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Schleimer LE, Liu A, Kalvin HL, Barekzai AB, Choubey AP, Jung J, Haque R, Jarnagin WR, Balachandran VP, Geevarghese R, Marinelli B, Gonen M, Drebin J, Allen PJ, D'Angelica MI, Wei AC, Zani S, Kingham TP, Lidsky ME, Soares KC. Robotic Versus Open Placement of Hepatic Artery Infusion Pumps. Ann Surg Oncol 2025:10.1245/s10434-025-16915-8. [PMID: 39875717 DOI: 10.1245/s10434-025-16915-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 01/06/2025] [Indexed: 01/30/2025]
Abstract
BACKGROUND A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement. METHODS We retrospectively reviewed HAIP placement without concurrent hepatectomy at Memorial Sloan Kettering Cancer Center from 1 January 2011 to 15 September 2022, and Duke Health from 1 November 2018 to 18 May 2023. Patients with prior liver surgery or who required catheterization of a non-standard vessel were excluded. Propensity score matching weights (PSMW) were calculated using age, sex, race, body mass index, American Society of Anesthesiologists class, neoadjuvant chemotherapy, colorectal procedure, and institution. Survey-weighted generalized linear models assessed the relationship between approach and outcomes. RESULTS Of 2002 consecutive HAIP placements, 819 (645 open/174 robotic) met the inclusion criteria. A higher proportion of open procedures involved combined colorectal procedures; other patient characteristics were similar. Overall, 15% of patients experienced an HAIP-specific complication and 12% required re-intervention; 2.7% had HAIP failure ≤ 90 days. After PSMW, the robotic approach had a longer operative time (β = 68 min, 95% confidence interval [CI] 55-81, p < 0.001) but shorter length of stay (β = - 1.8 days, 95% CI - 2.3 to 1.3, p < 0.001). The robotic approach was associated with increased HAIP-specific complications (odds ratio [OR] 1.72, p = 0.025) and re-intervention (OR 2.33, p < 0.001), with no difference in time to initiation of HAIP chemotherapy or HAIP failure. CONCLUSIONS Robotic HAIP placement was associated with increased postoperative complications and significantly shorter length of stay, with similar time to initiation of HAIP therapy. There was no difference in the rate of early HAIP failure versus the open approach. These results suggest robotic HAIP placement is feasible and effective.
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Affiliation(s)
- Lauren E Schleimer
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Annie Liu
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Hannah L Kalvin
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmad Bashir Barekzai
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ankur P Choubey
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joslyn Jung
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rubiya Haque
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R Jarnagin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P Balachandran
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruben Geevarghese
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett Marinelli
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeffrey Drebin
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J Allen
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Michael I D'Angelica
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alice C Wei
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael E Lidsky
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin C Soares
- Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Khan MMM, Woldesenbet S, Munir MM, Khalil M, Endo Y, Katayama E, Tsilimigras D, Rashid Z, Altaf A, Pawlik TM. Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost. HPB (Oxford) 2025; 27:111-122. [PMID: 39547904 DOI: 10.1016/j.hpb.2024.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 07/16/2024] [Accepted: 10/29/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication. METHODS Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery. RESULTS Among 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) of patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis demonstrated that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81-0.87) (all p < 0.001). CONCLUSION At index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.
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Affiliation(s)
- Muhammad M M Khan
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad M Munir
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Mujtaba Khalil
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zayed Rashid
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Abdullah Altaf
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Ypsilantis P, Stylianaki I, Papachristou F, Papatheodorou P, Svoronos C, Spyridakis K, Margaritis M, Ypsilantou I, Ypsilantis K, Papaioannou N, Karayiannakis A, Pitiakoudis M. Inflammation-attenuating effect of carbon dioxide versus room-air environment in a rat laparotomy model. Surg Endosc 2025; 39:376-383. [PMID: 39548008 DOI: 10.1007/s00464-024-11388-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 10/26/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND The mechanism by which laparoscopic operations induce lower post-operative inflammatory response compared to open surgery was investigated with regard to the effect of the type of gas environment. METHODS Rats were subjected to midline laparotomy at either CO2 (group CO2) or room-air environment (group Air) or to anesthesia only (group Control) under atmospheric pressure conditions. At various timepoints after surgery (1, 3, 6, 24, or 48 h), the expression of inflammation biomarkers interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and nuclear factor-κΒ (NFκΒ) were assessed immunohistochemically in tissue samples excised from the liver, intestine, and kidneys, accompanied by histopathologic analysis, and their levels were measured by ELISA in blood samples. RESULTS Tissue expression of IL-6, TNFα, and NFκΒ was downregulated in the liver and intestine in group CO2 compared to group Air and in the kidneys in group Air compared to group CO2. However, no differences were noted among groups regarding the histopathologic score of organ tissues and the blood serum levels of inflammation biomarkers. CONCLUSION Post-operative local inflammatory response was lower in intra-peritoneal organs of rats subjected to laparotomy at CO2 rather than room-air environment under atmospheric pressure conditions.
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Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece.
| | - Ioanna Stylianaki
- Laboratory of Pathology, Department of Veterinary Medicine, School of Health Sciences, Aristotelion University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Fotini Papachristou
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Panagiotis Papatheodorou
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Christos Svoronos
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Konstantinos Spyridakis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Michael Margaritis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Konstantinos Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Nikolaos Papaioannou
- Laboratory of Pathology, Department of Veterinary Medicine, School of Health Sciences, Aristotelion University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Anastasios Karayiannakis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Surgery and Surgical Research, Department of Medicine, School of Health Sciences, Democritus University of Thrace, Building 12, 68100, Alexandroupolis, Dragana, Greece
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Semash K, Dzhanbekov T. Laparoscopic donor hepatectomy: Are there obstacles on the path to global widespread? LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2024. [DOI: 10.1016/j.lers.2024.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
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Campbell RG, Zadro JR, Gamble AR, Chan CL, Mackey MG, Osie G, Png LH, Douglas RG, Pappas E. Work-Related Musculoskeletal Disorders in Endoscopic Sinus and Skull Base Surgery: A Systematic Review With Meta-analysis. Otolaryngol Head Neck Surg 2024; 171:1650-1669. [PMID: 38971976 PMCID: PMC11605027 DOI: 10.1002/ohn.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/06/2024] [Accepted: 06/22/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Endoscopic sinus and skull base surgery has led to significant improvements in patient outcomes, yet may have come at a cost to surgeons' musculoskeletal (MSK) health. We aimed to determine the prevalence and characteristics of work-related MSK disorders (WRMDs) in endoscopic sinus and skull base surgeons; to investigate contributing factors for WRMD in this population; and to evaluate the effectiveness of ergonomic interventions on the severity or prevalence of WRMD in this population. DATA SOURCES Medline, Embase, CINAHL, Web of Science, and Scopus from inception to April 2, 2024. A bibliographic examination was performed for further papers. REVIEW METHODS Inclusion criteria included original peer-reviewed papers with work-related MSK outcomes (prevalence, contributing factors, and interventions) relating to endoscopic sinus and/or skull base surgeons in any language. RESULTS Of 25,772 unique citations, 37 studies met the inclusion criteria. The pooled lifetime, point, and 12-month prevalences of WRMD were 75.9% (95% confidence interval; I2, 67.2%-83.6%, I2 95.6%), 80.8% (77.0%-84.3%, I2 98.0%), and 82.0% (71.8%-90.3%, I2 60.96%) respectively. The neck, lumbar spine, and thoracic spine were the most commonly involved areas. One of 9 studies on contributing factors investigated discomfort as an outcome. The remainder focussed on surrogate outcomes (eg, posture, hand dysfunction). Two of the 13 intervention studies investigated pain or fatigue as an outcome. The remainder targeted posture, muscle activity, or workload. CONCLUSION WRMDs are highly prevalent in endoscopic sinus and skull base surgeons. Further studies focusing on the direct outcomes of WRMD such as pain are needed.
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Affiliation(s)
- Raewyn G. Campbell
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Faculty of Medicine, Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
- Rhinology and Skull Base Research Group, Applied Medical Research CentreUniversity of New South WalesSydneyAustralia
| | - Joshua R. Zadro
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Musculoskeletal Health and Institute for Musculoskeletal HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Andrew R. Gamble
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Cliffton L. Chan
- Faculty of Medicine, Health and Human SciencesMacquarie UniversityMacquarie ParkNew South WalesAustralia
| | - Martin G. Mackey
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Gabriel Osie
- Rhinology and Skull Base Research Group, Applied Medical Research CentreUniversity of New South WalesSydneyAustralia
| | - Lu Hui Png
- Department of Otorhinolaryngology–Head and Neck SurgerySingapore General HospitalSingapore CitySingapore
| | - Richard G. Douglas
- Faculty of Medical and Health Sciences, SurgeryUniversity of AucklandAucklandNew Zealand
| | - Evangelos Pappas
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
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Mazzola M, Benedetti A, Giani A, Calcagno P, Zironda A, Paterno M, Giacomoni A, De Martini P, Ferrari G. Abdominal drainage after minimally invasive distal pancreatectomy: out of sight, out of mind? Surg Endosc 2024; 38:6396-6405. [PMID: 39218834 DOI: 10.1007/s00464-024-11217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUNDS The use of drains in pancreatic surgery remains controversial. The present study investigated postoperative outcomes in patients undergoing minimally invasive distal pancreatectomy (MIDP) without intraperitoneal drain placement. METHODS Data of consecutive patients undergoing MIDP between 2013 and 2023 were prospectively collected. Patients were divided in drain group (DG), including patients with prophylactic abdominal drain placed, and no-drain group (NDG) including those without drain. The groups were compared in terms of postoperative outcomes, using a propensity score-matched analysis. RESULTS 116 patients were selected. After matching, DG and NDG consisted of 29 patients each. The rates of POPF and abdominal collection were lower in NDG in comparison to DG (3.4% vs. 27.6%, p 0.025 and 3.4% vs. 31.0%, p 0.011, respectively). The length of stay was significantly shorter in the NDG (5 vs. 9 days, p < 0.001). No difference between the groups was found for other outcomes. CONCLUSION Drain omission was associated with lower rates of POPF and abdominal collections, as well as shorter hospital stays, not affecting the rate of severe complication, reoperation and readmission.
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Affiliation(s)
- Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Antonio Benedetti
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandro Giani
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Pietro Calcagno
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Andrea Zironda
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Michele Paterno
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandro Giacomoni
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Paolo De Martini
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
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Amodu LI, Hakmi H, Sohail AH, Akerman M, Petrone P, Halpern DK, Sonoda T. Laparoscopic Hartmann's procedure for complicated diverticulitis is associated with lower superficial surgical site infections compared to open surgery with similar other outcomes: a NSQIP-based, propensity score matched analysis. Eur J Trauma Emerg Surg 2024; 50:2097-2103. [PMID: 39356294 DOI: 10.1007/s00068-024-02661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/24/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Open Hartmann's procedure has traditionally been the procedure of choice to treat complicated diverticulitis. We analyzed the ACS-NSQIP database to compare outcomes in patients who underwent emergent laparoscopic Hartmann's procedure (LHP) to those who had an open Hartmann's procedure (OHP). STUDY DESIGN Data analyzed from 2015 to 2019 using ICD-10 codes. Patients were matched on several important covariates using a propensity score matching method (PSM). Patients were matched in a 4:1 ratio of controls to cases based on the propensity score. RESULTS We identified 5026, of which 456 had LHP and 4570 had OHP. PSM analysis yielded 369 LHP and 1476 OHP patients. LHP had lower rates of superficial surgical site infection (SSSI) compared to OHP (2.44% vs. 5.89%, p = 0.007). LHP had similar post-operative outcomes compared to OHP, including 30-day mortality (5.15% vs. 2.98%, p = 0.060), organ space surgical site infection (OSSSI) (14.36% vs. 12.60%, p = 0.161), wound disruption (1.36% vs. 2.44%, p = 0.349), median LOS (8 vs. 9 days, p = 0.252), readmission within 30 days (11.92% vs. 8.67%, p = 0.176), rate of reoperation (6.0 vs. 6.5%, p = 0.897), and discharge to home (76% vs. 77%, p = 0.992). LHP had longer operative times compared to OHP (median 129 vs. 118 min, p < 0.0001). CONCLUSION The LHP is associated with lower rates of SSSI. However, it is not associated with lower rates of mortality, OSSSI, readmissions and reoperations within 30 days. Surgical times are longer in LHP. More studies are needed to determine whether LHP offers advantages in the long-term, particularly in rates of incisional hernia and colostomy closure.
