scholarly journals Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yusuke Sato ◽  
Satoru Motoyama ◽  
Akiyuki Wakita ◽  
Yuta Kawakita ◽  
Yushi Nagaki ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Gastric Conduit ◽  
University Hospital ◽  
Logistic Analysis ◽  
Handsewn Anastomosis ◽  
Surgical Sutures ◽  
Posterior Mediastinal

Abstract The incidence of anastomotic leakage after esophagectomy remains around 10%. It was previously reported that PDSII rapidly loses tensile strength at pH 1.0 and pH 8.5. By contrast, LACLON degradation is reportedly insensitive to pH. We therefore compared LACLON with PDSII for esophago-gastric conduit, layer-to-layer, handsewn anastomosis. Between January 2016 and January 2020, 90 patients who received posterior mediastinal gastric conduit reconstruction with layer-to-layer handsewn anastomosis (51 using PDSII and 39 using LACLON) at Akita University Hospital were enrolled. The incidence of anastomotic leakage was significantly lower in the LACLON (2.6%, 1/39 patients) than PDSII group (15.7%, 8/51 patients) (p = 0.0268). Multivariable logistic analysis showed the risk of anastomotic leakage was significantly greater with PDSII than LACLON (odds ratio 11.01; 95% CI 1.326–277.64; p = 0.024). The percentages of time the pH was higher than 8 on the gastric conduit side of the anastomosis were 3.1%, 5.7%, 20.9% and 80.5%, respectively, in the four most recent patients. The present study showed that pH at the anastomosis soon after esophagectomy tends to be alkaline rather than acidic, which raises the possibility that this alkalinity facilitates the deterioration of surgical sutures including PDSII.

scholarly journals Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daiki Sakai ◽  
Wataru Matsumiya ◽  
Sentaro Kusuhara ◽  
Makoto Nakamura
Keyword(s):  
Candida Albicans ◽  
Medical Records ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Patient Characteristics ◽  
Antifungal Drugs ◽  
Factors Associated ◽  
Logistic Analysis ◽  
Multivariate Logistic Analysis ◽  
Systemic Antifungal Therapy

Abstract Purpose To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia. Methods The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development. Results The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC. Conclusion One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.

Using the diagnostic odds ratio to select multivariate sequential patterns in order to build an interpretable pattern-based classifier in a clinical domain (Preprint)

2021 ◽  
Author(s):  
Isidoro J. Casanova ◽  
Manuel Campos ◽  
Jose M. Juarez ◽  
Antonio Gomariz ◽  
Marta Lorente-Ros ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Odds Ratio ◽  
Diagnostic Odds Ratio ◽  
University Hospital ◽  
Classification Model ◽  
Sequential Patterns ◽  
Pattern Selection ◽  
Essential Property ◽  
Frequency Properties ◽  
Clinical Domain

BACKGROUND It is important to exploit all available data on patients in settings such as Intensive Care Burn Units (ICBUs), where several variables are recorded over time. It is possible to take advantage of the multivariate patterns that model the evolution of patients in order to predict their survival. However, pattern discovery algorithms generate a large number of patterns, of which only some are relevant for classification. The interpretability of the model is, moreover, an essential property in the clinical domain. OBJECTIVE We propose to use the Diagnostic Odds Ratio (DOR) to select the multivariate sequential patterns used in the classification in a clinical domain, rather than employing frequency properties. This makes it possible to employ a terminology closer to the language of clinicians, in which a pattern is considered to be a risk factor or to have a protection factor. METHODS We employ data obtained from the ICBU at the University Hospital of Getafe, where six temporal variables for 465 patients were registered every day during 5 days, and to model the evolution of these clinical variables we use multivariate sequential patterns. We compare four ways in which to employ the DOR for pattern selection: 1) We use it as a threshold in order to select patterns with a minimum DOR; 2) We select patterns whose differential DORs are higher than a threshold as regards their extensions; 3) We select patterns whose DOR confidence intervals do not overlap; and 4) We propose the combination of threshold and non-overlapping confidence intervals in order to select the most discriminative patterns. As a baseline, we compare our proposals with Jumping Emerging Patterns (JEPs), one of the most frequently used techniques for pattern selection that utilize frequency properties. RESULTS We have compared the number and length of the patterns eventually selected, classification performance, and pattern and model interpretability. We show that discretization has a great impact on the accuracy of the classification model, but that a trade off must be found between classification accuracy and the physicians' capacity to interpret the patterns obtained. We have, therefore, opted to use expert discretization without losing too much accuracy. We have also identified that the experiments combining threshold and non-overlapping confidence intervals (Option 4) obtained the fewest number of patterns but also with the smallest size, thus implying the loss of an acceptable accuracy as regards clinician interpretation. CONCLUSIONS A method for the classification of patients’ survival can benefit from the use of sequential patterns, since these patterns consider knowledge about the temporal evolution of the variables in the case of ICBU. We have proved that the DOR can be used in several ways, and that it is a suitable measure with which to select discriminative and interpretable quality patterns.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

