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Shareholder Considerations in Healthcare. 医疗保健领域的股东考虑因素。
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-14 DOI: 10.1097/SLA.0000000000006560
Niyum Gandhi
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引用次数: 0
Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer. 临床诊断为 T1 级胰腺癌患者的治疗和总生存期人群队列研究
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-14 DOI: 10.1097/SLA.0000000000006563
Anouk J de Wilde, Evelien J M de Jong, Marco J Bruno, Marc G Besselink, Lydia G M van der Geest, Sandra M E Geurts, Bas Groot Koerkamp, Ignace H J T de Hingh, Vincent E de Meijer, Razvan L Miclea, Jan-Werner Poley, Iryna V Samarska, Hjalmar C van Santvoort, Martijn W J Stommel, Rogier P Voermans, Steven W M Olde Damink, Judith de Vos-Geelen, Stefan A W Bouwense

Objective: To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer.

Background: Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease.

Methods: Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx were included from the Netherlands Cancer Registry (2014-2021). Primary endpoint was OS, analyzed using the Kaplan-Meier estimator. Multivariable Cox proportional hazards regression was used to identify OS predictors.

Results: Overall, 244 patients with cT1 ampullary cancer were included, of whom 75% (n=184) underwent resection. Among these, 68% (n=125) were upstaged to a higher pathologically T classification (pT2:40%, pT3:22%, pT4:5%). Similarly, cN0 was upstaged to pN1 in 47% of patients (n=87). Next, 100 patients with pT1 and cTx ampullary cancer were included, making a total of 159 patients with pT1 tumor. 92% (146/159) underwent pancreatoduodenectomy while 8% (13/159) underwent endoscopic or local surgical resection. The 1- and 5-year OS for cT1N0 ampullary cancer were 72% and 36%, while for pT1N0 they were 94% and 75%. Independent poor prognostic factors for OS were pN1 classification (HR 2.12; 95%CI 1.15-3.94, P=0.017), pNx classification (i.e. locally resected patients) (HR 2.82; 95%CI 1.22-6.55, P=0.016), and poorly differentiated tumors (HR 4.05; 95%CI 1.33-12.40, P=0.014).

Conclusion: In patients with cT1 ampullary cancer, more than two-thirds had a pathologically higher T classification, and almost half had a pathologically higher N classification. These findings suggest that pancreatoduodenectomy is recommended for cT1 ampullary cancer.

摘要评估确诊为T1型鞍状腺癌患者的治疗效果、总生存率(OS)以及OS的预后因素:背景:胰腺癌是一种罕见的胃肠道恶性肿瘤,来自大型队列的数据有限,尤其是关于T1疾病的数据:方法:从荷兰癌症登记处(2014-2021年)纳入临床(c)T1型胰腺癌患者和病理(p)T1型胰腺癌患者。主要终点为OS,采用Kaplan-Meier估计器进行分析。多变量考克斯比例危险回归用于确定OS预测因素:共纳入244名cT1级胰腺癌患者,其中75%(184人)接受了切除手术。在这些患者中,68%(n=125)的病理T分级更高(pT2:40%,pT3:22%,pT4:5%)。同样,47% 的患者(87 人)的 cN0 升为 pN1。接下来,100 名患有 pT1 和 cTx 的膀胱癌患者被纳入其中,这样共有 159 名患者患有 pT1 肿瘤。92%的患者(146/159)接受了胰十二指肠切除术,8%的患者(13/159)接受了内镜或局部手术切除。cT1N0胰壶腹癌的1年和5年生存率分别为72%和36%,而pT1N0胰壶腹癌的1年和5年生存率分别为94%和75%。OS的独立不良预后因素是pN1分级(HR 2.12;95%CI 1.15-3.94,P=0.017)、pNx分级(即局部切除患者)(HR 2.82;95%CI 1.22-6.55,P=0.016)和分化差的肿瘤(HR 4.05;95%CI 1.33-12.40,P=0.014):结论:在cT1级胰瓿癌患者中,超过三分之二的患者病理分级为较高的T级,近一半的患者病理分级为较高的N级。这些研究结果表明,建议对 cT1 ampullary 癌进行胰十二指肠切除术。
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引用次数: 0
Mutant KRAS in Circulating Tumor DNA as a Biomarker in Localized Pancreatic Cancer in Patients Treated with Neoadjuvant Chemotherapy. 循环肿瘤 DNA 中的突变 KRAS 作为新辅助化疗患者局部胰腺癌的生物标记物
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-14 DOI: 10.1097/SLA.0000000000006562
Dominic J Vitello, Dhavan Shah, Amy Wells, Larissa Masnyk, Madison Cox, Lauren M Janczewski, John Abad, Kevin Dawravoo, Arlene D'Souza, Grace Suh, Robert Bayer, Massimo Cristofanilli, David Bentrem, Yingzhe Liu, Hui Zhang, Lucas Santana-Santos, Lawrence J Jennings, Qiang Zhang, Akhil Chawla