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Affiliation(s)
- Leo I Amodu
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Hazim Hakmi
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Amir H Sohail
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Meredith Akerman
- Biostatistics Core, Division of Health Services Research, Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA.
| | - David K Halpern
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
| | - Toyooki Sonoda
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza North, Suite 300, Mineola, NY, 11501, USA
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Bakr DM, Behery Youssef R, Mohamed MS, Khalil MS. Dexmedetomidine Versus Fentanyl on Time to Extubation in Patients with Morbid Obesity Undergoing Laparoscopic Sleeve Gastrectomy. Anesth Pain Med 2024; 14:e144776. [PMID: 39416796 PMCID: PMC11480564 DOI: 10.5812/aapm-144776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/14/2024] [Accepted: 04/11/2024] [Indexed: 10/19/2024] Open
Abstract
Background Sleeve gastrectomy (SG) is an effective method for managing obesity. While opioids are used for their hemodynamic stability and their ability to reduce intraoperative stress, they also have reported side effects. Dexmedetomidine (DEX), an α2 adrenergic receptor agonist, is noted for its analgesic and anesthetic-sparing effects, leading to a higher quality of recovery. Objectives The study aims to compare the effects of fentanyl and dexmedetomidine (DEX) on the recovery of morbidly obese patients following laparoscopic sleeve gastrectomy (SG). Methods This randomized, double-blind study involved 64 patients, equally divided into two groups. The Dexmedetomidine group (Group D) received an intravenous (IV) loading dose of dexmedetomidine (1 μg/kg) over 15 minutes before anesthesia induction, followed by a 10 mL saline 0.9% infusion over 60 seconds during induction. Post-intubation, dexmedetomidine was administered at 0.5 μg/kg/h. The Fentanyl group (Group F) received a volume-matched saline 0.9% IV over 15 minutes pre-induction and fentanyl (1 μg/kg) diluted in 10 ml saline 0.9% IV over 60 seconds during induction. After intubation, a continuous fentanyl infusion was maintained at a rate of 1 μg/kg/hr. Results Extubation time was significantly shorter in the Dexmedetomidine group (Group D) at 8.25 ± 2.7 minutes compared to the Fentanyl group (Group F) at 10.47 ± 2.17 minutes, with a P-value of 0.001. Intraoperative heart rate and mean arterial blood pressure were also significantly lower in Group D than in Group F. Visual analogue scale (VAS) pain scores were significantly lower in Group D compared to Group F upon arrival at the post-anesthesia care unit and at 2 hours postoperatively (P-value < 0.05). Additionally, the morphine dose consumed in the first 12 hours after surgery was significantly lower in Group D (5.75 ± 2.20 mg) compared to Group F (8 ± 2.38 mg), with a P-value of 0.001. Conclusions For morbidly obese patients undergoing laparoscopic sleeve gastrectomy, dexmedetomidine (DEX) proves to be an effective anesthetic choice. It not only reduces extubation time but also lowers early postoperative visual analogue scale (VAS) pain scores and opioid consumption within the first 12 hours following surgery.
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Affiliation(s)
- Doha Mohammed Bakr
- Anesthesiology, Department of Surgical Intensive Care and Pain Management, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Rasha Behery Youssef
- Anesthesiology, Department of Surgical Intensive Care and Pain Management, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Maged Salah Mohamed
- Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Moataz Salah Khalil
- Anesthesiology, Department of Surgical Intensive Care and Pain Management, Faculty of Medicine, Helwan University, Helwan, Egypt
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Sarma R, Ray S, Baishya NK, Sultana W. Comparative Study of Levels of Serum Bilirubin, Serum Transaminase, Serum Alkaline Phosphatase, and Prothrombin Time After Laparoscopic Cholecystectomy and Open Cholecystectomy. Cureus 2024; 16:e60296. [PMID: 38872670 PMCID: PMC11170308 DOI: 10.7759/cureus.60296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
Laparoscopic cholecystectomy (LC) is universally accepted as the gold standard treatment for symptomatic gallstones. However, it has some drawbacks. Some of the major drawbacks of LC include increased bile duct injuries and longer operation time. Furthermore, it may cause changes in the body systems, such as alterations in acid-base, pulmonary status, cardiovascular system, and liver function. Thus far, no causes for these changes have been identified. This study aimed to evaluate the effect of laparoscopic and open cholecystectomy on liver enzymes, prothrombin time (PT), and serum bilirubin. In the current study, we found significant increases in aspartate transferase (AST), alanine transaminase (ALT), and total bilirubin, on day 1 and day 3 after LC but no significant change in alkaline phosphatase (ALKP) and PT. It is important for surgeons to know about these transient changes in the immediate postoperative period to avoid misdiagnosis and adopt proper treatment and management.
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Affiliation(s)
- Rahul Sarma
- General Surgery, GNRC Hospital, Guwahati, IND
| | - Sushmita Ray
- General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND
| | | | - Wahida Sultana
- General Surgery, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, IND
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10
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Serrano AB, Díaz-Cambronero Ó, Montiel M, Molina J, Núñez M, Mendía E, Mané MN, Lisa E, Martínez-Botas J, Gómez-Coronado D, Gaetano A, Casarejos MJ, Gómez A, Sanjuanbenito A. Impact of Standard Versus Low Pneumoperitoneum Pressure on Peritoneal Environment in Laparoscopic Cholecystectomy. Randomized Clinical Trial. Surg Laparosc Endosc Percutan Tech 2024; 34:1-8. [PMID: 37963307 DOI: 10.1097/sle.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND High CO 2 pneumoperitoneum pressure during laparoscopy adversely affects the peritoneal environment. This study hypothesized that low pneumoperitoneum pressure may be linked to less peritoneal damage and possibly to better clinical outcomes. MATERIALS AND METHODS One hundred patients undergoing scheduled laparoscopic cholecystectomy were randomized 1:1 to low or to standard pneumoperitoneum pressure. Peritoneal biopsies were performed at baseline time and 1 hour after peritoneum insufflation in all patients. The primary outcome was peritoneal remodeling biomarkers and apoptotic index. Secondary outcomes included biomarker differences at the studied times and some clinical variables such as length of hospital stay, and quality and safety issues related to the procedure. RESULTS Peritoneal IL6 after 1 hour of surgery was significantly higher in the standard than in the low-pressure group (4.26±1.34 vs. 3.24±1.21; P =0.001). On the contrary, levels of connective tissue growth factor and plasminogen activator inhibitor-I were higher in the low-pressure group (0.89±0.61 vs. 0.61±0.84; P =0.025, and 0.74±0.89 vs. 0.24±1.15; P =0.028, respectively). Regarding apoptotic index, similar levels were found in both groups and were 44.0±10.9 and 42.5±17.8 in low and standard pressure groups, respectively. None of the secondary outcomes showed differences between the 2 groups. CONCLUSIONS Peritoneal inflammation after laparoscopic cholecystectomy is higher when surgery is performed under standard pressure. Adhesion formation seems to be less in this group. The majority of patients undergoing surgery under low pressure were operated under optimal workspace conditions, regardless of the surgeon's expertise.
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Affiliation(s)
| | - Óscar Díaz-Cambronero
- Department of Anesthesiology, Perioperative Medicine Research Group, Hospital Universitari i Politécnic La Fe, Valencia, Spain
- EuroPeriscope: The ESA-IC Onco-Anaesthesiology Research Group
| | | | | | | | | | | | | | | | | | - Andrea Gaetano
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid
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11
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Pinheiro AV, Petrucci GN, Dourado A, Pires I. Anaesthesia in Veterinary Oncology: The Effects of Surgery, Volatile and Intravenous Anaesthetics on the Immune System and Tumour Spread. Animals (Basel) 2023; 13:3392. [PMID: 37958147 PMCID: PMC10648213 DOI: 10.3390/ani13213392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Throughout the course of oncological disease, the majority of patients require surgical, anaesthetic and analgesic intervention. However, during the perioperative period, anaesthetic agents and techniques, surgical tissue trauma, adjuvant drugs for local pain and inflammation and other non-pharmacological factors, such as blood transfusions, hydration, temperature and nutrition, may influence the prognosis of the disease. These factors significantly impact the oncologic patient's immune response, which is the primary barrier to tumour progress, promoting a window of vulnerability for its dissemination and recurrence. More research is required to ascertain which anaesthetics and techniques have immunoprotective and anti-tumour effects, which will contribute to developing novel anaesthetic strategies in veterinary medicine.
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Affiliation(s)
- Ana Vidal Pinheiro
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (A.D.); (I.P.)
| | - Gonçalo N. Petrucci
- Onevetgroup Hospital Veterinário do Porto (HVP), 4250-475 Porto, Portugal;
- Center for Investigation Vasco da Gama (CIVG), Department of Veterinary Sciences, Vasco da Gama University School (EUVG), 3020-210 Coimbra, Portugal
- CECAV—Veterinary and Animal Research Center, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
| | - Amândio Dourado
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (A.D.); (I.P.)
- Onevetgroup Hospital Veterinário do Porto (HVP), 4250-475 Porto, Portugal;
| | - Isabel Pires
- Department of Veterinary Sciences, School of Agricultural and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), 5000-801 Vila Real, Portugal; (A.D.); (I.P.)
- CECAV—Veterinary and Animal Research Center, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal
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12
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Ceresoli M, Braga M, Zanini N, Abu-Zidan FM, Parini D, Langer T, Sartelli M, Damaskos D, Biffl WL, Amico F, Ansaloni L, Balogh ZJ, Bonavina L, Civil I, Cicuttin E, Chirica M, Cui Y, De Simone B, Di Carlo I, Fette A, Foti G, Fogliata M, Fraga GP, Fugazzola P, Galante JM, Beka SG, Hecker A, Jeekel J, Kirkpatrick AW, Koike K, Leppäniemi A, Marzi I, Moore EE, Picetti E, Pikoulis E, Pisano M, Podda M, Sakakushev BE, Shelat VG, Tan E, Tebala GD, Velmahos G, Weber DG, Agnoletti V, Kluger Y, Baiocchi G, Catena F, Coccolini F. Enhanced perioperative care in emergency general surgery: the WSES position paper. World J Emerg Surg 2023; 18:47. [PMID: 37803362 PMCID: PMC10559594 DOI: 10.1186/s13017-023-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Enhanced perioperative care protocols become the standard of care in elective surgery with a significant improvement in patients' outcome. The key element of the enhanced perioperative care protocol is the multimodal and interdisciplinary approach targeted to the patient, focused on a holistic approach to reduce surgical stress and improve perioperative recovery. Enhanced perioperative care in emergency general surgery is still a debated topic with little evidence available. The present position paper illustrates the existing evidence about perioperative care in emergency surgery patients with a focus on each perioperative intervention in the preoperative, intraoperative and postoperative phase. For each item was proposed and approved a statement by the WSES collaborative group.
