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Egger ME, Feygin Y, Kong M, Poddar T, Ghosh I, Xu Q, McCabe RM, McMasters KM, Ellis CT. Variation in Lymph Node Assessment for Colon Cancer at the Tumor, Surgeon, and Hospital Level. J Am Coll Surg 2024; 238:520-528. [PMID: 38205923 DOI: 10.1097/xcs.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND We hypothesized that tumor- and hospital-level factors, compared with surgeon characteristics, are associated with the majority of variation in the 12 or more lymph nodes (LNs) examined quality standard for resected colon cancer. STUDY DESIGN A dataset containing an anonymized surgeon identifier was obtained from the National Cancer Database for stage I to III colon cancers from 2010 to 2017. Multilevel logistic regression models were built to assign a proportion of variance in achievement of the 12 LNs standard among the following: (1) tumor factors (demographic and pathologic characteristics), (2) surgeon factors (volume, approach, and margin status), and (3) facility factors (volume and facility type). RESULTS There were 283,192 unique patient records with 15,358 unique surgeons across 1,258 facilities in our cohort. Achievement of the 12 LNs standard was high (90.3%). Achievement of the 12 LNs standard by surgeon volume was 88.1% and 90.7% in the lowest and highest quartiles, and 86.8% and 91.6% at the facility level for high and low annual volume quartiles, respectively. In multivariate analysis, the following tumor factors were associated with meeting the 12 LNs standard: age, sex, primary tumor site, tumor grade, T stage, and comorbidities (all p < 0.001). Tumor factors were responsible for 71% of the variation in 12 LNs yield, whereas surgeon and facility characteristics contributed 17% and 12%, respectively. CONCLUSIONS Twenty-nine percent of the variation in the 12 LNs standard is linked to modifiable factors. The majority of variation in this quality metric is associated with non-modifiable tumor-level factors.
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Affiliation(s)
| | | | - Maiying Kong
- Biostatistics and Bioinformatics, School of Public Health and Information Sciences (Kong, Poddar, Ghosh, Xu), University of Louisville, Louisville, KY
| | - Triparna Poddar
- Biostatistics and Bioinformatics, School of Public Health and Information Sciences (Kong, Poddar, Ghosh, Xu), University of Louisville, Louisville, KY
| | - Indranil Ghosh
- Biostatistics and Bioinformatics, School of Public Health and Information Sciences (Kong, Poddar, Ghosh, Xu), University of Louisville, Louisville, KY
| | - Qian Xu
- Biostatistics and Bioinformatics, School of Public Health and Information Sciences (Kong, Poddar, Ghosh, Xu), University of Louisville, Louisville, KY
| | - Ryan M McCabe
- National Cancer Database, Commission on Cancer, American College of Surgeons (McCabe)
| | | | - C Tyler Ellis
- From the Departments of Surgery (Egger, McMasters, Ellis)
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Spitzer HV, Kemp Bohan PM, Carpenter EL, Adams AM, Chang SC, Grunkemeier G, Vreeland TJ, Tzeng CWD, Katz MHG, Nelson DW. Impact of Adherence to Operative Standards and Stage-Specific Guideline-Recommended Therapy in Nonmetastatic Pancreatic Adenocarcinoma. Ann Surg Oncol 2023; 30:6662-6670. [PMID: 37330447 DOI: 10.1245/s10434-023-13758-z] [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: 03/01/2023] [Accepted: 05/29/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Achieving optimal surgical outcomes in pancreatic adenocarcinoma requires a combination of both curative-intent resection to oncologic standards and stage-specific neoadjuvant or adjuvant therapy. This investigation sought to examine factors associated with receipt of standard-adherent surgery (SAS) and guideline-recommended therapy (GRT) and determine the impact of compliance on patient survival. PATIENTS AND METHODS From the 2006-2016 National Cancer Database, 21,304 patients underwent resection for nonmetastatic pancreatic adenocarcinoma. SAS was defined as pancreatic resection with negative margins and ≥ 15 lymph nodes examined. Stage-specific GRT was defined by current National Comprehensive Cancer Network guidelines. Multivariable models