Objective: The primary objective was to determine the prognostic significance of circulating tumor DNA (ctDNA) in patients receiving neoadjuvant chemotherapy (NAC) for localized pancreatic ductal adenocarcinoma (PDAC) using digital droplet polymerase chain reaction (ddPCR).

Summary and background data: Increasingly, ctDNA is being used for clinical decision-making in a variety of solid malignancies. However, the detection and prognostic value of KRAS ctDNA as assessed by ddPCR during NAC has yet to be characterized.

Methods: Patients with localized PDAC eligible to receive NAC were prospectively enrolled. Peripheral blood samples were obtained at diagnosis, after NAC, and after resection and analyzed for ctDNA using ddPCR. Log-rank tests and Cox proportional hazards model were used to assess for association with OS.

Results: 84 patients were included in the analysis. Mutant KRAS ctDNA was detected in 49.3% of patients at diagnosis, 69.6% of patients after NAC, and 69.7% of patients after resection, respectively. There were 15 (17.9%) patients that cleared mutational ctDNA over the course of treatment. Clearance of ctDNA during NAC was associated with improved overall survival (OS) (18.4 mo. vs NR, P<0.05). Detection of mutant KRAS G12V after NAC and resection was associated with shorter OS (18.0 versus NR months, P<0.031). Detection of the KRAS G12V mutation after resection was associated with reduced OS (aHR 36.75, 95% CI 2.93-461.38).

Conclusions: Throughout treatment, KRAS ctDNA is detectable by ddPCR in patients with localized PDAC treated with NAC. Detection of mutant KRAS G12V after resection was associated with reduced OS.

研究目的主要目的是利用数字液滴聚合酶链反应(ddPCR)确定接受新辅助化疗(NAC)的局部胰腺导管腺癌(PDAC)患者体内循环肿瘤DNA(ctDNA)的预后意义:ctDNA越来越多地被用于各种实体恶性肿瘤的临床决策。然而,NAC期间通过ddPCR评估的KRAS ctDNA的检测和预后价值尚未定性:方法:前瞻性地招募了符合接受 NAC 的局部 PDAC 患者。在诊断时、NAC 后和切除术后采集外周血样本,并使用 ddPCR 分析 ctDNA。采用对数秩检验和Cox比例危险模型评估与OS的关系:84例患者纳入分析。诊断时检测到突变 KRAS ctDNA 的患者占 49.3%,NAC 后检测到突变 KRAS ctDNA 的患者占 69.6%,切除术后检测到突变 KRAS ctDNA 的患者占 69.7%。有 15 例(17.9%)患者在治疗过程中清除了突变 ctDNA。NAC期间ctDNA的清除与总生存期(OS)的改善有关(18.4个月 vs NR,PConclusions.):在整个治疗过程中,接受 NAC 治疗的局部 PDAC 患者可通过 ddPCR 检测到 KRAS ctDNA。切除术后检测到突变 KRAS G12V 与 OS 下降有关。
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引用次数: 0
Failure Mode Effects Analysis of Re-triage of Injured Patients to Receiving High-Level Illinois Trauma Centers. 将受伤病人重新分流到伊利诺伊州高级创伤中心的故障模式效应分析。
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-11 DOI: 10.1097/SLA.0000000000006561
John D Slocum, Jane L Holl, William M Brigode, Mary Beth Voights, Michael J Anstadt, Marion C Henry, Justin Mis, Richard J Fantus, Timothy P Plackett, Eddie J Markul, Grace H Chang, Michael B Shapiro, Nicole Siparsky, Anne M Stey

Objective: This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients.