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Affiliation(s)
- Marco Ceresoli
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
| | - Marco Braga
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Nicola Zanini
- General Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Fikri M Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Dario Parini
- General Surgery Department - Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Thomas Langer
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Dimitrios Damaskos
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Francesco Amico
- John Hunter Hospital Trauma Service and School of Medicine and Public Health, The University of Newcastle, Newcastle, AU, Australia
| | - Luca Ansaloni
- General Surgery, Fondazione IRCCS San Matteo, Pavia, Italy
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Ian Civil
- University of Auckland, Auckland, New Zealand
| | | | - Mircea Chirica
- Department of Digestive Surgery, CHU Grenoble Alpes, Grenoble, France
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Belinda De Simone
- Unit of Emergency and Trauma Surgery, Villeneuve St Georges Academic Hospital, Villeneuve St Georges, France
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | | | - Giuseppe Foti
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- Department of Critical Care and Anesthesia, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Michele Fogliata
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
- General and Emergency Surgery Department, Fondazione IRCCS San Gerardo dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (FCM), University of Campinas (Unicamp), Campinas, Brazil
| | | | | | | | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Gießen, Germany
| | | | - Andrew W Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ari Leppäniemi
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Andrei Litvin, CEO AI Medica Hospital Center, Kaliningrad, Russia
| | - Ingo Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, Goethe University, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Ernest E Moore
- Director of Surgery Research, Ernest E. Moore Shock Trauma Center, Distinguished Professor of Surgery, University of Colorado, Denver, CO, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Emmanouil Pikoulis
- Third Department of Surgery, Attikon University Hospital, Athene, Greece
| | - Michele Pisano
- General Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Edward Tan
- Former Chair Department of Emergency Medicine, HEMS Physician, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Giovanni D Tebala
- Digestive and Emergency Surgery Department, Azienda Ospedaliera S.Maria, Terni, Italy
| | - George Velmahos
- Harvard Medical School - Massachusetts General Hospital, Boston, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, Head of Service and Director of Trauma, Royal Perth Hospital, The University of Western Australia, Perth, Australia
| | - Vanni Agnoletti
- Anesthesia and Critical Care Department, Bufalini Hospital, Cesena, Italy
| | - Yoram Kluger
- Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel
| | - Gianluca Baiocchi
- General Surgery, University of Brescia, ASST Cremona, Cremona, Italy
| | - Fausto Catena
- General Surgery Department, Bufalini Hospital, Cesena, Italy
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13
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Kampman SL, Smalbroek BP, Dijksman LM, Smits AB. Postoperative inflammatory response in colorectal cancer surgery: a meta-analysis. Int J Colorectal Dis 2023; 38:233. [PMID: 37725227 DOI: 10.1007/s00384-023-04525-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Surgical removal of the cancerous tissue remains the cornerstone of curative treatment for colorectal cancer and results in an inflammatory response. An exaggerated inflammatory response has been implicated in the promotion of tumor proliferation and has shown associations with postoperative complications. Literature on the preferred surgical technique to minimize inflammatory response is inconclusive. Therefore, the aim of this study was to assess the inflammatory response and postoperative incidence of infectious complications following surgery for colorectal cancer. METHODS Embase, PubMed, and Cochrane databases were searched for RCTs that reported inflammatory parameters as a function of surgical modality only. Data related to CRP or IL-6 levels on postoperative days 1 and 3 and data related to postoperative infections were subject to a pairwise meta-analysis to compare open versus laparoscopic techniques. RESULTS The literature search and screening process yielded 4151 studies. Ten studies met criteria, including 568 patients. Only studies on laparoscopic and open surgery were found. Pooled analyses found lower Il-6 and CRP levels on postoperative day 1 and lower CRP levels on postoperative day 3 for laparoscopic surgery compared to open surgery. However, there was no difference in incidence of postoperative infectious complications. CONCLUSION The findings of this study indicate a superior inflammatory profile for laparoscopic surgery compared to an open approach for colorectal cancer surgery. For future research, it would be worthwhile to conduct a randomized controlled trial to compare the postoperative inflammatory response and related clinical outcomes between minimally invasive surgical approaches, including laparoscopic and robot-assisted surgery.
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Affiliation(s)
- S L Kampman
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B P Smalbroek
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
- Department of Value based healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - L M Dijksman
- Department of Value based healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A B Smits
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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14
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Shao J, Xie J, Sun P, Zhang Y, Chen D, Chen Y, Xu M. Factors Influencing Postoperative Recovery Time of Patients With Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2023; 33:370-374. [PMID: 37235717 DOI: 10.1097/sle.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/31/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND To explore the factors associated with prolonged enhanced recovery after surgery (ERAS) time in gastric cancer patients who underwent gastrectomy. METHODS This was a retrospective of patients with gastric cancer who received ERAS at our hospital between 01/2014 and 01/2022. The outcome was prolonged ERAS time. Factors associated with prolonged ERAS time of patients undergoing gastric cancer surgery were analyzed by logistic regression. RESULTS Among 663 patients, 182 (27.6%) patients had a prolonged ERAS time. The postoperative time to the first flatus time was 2.8 ± 1.2 days. There were 41 (6.2%) patients with intestinal obstruction, 25 (3.8%) with abdominal infection, and four (0.5%) with anastomotic leakage. The multivariable analysis showed that age >80 years (OR = 1.57, 95% CI: 1.31-4.40, P = 0.048), laparoscopic surgery (OR = 0.45, 95% CI: 0.21-0.95, P = 0.035), intraoperative jejunostomy (OR = 334.60, 95% CI: 2.81-39,831.90, P = 0.017), postoperative time to the first flatus time (OR = 3.79, 95% CI: 1.23-11.68, P = 0.021), total gastrectomy (OR = 0.08, 95% CI: 0.01-0.94, P = 0.044), and patient compliance with ERAS (OR = 0.01, 95% CI: 0-0.09, P < 0.001) were independently associated with prolonged ERAS time. CONCLUSIONS Age >80 years, laparoscopic surgery, intraoperative jejunostomy, postoperative time to the first flatus time, total gastrectomy, and patient compliance with ERAS might be factors associated with prolonged ERAS time in gastric cancer patients.
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Affiliation(s)
- Jun Shao
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
| | - Jiang Xie
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
| | - Peng Sun
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
| | - Yunpeng Zhang
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
| | - Daqing Chen
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
| | - Ying Chen
- Department of Oncology, Shanghai Tongren Hospital, Shanghai China
| | - Ming Xu
- Department of General Surgery Gastrointestinal group, Shanghai Tongren Hospital
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15
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Schleimer LE, Chabot JA, Kluger MD. Innovation in the Surgical Management of Pancreatic Cystic Neoplasms: Same Operations, Narrower Indications, and an Individualized Approach to Decision-Making. Gastrointest Endosc Clin N Am 2023; 33:655-677. [PMID: 37245941 DOI: 10.1016/j.giec.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Historically, the management of pancreatic cystic neoplasms (PCN) has been operative. Early intervention for premalignant lesions, including intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN), offers an opportunity to prevent pancreatic cancer-with potential decrement to patients' short-term and long-term health. The operations performed have remained fundamentally the same, with most patients undergoing pancreatoduodenectomy or distal pancreatectomy using oncologic principles. The role of parenchymal-sparing resection and total pancreatectomy remains controversial. We review innovations in the surgical management of PCN, focusing on the evolution of evidence-based guidelines, short-term and long-term outcomes, and individualized risk-benefit assessment.
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Affiliation(s)
- Lauren E Schleimer
- Department of Surgery, Columbia University Irving Medical Center, 177 Fort Washington Avenue, 8 Garden South, New York, NY 10032, USA. https://twitter.com/lschleim
| | - John A Chabot
- Division of GI/Endocrine Surgery, Department of Surgery, Herbert Irving Pavilion, Columbia University Irving Medical Center, Columbia University, Vagelos College of Physicians & Surgeons, 161 Fort Washington Avenue, Suite 819, New York, NY 10032, USA
| | - Michael D Kluger
- Division of GI/Endocrine Surgery, Department of Surgery, Herbert Irving Pavilion, Columbia University Irving Medical Center, Columbia University, Vagelos College of Physicians & Surgeons, 161 Fort Washington Avenue, Suite 823, New York, NY 10032, USA.
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16
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Kakos CD, Papanikolaou A, Ziogas IA, Tsoulfas G. Global dissemination of minimally invasive living donor hepatectomy: What are the barriers? World J Gastrointest Surg 2023; 15:776-787. [PMID: 37342850 PMCID: PMC10277954 DOI: 10.4240/wjgs.v15.i5.776] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/16/2023] [Accepted: 03/16/2023] [Indexed: 05/26/2023] Open
Abstract
Minimally invasive donor hepatectomy (MIDH) is a relatively novel procedure that can potentially increase donor safety and contribute to faster rehabilitation of donors. After an initial period in which donor safety was not effectively validated, MIDH currently seems to provide improved results, provided that it is conducted by experienced surgeons. Appropriate selection criteria are crucial to achieve better outcomes in terms of complications, blood loss, operative time, and hospital stay. Beyond a pure laparoscopic technique, various approaches have been recommended such as hand-assisted, laparoscopic-assisted, and robotic donation. The latter has shown equal outcomes compared to open and laparoscopic approaches. A steep learning curve seems to exist in MIDH, mainly due to the fragility of the liver parenchyma and the experience needed for adequate control of bleeding. This review investigated the challenges and the opportunities of MIDH and the barriers to its global dissemination. Surgeons need expertise in liver transplantation, hepatobiliary surgery, and minimally invasive techniques to perform MIDH. Barriers can be categorized into surgeon-related, institutional-related, and accessibility. More robust data and the creation of international registries are needed for further evaluation of the technique and the acceptance from more centers worldwide.
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Affiliation(s)
- Christos Dimitrios Kakos
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
| | - Angelos Papanikolaou
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Georgios Tsoulfas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54622, Greece
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17
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Davey MG, Ryan ÉJ, Donlon NE, Ryan OK, Al Azzawi M, Boland MR, Kerin MJ, Lowery AJ. Comparing surgical outcomes of approaches to adrenalectomy - a systematic review and network meta-analysis of randomised clinical trials. Langenbecks Arch Surg 2023; 408:180. [PMID: 37145303 PMCID: PMC10163131 DOI: 10.1007/s00423-023-02911-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND No randomised clinical trials (RCTs) have simultaneously compared the safety of open (OA), transperitoneal laparoscopic (TLA), posterior retroperitoneal (PRA), and robotic adrenalectomy (RA) for resecting adrenal tumours. AIM To evaluate outcomes for OA, TLA, PRA, and RA from RCTs. METHODS A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny. RESULTS Eight RCTs with 488 patients were included (mean age: 48.9 years). Overall, 44.5% of patients underwent TLA (217/488), 37.3% underwent PRA (182/488), 16.4% underwent RA (80/488), and just 1.8% patients underwent OA (9/488). The mean tumour size was 35 mm in largest diameter with mean sizes of 44.3 mm for RA, 40.9 mm for OA, 35.5 mm for TLA, and 34.4 mm for PRA (P < 0.001). TLA had the lowest blood loss (mean: 50.6 ml), complication rates (12.4%, 14/113), and conversion to open rates (1.3%, 2/157), while PRA had the shortest intra-operative duration (mean: 94 min), length of hospital stay (mean: 3.7 days), lowest visual analogue scale pain scores post-operatively (mean: 3.7), and was most cost-effective (mean: 1728 euros per case). At NMA, there was a significant increase in blood loss for OA (mean difference (MD): 117.00 ml (95% confidence interval (CI): 1.41-230.00)) with similar blood loss observed for PRA (MD: - 10.50 (95% CI: - 83.40-65.90)) compared to TLA. CONCLUSION LTA and PRA are important contemporary options in achieving favourable outcomes following adrenalectomy. The next generation of RCTs may be more insightful for comparison surgical outcomes following RA, as this approach is likely to play a future role in minimally invasive adrenalectomy. PROSPERO REGISTRATION CRD42022301005.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland.
- Department of Surgery, Galway University Hospitals, Galway, H91YR71, Republic of Ireland.