were used to determine predictors of adherence to SAS and GRT and prognostic impact on overall survival. RESULTS Overall, SAS was achieved in 39% and GRT in 65% of patients, but only 30% received both SAS and GRT. Increasing age, minority race, uninsured status, and greater comorbidities were associated with a decreased odds of receiving both SAS and GRT (all p < 0.05). SAS (HR 0.79; CI 0.76-0.81; p < 0.001) and GRT (HR 0.67; CI 0.65-0.69; p < 0.001) were each independently associated with a survival advantage. Receipt of both SAS and GRT was associated with significant improvement in median OS compared with receiving neither (2.2 years vs 1.1 years; p < 0.001) which was independently associated with a 78% increased risk of death (HR 1.78; CI 1.70-1.86; p < 0.001). CONCLUSIONS Despite survival benefits associated with adherence to operative standards and receipt of guideline-recommended therapy, compliance remains poor. Future efforts must be directed toward improved education and implementation efforts around both operative standards and therapy guidelines.
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Affiliation(s)
- Holly V Spitzer
- Department of Surgery, William Beaumont Army Medical Center, Uniformed Services University of the Health Sciences, Fort Bliss, TX, USA
| | | | | | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | | | - Gary Grunkemeier
- Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Timothy J Vreeland
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Matthew H G Katz
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, Uniformed Services University of the Health Sciences, Fort Bliss, TX, USA.
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Johnston SS, Afolabi M, Tewari P, Danker W. Clinical and Economic Burden Associated with Disruptive Surgical Bleeding: A Retrospective Database Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:535-547. [PMID: 37424958 PMCID: PMC10327677 DOI: 10.2147/ceor.s411778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Hemostatic agents are used to control surgical bleeding; however, some patients experience disruptive bleeding despite the use of hemostats. In patients receiving hemostats, we compared clinical and economic outcomes between patients with vs without disruptive bleeding during a variety of surgical procedures. Methods This was a retrospective analysis of the Premier Healthcare Database. Study patients were age ≥18 with a hospital encounter for one of 9 procedures with evidence of hemostatic agent use between 1-Jan-2019 and 31-Dec-2019: cholecystectomy, coronary artery bypass grafting (CABG), cystectomy, hepatectomy, hysterectomy, pancreatectomy, peripheral vascular, thoracic, and valve procedures (first procedure = index). Patients were grouped by presence vs absence of disruptive bleeding. Outcomes evaluated during index included intensive care unit (ICU) admission/duration, ventilator use, operating room time, length of stay (LOS), in-hospital mortality, and total hospital costs; 90-day all-cause inpatient readmission was also evaluated. Multivariable analyses were used to examine the association of disruptive bleeding with outcomes, adjusting for patient, procedure, and hospital/provider characteristics. Results The study included 51,448 patients; 16% had disruptive bleeding (range 1.5% for cholecystectomy to 44.4% for valve). In procedures for which ICU and ventilator use is not routine, disruptive bleeding was associated with significant increases in the risks of admission to ICU and requirement for ventilator (all p≤0.05). Across all procedures, disruptive bleeding was also associated with significant incremental increases in days spent in ICU (all p≤0.05, except CABG), LOS (all p≤0.05, except thoracic), and total hospital costs (all p≤0.05); 90-day all-cause inpatient readmission, in-hospital mortality, and operating room time were higher in the presence of disruptive bleeding and varied in statistical significance across procedures. Conclusion Disruptive bleeding was associated with substantial clinical and economic burden across a wide variety of surgical procedures. Findings emphasize the need for more effective and timely intervention for surgical bleeding events.