Summary background data: The re-triage process averages four hours despite the fact timely re-triage within two hours mitigates injury-associated mortality. Non-trauma and low-level trauma centers reported most critical failures were in finding an accepting high-level trauma center. Critical failures at high-level trauma centers have not been assessed.

Methods: This was an observational cross-sectional study at nine high-level adult trauma centers and three high-level pediatric trauma centers. Failure Modes Effects Analysis (FMEA) of the re-triage process was conducted in four phases. Phase 1 purposively sampled trauma coordinators followed by snowball sampling of clinicians, operations, and leadership to ensure representative participation. Phase 2 mapped each re-triage step. Phase 3 identified failures at each step. Phase 4 scored each failure on impact, frequency, and safeguards for detection. Standardized rubrics were used in Phase 4 to rate each failure's impact (I), frequency (F), and safeguard for detection (S) to calculate their Risk Priority Number (RPN) (I x F x S). Failures were rank ordered for criticality.

Results: A total of 64 trauma coordinators, surgeons, emergency medicine physicians, nurses, operations and quality managers across twelve high-level trauma centers participated. There were 178failures identified at adult and pediatric high-level trauma centers. The most critical failures were: Insufficient trained transport staff (RPN=648); Issues transmitting imaging from sending to receiving centers (RPN=400); Incomplete exchange of clinical information(RPN=384).

Conclusions: The most critical failures were limited transportation and incomplete exchange of clinical, radiological and arrival timing information. Further investigation of these failures that includes several regions is needed to determine the reproducibility of these findings.

目的:本研究确定了接收重伤患者的高级创伤中心在医院间紧急转运或再分流方面的失败:本研究发现了接收重伤患者的高级创伤中心在医院间紧急转运或重新分流方面的失误:尽管在两小时内及时重新转运可降低与受伤相关的死亡率,但重新转运过程平均需要四小时。非创伤中心和低级别创伤中心报告称,最严重的失败是找不到可接受的高级别创伤中心。尚未对高级别创伤中心的重大失误进行评估:这是一项观察性横断面研究,研究对象是九个高级别成人创伤中心和三个高级别儿童创伤中心。重新分流流程的故障模式影响分析(FMEA)分四个阶段进行。第一阶段有目的性地对创伤协调员进行抽样,然后对临床医生、操作人员和领导层进行滚雪球式抽样,以确保参与的代表性。第 2 阶段绘制每个再分流步骤图。第 3 阶段确定每个步骤的失败之处。第 4 阶段对每个故障的影响、频率和检测保障措施进行评分。第 4 阶段使用标准化评分标准对每个故障的影响 (I)、频率 (F) 和检测保障 (S) 进行评分,以计算其风险优先级编号 (RPN)(I x F x S)。故障的严重程度按等级排序:共有 12 个高级创伤中心的 64 名创伤协调员、外科医生、急诊内科医生、护士、运营和质量管理人员参与了此次研究。成人和儿童高级创伤中心共发现 178 个故障。最严重的故障包括训练有素的转运人员不足(RPN=648);从发送中心到接收中心的影像传输问题(RPN=400);临床信息交换不完整(RPN=384):最关键的故障是运输受限以及临床、放射和到达时间信息交流不完整。需要在多个地区对这些故障进行进一步调查,以确定这些结果的可重复性。
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引用次数: 0
Financial Toxicity in Complex Gastrointestinal Surgery and Correlation with Patient Reported Outcomes. 复杂胃肠道手术中的经济毒性及与患者报告结果的相关性。
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-11 DOI: 10.1097/SLA.0000000000006559
Lindsey Young, Rosemary Vergara, John Henriquez, Alvis Fong, Talal Al-Assil, Saad Shebrain, Gitonga Munene

Objectives: To describe financial toxicity (FT) in patients who have undergone gastrointestinal (GI) surgery and its correlation with patients' emotional (EWB) and social well-being (SWB).

Background: FT describes the financial burden associated with treatment and its impact on patient outcomes. Few prior studies have examined FT in gastrointestinal surgery and its impact on patient quality of life.

Methods: Patients who underwent gastrointestinal surgery at our institution were assessed for FT with a validated instrument between Jan 2022 and Jan 2023. EWB and SWB were assessed with a validated instrument. Risk factors for FT were determined using a multivariable model. The correlation between FT and patient EWB and SWB was assessed using Pearson correlation.

