Pub Date : 2024-10-14DOI: 10.1097/SLA.0000000000006560
Niyum Gandhi
{"title":"Shareholder Considerations in Healthcare.","authors":"Niyum Gandhi","doi":"10.1097/SLA.0000000000006560","DOIUrl":"10.1097/SLA.0000000000006560","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456550","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 : 2024-10-14DOI: 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.
{"title":"Population-Based Cohort Study on Treatment and Overall Survival of Patients Clinically Diagnosed With T1 Ampullary Cancer.","authors":"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","doi":"10.1097/SLA.0000000000006563","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006563","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer.</p><p><strong>Background: </strong>Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543247","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 : 2024-10-14DOI: 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.
{"title":"Mutant KRAS in Circulating Tumor DNA as a Biomarker in Localized Pancreatic Cancer in Patients Treated with Neoadjuvant Chemotherapy.","authors":"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","doi":"10.1097/SLA.0000000000006562","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006562","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Summary and background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543245","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 : 2024-10-11DOI: 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。
{"title":"Failure Mode Effects Analysis of Re-triage of Injured Patients to Receiving High-Level Illinois Trauma Centers.","authors":"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","doi":"10.1097/SLA.0000000000006561","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006561","url":null,"abstract":"<p><strong>Objective: </strong>This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients.</p><p><strong>Summary background data: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</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":"142543242","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}
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.
{"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}
Pub Date : 2024-10-11DOI: 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}
Pub Date : 2024-10-08DOI: 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}
Pub Date : 2024-10-03DOI: 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}
Pub Date : 2024-10-03DOI: 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.
{"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}
Pub Date : 2024-10-02DOI: 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.
{"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}