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Affiliation(s)
- Stephen S Johnston
- MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA
| | - Mosadoluwa Afolabi
- MedTech Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA
| | | | - Walter Danker
- Franchise Health Economics and Market Access, Ethicon, Johnson & Johnson, Raritan, NJ, USA
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Short term results in a population based study indicate advantage for laparoscopic colon cancer surgery versus open. Sci Rep 2023; 13:4335. [PMID: 36927758 PMCID: PMC10020555 DOI: 10.1038/s41598-023-30448-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
The aim of this study was to compare LAP with OPEN regarding short-term mortality, morbidity and completeness of the cancer resection for colon cancer in a routine health care setting using population based register data. All 13,683 patients who were diagnosed 2012-2018 and underwent elective surgery for right-sided or sigmoid colon cancer were included from the Swedish Colorectal Cancer Registry and the National Patient Registry. Primary outcome was 30-day mortality. Secondary outcomes were 90-day mortality, length of hospital stay, reoperation, readmission and positive resection margin (R1). Weighted and unweighted multi regression analyses were performed. There were no difference in 30-day mortality: LAP (0.9%) and OPEN (1.3%) (OR 0.89, 95% CI 0.62-1.29, P = 0.545). The weighted analyses showed an increased 90-day mortality following OPEN, P < 0.001. Re-operations and re-admission were more frequent after OPEN and length of hospital stay was 2.9 days shorter following LAP (P < 0.001). R1 resections were significantly more common in the OPEN group in the unweighted and weighted analysis with P = 0.004 and P < 0.001 respectively. Therefore, the favourable short-term outcomes following elective LAP versus OPEN resection for colon cancer in routine health care indicate an advantage of laparoscopic surgery.
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Zhang J, Bao Y. Value of MSCT plus MRI in the Detection of Colon Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6507865. [PMID: 35685721 PMCID: PMC9173996 DOI: 10.1155/2022/6507865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
Abstract
Colon cancer is a common digestive system malignancy with nonspecific early symptoms, which necessitates better early detection methods. The present study was conducted to assess the accuracy and clinical value of multislice spiral CT (MSCT) plus magnetic resonance imaging (MRI) for colon cancer. Between January 2019 and July 2020, 100 patients with pathologically confirmed colon cancer treated in Wuxi People's Hospital were assessed for eligibility and recruited. All eligible patients received MRI and MSCT without any treatment prior to scanning. The accuracy of preoperative diagnosis and staging of colon cancer by MRI, MSCT, and MRI plus MSCT were analyzed using postoperative pathological results as the gold standard, and consistency analysis was performed. The receiver operating characteristic curve (ROC) was plotted, and the area under the curve (AUC) was obtained to analyze the preoperative diagnostic value. The accuracy of MRI, MSCT, and MRI plus MSCT was 98.00%, 96.00%, and 100% with good consistency (Kappa = 0.732, 0.703, and 0.756). The AUC of MRI, MSCT, and MRI plus MSCT was 0.889, 0.861, and 0.903, respectively. The preoperative diagnostic accuracy of MRI for colon cancer at T1, T2, T3, and T4 stages was 76.92%, 82.61%, 73.47%, and 86.67%, respectively, those of MSCT was 53.85%, 69.57%, 63.27%, and 40.00%, respectively, and those of MRI plus MSCT was 100.00%, 95.65%, 95.92%, and 86.67%, respectively. Consistency analysis yielded good consistency for the diagnosis of the T-staging of colon cancer (Kappa = 0.754, 0.731, 0.776). MSCT plus MRI yielded higher accuracy, specificity, and sensitivity in the detection of colon cancer versus the standalone MRI or MSCT, which demonstrated great potential in the early detection of colon cancer with a high clinical value.