Results: 188 patients were surveyed, the majority had pancreatic resections (n = 90, 47.9%), 59 (31.4%) patients experienced FT. On multivariable analysis, categories associated with increased likelihood of exhibiting financial toxicity included single marital status and not receiving chemotherapy and/or radiation therapy, with odds ratio (95% C.I) of [3.02 (1.07, 8.51), P=.037] and [3.86 (1.3, 11.44), P=.015) respectively. Higher EWB and SWB scores directly correlated with higher FT scores.

Conclusion: Patients undergoing complex gastrointestinal surgery often experience financial toxicity that affects patient reported outcomes. Financial toxicity is associated with identifiable pre-operative factors that can be utilized to screen patients for interventions that may mitigate some of the harmful effects of FT.

目的: 描述胃肠道手术患者的经济毒性(FT)及其与患者情绪(EWB)和社会福利(SWB)的相关性:描述胃肠道(GI)手术患者的经济毒性(FT)及其与患者情感(EWB)和社会福利(SWB)的相关性:背景:FT 描述了与治疗相关的经济负担及其对患者预后的影响。此前很少有研究探讨胃肠道手术中的财务负担及其对患者生活质量的影响:方法: 在 2022 年 1 月至 2023 年 1 月期间,使用有效工具对在我院接受胃肠道手术的患者进行 FT 评估。使用有效工具对 EWB 和 SWB 进行评估。使用多变量模型确定了FT的风险因素。使用皮尔逊相关性评估了 FT 与患者 EWB 和 SWB 之间的相关性:188名患者接受了调查,其中大部分患者接受了胰腺切除术(90人,占47.9%),59人(占31.4%)经历了FT。经多变量分析,与经济毒性可能性增加相关的类别包括单身婚姻状况和未接受化疗和/或放疗,其几率比(95% C.I)分别为[3.02 (1.07, 8.51), P=.037] 和[3.86 (1.3, 11.44), P=.015]。较高的 EWB 和 SWB 分数与较高的 FT 分数直接相关:结论:接受复杂胃肠道手术的患者经常会经历财务毒性,从而影响患者报告的结果。财务毒性与可识别的术前因素有关,可利用这些因素筛查患者,以便采取干预措施,减轻财务毒性的一些有害影响。
{"title":"Financial Toxicity in Complex Gastrointestinal Surgery and Correlation with Patient Reported Outcomes.","authors":"Lindsey Young, Rosemary Vergara, John Henriquez, Alvis Fong, Talal Al-Assil, Saad Shebrain, Gitonga Munene","doi":"10.1097/SLA.0000000000006559","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006559","url":null,"abstract":"<p><strong>Objectives: </strong>To describe financial toxicity (FT) in patients who have undergone gastrointestinal (GI) surgery and its correlation with patients' emotional (EWB) and social well-being (SWB).</p><p><strong>Background: </strong>FT describes the financial burden associated with treatment and its impact on patient outcomes. Few prior studies have examined FT in gastrointestinal surgery and its impact on patient quality of life.</p><p><strong>Methods: </strong>Patients who underwent gastrointestinal surgery at our institution were assessed for FT with a validated instrument between Jan 2022 and Jan 2023. EWB and SWB were assessed with a validated instrument. Risk factors for FT were determined using a multivariable model. The correlation between FT and patient EWB and SWB was assessed using Pearson correlation.</p><p><strong>Results: </strong>188 patients were surveyed, the majority had pancreatic resections (n = 90, 47.9%), 59 (31.4%) patients experienced FT. On multivariable analysis, categories associated with increased likelihood of exhibiting financial toxicity included single marital status and not receiving chemotherapy and/or radiation therapy, with odds ratio (95% C.I) of [3.02 (1.07, 8.51), P=.037] and [3.86 (1.3, 11.44), P=.015) respectively. Higher EWB and SWB scores directly correlated with higher FT scores.