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Noel E Donlon
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Odhrán K Ryan
- Surgical Professorial Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, D04 T6F4, Ireland
| | - Mohammed Al Azzawi
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael R Boland
- Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, D02YN77, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91YR71, Ireland
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18
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Sattari SA, Sattari AR, Makary MA, Hu C, He J. Laparoscopic Versus Open Pancreatoduodenectomy in Patients With Periampullary Tumors: A Systematic Review and Meta-analysis. Ann Surg 2023; 277:742-755. [PMID: 36519444 DOI: 10.1097/sla.0000000000005785] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis of randomized controlled trials compared laparoscopic pancreatoduodenectomy (LPD) versus open pancreatoduodenectomy (OPD) in patients with periampullary tumors. BACKGROUND LPD has gained attention; however, its safety and efficacy versus OPD remain debatable. METHODS We searched PubMed and Embase. Primary outcomes were the length of hospital stay (LOS) (day), Clavien-Dindo grade ≥III complications, and 90-day mortality. Secondary outcomes were blood loss (milliliter), blood transfusion, duration of operation (minute), readmission, reoperation, comprehensive complication index score, bile leak, gastrojejunostomy or duodenojejunostomy leak, postoperative pancreatic fistula, postpancreatectomy hemorrhage, delayed gastric emptying, surgical site infection, intra-abdominal infection, number of harvested lymph nodes, and R0 resection. Pooled odds ratio (OR) or mean difference (MD) of data was calculated using the random-effect model. The grading of recommendations, assessment, development and evaluation approach was used for grading the level of evidence. RESULTS Four randomized controlled trials yielding 818 patients were included, of which 411 and 407 patients underwent LPD and OPD, respectively. The meta-analysis concluded that 2 approaches were similar, except in the LPD group, the LOS tended to be shorter [MD=-2.54 (-5.17, 0.09), P =0.06], LOS in ICU was shorter [MD=-1 (-1.8, -0.2), P =0.01], duration of operation was longer [MD=75.16 (23.29, 127.03), P =0.005], blood loss was lower [MD=-115.40 (-152.13, -78.68), P <0.00001], blood transfusion was lower [OR=0.66 (0.47, 0.92), P =0.01], and surgical site infection was lower [OR=0.35 (0.12, 0.96), P =0.04]. The overall certainty of the evidence was moderate. CONCLUSIONS Within the hands of highly skilled surgeons in high-volume centers, LPD is feasible and as safe and efficient as OPD.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Cheng X, Wang C, Liu Y, Zhang X, Zhou L, Lin Z, Zeng W, Liu L, Yang C, Li W. Effects of different radical distal gastrectomy on postoperative inflammatory response and nutritional status in patients with gastric cancer. Front Surg 2023; 10:1112473. [PMID: 37009613 PMCID: PMC10050336 DOI: 10.3389/fsurg.2023.1112473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
ObjectivesThe inflammatory response caused by gastric cancer surgery and the low nutritional status of patients with gastric cancer can cause growth of tumour cells, reduce immunity, and increase tumour burden. We investigated the effects of different surgical methods on postoperative inflammatory response and nutritional status in patients with distal gastric cancer.MethodsClinical data of 249 patients who underwent radical distal gastrectomy for distal gastric cancer from February 2014 to April 2017 were retrospectively analysed. Patients were divided according to the surgical method (open distal gastrectomy [ODG], laparoscopic-assisted distal gastrectomy [LADG] and total laparoscopic distal gastrectomy [TLDG]). Characteristics of different surgical procedures, including inflammation parameters and nutritional indicators, and different time points (preoperatively, 1 day postoperatively, and 1 week postoperatively) were compared using non-parametric test analysis.ResultsAt postoperative day 1, white blood cell count [WBC], neutrophil count [N], neutrophil/lymphocyte ratio [NLR], and platelet/lymphocyte ratio [PLR] increased in the three groups, and ΔN and ΔNLR were significant; the smallest change was observed in TLDG (P < 0.05). Albumin [A]and prognostic nutrition index [PNI] significantly decreased; the smallest ΔA and ΔPNI, which were statistically significant, were noted in TLDG. One week postoperatively, WBC, N, NLR, and PLR decreased, and WBC, N, and NLR showed significant difference. A and PNI of the three groups increased after 1 week, and A and PNI showed significant differences.ConclusionPostoperative inflammatory response and nutritional status of patients with distal gastric cancer are associated with the surgical technique. TLDG has little influence on the inflammatory response and nutritional level compared with LADG and ODG.
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Affiliation(s)
- Xuefei Cheng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yi Liu
- Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Liyuan Zhou
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Zhizun Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Wei Zeng
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Lihang Liu
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
- Correspondence: Weihua Li
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Olsen AA, Bazancir LA, Dahl S, Fukumori D, Shiwaku H, Svendsen LB, Achiam MP. Mesenteric traction syndrome - Incidence, impact, and treatment: A systematic scoping review of the literature. Anaesth Crit Care Pain Med 2023; 42:101162. [PMID: 36162787 DOI: 10.1016/j.accpm.2022.101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/14/2022] [Accepted: 09/01/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mesenteric traction syndrome (MTS) is commonly seen during major abdominal surgery and is characterised by facial flushing, hypotension, and tachycardia 15 min into surgery. MTS also impacts the postoperative course, as severe MTS has been associated with increased postoperative morbidity. However, despite MTS being common and severe MTS causing increased postoperative morbidity, the gaps in the literature are not clearly defined. We aimed to examine the diagnostic criteria, incidence, intraoperative and postoperative impact, and potential preventative measures of MTS while highlighting potential gaps in the literature. METHODS We followed the Prisma guidelines and performed a systematic literature search. We included only human studies examining MTS. All hits were screened for title and abstract, followed by a full-text review by at least two authors for determining eligibility for inclusion. Data were extracted and risk of bias was assessed by two independent reviewers. RESULTS A total of 37 studies, comprising 1102 patients were included in the review. The combined incidence of MTS during open abdominal surgery was found to be 76%, with 35% developing severe MTS. It was found that the development of MTS was associated with marked haemodynamic changes. It was also found that several different subjective diagnostic criteria exist and that severe MTS was associated with increased postoperative morbidity. Furthermore, several preventative measures for protecting against MTS have been examined, but only on the incidence of MTS and not on the postoperative course. CONCLUSION MTS occurs in 76% of patients undergoing major abdominal surgery and is associated with deleterious haemodynamic effects, which are more pronounced in patients developing severe MTS. Severe MTS is also associated with a worse postoperative outcome. However, gaps are still present in the current literature on MTS.
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Affiliation(s)
- August A Olsen
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Laser A Bazancir
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stig Dahl
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daisuke Fukumori
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hironari Shiwaku
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Lars Bo Svendsen
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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21
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Sakata T, Tanikawa M, Yamada H, Fujinami R, Nishikawa Y, Yamada S, Mase M. Minimally invasive treatment for glioblastoma through endoscopic surgery including tumor embolization when necessary: a technical note. Front Neurol 2023; 14:1170045. [PMID: 37153685 PMCID: PMC10160401 DOI: 10.3389/fneur.2023.1170045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
Background Although there have been some reports on endoscopic glioblastoma surgery, the indication has been limited to deep-seated lesions, and the difficulty of hemostasis has been a concern. In that light, we attempted to establish an endoscopic procedure for excision of glioblastoma which could be applied even to hypervascular or superficial lesions, in combination with pre-operative endovascular tumor embolization. Methods Medical records of six consecutive glioblastoma patients who received exclusive endoscopic removal between September and November 2020 were analyzed. Preoperative tumor embolization was performed in cases with marked tumor stain and proper feeder arteries having an abnormal shape, for instance, tortuous or dilated, without passing through branches to the normal brain. Endoscopic tumor removal through a key-hole craniotomy was performed by using an inside-out excision for a deep-seated lesion, with the addition of an outside-in extirpation for a shallow portion when needed. Results Endoscopic removal was successfully performed in all six cases. Before resection, endovascular tumor embolization was performed in four cases with no resulting complications, including ischemia or brain swelling. Gross total resection was achieved in three cases, and near total resection in the other three cases. Intraoperative blood loss exceeded 1,000 ml in only one case, whose tumor showed a prominent tumor stain but no proper feeder artery for embolization. In all patients, a smooth transition to adjuvant therapy was possible with no surgical site infection. Conclusion Endoscopic removal for glioblastoma was considered to be a promising procedure with minimal invasiveness and a favorable impact on prognosis.
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22
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Gil LA, Asti L, Apfeld JC, Sebastião YV, Deans KJ, Minneci PC. Perioperative outcomes in minimally-invasive versus open surgery in infants undergoing repair of congenital anomalies. J Pediatr Surg 2022; 57:755-762. [PMID: 35985848 DOI: 10.1016/j.jpedsurg.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study compared perioperative outcomes among infants undergoing repair of congenital anomalies using minimally invasive (MIS) versus open surgical approaches. METHODS The ACS NSQIP Pediatric (2013-2018) was queried for patients undergoing repair of any of the following 9 congenital anomalies: congenital lung lesion (LL), mediastinal mass (MM), congenital malrotation (CM), anorectal malformation (ARM), Hirschsprung disease (HD), congenital diaphragmatic hernia (CDH), tracheoesophageal fistula (TEF), hepatobiliary anomalies (HB), and intestinal atresia (IA). Inverse probability of treatment weights (IPTW) derived from propensity scores were utilized to estimate risk-adjusted association between surgical approach and 30-day outcomes. RESULTS 12,871 patients undergoing congenital anomaly repair were included (10,343 open; 2528 MIS). After IPTW, MIS was associated with longer operative time (difference; 95% CI) (16 min; 9-23) and anesthesia time (13 min; 6-21), but less postoperative ventilation days (-1.0 days; -1.4- -0.6) and shorter postoperative length of stay (-1.4 days; -2.4- -0.3). MIS repairs had decreased risk of any surgical complication (risk difference: -6.6%; -9.2- -4.0), including hematologic complications (-7.3%; -8.9- -5.8). There was no significant difference in risk of complication when hematologic complications were excluded (RD -2.3% [-4.7%, 0.1%]). There were no significant differences in the risk of unplanned reoperation (0.4%; -1.5-2.2) or unplanned readmission (0.2%; -1.2-1.5). CONCLUSIONS MIS repair of congenital anomalies is associated with improved perioperative outcomes when compared to open. Additional studies are needed to compare long-term functional and disease-specific outcomes. MINI-ABSTRACT In this propensity-weighted multi-institutional analysis of nine congenital anomalies, minimally invasive surgical repair was associated with improved 30-day outcomes when compared to open surgical repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lindsay A Gil
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Lindsey Asti
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Jordan C Apfeld
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Yuri V Sebastião
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Division of Global Women's Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA; Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, USA.
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23
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Effects of deep neuromuscular block on surgical pleth index-guided remifentanil administration in laparoscopic herniorrhaphy: a prospective randomized trial. Sci Rep 2022; 12:19176. [PMID: 36357559 PMCID: PMC9649628 DOI: 10.1038/s41598-022-23876-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Deep neuromuscular block (NMB) has been increasingly utilized, but its role in reducing intraoperative opioid requirement has yet to be investigated. Surgical pleth index (SPI) quantifies nociception. We investigated the effects of deep NMB on SPI-guided remifentanil administration in laparoscopic herniorrhaphy. Total 128 patients undergoing laparoscopic inguinal herniorrhaphy were randomly allocated to two groups of NMB: deep (n = 64) and moderate (n = 64). The remifentanil dose was assessed during intubation, from skin incision until CO2 insertion, and pneumoperitoneum. Mean infusion rate of remifentanil during pneumoperitoneum was higher in moderate NMB group than in deep NMB group (0.103 [0.075-0.143] µg/kg/min vs. 0.073 [0.056-0.097] µg/kg/min, p < 0.001). Consequently, median infusion rate of remifentanil during anesthesia was higher in moderate NMB group (0.076 [0.096-0.067] µg/kg/min vs. 0.067 [0.084-0.058] µg/kg/min, p = 0.016). The duration of post-anesthesia care unit stay was longer in the moderate NMB group (40 [30-40] min vs. 30 [30-40] min, p = 0.045). In conclusion, deep NMB reduced the remifentanil requirement compared with moderate NMB in SPI-guided anesthesia for laparoscopic herniorrhaphy.
