaz Qadan,Yasmin Hernandez-Barco,Satita Aimprasittichai,Avinash Kambadakone,Mari Mino-Kenudson,Amarachi Ike,Sheng-Yin Chen,Chen Sheng,William Brugge,Andrew L Warshaw,Keith D Lillemoe,Carlos Fernández-Del Castillo
OBJECTIVETo describe the long-term natural history of Branch duct intraductal papillary mucinous neoplasm (BD-IPMN).BACKGROUNDThe BD-IPMN is a known precursor of pancreatic cancer, yet its long-term natural history is largely unknown.METHODSWe retrospectively reviewed patients with BD-IPMN who were followed at the Massachusetts General Hospital for at least ten years without surgical intervention. Patient and cyst characteristics, development of worrisome features (WF), need for surgery, and malignancy were recorded. The risk of pancreatic cancer in this cohort was compared with the general population by determining the Standardized Incidence Ratio (SIR).RESULTS316 patients with BD-IPMN who were followed for at least ten years without intervention were identified. The median age was 63 years, and the median follow-up was 13.5 years (range 10 - 28.8 years). Median cyst size at diagnosis was 1.2 cm (IQR 0.8 - 1.7), was 1.8 cm (IQR 1.2-2.6) at ten years, and increased to 2.0 cm (IQR 1.3 - 3.0) by the end of surveillance. At the 10-year mark, 24% of patients had WF, and by the end of surveillance, an additional 20% had developed WF or high-risk stigmata. 8.2% of patients developed pancreatic malignancy (high-grade dysplasia or invasive cancer). The SIR for pancreatic cancer was 9.28 (95%CI of 5.82 - 14.06), with almost two-thirds of invasive cancers occurring within the pancreatic cyst.CONCLUSIONSAfter ten years of surveillance for BD-IPMN without intervention, the disease continues to progress and one of every 12 patients will develop malignancy. The risk of pancreatic cancer appears to be nine times higher than in the comparable age-matched population.
{"title":"Unraveling the Long-term Natural History of Branch Duct Intraductal Papillary Mucinous Neoplasm: Beyond 10 years.","authors":"Charnwit Assawasirisin,Peter Fagenholz,Motaz Qadan,Yasmin Hernandez-Barco,Satita Aimprasittichai,Avinash Kambadakone,Mari Mino-Kenudson,Amarachi Ike,Sheng-Yin Chen,Chen Sheng,William Brugge,Andrew L Warshaw,Keith D Lillemoe,Carlos Fernández-Del Castillo","doi":"10.1097/sla.0000000000006535","DOIUrl":"https://doi.org/10.1097/sla.0000000000006535","url":null,"abstract":"OBJECTIVETo describe the long-term natural history of Branch duct intraductal papillary mucinous neoplasm (BD-IPMN).BACKGROUNDThe BD-IPMN is a known precursor of pancreatic cancer, yet its long-term natural history is largely unknown.METHODSWe retrospectively reviewed patients with BD-IPMN who were followed at the Massachusetts General Hospital for at least ten years without surgical intervention. Patient and cyst characteristics, development of worrisome features (WF), need for surgery, and malignancy were recorded. The risk of pancreatic cancer in this cohort was compared with the general population by determining the Standardized Incidence Ratio (SIR).RESULTS316 patients with BD-IPMN who were followed for at least ten years without intervention were identified. The median age was 63 years, and the median follow-up was 13.5 years (range 10 - 28.8 years). Median cyst size at diagnosis was 1.2 cm (IQR 0.8 - 1.7), was 1.8 cm (IQR 1.2-2.6) at ten years, and increased to 2.0 cm (IQR 1.3 - 3.0) by the end of surveillance. At the 10-year mark, 24% of patients had WF, and by the end of surveillance, an additional 20% had developed WF or high-risk stigmata. 8.2% of patients developed pancreatic malignancy (high-grade dysplasia or invasive cancer). The SIR for pancreatic cancer was 9.28 (95%CI of 5.82 - 14.06), with almost two-thirds of invasive cancers occurring within the pancreatic cyst.CONCLUSIONSAfter ten years of surveillance for BD-IPMN without intervention, the disease continues to progress and one of every 12 patients will develop malignancy. The risk of pancreatic cancer appears to be nine times higher than in the comparable age-matched population.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Evaluating the safety and efficacy of implanting a liver with islet grafts into patients with end-stage liver disease and diabetes mellitus (DM).