</p><p><strong>Conclusion: </strong>Patients undergoing complex gastrointestinal surgery often experience financial toxicity that affects patient reported outcomes. Financial toxicity is associated with identifiable pre-operative factors that can be utilized to screen patients for interventions that may mitigate some of the harmful effects of FT.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543243","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}
引用次数: 0
Spread through air spaces (STAS): Cancer beyond the cutting edge. 通过空气传播(STAS):超越前沿的癌症
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-11 DOI: 10.1097/SLA.0000000000006558
Amina Tidjani, Hina Bhat, Prasad S Adusumilli
{"title":"Spread through air spaces (STAS): Cancer beyond the cutting edge.","authors":"Amina Tidjani, Hina Bhat, Prasad S Adusumilli","doi":"10.1097/SLA.0000000000006558","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006558","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543248","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}
引用次数: 0
New Persistent Opioid Use: Uncovering Mortality Risks for Surgical and Trauma Patients. 新的阿片类药物持续使用:揭示手术和创伤患者的死亡风险。
IF 9 1区 医学 Q1 SURGERY Pub Date : 2024-10-08 DOI: 10.1097/sla.0000000000006557
Mark C Bicket,Jennifer F Waljee,Mark R Hemmila
{"title":"New Persistent Opioid Use: Uncovering Mortality Risks for Surgical and Trauma Patients.","authors":"Mark C Bicket,Jennifer F Waljee,Mark R Hemmila","doi":"10.1097/sla.0000000000006557","DOIUrl":"https://doi.org/10.1097/sla.0000000000006557","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385287","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}
引用次数: 0
Is It the Holy Grail or Snake Oil? 是圣杯还是蛇油?
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-03 DOI: 10.1097/SLA.0000000000006556
Angela L F Gibson, Lee D Faucher
{"title":"Is It the Holy Grail or Snake Oil?","authors":"Angela L F Gibson, Lee D Faucher","doi":"10.1097/SLA.0000000000006556","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006556","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364068","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}
引用次数: 0
Paravertebral versus EPidural Analgesia in Minimally Invasive Esophageal ResectioN (PEPMEN): A Randomized Controlled Multicenter Trial. 微创食管切除术中的椎旁镇痛与硬膜外镇痛(PEPMEN):随机对照多中心试验。
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-03 DOI: 10.1097/SLA.0000000000006551
Minke L Feenstra, Cezanne D Kooij, Wietse J Eshuis, Eline M de Groot, Jeroen Hermanides, B Feike Kingma, Suzanne S Gisbertz, Jelle P Ruurda, Freek Daams, Marije Marsman, Oscar F C van den Bosch, Werner Ten Hoope, Lucas Goense, Misha D P Luyer, Grard A P Nieuwenhuijzen, Harm J Scholten, Marc Buise, Marc J van Det, Ewout A Kouwenhoven, Franciscus van der Meer, Geert W J Frederix, Markus W Hollmann, Edward Cheong, Mark I van Berge Henegouwen, Richard van Hillegersberg