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Affiliation(s)
- Jingni Zhang
- Department of Radiology, Affiliated Hospital of Jiangnan University, Wuxi 214062, Jiangsu Province, China
| | - Yu Bao
- Medical Imaging Center, Wuxi People's Hospital, Wuxi 214043, Jiangsu Province, China
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Katz MHG, Francescatti AB, Hunt KK. Technical Standards for Cancer Surgery: Commission on Cancer Standards 5.3–5.8. Ann Surg Oncol 2022; 29:6549-6558. [DOI: 10.1245/s10434-022-11375-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/16/2022] [Indexed: 12/30/2022]
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Suo Lang DJ, Ci Ren YZ, Bian Ba ZX. Minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas. World J Clin Cases 2021; 9:10919-10926. [PMID: 35047602 PMCID: PMC8678858 DOI: 10.12998/wjcc.v9.i35.10919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon cancer is associated with a higher incidence among residents in high-altitude areas. Hypoxic environment at high altitudes inhibits the phagocytic and oxygen-dependent killing function of phagocytes, thereby increasing the inflammatory factors, inhibiting the body’s innate immunity and increasing the risk of colon cancer.
AIM To examine the effect of minimally invasive surgery vs laparotomy in patients with colon cancer residing in high-altitude areas.
METHODS Ninety-two patients with colon cancer in our hospital from January 2019 to February 2021 were selected and divided into the minimally invasive surgery and laparotomy groups using the random number table method, with 46 patients in each group. Minimally invasive surgery was performed in the minimally invasive group and laparotomy in the laparotomy group. Operative conditions, inflammatory index pre- and post-surgery, immune function index and complication probability were measured.
RESULTS Operative duration was significantly longer and intraoperative blood loss and recovery time of gastrointestinal function were significantly less (all P < 0.05) in the minimally invasive group than in the laparotomy group. The number of lymph nodes dissected was not significantly different. Before surgery, there were no significant differences in serum C-reactive protein, interleukin-6 and tumor necrosis factor-α levels between the groups, whereas after surgery, the levels were significantly higher in the minimally invasive group (26.98 ± 6.91 mg/L, 146.38 ± 11.23 ng/mL and 83.51 ± 8.69 pg/mL vs 41.15 ± 8.39 mg/L, 186.79 ± 15.36 ng/mL and 110.65 ± 12.84 pg/mL, respectively, P < 0.05). Furthermore, before surgery, there were no significant differences in CD3+, CD4+ and CD4+/CD8+ levels between the groups, whereas after surgery, the levels decreased in both groups, being significantly higher in the minimally invasive group (55.61% ± 4.39%, 35.45% ± 3.67% and 1.30 ± 0.35 vs 49.68% ± 5.33%, 31.21% ± 3.25% and 1.13 ± 0.30, respectively, P < 0.05). Complication probability was significantly lower in the minimally invasive group (4.35% vs 17.39%, P < 0.05).
CONCLUSION Laparoscopic minimally invasive procedures reduce surgical trauma and alleviate the inflammatory response and immune dysfunction caused by invasive operation. It also shortens recovery time and reduces complication probability.
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Affiliation(s)
- Duo-Ji Suo Lang
- Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lasa 850000, Tibet Autonomous Region, China
| | - Yang-Zhen Ci Ren
- Department of Internal Medicine, The Tibet Autonomous Region Centers for Disease Control and Prevention, Lasa 850000, Tibet Autonomous Region, China
| | - Zha-Xi Bian Ba
- Department of General Surgery, People’s Hospital of Tibet Autonomous Region, Lasa 850000, Tibet Autonomous Region, China
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Hu Q, Sun YS, Yang XY. Comment on "Comparison of open and minimally invasive approaches to colon cancer resection in compliance with 12 regional lymph node harvest quality measure". J Surg Oncol 2021; 125:301-305. [PMID: 34791667 DOI: 10.1002/jso.26580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Qiang Hu
- Department of general surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Yuan Shui Sun
- Department of general surgery, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xi Yin Yang
- Department of Traditional Chinese Medicine, Community Health Service Center of Guali Town of Xiaoshan, Hangzhou, Zhejiang, China
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