Venous Thromboembolism in Patients With Thrombocytopenia: Risk Factors, Treatment, and Outcome

2015 ◽  
Vol 23 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Jens Kristian Baelum ◽  
Espen Ellingsen Moe ◽  
Mads Nybo ◽  
Pernille Just Vinholt
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Venous Thromboembolism ◽  
Blood Cells ◽  
Medical Records ◽  
Odds Ratio ◽  
Conditional Logistic Regression ◽  
University Hospital ◽  
Hospital Department ◽  
Bleeding Episodes

Background: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. Objectives: To identify VTE risk factors and describe treatment and outcome (bleeding episodes and mortality) in patients with thrombocytopenia. Patients/Methods: Patients with thrombocytopenia (platelet count <100 × 109/L) admitted to Odense University Hospital, Denmark, between April 2000 and April 2012 were included. Fifty cases had experienced VTE. Controls without VTE were matched 3:1 with cases on sex and hospital department. Medical records were examined, and data were analyzed using conditional logistic regression. Results: In multivariate analysis, platelet count <50 × 109/L (odds ratio [OR] 0.22, P < .05) and chronic liver disease (OR 0.05, 95% confidence interval [CI] 0.01-0.58) reduced the risk of VTE. Surgery (OR 6.44, 95% CI 1.37-30.20) and previous thromboembolism (OR 6.16, 95% CI 1.21-31.41) were associated with an increased VTE risk. Ninety-two percent of cases were treated with anticoagulants. There was no difference in bleeding incidence between cases and controls. Conclusions: Several known VTE risk factors also seems to apply in patients with thrombocytopenia. Also, patients with thrombocytopenia may be VTE risk stratified based on platelet count and comorbidities. Finally, patients having thrombocytopenia with VTE seem to be safely treated with anticoagulants without increased occurrence of bleeding.

NIMG-22. PREDICTION OF GLIOBLASTOMA CELLULAR INFILTRATION AND RECURRENCE USING MACHINE LEARNING AND MULTI-PARAMETRIC MRI ANALYSIS: RESULTS FROM THE MULTI-INSTITUTIONAL RESPOND CONSORTIUM

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi132-vi133
Author(s):  
Hamed Akbari ◽  
Suyash Mohan ◽  
Jose A Garcia ◽  
Anahita Fathi Kazerooni ◽  
Chiharu Sako ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Tumor Recurrence ◽  
De Novo ◽  
Predictive Biomarkers ◽  
Neoplastic Cell ◽  
University Hospital ◽  
Cell Infiltration ◽  
New York University ◽  
Single Institution ◽  
Peritumoral Tissue

Abstract PURPOSE Multi-parametric MRI and artificial intelligence (AI) methods were previously used to predict peritumoral neoplastic cell infiltration and risk of future recurrence in glioblastoma, in single-institution studies. We hypothesize that important characteristics of peritumoral tissue heterogeneity captured, engineered/selected, and quantified by these methods relate to predictions generalizable in the multi-institutional ReSPOND (Radiomics Signatures for PrecisiON Diagnostics) consortium. METHODS To support further development, generalization, and clinical translation of our proposed method, we trained the AI model on a retrospective cohort of 29 de novo glioblastoma patients from the Hospital of the University of Pennsylvania (UPenn) (Male/Female:20/9, age:22-78 years) followed by evaluation on a prospective multi-institutional cohort of 84 glioblastoma patients (Male/Female:51/33, age:34-89 years) from Case Western Reserve University/University Hospitals (CWRU/UH, 25), New York University (NYU, 13), Ohio State University (OSU, 13), University Hospital Río Hortega (RH, 2), and UPenn (31). Features extracted from pre-resection MRI (T1, T1-Gd, T2, T2-FLAIR, ADC) were used to build our model predicting the spatial pattern of subsequent tumor recurrence. These predictions were evaluated against regions of pathology-confirmed post-resection recurrence. RESULTS Our model predicted the locations that later harbored tumor recurrence with sensitivity 83%, AUC 0.83 (99% CI, 0.73-0.93), and odds ratio 7.23 (99% CI, 7.09-7.37) in the prospective cohort. Odds ratio (99% CI)/AUC(99% CI) per institute were: CWRU/UH, 7.8(7.6-8.1)/0.82(0.75-0.89); NYU, 3.5(3.3-3.6)/0.84(074-0.93); OSU, 7.9(7.6-8.3)/0.8(0.67-0.94); RH, 22.7(20-25.1)/0.94(0.27-1); UPenn, 7.1(6.8-7.3)/0.83(0.76-0.91). CONCLUSION This is the first study that provides relatively extensive multi-institutional validated evidence that AI can provide good predictions of peritumoral neoplastic cell infiltration and future recurrence, by dissecting the MRI signal heterogeneity in peritumoral tissue. Our analyses leveraged the unique dataset of the ReSPOND consortium, which aims to develop and evaluate AI-based biomarkers for individualized prediction and prognostication, by moving from single-institution studies to generalizable, well-validated multi-institutional predictive biomarkers.