Objective: To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).

Summary background data: Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.

Methods: This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality.

Results: From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay.

Conclusions: This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.

目的比较接受硬膜外镇痛或椎旁镇痛的微创食管切除术(MIE)患者的术后恢复质量:椎旁镇痛可能是硬膜外镇痛的一种有前途的替代方法,可避免潜在的副作用并改善术后恢复:这项随机对照优越性试验在四个荷兰中心进行,对象是计划接受经胸 MIE 和胸腔内吻合术的食管癌患者,随机分配患者接受硬膜外镇痛或椎旁镇痛。主要结果是术后第三天(POD)的恢复质量(QoR-40)。次要结果包括生活质量、术后疼痛、阿片类药物用量、肌力/血管加压药物用量、住院时间、并发症、再入院率和死亡率:从 2019 年 12 月到 2023 年 2 月,共纳入 192 名患者:94人接受硬膜外镇痛,98人接受椎旁镇痛。POD3的QoR-40评分在组间无差异(平均差异为3.7,95%CI为-2.3至9.7;P=0.268)。硬膜外麻醉患者在 POD1 和 2 的 QoR-40 评分明显更高(平均差异为 7.7,95%CI 为 2.3-13.1;P=0.018;平均差异为 7.3,95%CI 为 1.9-12.7;P=0.020),疼痛评分更低(中位数为 1 对 2;P=结论:这项随机对照试验并未证明椎旁镇痛比硬膜外镇痛在MIE术后POD3的恢复质量方面更具优势。这两种技术都很有效,可以在临床实践中使用。
{"title":"Paravertebral versus EPidural Analgesia in Minimally Invasive Esophageal ResectioN (PEPMEN): A Randomized Controlled Multicenter Trial.","authors":"Minke L Feenstra, Cezanne D Kooij, Wietse J Eshuis, Eline M de Groot, Jeroen Hermanides, B Feike Kingma, Suzanne S Gisbertz, Jelle P Ruurda, Freek Daams, Marije Marsman, Oscar F C van den Bosch, Werner Ten Hoope, Lucas Goense, Misha D P Luyer, Grard A P Nieuwenhuijzen, Harm J Scholten, Marc Buise, Marc J van Det, Ewout A Kouwenhoven, Franciscus van der Meer, Geert W J Frederix, Markus W Hollmann, Edward Cheong, Mark I van Berge Henegouwen, Richard van Hillegersberg","doi":"10.1097/SLA.0000000000006551","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006551","url":null,"abstract":"<p><strong>Objective: </strong>To compare quality of recovery in patients receiving epidural or paravertebral analgesia for minimally invasive esophagectomy (MIE).</p><p><strong>Summary background data: </strong>Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery.</p><p><strong>Methods: </strong>This randomized controlled superiority trial was conducted across four Dutch centers with esophageal cancer patients scheduled for transthoracic MIE with intrathoracic anastomosis, randomizing patients to receive either epidural or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included quality of life, postoperative pain, opioid consumption, inotropic/vasopressor medication use, hospital stay, complications, readmission, and mortality.</p><p><strong>Results: </strong>From December 2019 to February 2023, 192 patients were included: 94 received epidural and 98 paravertebral analgesia. QoR-40 score on POD3 was not different between groups (mean difference 3.7, 95%CI -2.3 to 9.7; P=0.268). Epidural patients had significant higher QoR-40 scores on POD1 and 2 (mean difference 7.7, 95%CI 2.3-13.1; P=0.018 and mean difference 7.3, 95%CI 1.9-12.7; P=0.020) and lower pain scores (median 1 versus 2; P=<0.001 and median 1 versus 2; P=0.033). More epidural patients required vasopressor medication on POD1 (38.3% versus 13.3%; P<0.001). Urinary catheters were removed earlier in the paravertebral group (median POD3 versus 4; P=<0.001). No significant differences were found in postoperative complications or hospital/Intensive Care Unit stay.</p><p><strong>Conclusions: </strong>This randomized controlled trial did not demonstrate superiority of paravertebral over epidural analgesia regarding quality of recovery on POD3 after MIE. Both techniques are effective and can be offered in clinical practice.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364069","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}
引用次数: 0
Frequency and Natural History of Emergency General Surgery Conditions in Cancer Patients: A SEER-Medicare Population Analysis. 癌症患者接受普通外科急诊的频率和自然病史:SEER-Medicare 人口分析。
IF 7.5 1区 医学 Q1 SURGERY Pub Date : 2024-10-02 DOI: 10.1097/SLA.0000000000006554
Joshua S Jolissaint, Stephanie M Lobaugh, Debra A Goldman, Sarah M McIntyre, Elvira L Vos, Katherine S Panageas, Alice C Wei

Objective: To determine if cancer patients experience variability in incidence or management of emergency general surgery (EGS) conditions compared to non-cancer patients.

Background: The true frequency, and natural history of EGS conditions among cancer patients has not been characterized.

Methods: We utilized SEER-Medicare data from January 2006-December 2015 to compare patients with breast, prostate, and lung cancer to a non-cancer cohort. Patients were followed from date of cancer diagnosis, or an index date for non-cancer patients, to the development of an EGS condition, death or last follow up. We assessed the cumulative incidence of EGS conditions over time, and fit multivariable Cox proportional hazards models to evaluate the impact of time-dependent surgical intervention on mortality.

Results: We identified 322,756 patients with breast (N=82,147), lung (N=128,618), and prostate cancer (N=111,991) and 210,429 non-cancer patients.. Cancer patients had a higher incidence of an EGS condition within the first year after diagnosis (4.8% vs. 3.2%), with lung (6.8%) and breast cancer (4.0%) showing consistent rends. Cancer patients were less likely to undergo surgery for (13% vs. 14%, P=0.005), though this varied by cancer type and EGS conditions. Patients with breast (HR 1.27, 95%CI 1.17-1.39) and lung cancer (HR 3.27, 95%CI 3.07-3.48) were more likely to die within 30-days of an EGS diagnosis.