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Li J, Li S, Yu L, Wei J, Li S, Tan H. The Effects of Resistin Gene Polymorphism on Pain Thresholds and Postoperative Sufentanil Consumption in Gastric Cancer Patients. J Pain Res 2022; 15:1995-2004. [PMID: 35873952 PMCID: PMC9304898 DOI: 10.2147/jpr.s372845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/06/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose As an adipocyte-secreted hormone, resistin is linked to inflammation, insulin resistance and atherosclerosis. Currently, resistin is proposed as a novel biomarker for postoperative pain intensity. However, due to the various types of surgery and limited numbers of studies, previous conclusions should be validated. This study aimed to explore the effect of resistin polymorphism (rs3745367) on pain thresholds and sufentanil consumption in gastric cancer patients. Patients and Methods A total of 148 gastric cancer patients enrolled in this study had their pain thresholds measured before surgery. After the exclusion of 16 patients, the characteristics of demography and clinic, numerical rating scale (NRS) and sufentanil consumption of 132 patients were recorded. Rs3745367 of resistin was identified by Sanger sequencing. Multivariate linear regression analysis was performed for sufentanil consumption and mechanical pain threshold. Results The distributions of the GG, AG, and AA genotypes of rs3745367 among the participants were 54 (40.9%), 65 (49.2%), and 13 (9.9%), respectively. The mechanical pain threshold (P=0.04) and postoperative sufentanil consumption in the 1st 24 h (P=0.03) were significantly different among GG, AG, and AA genotype carriers. There was no significant difference among the three genotypes for the heat pain threshold and cold pain threshold. Regarding the NRS, no statistically significant difference among the three different genotypes was found 24 h postoperatively. Conclusion Rs3745367 of resistin is associated with the mechanical pain threshold and postoperative sufentanil consumption in gastric cancer patients. Patients with the AA genotype of rs3745367 present an increased mechanical pain threshold and decreased postoperative sufentanil consumption.
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Affiliation(s)
- Jianing Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuo Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Ling Yu
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jin Wei
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuang Li
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hongyu Tan
- Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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Vlasov AP, Salakhov EK, Markin OV, Vlasova TI, Khachaturov MY, Romanov DA, Sitdikov II. [Possible ways to approach the effectiveness of open abdominal interventions to laparoscopic]. Khirurgiia (Mosk) 2022:80-87. [PMID: 35658140 DOI: 10.17116/hirurgia202206180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE PURPOSE OF THE WORK Based on the determination of the mechanisms of negative manifestations of surgical aggression in open interventions, compared with laparoscopic, to determine ways to optimize the early postoperative period when using them. MATERIAL AND METHODS The work is based on clinical and laboratory analysis of 147 patients with acute appendicitis complicated by acute peritonitis. In the first group (n=58), patients were operated with traditional laparotomy access. In the second group (n=47) - laparoscopic interventions were used. In the first and second groups, traditional therapy was carried out according to clinical recommendations. In the third group (n=42), patients were operated with traditional laparotomy access, and in the early postoperative period, their therapy included remaxol (intravenous injections of 800.0 ml of the drug in the first two days, then within three days - 400.0 ml). Laboratory and instrumental studies were carried out in patients, including the level of hydrophilic and hydrophobic toxins in the blood, the intensity of peroxidation of membrane lipids and antioxidant enzyme potential, the activity of phospholipase A2. The functional status of the intestine and liver was assessed. RESULTS It was found that the most important manifestation of the reduction of surgical aggression in the early stages after surgery, which is characteristic of laparoscopic operations, are significantly low phenomena of endogenous intoxication against the background of a significant decrease in the activity of peroxidation of membrane lipids and phospholipase systems - triggers of catabolic phenomena and lesions of various organs and systems, including the intestine and liver. The inclusion of remaxol in complex therapy for patients who have undergone open surgical operations leads to a number of positive clinical and laboratory effects. The most important of them is the reduction of endogenous intoxication. This beneficial effect is associated with the restoration of the functional status of the intestine and liver, as well as a decrease in the severity of catabolic phenomena. The effectiveness of complex therapy with remaxol was marked by reducing the number of postoperative complications and the length of the patient's stay in the hospital. CONCLUSION The use of remaxol in patients with acute peritonitis complicated by peritonitis who have undergone open surgical interventions, due to the relatively rapid restoration of the functional status of the intestine and liver, reduction of catabolic phenomena, reduces the severity of endogenous intoxication syndrome, which was the basis for a significant improvement in the course of the early postoperative period, bringing it closer to that when using laparoscopic technology.
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Affiliation(s)
- A P Vlasov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - E K Salakhov
- Mendeleev Central District Hospital, Mendeleevsk, Russia
| | - O V Markin
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - T I Vlasova
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - M Yu Khachaturov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - D A Romanov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
| | - I I Sitdikov
- N.P. Ogareva National Research Mordovian State University, Saransk, Russia
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Delvecchio A, Conticchio M, Riccelli U, Ferraro V, Ratti F, Gelli M, Anelli FM, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, Di Benedetto F, de'Angelis N, Briceño-Delgado J, Adam R, Cherqui D, Aldrighetti L, Memeo R. Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis. HPB (Oxford) 2022; 24:933-941. [PMID: 34815189 DOI: 10.1016/j.hpb.2021.10.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/01/2021] [Accepted: 10/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical resection is a first-line curative option for hepatocellular carcinoma, but its role is still unclear in elderly patients. The aim of our study was to compare short- and long-term outcomes of laparoscopic and open liver resection in elderly patients with hepatocellular carcinoma. METHODS The study included 665 consecutive hepatocellular carcinoma liver resection cases in patients with ≥70 years of age treated in eight European hospital centres. Patients were divided into laparoscopic and open liver resection groups. Perioperative and long-term outcomes were compared between these groups. RESULTS After a 1:1 propensity score matching, 219 patients were included in each group. Clavien-Dindo grades III/IV (6 vs. 20%, p = 0.04) were lower in the laparoscopic than in the open matched group. Hospital stay was shorter in the laparoscopic than in the open matched group (5 vs. 7 days, p < 0.001). There were no significant differences between laparoscopic and open groups regarding overall survival and disease-free survival at 1-, 3- and 5- year periods. CONCLUSION Laparoscopic liver resection for hepatocellular carcinoma is associated with good short-term outcomes in patients with ≥70 years of age compared to open liver resection. Laparoscopic liver resection is safe and feasible in elderly patients with hepatocellular carcinoma.
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Affiliation(s)
| | | | - Umberto Riccelli
- Maxillo-Facial Surgery, Casa Sollievo Della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Valentina Ferraro
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy
| | - Francesca Ratti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Institute of Oncology Gustave Roussy, Villejuif, France; Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Ferdinando M Anelli
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Alexis Laurent
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France
| | - Giulio C Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, IRCAD, Strasbourg, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, Reims, France; Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor University Hospital, AP-HP, UPEC University, Créteil, France
| | - Javier Briceño-Delgado
- Department of General Surgery and Liver and Pancreas Transplantation, University Hospital Reina Sofía, Córdoba, Spain
| | - Rene Adam
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Daniel Cherqui
- Hepatobiliary Centre, Paul Brousse University Hospital, Villejuif, France
| | - Luca Aldrighetti
- Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy.
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27
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Cui H, Zhang KC, Cao B, Deng H, Liu GB, Song LQ, Zhao RY, Liu Y, Chen L, Wei B. Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy. World J Gastrointest Surg 2022; 14:452-469. [PMID: 35734616 PMCID: PMC9160691 DOI: 10.4240/wjgs.v14.i5.452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/17/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) combined with surgery is regarded as an effective treatment for advanced gastric cancer (AGC). Laparoscopic surgery represents the mainstream of minimally invasive surgery. Currently, surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT. Thus, we sought to evaluate short- and long-term outcomes between laparoscopic total gastrectomy (LTG) and open total gastrectomy (OTG) after NACT.
AIM To compare the short and long-term outcomes between LTG and OTG for AGC after NACT.
METHODS We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019, including 61 patients who underwent LTG and 75 who underwent OTG. Clinicopathological characteristics between the LTG and OTG groups showed no significant difference. SPSS 26.0, R software, and GraphPad PRISM 8.0 were used to perform statistical analyses.
RESULTS Of the 136 patients included, eight acquired pathological complete response, and the objective response rate was 47.8% (65/136). The LTG group had longer operation time (P = 0.015), less blood loss (P = 0.003), shorter days to first flatus (P < 0.001), and shorter postoperative hospitalization days (P < 0.001). LTG spent more surgical cost than OTG (P < 0.001), while total hospitalized cost of LTG was less than OTG (P < 0.001). 21 (28.0%) patients in the OTG group and 14 (23.0%) in the LTG group had 30-d postoperative complications, but there was no significant difference between the two groups (P = 0.503). The 3-year overall survival (OS) rate was 60.6% and 64.6% in the LTG and OTG groups, respectively [hazard ratio (HR) = 0.859, 95% confidence interval (CI): 0.522-1.412, P = 0.546], while the 3-year disease-free survival (DFS) rate was 54.5% and 51.8% in the LTG and OTG group, respectively (HR = 0.947, 95%CI: 0.582-1.539, P = 0.823). Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS (P < 0.05).
CONCLUSION After NACT, LTG shows comparable 30-d postoperative morbidity as well as 3-year OS and DFS rate to OTG. We recommend that experienced surgeons select LTG other than OTG for proper AGC patients after NACT.
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Affiliation(s)
- Hao Cui
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Ke-Cheng Zhang
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Cao
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School, Chinese PLA General Hospital, Beijing 100853, China
| | - Huan Deng
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School, Chinese PLA General Hospital, Beijing 100853, China
| | - Gui-Bin Liu
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Li-Qiang Song
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Rui-Yang Zhao
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
- Medical School, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi Liu
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- Department of General Surgery and Institute of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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D'Silva M, Han HS, Yoon YS, Cho JY. Comparative Study of Laparoscopic Versus Open Liver Resection in Gallbladder Cancer. J Laparoendosc Adv Surg Tech A 2021; 32:854-859. [PMID: 34842448 DOI: 10.1089/lap.2021.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In recent decades, laparoscopic liver resection (LLR) has been gradually adopted at high-volume centers, particularly for hepatocellular carcinoma and liver metastasis. However, LLR in patients with gallbladder cancer (GBC) is a controversial issue, and there are few studies of LLR for GBC. Our aim was to compare the outcomes of patients who underwent laparoscopic or open liver resection for GBC. Materials and Methods: All patients admitted with stage II or III GBC requiring liver resection, together with cholecystectomy and lymphadenectomy, were analyzed retrospectively. Patients with thickness of the resected liver specimen >2 cm in pathology reports were included. Results: A total of 56 patients with stage II or III GBC were included in this study; 23 (41.1%) underwent laparoscopic surgery and 33 (58.9%) underwent open surgery. Propensity score matching was performed using a 1:1 matching scheme. After matching, 12 patients were included in each group. The preoperative characteristics of both groups were similar, as were the operative times (laparoscopic versus open group: 237.5 minutes versus 272.5 minutes, respectively; P = .319) and blood loss (300 mL versus 275 mL, respectively; P = .307). The laparoscopic group had a significantly shorter postoperative hospital stay than the open surgery group (4.5 days versus 8 days, respectively; P = .012). There were no major complications in either group. There was no difference between the groups in the number of lymph nodes harvested at surgery (P = .910). There were no differences between the two groups in disease-free (P = .503) or overall (P = .719) survival. Conclusion: LLR extended to GBC provides outcomes similar to those of open surgery. With increasing experience, LLR can be a viable alternative to open surgery for GBC.