Background: DM and end-stage liver diseases are significant health concern worldwide, often coexisting and mutually influencing each other. Addressing both diseases simultaneously is paramount.
Methods: We utilized the islet transplantation combined ischemia-free liver transplantation (ITIFLT) technique to treat a patient with hepatocellular carcinoma (HCC) and type 2 diabetes mellitus (T2DM). The liver was procured and preserved using the ischemia-free liver transplantation (IFLT) technique, and during normothermic machine perfusion (NMP), isolated and purified islet grafts were transplanted into the liver through the portal vein. Finally, the liver, incorporating with the transplant islet grafts, was implanted into the recipient without interruption of blood supply.
Results: The patient received both liver and islet graft from the same donor. The patient achieved insulin-independence by post-transplant day (PTD) 9, and both liver and islet function remained robust. The patient was discharged on PTD 18 and experienced no surgical or transplantation-related complications during the follow-up period. Furthermore, islet grafts presence was observed in liver biopsies after islet transplantation.
Conclusions: This landmark case marks the inaugural application of ITIFLT in humans, signifying its potential as a promising treatment modality for end-stage liver disease with DM.
{"title":"The First Case of Intra-portal Islet Implantation During Liver Machine Perfusion Allowing Simultaneous Islet-liver Transplantation in A Human: A New and Safe Treatment for End-stage Liver Disease Combined With Diabetes Mellitus.","authors":"Qiang Zhao, Jiahao Li, Zepeng Lin, Yunhua Tang, Daopeng Yang, Meiting Qin, Xue Ma, Haibin Ji, Honghui Chen, Tielong Wang, Maogen Chen, Weiqiang Ju, Dongping Wang, Zhiyong Guo, Xiaofeng Zhu, Jia Dan, Anbin Hu, Xiaoshun He","doi":"10.1097/SLA.0000000000006526","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006526","url":null,"abstract":"<p><strong>Objective: </strong>Evaluating the safety and efficacy of implanting a liver with islet grafts into patients with end-stage liver disease and diabetes mellitus (DM).</p><p><strong>Background: </strong>DM and end-stage liver diseases are significant health concern worldwide, often coexisting and mutually influencing each other. Addressing both diseases simultaneously is paramount.</p><p><strong>Methods: </strong>We utilized the islet transplantation combined ischemia-free liver transplantation (ITIFLT) technique to treat a patient with hepatocellular carcinoma (HCC) and type 2 diabetes mellitus (T2DM). The liver was procured and preserved using the ischemia-free liver transplantation (IFLT) technique, and during normothermic machine perfusion (NMP), isolated and purified islet grafts were transplanted into the liver through the portal vein. Finally, the liver, incorporating with the transplant islet grafts, was implanted into the recipient without interruption of blood supply.</p><p><strong>Results: </strong>The patient received both liver and islet graft from the same donor. The patient achieved insulin-independence by post-transplant day (PTD) 9, and both liver and islet function remained robust. The patient was discharged on PTD 18 and experienced no surgical or transplantation-related complications during the follow-up period. Furthermore, islet grafts presence was observed in liver biopsies after islet transplantation.</p><p><strong>Conclusions: </strong>This landmark case marks the inaugural application of ITIFLT in humans, signifying its potential as a promising treatment modality for end-stage liver disease with DM.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/SLA.0000000000006525
Hang Cao, Qiang Zheng, Chaoqiang Deng, Zichen Fu, Xuxia Shen, Yan Jin, Yongguo Yang, Bin Qian, Chunyan Yuan, Weihua Wang, Lei Zhang, Qingping Song, Shuying Zuo, Junjie Ma, Shuqing You, Senzhong Zheng, Qingli Gao, Guangli Su, Yang Zhang, Haiquan Chen, Yuan Li
Objective: To investigate the value of intraoperative assessment of spread through air spaces (STAS) on frozen sections (FS) in peripheral small-sized lung adenocarcinoma.