Conclusions: Cancer patients experience a higher incidence of EGS conditions within the first year following diagnosis, but are less likely to undergo surgery. Future research is needed to explore the interplay between EGS conditions, their management, and receipt of intended oncologic therapy, and resulting outcomes.

目的: 确定与非癌症患者相比,癌症患者的急诊普外科(EGS)病症发生率或管理是否存在差异:确定与非癌症患者相比,癌症患者在急诊普外科(EGS)病症的发生率或管理方面是否存在差异:癌症患者中 EGS 病症的真实频率和自然病史尚未确定:我们利用 SEER-Medicare 2006 年 1 月至 2015 年 12 月的数据,将乳腺癌、前列腺癌和肺癌患者与非癌症患者进行了比较。从癌症确诊日期或非癌症患者的指数日期开始,对患者进行随访,直至出现 EGS 病症、死亡或最后一次随访。我们评估了 EGS 病症随时间变化的累积发病率,并建立了多变量 Cox 比例危险模型,以评估随时间变化的手术干预对死亡率的影响:我们确定了 322,756 名乳腺癌(82,147 人)、肺癌(128,618 人)和前列腺癌(111,991 人)患者以及 210,429 名非癌症患者。癌症患者在确诊后第一年内的 EGS 发病率较高(4.8% 对 3.2%),其中肺癌(6.8%)和乳腺癌(4.0%)的发病率呈持续上升趋势。癌症患者接受手术的几率较低(13% vs. 14%,P=0.005),但这因癌症类型和 EGS 状况而异。乳腺癌(HR 1.27,95%CI 1.17-1.39)和肺癌(HR 3.27,95%CI 3.07-3.48)患者更有可能在确诊 EGS 后 30 天内死亡:结论:癌症患者在确诊后第一年内发生 EGS 的几率较高,但接受手术的几率较低。未来的研究需要探索 EGS 病症、其管理和接受预期肿瘤治疗之间的相互作用以及由此产生的结果。
{"title":"Frequency and Natural History of Emergency General Surgery Conditions in Cancer Patients: A SEER-Medicare Population Analysis.","authors":"Joshua S Jolissaint, Stephanie M Lobaugh, Debra A Goldman, Sarah M McIntyre, Elvira L Vos, Katherine S Panageas, Alice C Wei","doi":"10.1097/SLA.0000000000006554","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006554","url":null,"abstract":"<p><strong>Objective: </strong>To determine if cancer patients experience variability in incidence or management of emergency general surgery (EGS) conditions compared to non-cancer patients.</p><p><strong>Background: </strong>The true frequency, and natural history of EGS conditions among cancer patients has not been characterized.</p><p><strong>Methods: </strong>We utilized SEER-Medicare data from January 2006-December 2015 to compare patients with breast, prostate, and lung cancer to a non-cancer cohort. Patients were followed from date of cancer diagnosis, or an index date for non-cancer patients, to the development of an EGS condition, death or last follow up. We assessed the cumulative incidence of EGS conditions over time, and fit multivariable Cox proportional hazards models to evaluate the impact of time-dependent surgical intervention on mortality.</p><p><strong>Results: </strong>We identified 322,756 patients with breast (N=82,147), lung (N=128,618), and prostate cancer (N=111,991) and 210,429 non-cancer patients.. Cancer patients had a higher incidence of an EGS condition within the first year after diagnosis (4.8% vs. 3.2%), with lung (6.8%) and breast cancer (4.0%) showing consistent rends. Cancer patients were less likely to undergo surgery for (13% vs. 14%, P=0.005), though this varied by cancer type and EGS conditions. Patients with breast (HR 1.27, 95%CI 1.17-1.39) and lung cancer (HR 3.27, 95%CI 3.07-3.48) were more likely to die within 30-days of an EGS diagnosis.</p><p><strong>Conclusions: </strong>Cancer patients experience a higher incidence of EGS conditions within the first year following diagnosis, but are less likely to undergo surgery. Future research is needed to explore the interplay between EGS conditions, their management, and receipt of intended oncologic therapy, and resulting outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360958","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}
引用次数: 0
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Annals of surgery
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