scholarly journals Early Detection and Minimally Invasive Management of Complications Reduces Mortality after Pancreatic Resection: The Nationwide PORSCH Trial

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S672
Author(s):  
J. Smits ◽  
A.C. Henry ◽  
Q. Molenaar ◽  
H. van Santvoort
Keyword(s):  
Early Detection ◽  
Minimally Invasive ◽  
Pancreatic Resection ◽  
Management Of Complications ◽  
Invasive Management

scholarly journals Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster randomized trial

2019 ◽  
Author(s):  
Francina J Smits ◽  
AC Henry ◽  
CH van Eijck ◽  
MG Besselink ◽  
OR Busch ◽  
...  
Keyword(s):  
Early Detection ◽  
Minimally Invasive ◽  
Pancreatic Fistula ◽  
Organ Failure ◽  
Pancreatic Resection ◽  
Current Practice ◽  
Postoperative Pancreatic Fistula ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Invasive Management

Abstract Background Pancreatic resection is a major abdominal operation with 50% risk of postoperative complications. A common complication is pancreatic fistula, which may have severe clinical consequences such as postoperative bleeding, organ-failure and death. The objective of this study is to investigate whether implementation of an algorithm for early detection and minimally invasive management of pancreatic fistula may improve outcomes after pancreatic resection.Methods This is a nationwide stepped-wedge, cluster randomized, superiority trial, designed in adherence to the CONSORT guidelines. During a period of 22 months, all Dutch centers performing pancreatic surgery will cross over in a randomized order from current practice to best practice according to the algorithm. This evidence- and consensus based algorithm will provide daily multilevel advice on the management of patients after pancreatic resection (i.e. indication for abdominal imaging, antibiotic treatment, percutaneous drainage and removal of abdominal drains). The algorithm is designed to aid early detection and minimally invasive step-up management of postoperative pancreatic fistula. Outcomes of current practice will be compared with outcomes after implementation of the algorithm. The primary outcome is a composite of major complications (i.e. postpancreatectomy bleeding, new-onset organ failure and death) and will be measured in a sample size of at least 1600 patients undergoing pancreatic resection. Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, healthcare resource utilization and costs analysis. Follow-up will be up to 90 days after pancreatic resection.Discussion It is hypothesized that a structured nationwide implementation of a dedicated algorithm for early detection and minimally invasive step-up management of postoperative pancreatic fistula will reduce the risk of major complications and death after pancreatic resection, as compared to current practice.

scholarly journals Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster randomized trial

2020 ◽  
Author(s):  
Francina J Smits ◽  
AC Henry ◽  
CH van Eijck ◽  
MG Besselink ◽  
OR Busch ◽  
...  
Keyword(s):  
Early Detection ◽  
Minimally Invasive ◽  
Pancreatic Fistula ◽  
Organ Failure ◽  
Pancreatic Resection ◽  
Current Practice ◽  
Postoperative Pancreatic Fistula ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Invasive Management

Abstract Background Pancreatic resection is a major abdominal operation with 50% risk of postoperative complications. A common complication is pancreatic fistula, which may have severe clinical consequences such as postoperative bleeding, organ-failure and death. The objective of this study is to investigate whether implementation of an algorithm for early detection and minimally invasive management of pancreatic fistula may improve outcomes after pancreatic resection. Methods This is a nationwide stepped-wedge, cluster randomized, superiority trial, designed in adherence to the CONSORT guidelines. During a period of 22 months, all Dutch centers performing pancreatic surgery will cross over in a randomized order from current practice to best practice according to the algorithm. This evidence- and consensus based algorithm will provide daily multilevel advice on the management of patients after pancreatic resection (i.e. indication for abdominal imaging, antibiotic treatment, percutaneous drainage and removal of abdominal drains). The algorithm is designed to aid early detection and minimally invasive step-up management of postoperative pancreatic fistula. Outcomes of current practice will be compared with outcomes after implementation of the algorithm. The primary outcome is a composite of major complications (i.e. postpancreatectomy bleeding, new-onset organ failure and death) and will be measured in a sample size of at least 1600 patients undergoing pancreatic resection. Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, healthcare resource utilization and costs analysis. Follow-up will be up to 90 days after pancreatic resection. Discussion It is hypothesized that a structured nationwide implementation of a dedicated algorithm for early detection and minimally invasive step-up management of postoperative pancreatic fistula will reduce the risk of major complications and death after pancreatic resection, as compared to current practice.

Early Detection and Minimally Invasive Management of Intramural Pregnancy

2013 ◽  
Vol 20 (1) ◽  
pp. 123-126 ◽  
Author(s):  
Pei-Ju Wu ◽  
Chien-Min Han ◽  
Chin-Jung Wang ◽  
Chyi-Long Lee
Keyword(s):  
Early Detection ◽  
Minimally Invasive ◽  
Invasive Management

scholarly journals Metabolomic Biomarkers for the Detection of Obesity-Driven Endometrial Cancer

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 718
Author(s):  
Kelechi Njoku ◽  
Amy E. Campbell ◽  
Bethany Geary ◽  
Michelle L. MacKintosh ◽  
Abigail E. Derbyshire ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Detection ◽  
Minimally Invasive ◽  
Cancer Detection ◽  
Test Performance ◽  
Female Genital Tract ◽  
Screening Tools ◽  
Normal Endometrium ◽  
Endometrioid Endometrial Cancer ◽  
Post Menopausal

Endometrial cancer is the most common malignancy of the female genital tract and a major cause of morbidity and mortality in women. Early detection is key to ensuring good outcomes but a lack of minimally invasive screening tools is a significant barrier. Most endometrial cancers are obesity-driven and develop in the context of severe metabolomic dysfunction. Blood-derived metabolites may therefore provide clinically relevant biomarkers for endometrial cancer detection. In this study, we analysed plasma samples of women with body mass index (BMI) ≥ 30 kg/m2 and endometrioid endometrial cancer (cases, n = 67) or histologically normal endometrium (controls, n = 69), using a mass spectrometry-based metabolomics approach. Eighty percent of the samples were randomly selected to serve as a training set and the remaining 20% were used to qualify test performance. Robust predictive models (AUC > 0.9) for endometrial cancer detection based on artificial intelligence algorithms were developed and validated. Phospholipids were of significance as biomarkers of endometrial cancer, with sphingolipids (sphingomyelins) discriminatory in post-menopausal women. An algorithm combining the top ten performing metabolites showed 92.6% prediction accuracy (AUC of 0.95) for endometrial cancer detection. These results suggest that a simple blood test could enable the early detection of endometrial cancer and provide the basis for a minimally invasive screening tool for women with a BMI ≥ 30 kg/m2.

scholarly journals The Minimally Invasive Management of Visceral Artery Aneurysms and Pseudoaneurysms

2010 ◽  
Vol 51 (4) ◽  
pp. 1071
Author(s):  
Grant T. Fankhauser ◽  
William M. Stone ◽  
Sailendra G. Naidu ◽  
Gustavo S. Oderich ◽  
Joseph J. Ricotta ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Visceral Artery ◽  
Visceral Artery Aneurysms ◽  
Invasive Management
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