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Affiliation(s)
- Mizelle D'Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea
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Cuk P, Pedersen AK, Lambertsen KL, Mogensen CB, Nielsen MF, Helligsø P, Gögenur I, Ellebæk MB. Systemic inflammatory response in robot-assisted and laparoscopic surgery for colon cancer (SIRIRALS): study protocol of a randomized controlled trial. BMC Surg 2021; 21:363. [PMID: 34635066 PMCID: PMC8507379 DOI: 10.1186/s12893-021-01355-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Background Robot-assisted surgery is being increasingly adopted in treating colorectal cancer, and the transition from laparoscopic surgery to robot-assisted surgery is a trend. The evidence of the benefits of robot-assisted surgery is sparse. However, findings are associated with improved patient-related outcomes and overall morbidity rates compared to laparoscopic surgery. This induction is unclear, considering both surgical modalities are characterized as minimally invasive. This study aims to evaluate the systemic and peritoneal inflammatory stress response induced by robot-assisted surgery compared with laparoscopic surgery for elective colon cancer resections in a prospective, randomized controlled clinical trial. Methods This study is a single-centre randomized controlled superiority trial with 50 colon cancer participants. The primary endpoint is the level of systemic inflammatory response expressed as serum C-reactive protein (CRP) and interleukin 6 (IL-6) levels between postoperative days one and three. Secondary endpoints include (i) levels of systemic inflammation in serum expressed by a panel of inflammatory and pro-inflammatory cytokines measured during the first three postoperative days, (ii) postoperative surgical and medical complications (30 days) according to Clavien-Dindo classification and Comprehensive Complication Index, (iii) intraoperative blood loss, (iv) conversion rate to open surgery, (v) length of surgery, (vi) operative time, (vii) the number of harvested lymph nodes, and (viii) length of hospital stay. The exploratory endpoints are (i) levels of peritoneal inflammatory response in peritoneal fluid expressed by inflammatory and pro-inflammatory cytokines between postoperative day one and three, (ii) patient-reported health-related quality of recovery-15 (QoR-15), (iii) 30 days mortality rate, (iv) heart rate variability and (v) gene transcript (mRNA) analysis. Discussion To our knowledge, this is the first clinical randomized controlled trial to clarify the inflammatory stress response induced by robot-assisted or laparoscopic surgery for colon cancer resections. Trial registration This trial is registered at Clinicaltrials.gov (Identifier: NCT04687384) on December, 29, 2020, Regional committee on health research ethics, Region of Southern Denmark (N75709) and Data Protection Agency, Hospital Sønderjylland, University Hospital of Southern Denmark (N20/46179). Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01355-4.
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Affiliation(s)
- Pedja Cuk
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark. .,OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Kate Lykke Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Odense University Hospital, Odense, Denmark.,BRIDGE, Brain Research - Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Michael Festersen Nielsen
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Per Helligsø
- Surgical Department, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens vej 15, 6200, Aabenraa, Denmark
| | - Ismail Gögenur
- Surgical Department, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Mark Bremholm Ellebæk
- Surgical Research Unit, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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Warps ALK, Zwanenburg ES, Dekker JWT, Tollenaar RAEM, Bemelman WA, Hompes R, Tanis PJ, de Groof EJ. Laparoscopic Versus Open Colorectal Surgery in the Emergency Setting: A Systematic Review and Meta-analysis. ANNALS OF SURGERY OPEN 2021; 2:e097. [PMID: 37635817 PMCID: PMC10455067 DOI: 10.1097/as9.0000000000000097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This systematic review and meta-analysis aimed to compare published outcomes of patients undergoing laparoscopic versus open emergency colorectal surgery, with mortality as primary outcome. Background In contrast to the elective setting, the value of laparoscopic emergency colorectal surgery remains unclear. Methods PubMed, Embase, the Cochrane Library, and CINAHL were searched until January 6, 2021. Only comparative studies were included. Meta-analyses were performed using a random-effect model. The Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale were used for quality assessment. Results Overall, 28 observational studies and 1 randomized controlled trial were included, comprising 7865 laparoscopy patients and 55,862 open surgery patients. Quality assessment revealed 'good quality' in 16 of 28 observational studies, and low to intermediate risk of bias for the randomized trial. Laparoscopy was associated with significantly lower postoperative mortality compared to open surgery (odds ratio [OR] 0.44; 95% confidence interval [CI], 0.35-0.54). Laparoscopy resulted in significantly less postoperative overall morbidity (OR, 0.53; 95% CI, 0.43-0.65), wound infection (OR, 0.63; 95% CI, 0.45-0.88), wound dehiscence (OR, 0.37; 95% CI, 0.18-0.77), ileus (OR, 0.68; 95% CI 0.51-0.91), pulmonary (OR, 0.43; 95% CI, 0.24-0.78) and cardiac complications (OR, 0.56; 95% CI, 0.35-0.90), and shorter length of stay. No meta-analyses were performed for long-term outcomes due to scarcity of data. Conclusions The systematic review and meta-analysis suggest a benefit of laparoscopy for emergency colorectal surgery, with a lower risk of postoperative mortality and morbidity. However, the almost exclusive use of retrospective observational study designs with inherent biases should be taken into account.
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Affiliation(s)
- Anne-Loes K Warps
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
- Department of Surgery, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden, The Netherlands
| | - Emma S Zwanenburg
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg, Delft, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef, Leiden, The Netherlands
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing, Rijnsburgerweg, Leiden, The Netherlands
| | - Willem A Bemelman
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Roel Hompes
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, de Boelelaan, Amsterdam, The Netherlands
| | - Elisabeth J de Groof
- From the Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef, Amsterdam, The Netherlands
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Fujikawa H, Okugawa Y, Yamamoto A, Imaoka H, Shimura T, Kitajima T, Kawamura M, Yasuda H, Okita Y, Yokoe T, Ohi M, Toiyama Y. Cumulative C-reactive Protein in the Perioperative Period as a Novel Marker for Oncological Outcome in Patients with Colorectal Cancer Undergoing Curative Resection. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:281-290. [PMID: 34395941 PMCID: PMC8321586 DOI: 10.23922/jarc.2021-013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/02/2021] [Indexed: 12/24/2022]
Abstract
Objectives: Systemic inflammatory response is strongly associated with poor oncological outcome in colorectal cancer (CRC). Perioperative inflammation caused by surgical stress can lead to the development of postoperative infectious complications (PIC) as well as cancer-related inflammation. We aimed to evaluate the prognostic potential of perioperative systemic inflammation by calculating the time-dependent cumulative C-reactive protein (CRP) levels during the perioperative period. Methods: We analyzed clinicopathological data from 540 patients with CRC who underwent potentially curative surgery at our institution. The time-dependent aggregated CRP level was denoted “cumulative CRP,” which represents the area under the line of time (days) and the CRP levels preoperatively and on postoperative days 1, 3, and 7. Results: Cumulative CRP was significantly higher in patients with CRC undergoing open surgery than in patients undergoing laparoscopic surgery. In multivariate analysis, high cumulative CRP was an independent prognostic factor for disease-free survival (DFS) and overall survival (OS) in both the laparoscopic and open surgery groups. Patients with CRC and high cumulative CRP had significantly poorer DFS and OS than those with low cumulative CRP, including those patients without PIC. Conclusions: Cumulative CRP is an independent predictive marker of OS and DFS in patients with CRC who undergo curative surgery.
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Affiliation(s)
- Hiroyuki Fujikawa
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshinaga Okugawa
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akira Yamamoto
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroki Imaoka
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tadanobu Shimura
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takahito Kitajima
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mikio Kawamura
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiromi Yasuda
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshiki Okita
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takeshi Yokoe
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ohi
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yuji Toiyama
- Departments of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Tsu, Japan
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Laparoscopic complete mesocolic excision versus conventional resection for right-sided colon cancer: a propensity score matching analysis of short-term outcomes. Surg Endosc 2021; 36:3049-3058. [PMID: 34129088 DOI: 10.1007/s00464-021-08601-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) for right-sided colon cancer (RCC) is a demanding operation, especially when performed laparoscopically. The potential impact of CME in increasing postoperative complications is still unclear. The aim of our study was to evaluate the safety and feasibility of laparoscopic CME compared with laparoscopic non-complete mesocolic excision (NCME) during colectomy for RCC. METHODS Data from a prospectively collected database of patients who underwent laparoscopic right and extended right colectomy at our institution between January 2008 and February 2020 were retrieved and analyzed. Short-term outcomes of patients undergoing CME and NCME were compared. A 1:1 propensity score matching (PSM) was used to balance baseline characteristics between groups. RESULTS A total of 663 consecutive patients underwent resection of RCC in the study period. Among these, 500 met the inclusion criteria and after PSM a total of 372 patients were correctly matched, 186 in each group. A similar rate of overall postoperative complications was found between the CME and NCME groups (21.5% and 18.3%, p = 0.436). No difference was found in terms of conversion rate, severe complications, reoperations, readmissions, and mortality. The median number of harvested lymph nodes was higher in the CME group (22 versus 19, p = 0.003), with a lower rate of inadequate sampling (7.0% and 15.1%, p = 0.013). CONCLUSION Laparoscopic CME for RCC is technically feasible and safe. It does not seem to be associated with a higher rate of complications or mortality compared with the "traditional" approach, but it allows better nodal sampling.
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Graziano F, Lo Bue E, Scalia G, Umana GE, Iacopino DG, Tumbiolo S, Maugeri R, Nicoletti GF. Neurosurgical post-operative complications with incidental life-saving findings. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pulle MV, Puri HV, Asaf BB, Bishnoi S, Malik M, Kumar A. Predictors of Mortality after Surgery for Empyema Thoracis in Chronic Kidney Disease Patients. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:392-399. [PMID: 33234767 PMCID: PMC7721523 DOI: 10.5090/kjtcs.20.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
Background Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. Methods This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2 for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demographic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results Patients' age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring maintenance hemodialysis. The mean operative time was 304 minutes and the mean intraoperative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (Eastern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.
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Affiliation(s)
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Manish Malik
- Department of Nephrology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Mazzotta E, Villalobos-Hernandez EC, Fiorda-Diaz J, Harzman A, Christofi FL. Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols. Front Pharmacol 2020; 11:583422. [PMID: 33390950 PMCID: PMC7774512 DOI: 10.3389/fphar.2020.583422] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022] Open
Abstract
Postoperative ileus (POI) and postoperative gastrointestinal tract dysfunction (POGD) are well-known complications affecting patients undergoing intestinal surgery. GI symptoms include nausea, vomiting, pain, abdominal distention, bloating, and constipation. These iatrogenic disorders are associated with extended hospitalizations, increased morbidity, and health care costs into the billions and current therapeutic strategies are limited. This is a narrative review focused on recent concepts in the pathogenesis of POI and POGD, pipeline drugs or approaches to treatment. Mechanisms, cellular targets and pathways implicated in the pathogenesis include gut surgical manipulation and surgical trauma, neuroinflammation, reactive enteric glia, macrophages, mast cells, monocytes, neutrophils and ICC's. The precise interactions between immune, inflammatory, neural and glial cells are not well understood. Reactive enteric glial cells are an emerging therapeutic target that is under intense investigation for enteric neuropathies, GI dysmotility and POI. Our review emphasizes current therapeutic strategies, starting with the implementation of colorectal enhanced recovery after surgery protocols to protect against POI and POGD. However, despite colorectal enhanced recovery after surgery, it remains a significant medical problem and burden on the healthcare system. Over 100 pipeline drugs or treatments are listed in Clin.Trials.gov. These include 5HT4R agonists (Prucalopride and TAK 954), vagus nerve stimulation of the ENS-macrophage nAChR cholinergic pathway, acupuncture, herbal medications, peripheral acting opioid antagonists (Alvimopen, Methlnaltexone, Naldemedine), anti-bloating/flatulence drugs (Simethiocone), a ghreline prokinetic agonist (Ulimovelin), drinking coffee, and nicotine chewing gum. A better understanding of the pathogenic mechanisms for short and long-term outcomes is necessary before we can develop better prophylactic and treatment strategies.