Background: Surgical decision-making based on FS diagnosis of STAS may be useful to prevent local control failure after sublobar resection.
Methods: We conducted a multicenter prospective observational study of consecutive patients with cT1N0M0 invasive lung adenocarcinoma to evaluate the accuracy of FS for the intraoperative detection of STAS. The final pathology (FP) diagnosis of STAS was based on corresponding permanent paraffin sections.
Results: This study included 878 patients with cT1N0M0 invasive lung adenocarcinoma. A total of 833 cases (95%) were assessable for STAS on FS. 26.4% of the cases evaluated positive for STAS on FP, whereas 18.2% on FS. The accuracy, sensitivity, and specificity of FS diagnosis of STAS were 85.1%, 56.4%, and 95.4%, respectively, with moderate agreement (κ=0.575). Inter-observer agreement was substantial (κ=0.756) among the three pathologists. Subgroup analysis based on tumor size or consolidation-to-tumor ratio all showed moderate agreement for concordance. After rigorous reassessment of false-positive cases, the presence of artifacts may be the main cause of interpretation errors. Additionally, true positive cases showed more high-grade histological patterns and more advanced p-TNM stages than false negative cases.
Conclusions: This is the largest prospective observational study to evaluate STAS on FS in patients with cT1N0M0 invasive lung adenocarcinoma. FS is highly specific with moderate agreement, but is not sensitive for STAS detection. While appropriately reporting STAS on FS may provide surgeons with valuable information for intraoperative decision-making, better approaches are needed.
{"title":"Prediction of Spread Through Air Spaces (STAS) By Intraoperative Frozen Section for Patients with cT1N0M0 Invasive Lung Adenocarcinoma: A Multi-Center Observational Study (ECTOP-1016).","authors":"Hang Cao, Qiang Zheng, Chaoqiang Deng, Zichen Fu, Xuxia Shen, Yan Jin, Yongguo Yang, Bin Qian, Chunyan Yuan, Weihua Wang, Lei Zhang, Qingping Song, Shuying Zuo, Junjie Ma, Shuqing You, Senzhong Zheng, Qingli Gao, Guangli Su, Yang Zhang, Haiquan Chen, Yuan Li","doi":"10.1097/SLA.0000000000006525","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006525","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the value of intraoperative assessment of spread through air spaces (STAS) on frozen sections (FS) in peripheral small-sized lung adenocarcinoma.</p><p><strong>Background: </strong>Surgical decision-making based on FS diagnosis of STAS may be useful to prevent local control failure after sublobar resection.</p><p><strong>Methods: </strong>We conducted a multicenter prospective observational study of consecutive patients with cT1N0M0 invasive lung adenocarcinoma to evaluate the accuracy of FS for the intraoperative detection of STAS. The final pathology (FP) diagnosis of STAS was based on corresponding permanent paraffin sections.</p><p><strong>Results: </strong>This study included 878 patients with cT1N0M0 invasive lung adenocarcinoma. A total of 833 cases (95%) were assessable for STAS on FS. 26.4% of the cases evaluated positive for STAS on FP, whereas 18.2% on FS. The accuracy, sensitivity, and specificity of FS diagnosis of STAS were 85.1%, 56.4%, and 95.4%, respectively, with moderate agreement (κ=0.575). Inter-observer agreement was substantial (κ=0.756) among the three pathologists. Subgroup analysis based on tumor size or consolidation-to-tumor ratio all showed moderate agreement for concordance. After rigorous reassessment of false-positive cases, the presence of artifacts may be the main cause of interpretation errors. Additionally, true positive cases showed more high-grade histological patterns and more advanced p-TNM stages than false negative cases.</p><p><strong>Conclusions: </strong>This is the largest prospective observational study to evaluate STAS on FS in patients with cT1N0M0 invasive lung adenocarcinoma. FS is highly specific with moderate agreement, but is not sensitive for STAS detection. While appropriately reporting STAS on FS may provide surgeons with valuable information for intraoperative decision-making, better approaches are needed.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study aimed to understand the effectiveness of regular care in reducing the incidence of severe peristomal skin disorders, as well as to identify their risk factors.
Summary background data: Peristomal skin disorders occur frequently in outpatient settings and require appropriate intervention. It remains, however, to be demonstrated when the need to follow up these patients decreases and whether assessing severity of peristomal skin disorders is useful.
