Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome

Abstract Background Long-gap esophageal atresia (LGEA) is defined as atresia without distal tracheoesophageal fistula. Preserving the native esophagus is considered superior over intestinal interposition. Thoracoscopic traction technique facilitates lengthening of the esophageal ends, and allows anastomosis within the first weeks of life. The aim of this study was to evaluate the long-term outcome of LGEA patients treated by thoracoscopic traction technique. Methods From 2007 to 2018, 13 consecutive patients with LGEA were treated by thoracoscopic traction technique. During the first operation a bronchoscopy was performed to evaluate the presence of a proximal fistula. Then thoracoscopic traction sutures were placed at both esophageal ends. Initially a gastrostomy was performed. However, nowadays only a gastropexy is performed to prevent the stomach from migrating into the thorax. Approximation of the esophageal ends was evaluated by postoperative X-rays. Thoracoscopic adhesiolysis was performed when necessary. Both ends were anastomosed during the final surgical procedure, usually within a week. Results In 11 patients the anastomosis could be completed by thoracoscopic traction technique. In two patients the elongation procedure failed. In the first patient the sutures tore out. The second patient had an accidental perforation of the proximal pouch by the Replogle tube. Median time on ventilation until after the final anastomosis was 14 days (range 4–34 days). Five patients required chest tube drainage for anastomotic leakage. The median hospitalization time during the first admission was 47 days (range 31–170 days). All patients needed a median of 4 (range 1–16) dilatations for anastomotic stenosis. Ten patients needed a fundoplication within a median time of 8 weeks (range 2–16 weeks) after the esophageal anastomosis. One patient developed an esophago-bronchial fistula. Median weight at age of 2 years was −1.88 SD (range −3.54 – −0.16) and at age of 4 years −1.53 SD (range −2.94–0.66). All patients tolerated full oral feeding. Conclusion LGEA can be treated successfully after elongation by thoracoscopic traction technique. The procedure leads to an earlier anastomosis and shorter initial hospital stay as compared to delayed primary anastomosis. Full oral feeding is possible in all patients. Dilatation for anastomotic strictures and antireflux surgery is necessary in (almost) all patients.

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Find the Flame: Predictive Biomarkers for Immunotherapy in Melanoma

Cancers ◽

10.3390/cancers13081819 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1819

Author(s):

Mattia Garutti ◽

Serena Bonin ◽

Silvia Buriolla ◽

Elisa Bertoli ◽

Maria Antonietta Pizzichetta ◽

...

Keyword(s):

Meta Analysis ◽

Tumor Biology ◽

Predictive Biomarkers ◽

Decision Making Process ◽

Checkpoint Inhibition ◽

Clinical Context ◽

Term Outcome ◽

Long Term Outcome ◽

Therapeutic Landscape

Immunotherapy has revolutionized the therapeutic landscape of melanoma. In particular, checkpoint inhibition has shown to increase long-term outcome, and, in some cases, it can be virtually curative. However, the absence of clinically validated predictive biomarkers is one of the major causes of unpredictable efficacy of immunotherapy. Indeed, the availability of predictive biomarkers could allow a better stratification of patients, suggesting which type of drugs should be used in a certain clinical context and guiding clinicians in escalating or de-escalating therapy. However, the difficulty in obtaining clinically useful predictive biomarkers reflects the deep complexity of tumor biology. Biomarkers can be classified as tumor-intrinsic biomarkers, microenvironment biomarkers, and systemic biomarkers. Herein we review the available literature to classify and describe predictive biomarkers for checkpoint inhibition in melanoma with the aim of helping clinicians in the decision-making process. We also performed a meta-analysis on the predictive value of PDL-1.

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Biomarkers Predictive of Long-Term Outcome After Ischemic Stroke: A Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2021.10.157 ◽

2021 ◽

Author(s):

Sauson Soldozy ◽

Kaan Yağmurlu ◽

Pedro Norat ◽

Mazin Elsarrag ◽

John Costello ◽

...

Keyword(s):

Ischemic Stroke ◽

Meta Analysis ◽

Term Outcome ◽

Long Term Outcome

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Hydrostatic stretch-induced growth facilitating primary anastomosis in long-gap esophageal atresia

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2006.01.076 ◽

2006 ◽

Vol 41 (6) ◽

pp. 1170-1172 ◽

Cited By ~ 18

Author(s):

Adam M. Vogel ◽

Edmund Y. Yang ◽

Steven J. Fishman

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Long Gap ◽

Long Gap Esophageal Atresia

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Long-term neurodevelopment in children born with esophageal atresia: a systematic review

Diseases of the Esophagus ◽

10.1093/dote/doab054 ◽

2021 ◽

Author(s):

Camille E van Hoorn ◽

Chantal A ten Kate ◽

Andre B Rietman ◽

Leontien C C Toussaint-Duyster ◽

Robert Jan Stolker ◽

...