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Affiliation(s)
- Elvio Mazzotta
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Juan Fiorda-Diaz
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alan Harzman
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Fievos L. Christofi
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
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In response to: Laparoscopy may improve postoperative outcomes of COVID-19 patients. J Trauma Acute Care Surg 2020; 89:e152-e153. [PMID: 32658144 DOI: 10.1097/ta.0000000000002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kirdak T, Uysal E, Sezgin E, Cecen GS, Cavun S. Inflammatory response markers in rats undergoing abdominal surgical procedures. Ann Gastroenterol 2020; 33:528-535. [PMID: 32879601 PMCID: PMC7406820 DOI: 10.20524/aog.2020.0511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background The aim of this study was to determine the effectiveness of cortisol, interleukin (IL)-6, C-reactive protein (CRP), and white blood cell (WBC) count as inflammatory markers to evaluate the postoperative inflammatory response associated with various abdominal surgical procedures in rats. Methods Wistar albino rats (N=152) were randomly assigned to 7 groups: control, hepatectomy, splenectomy, nephrectomy, colectomy, gastrectomy, and sham. Apart from the control group, each group was then divided into 3 subgroups: 6th, 24th and 48th h. Thus, a total of 19 groups were defined, each including 8 rats. At the 6th, 24th and 48th h following the surgical procedures blood samples from each rat were collected. The plasma concentrations of IL- 6, cortisol, CRP, and WBC were measured. Results Both the surgery category and the elapsed time after the surgery had a significant effect on IL-6 levels (P<0.0001). Blood CRP levels were primarily determined by the surgery category (P<0.0001). Neither surgery nor the elapsed time had a significant effect on the cortisol levels. The elapsed time after surgery was the major factor that influenced the differences in WBC count among the surgery groups (P<0.0001). Conclusions Our results cumulatively indicate that the levels of IL-6, CRP, and cortisol and WBC count change at different time points after several abdominal surgical procedures. Cortisol level is not related to the type of surgical procedure or the elapsed time, while WBC count decreases with the elapsed time. None of the changes in the markers investigated in this study is specifically related to the category of abdominal surgical procedure.
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Affiliation(s)
- Türkay Kirdak
- Department of General Surgery, Uludag University School of Medicine, Bursa
| | - Erdal Uysal
- Department of General Surgery, Gaziantep, Sanko University School of Medicine
| | - Efe Sezgin
- Department of Food Engineering, Izmir, lzmir lnstitute of Technology, Laboratory of Nutrigenomics and Epidemiology
| | - Gülce Sevdar Cecen
- Department of Medical Pharmacology, Uludag University School of Medicine, Bursa, Turkey
| | - Sinan Cavun
- Department of Medical Pharmacology, Uludag University School of Medicine, Bursa, Turkey
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Pinto RA, Bustamante-Lopez LA, Soares DFM, Nahas CSR, Marques CFS, Cecconello I, Nahas SC. IS LAPAROSCOPIC REOPERATION FEASIBLE TO TREAT EARLY COMPLICATIONS AFTER LAPAROSCOPIC COLORECTAL RESECTIONS? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2020; 33:e1502. [PMID: 32667532 PMCID: PMC7357554 DOI: 10.1590/0102-672020190001e1502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
Background: Recently, with the performance of minimally invasive procedures for the management of colorectal disorders, it was allowed to extend the indication of laparoscopy in handling various early and late postoperative complications. Aim: To present the experience with laparoscopic reoperations for early complications after laparoscopic colorectal resections. Methods: Patients undergoing laparoscopic colorectal resections with postoperative surgical complications were included and re-treated laparoscopically. Selection for laparoscopic approach were those cases with early diagnosis of complications, hemodynamic stability without significant abdominal distention and without clinical comorbidities that would preclude the procedure. Results: In four years, nine of 290 (3.1%) patients who underwent laparoscopic colorectal resections were re-approached laparoscopically. There were five men. The mean age was 40.67 years. Diagnoses of primary disease included adenocarcinoma (n=3), familial adenomatous polyposis (n=3), ulcerative colitis (n=1), colonic inertia (n=1) and chagasic megacolon (n=1). Initial procedures included four total proctocolectomy with ileal pouch anal anastomosis; three anterior resections; one completion of total colectomy; and one right hemicolectomy. Anastomotic dehiscence was the most common complication that resulted in reoperations (n=6). There was only one case of an unfavorable outcome, with death on the 40th day of the first approach, after consecutive complications. The remaining cases had favorable outcome. Conclusion: In selected cases, laparoscopic access may be a safe and minimally invasive approach for complications of colorectal resection. However, laparoscopic reoperation must be cautiously selected, considering the type of complication, patient’s clinical condition and experience of the surgical team.
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Affiliation(s)
- Rodrigo Ambar Pinto
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Diego Fernandes Maia Soares
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Caio Sergio R Nahas
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Frederico S Marques
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Sergio Carlos Nahas
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Fiorentini G, Sarti D, Patriti A, Eugeni E, Guerra F, Masedu F, Mackay AR, Guadagni S. Immune response activation following hyperthermic intraperitoneal chemotherapy for peritoneal metastases: A pilot study. World J Clin Oncol 2020; 11:397-404. [PMID: 32874953 PMCID: PMC7450817 DOI: 10.5306/wjco.v11.i6.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal metastases (PM) is considered to be feasible, safe and to improve survival.
AIM To investigate whether an immune response is activated following HIPEC for PM.
METHODS Six patients were enrolled in this study. Peripheral blood samples were obtained from each patient prior to (day 0) and post-procedure (day 30), and used to evaluate the number of CD3+ total, CD3+/CD4+ T-Helper, CD3+/CD8+ cytotoxic T, CD3+/CD56+ natural killer and CD19+ B lymphocyte numbers, and CD4+: CD8+ T lymphocyte ratios.
RESULTS The total numbers of CD3+, CD3+/CD4+ T-Helper, CD3+/CD8+ cytotoxic T, CD3+/CD56+ natural killer and CD19+ B lymphocytes, and CD4+: CD8+ lymphocyte ratios were increased in all but one patient 30 d following the cytoreductive surgery-HIPEC procedure, and these increases were significant (P ≤ 0.05) for CD3+/CD4+ T Helper and CD3+/CD8+ cytotoxic T lymphocyte numbers.
CONCLUSION This report provides the first evidence that HIPEC exhibits immunomodulating activity in PM patients, resulting in generalized activation of the adaptive immune response. Moreover, the majority of lymphocyte populations increased following HIPEC and continued to be elevated several weeks following the procedure, consistent with a potential authentic immunomodulating effect rather than a normal inflammatory response, to be fully characterised in future studies.
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Affiliation(s)
- Giammaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro 61122, Italy
| | - Donatella Sarti
- Department of Onco-Hematology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro 61122, Italy
| | - Alberto Patriti
- Department of General Surgery, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro 61122, Italy
| | - Emilio Eugeni
- Department of General Surgery, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro 61122, Italy
| | - Francesco Guerra
- Department of General Surgery, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, Pesaro 61122, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
| | - Andrew Reay Mackay
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
| | - Stefano Guadagni
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
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Does Helium Pneumoperitoneum Reduce the Hyperinflammatory Response in Septic Animals during Laparoscopy? Surg Res Pract 2020; 2020:5738236. [PMID: 32232117 PMCID: PMC7091538 DOI: 10.1155/2020/5738236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/24/2020] [Indexed: 01/17/2023] Open
Abstract
Background/Aim. An exacerbated reaction to peritoneal infection and attendant surgical procedures is characterized by an intense hyperinflammatory state, the magnitude of which is proportional to the severity of tissue injury. Laparoscopy generates lower levels of tissue damage compared with open surgery and should induce less pronounced immune responses. The aim of this study was to determine whether laparoscopy assisted by helium rather than carbon dioxide pneumoperitoneum would induce an attenuated inflammatory state in septic animals. Materials and Methods. Thirty-two Wistar rats were divided randomly into four equal groups, two of which were submitted to carbon dioxide or helium pneumoperitoneum-assisted laparoscopic cecal ligation and puncture (CLP) induced sepsis and subsequent abdominal lavage. Two control groups were submitted to identical laparoscopic procedures with carbon dioxide or helium as insufflator gas but without CLP. After 24 hours, serum levels of tumor necrosis factor alpha (TNF-α), interleukins 1 and 6 (IL-1 and IL-6, respectively), and cortisol were determined.
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Mazzaglia PJ, Varghese J, Habra MA. Evaluation and management of adrenal neoplasms: endocrinologist and endocrine surgeon perspectives. Abdom Radiol (NY) 2020; 45:1001-1010. [PMID: 32189021 DOI: 10.1007/s00261-020-02464-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The evaluation and management of adrenal disease is a complex endeavor that relies on an expert knowledge of human physiology and anatomy. Careful and proper patient assessment mandates a balanced approach which marries the disciplines of endocrinology, surgery, and radiology. Any of these three specialties may be on the front line in performing the initial workup when an adrenal neoplasm is discovered. With an ever-increasing volume of cross-sectional imaging, be it CT, MRI, or PET, large numbers of adrenal incidentalomas are being discovered. A close collaboration amongst specialties should strive to streamline the initial evaluation and minimize unnecessary testing and treatment.
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43
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Hong SK, Suh KS, Kim KA, Lee JM, Cho JH, Yi NJ, Lee KW. Pure Laparoscopic Versus Open Left Hepatectomy Including the Middle Hepatic Vein for Living Donor Liver Transplantation. Liver Transpl 2020; 26:370-378. [PMID: 31808294 DOI: 10.1002/lt.25697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/26/2019] [Indexed: 12/21/2022]
Abstract
Pure laparoscopic donor hepatectomy (PLDH) has become increasingly accepted in the era of minimally invasive surgeries. However, the outcomes of pure laparoscopic donor left hepatectomy (PLDLH) are relatively less known than for left lateral sectionectomy or right hepatectomy. This study aimed to report our experience with and the outcomes of PLDLH including the middle hepatic vein (MHV) and to compare these outcomes with conventional donor left hepatectomy (CDLH). The medical records of living liver donors between January 2010 and January 2018 at Seoul National University Hospital were retrospectively reviewed. Donors who underwent left hepatectomy including the MHV were included. To minimize selection bias, donors who underwent CDLH after the initiation of the PLDH program were excluded. Finally, there were 18 donors who underwent CDLH and 8 who underwent PLDLH. The median (interquartile range [IQR]) warm ischemia time (11 [10-16] minutes versus 4 [2-7] minutes; P = 0.001) was longer in the PLDLH group than the CDLH group. The total operation time (333 [281-376] minutes versus 265 [255-308] minutes; P = 0.09) and time to remove the liver (245 [196-276] minutes versus 182 [172-205] minutes; P = 0.08) were also longer in PLDLH although not statistically significant. The length of postoperative hospital stay was significantly shorter in the PLDLH group (7 [7-8] days versus 9 [8-10] days; P = 0.01). There were no postoperative complications in the PLDLH group. The rate of complications in recipients was similar in both groups. In conclusion, PLDLH including the MHV appears to be safe and feasible. Further analysis including longterm outcomes is needed.