Methods: This prospective, multicenter, observational cohort study was conducted in six regional high-volume Japanese hospitals. The primary endpoint of the study was the effectiveness of regular follow-up in reducing the incidence of severe peristomal skin disorders via a scoring system at a defined regular outpatient visit. Propensity score matching was performed to compare a control group and patients with severe peristomal skin disorders.
Results: In total, 217 patients between December 2019 and December 2021 were enrolled, and 191 patients were analyzed. Multivariate analysis showed that loop stoma (odds ratio [OR], 5.017; 95% confidence interval [CI], 1.350-18.639; P=0.016) and stoma height of <10 mm (OR, 7.831; 95% CI, 1.760-34.838; P=0.007) were independent risk factors for all peristomal skin disorders. After propensity score matching, the incidence of the disorders was not significantly different between the specified evaluation timing and historical control groups (75.7% vs. 77.2%, P=0.775), and the incidence of the severe disorders based on the ABCD and DET scores (5.9% vs. 19.1%, P<0.001 and 1.5% vs. 29.4%, P<0.001, respectively) was significantly lower in the specified evaluation timing group than in the historical control group.
Conclusion: Regular peristomal skin disease follow-up and scoring, as well as appropriate stoma care at the stoma outpatient visit did not change the frequency of peristomal skin disease, but severe peristomal skin disorders were prevented. Additionally, risk factors for peristomal skin disorders were found to be height <10 mm and loop stoma.
{"title":"Prospective Multicenter Study to Clarify the Frequency of Peristomal Skin Disorders and Appropriate Evaluation Time in Patients with Malignant Rectal Tumors.","authors":"Takuya Shiraishi, Yuji Nishizawa, Mifumi Nakajima, Ryoko Kado, Hiroomi Ogawa, Satoh Naomi, Yohei Owada, Tsuyoshi Enomoto, Shinji Yazawa, Yukihiro Hamahata, Yumi Isogami, Kazuo Kitagawa, Maki Sakamoto, Hiroya Enomoto, Akiko Egawa, Daichi Kitaguchi, Hiro Hasegawa, Koji Ikeda, Yuichiro Tsukada, Masaaki Ito","doi":"10.1097/SLA.0000000000006522","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006522","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to understand the effectiveness of regular care in reducing the incidence of severe peristomal skin disorders, as well as to identify their risk factors.</p><p><strong>Summary background data: </strong>Peristomal skin disorders occur frequently in outpatient settings and require appropriate intervention. It remains, however, to be demonstrated when the need to follow up these patients decreases and whether assessing severity of peristomal skin disorders is useful.</p><p><strong>Methods: </strong>This prospective, multicenter, observational cohort study was conducted in six regional high-volume Japanese hospitals. The primary endpoint of the study was the effectiveness of regular follow-up in reducing the incidence of severe peristomal skin disorders via a scoring system at a defined regular outpatient visit. Propensity score matching was performed to compare a control group and patients with severe peristomal skin disorders.</p><p><strong>Results: </strong>In total, 217 patients between December 2019 and December 2021 were enrolled, and 191 patients were analyzed. Multivariate analysis showed that loop stoma (odds ratio [OR], 5.017; 95% confidence interval [CI], 1.350-18.639; P=0.016) and stoma height of <10 mm (OR, 7.831; 95% CI, 1.760-34.838; P=0.007) were independent risk factors for all peristomal skin disorders. After propensity score matching, the incidence of the disorders was not significantly different between the specified evaluation timing and historical control groups (75.7% vs. 77.2%, P=0.775), and the incidence of the severe disorders based on the ABCD and DET scores (5.9% vs. 19.1%, P<0.001 and 1.5% vs. 29.4%, P<0.001, respectively) was significantly lower in the specified evaluation timing group than in the historical control group.</p><p><strong>Conclusion: </strong>Regular peristomal skin disease follow-up and scoring, as well as appropriate stoma care at the stoma outpatient visit did not change the frequency of peristomal skin disease, but severe peristomal skin disorders were prevented. Additionally, risk factors for peristomal skin disorders were found to be height <10 mm and loop stoma.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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：