Keyword(s):

Cognitive Development ◽

Motor Function ◽

Esophageal Atresia ◽

Current Knowledge ◽

Neurodevelopmental Outcome ◽

Cognitive Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

The One

Summary Background Although the survival rate of esophageal atresia (EA) has increased to over 90%, the risk of functional long-term neurodevelopmental deficits is uncertain. Studies on long-term outcomes of children with EA show conflicting results. Therefore, we provide an overview of the current knowledge on the long-term neurodevelopmental outcome of children with EA. Methods We performed a structured literature search in Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google scholar on November 8, 2020 with the keywords ‘esophageal atresia’, ‘long-term outcome’, ‘motor development’, ‘cognitive development’, and ‘neurodevelopment’. Results The initial search identified 945 studies, of which 15 were included. Five of these published outcomes of multiple tests or tested at multiple ages. Regarding infants, one of six studies found impaired neurodevelopment at 1 year of age. Regarding preschoolers, two of five studies found impaired neurodevelopment; the one study assessing cognitive development found normal cognitive outcome. Both studies on motor function reported impairment. Regarding school-agers, the one study on neurodevelopmental outcome reported impairment. Cognitive impairment was found in two out of four studies, and motor function was impaired in both studies studying motor function. Conclusions Long-term neurodevelopment of children born with EA has been assessed with various instruments, with contrasting results. Impairments were mostly found in motor function, but also in cognitive performance. Generally, the long-term outcome of these children is reason for concern. Structured, multidisciplinary long-term follow-up programs for children born with EA would allow to timely detect neurodevelopmental impairments and to intervene, if necessary.

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Outcome of esophageal atresia: inborn versus outborn patients

Diseases of the Esophagus ◽

10.1093/dote/doab092 ◽

2022 ◽

Author(s):

Denise Schlee ◽

Till-Martin Theilen ◽

Henning Fiegel ◽

Martin Hutter ◽

Udo Rolle

Keyword(s):

Esophageal Atresia ◽

Primary Anastomosis ◽

Clinical Status ◽

Special Focus ◽

High Morbidity ◽

Term Outcome ◽

Long Term Outcome ◽

Hospitalization Period ◽

Volume Outcome ◽

Centralized Care

Summary Esophageal atresia (EA) is a rare congenital disease which is usually not of the detected prenatally. Due to the lack of prenatal diagnosis, some newborns with EA are born outside of specialized centers. Nevertheless, centralized care of EA has been proposed, even if a clear volume–outcome association in EA management remains unconfirmed. Furthermore, whether outcomes differ between outborn and inborn patients with EA has not been systematically investigated. Therefore, this single-center, retrospective study aimed to investigate EA management and outcomes with a special focus on inborn versus outborn patients. The following data were extracted from the medical records of infants with EA from 2009 to 2019: EA type, associated anomalies, complications, and long-term outcome. Patients were allocated into inborn and outborn groups. Altogether, 57 patients were included. Five patients were excluded (referral before surgery, loss of data, death before surgery [n = 1], and incorrect diagnosis [diverticulum, n = 1]). Among all patients, the overall survival rate was 96%, with no mortalities among outborn patients. The overall hospitalization period was shorter for outborn patients. The median follow-up durations were 3.8 years and 3.2 years for inborn and outborn patients, respectively. Overall, 15% of patients underwent delayed primary anastomosis (long-gap atresia [n = 4] and other reasons [n = 4]). Early complications included three anastomotic leakages and one post-operative fistula; 28% of patients developed strictures, which required dilatation, and 38% of patients showed relevant gastroesophageal reflux, which required fundoplication, without any differences between the groups. The two groups had comparable low mortality and expected high morbidity with no significant differences in outcome. The outborn group showed nonsignificant trends toward lower morbidity and shorter hospitalization periods, which might be explained by the overall better clinical status.

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Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.113.127753 ◽

2014 ◽

Vol 205 (2) ◽

pp. 88-94 ◽

Cited By ~ 278

Author(s):

Matti Penttilä ◽

Erika Jääskeläinen ◽

Noora Hirvonen ◽

Matti Isohanni ◽

Jouko Miettunen

Keyword(s):

Negative Symptoms ◽

Meta Analysis ◽

Hospital Treatment ◽

Duration Of Untreated Psychosis ◽

Long Term Effects ◽

Term Outcome ◽

Long Term Outcome ◽

Positive Effects ◽

Early Intervention In Psychosis

BackgroundDuration of untreated psychosis (DUP) is one of the few potentially modifiable predictors of outcomes of schizophrenia. Long DUP as a predictor of poor short-term outcome has been addressed in previous meta-analyses, but the long-term effects of DUP remain unclear.AimsTo analyse the associations between DUP and long-term outcomes of schizophrenia.MethodA systematic literature search was performed using seven electronic databases and manual searches. Random effects weighted meta-analysis with correlation coefficients was used to pool the results.ResultsWe identified 3493 unique publications, from which 33 samples met our predefined selection criteria. Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13–0.18). Long DUP was not associated with employment, quality of life or hospital treatment.ConclusionsThe small but mostly consistent correlation between long DUP and poor outcome indicates that early intervention in psychosis may have at least subtle positive effects on the long-term course of illness.

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