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Affiliation(s)
- Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Ae Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jeong-Moo Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Hyung Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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44
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Tankel J, Yellinek S, Vainberg E, David Y, Greenman D, Kinross J, Reissman P. Sarcopenia defined by muscle quality rather than quantity predicts complications following laparoscopic right hemicolectomy. Int J Colorectal Dis 2020; 35:85-94. [PMID: 31776699 DOI: 10.1007/s00384-019-03423-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE While sarcopenia has prognostic value in elective colorectal surgery for predicting peri-operative morbidity and mortality, its role in elective laparoscopic surgery is poorly defined. METHODS A retrospective single-center analysis of patients undergoing elective laparoscopic right hemicolectomy for adenocarcinoma between January 2010 and December 2016. Univariate analysis compared the robustness of total psoas index (TPI) with Hounsfield unit average calculation (HUAC) calculated from pre-operative CT imaging in predicting post-operative complications. Multivariate analysis compared these measures with American Society of Anesthesiologists (ASA) grade and Charlson scores in predicting post-operative complications. RESULTS Of the 580 patients identified, 185 met the inclusion criteria (91 males and 94 females, with a median age of 68). Using TPI and HUAC, 46 and 44 patients respectively were identified as sarcopenic, including 18 patients that were identified by both measures. HUAC-defined sarcopenia was significantly associated with pre-operative comorbidities, peri-operative mortality, and a greater incidence of respiratory, cardiac, and serious post-operative complications (Clavien-Dindo ≥ 3). Those with HUAC-defined sarcopenia aged > 75 were at particular risk of morbidity (OR 5.52, p = 0.002). No such relationships were found with TPI-defined sarcopenia. Only HUAC remained predictive of post-operative complications on multivariate analysis. CONCLUSION Sarcopenia is a novel methodology for stratifying surgical risk in elective colorectal cancer surgery. HUAC has a high prognostic accuracy for the prediction of complications following laparoscopic colorectal surgery compared with TPI, ASA grade, and Charlson score.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel. .,Department of Surgery and Cancer, Imperial College Healthcare Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Shlomo Yellinek
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Elena Vainberg
- Department of Radiology, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Yotam David
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - Dmitry Greenman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel.,Department of Anesthesiology, Perioperative Medicine and Pain Treatment, Shaare Zedek Medical Center, The Hebrew Univeristy School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
| | - James Kinross
- Department of Surgery and Cancer, Imperial College Healthcare Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, 12 Shmeul Bait Street, 9103102, Jerusalem, Israel
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45
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van Hilst J, Brinkman DJ, de Rooij T, van Dieren S, Gerhards MF, de Hingh IH, Luyer MD, Marsman HA, Karsten TM, Busch OR, Festen S, Heger M, Besselink MG. The inflammatory response after laparoscopic and open pancreatoduodenectomy and the association with complications in a multicenter randomized controlled trial. HPB (Oxford) 2019; 21:1453-1461. [PMID: 30975599 DOI: 10.1016/j.hpb.2019.03.353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The systemic inflammatory response seen after surgery seems to be related to postoperative complications. A reduction of the inflammatory response through minimally invasive surgery might therefore be the mechanism via which postoperative outcome could be improved. The aim of this study was to investigate if postoperative inflammatory markers differed between laparoscopic (LPD) and open pancreatoduodenectomy (OPD) and if there was a relationship between inflammatory markers and the occurrence of postoperative complications. METHODS A side study of the multicenter randomized controlled LEOPARD-2 trial comparing LPD to OPD was performed. Area under the curve (AUC) for plasma inflammatory markers, including interleukin (IL-) 6, IL-8 and C reactive protein (CRP) levels, were determined during the first 96 postoperative hours and compared between LPD and OPD, Clavien-Dindo ≥ III complications, and postoperative pancreatic fistula (POPF) grade B/C. RESULTS Overall, 38 patients were included (18 LPD and 20 OPD). The median AUC of IL-6 was 627 (195-1378) after LPD vs. 338 (175-694)pg/mL after OPD, (p = 0.114). The AUC of IL-8 and CRP were comparable. IL-6 levels were higher in patients with a Clavien-Dindo ≥ III complication (634[309-1489] vs. 297 [171-680], p = 0.034) and POPF grade B/C (994 [534-3265] vs. 334 [173-704], p = 0.003). In patients with a POPF grade B/C, IL-6 levels tended to be higher after LPD, as compared to OPD (3533[IQR 1133-3533] vs. 715[IQR 39-1658], p = 0.053). CONCLUSION LPD, as compared to OPD, did not reduce the postoperative inflammatory response. IL-6 levels were associated with postoperative complications and pancreatic fistula.
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Affiliation(s)
- Jony van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
| | - David J Brinkman
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Thijs de Rooij
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Susan van Dieren
- Clinical Epidemiologist, Department of Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | | | - Ignace H de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Misha D Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Tom M Karsten
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | | | - Michal Heger
- Department of Experimental Surgery, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
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Kaistha S, Nandi B, Kumar A. Laparoscopic surgery in pancreatic diseases: Pushing the boundaries. Med J Armed Forces India 2019; 75:361-369. [PMID: 31719728 PMCID: PMC6838490 DOI: 10.1016/j.mjafi.2018.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/14/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has expanded exponentially in the last two decades but, somehow it is limited in pancreatic surgery by virtue of the pancreas being a friable, retroperitoneal organ with difficult access and adjacent major vessels risking torrential bleed. It is thought to be unforgiving if not handled well. However, improvements in technology and surgeon's expertise have pushed the boundaries of minimal access surgery (MAS) to include pancreas in its domain. We present our series of laparoscopic pancreatic surgery (LPS) with an aim to look at the feasibility and outcomes. METHODS This is a retrospective review of all LPS done at the Gastrointestinal Surgery (GIS) centre of a tertiary care Armed Forces Hospital over a period of 3 years. RESULTS A total of 24 LPS were done during this period. The median age of the patients was 46 years (range; 13-81). There were 14 male and 10 female patients. Nine patients had at least one co-morbidity. Three patients underwent laparoscopic lateral pancreaticojejunostomy, 4 distal pancreatectomy, 4 laparoscopic Whipples pancreaticoduodenectomy, 6 laparoscopic pancreatic necrosectomy, 6 laparoscopic cystogastrostomy and 1 roux en y cystojejunostomy. CONCLUSION LPS can be performed for almost all open pancreatic surgeries and can be done with reasonable outcomes. However, it has a steep learning curve and therefore, a hybrid approach leading to a totally laparoscopic approach may be the way forward.
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Affiliation(s)
- Sumesh Kaistha
- Classified Specialist (Surgery) & GI Surgeon, Command Hospital (Central Command), Lucknow, India
| | | | - Ameet Kumar
- Classified Specialist (Surgery) & GI Surgeon, Command Hospital (Air Force), Bengaluru, India
- Corresponding author.
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Dai J, Yu Z. Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer. Comb Chem High Throughput Screen 2019; 22:179-186. [PMID: 30973104 DOI: 10.2174/1386207322666190411113252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/20/2018] [Accepted: 12/11/2018] [Indexed: 01/07/2023]
Abstract
Aim:
To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer
with open surgery.
Methods:
The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were
adopted to search for the relevant studies, and full-text articles involving the comparison of
unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate
the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias
analysis for the articles included were also conducted.
Results:
Finally, 1186 patients were included in the 10 studies, which eventually satisfied the
eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The
meta-analysis suggested that there was no significant difference of the operation time between
laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss
and complication rate of laparoscopic group are much less than those of open surgery.
Conclusion:
Although both these two punctures provide similar operation time, we encourage the
use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal
cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.
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Affiliation(s)
- Jian Dai
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang, China
| | - Zhou Yu
- Department of Colorectal and Anal Surgery, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua 321000, Zhejiang, China
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Chen Y, Wang J, Ye Q, Wang Z, Weng W, Zhu J. Fast-track care with intraoperative blood salvage in laparoscopic splenectomy. Sci Rep 2019; 9:9945. [PMID: 31289303 PMCID: PMC6617455 DOI: 10.1038/s41598-019-45865-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/06/2019] [Indexed: 12/25/2022] Open
Abstract
Fast-track surgery is claimed to reduce medical morbidity, eliminate the hospitalization needs, and shorten the convalescence period. Intraoperative bleeding as the main complication is also the primary cause of conversion from laparoscopic to open splenectomy. Intraoperative blood salvage can reduce transfusion requirements, decrease the conversion rate to open, and promote fast-tracking in laparoscopic splenectomy (LS). From November 2007 through December 2016 we collected medical data of 115 LS patients. There were three groups: 54 patients receiving routine care (we marks them as Group RT), 33 patients with fast-track care (Group FT), and 28 receiving fast-track care receiving intraoperative splenic blood salvage and autotransfusion (Group FT + ISBS). These medical data are comprised of included three phases (pre-, intra-, and postoperative). There were significant differences (P < 0.05) between RT, FT, and FT + ISBS groups. The hemoglobin level in Group FT + ISBS was significantly higher than in Group RT and Group FT. Comparing the duration of hospital stay of 3 groups, Group RT stayed for a significantly longer time than Group FT and Group FT + ISBS, Group FT + ISBSmuch shorter than Group FT. Comparing the hospitalization expense, GroupFT + ISBS significantly expended less than Group RT and Group FT. Our study shows that laparoscopic splenectomy with fast-track care is feasible, effective, and safe for patients who require splenectomy. Fast-tracking with intraoperative blood salvage improved the fast-track laparoscopic splenectomy procedure.
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Affiliation(s)
- Yan Chen
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jianwei Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qinghuang Ye
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Zhijiang Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Weihong Weng
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jinhui Zhu
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
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Liao HC, Chuang JH, Hsu HH, Chen KC, Chen JS. Video-assisted thoracoscopic surgery for thoracic empyema in patients on maintenance hemodialysis. Surg Endosc 2019; 34:1641-1647. [PMID: 31286249 DOI: 10.1007/s00464-019-06935-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/12/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Thoracic empyema in uremic patients on maintenance hemodialysis is a challenging situation. The clinical characteristics are rarely reported, and the surgical outcomes remain unclear. We report our experience with video-assisted thoracoscopic surgery in these patients during 10-year period of time. METHODS Between 2005 and 2015, we retrospectively reviewed the clinical characteristics, bacteriological studies, and thoracoscopic surgical results of 23 empyema patients undergoing maintenance hemodialysis. RESULTS The mean patient age was 67.1 ± 12.9 years. All patients had additional preexisting systemic diseases. The mean duration of hemodialysis was 34.7 ± 25.8 months. The infections causing empyema were pneumonia in 11 (47.8%), blood stream infection in 8 (34.8%), and uremic pleuritis in 4 (17.4%). Among the 22 identified microorganisms, the most common pathogen was methicillin-resistant Staphylococcus aureus (31.8%). After thoracoscopic surgery, 8 patients (34.8%) required additional procedures for complications, including 2 patients who required repeated thoracoscopy for hemothorax and 6 (26.1%) patients who required open drainage for residual empyema. The mean hospital stay was 62.4 days, and 6 patients (26.1%) died in the hospital. Univariate and multivariate analyses revealed that maintenance hemodialysis longer than 5 years was a significant factor associated with in-hospital mortality (odds ratio: 14.8, 95% confidence interval 1.5-151.6; p < 0.0001). CONCLUSION While surgical management of thoracic empyema in uremic patients undergoing maintenance hemodialysis is associated with high rates of complication and mortality, thoracoscopic surgery is feasible, especially for patients undergoing hemodialysis for less than 5 years.
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Affiliation(s)
- Hsien-Chi Liao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Jen-Hao Chuang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Ke-Cheng Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan. .,Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung Shan South Road, Taipei, 100, Taiwan
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50
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Chiu CC, Lin WL, Shi HY, Huang CC, Chen JJ, Su SB, Lai CC, Chao CM, Tsao CJ, Chen SH, Wang JJ. Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution. J Clin Med 2019; 8:jcm8060875. [PMID: 31248135 PMCID: PMC6616913 DOI: 10.3390/jcm8060875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023] Open
Abstract
The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Liouying 73657, Taiwan.
- Department of General Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan.
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Wen-Li Lin
- Department of Cancer Center, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Business Management, National Sun Yat Sen University, Kaohsiung 80424, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan.
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 71004, Taiwan.
- Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Jyh-Jou Chen
- Department of Gastroenterology and Hepatology, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Shih-Bin Su
- Department of Occupational Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
- Department of Occupational Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan.
- Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
| | - Chih-Cheng Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Chao-Jung Tsao
- Department of Oncology, Chi Mei Medical Center, Liouying 73657, Taiwan.
| | - Shang-Hung Chen
- National Institute of Cancer Research, National Health Research Institutes, Tainan 70403, Taiwan.
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan.
- AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan.
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