FA05.03: EFFECT OF EPHEDRINE ON GASTRIC CONDUIT PERFUSION MEASURED BY LASER SPECKLE CONTRAST IMAGING (LSCO) AFTER ESOPHAGECTOMY: A PROSPECTIVE IN-VIVO COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Simon Strackee ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Gastric Conduit ◽  
Laser Speckle ◽  
Contrast Imaging ◽  
Laser Speckle Contrast Imaging ◽  
Speckle Contrast ◽  
Before And After ◽  
Gastric Tube Reconstruction

Abstract Background Compromised perfusion due to ligation of arteries and veins in esophagectomy with gastric tube reconstruction often (5–20%) results in necrosis and anastomotic leakage, which relate to high morbidity and mortality (3–4%). Ephedrine is used widely in anesthesia to treat intra-operative hypotension and may improve perfusion by the increase of cardiac output (CO) and mean arterial pressure (MAP). This study tests the effect of ephedrine on perfusion of the future anastomotic site of the gastric conduit, measured by Laser Speckle Contrast Imaging (LSCI). Methods This prospective, observational, in-vivo pilot study includes 26 patients undergoing esophagectomy with gastric tube reconstruction from October 2015 to June 2016 in the Academic Medical Center (Amsterdam). Perfusion of the gastric conduit was measured with LSCI directly after reconstruction and after an increase of MAP by ephedrine 5 mg. Perfusion was quantified in flux (LSPU) in four perfusion locations, from good perfusion (base of the gastric tube) towards decreased perfusion (fundus). Intra-patient differences before and after ephedrine in terms flux were statistically tested for significance with a paired t-test. Results LSCI was feasible to image gastric microcirculation in all patients. Flux (LSPU) was significantly higher in the base of the gastric tube (791 ± 442) compared to the fundus (328 ± 187) (P < 0.001). After administration of ephedrine, flux increased significantly in the fundus (P < 0·05) measured intra-patients. Three patients developed anastomotic leakage. In these patients, the difference between measured flux in the fundus compared to the base of the gastric tube was high. Conclusion This study presents the effect of ephedrine on perfusion of the gastric tissue measured with LSCI in terms of flux (LSPU) after esophagectomy with gastric tube reconstruction. We show a small but significant difference between flux measured before and after administration of ephedrine in the future anastomotic tissue (313 ± 178 vs. 397 ± 290). We also show a significant decrease of flux towards the fundus. Disclosure All authors have declared no conflicts of interest.

PS01.171: DOUBLE-PEDICLED FREE JEJUNAL TRANSFER FOR RECONSTRUCTION OF PHARYNGOLARYNGOESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 97-99
Author(s):  
Hiromi Mukaide ◽  
Taku Michiura ◽  
Kentaro Inoue ◽  
Hirokazu Miki ◽  
Keigo Yamamichi ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Conflicts Of Interest ◽  
University Hospital ◽  
Perioperative Outcomes ◽  
Arteriovenous Anastomoses ◽  
Vascular Thrombosis ◽  
Transfer Group ◽  
Free Jejunal Transfer ◽  
Medical University ◽  
Age Range

Abstract Background We recently selected double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy to reduce the vascular thrombosis-induced necrosis in free jejunal transfer. We herein report our experience with this procedure. Methods Single-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy was performed from January 2006 to November 2013, and double-pedicled free jejunal transfer (i.e. two pairs of jejunal arteriovenous anastomoses) was performed from December 2013 to December 2016 in Kansai Medical University Hospital. We compared the perioperative outcomes and complications between these two procedures. Results Sixty-two patients (58 men, 4 women; median age, 66 years; age range, 51–83 years) underwent single-pedicled free jejunal transfer. Twenty-eight patients (25 men, 3 women; median age, 70 years; age range, 47–84 years) underwent double-pedicled free jejunal transfer. Twenty-eight patients received preoperative treatments. Table 1 shows the perioperative outcomes and complications. Conclusion No thrombus of the free jejunum occurred, no anastomotic leakage occurred, and all flaps survived in the double-pedicled free jejunal transfer group. We believe that double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy is a reliable and useful procedure. Disclosure All authors have declared no conflicts of interest.

P103 A HAND-SEWN INTRATHORACIC ANASTOMOSIS IN ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): A DETAILED DESCRIPTION OF TECHNIQUE AND OUTCOMES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E M de Groot ◽  
B F Kingma ◽  
R van Hillegersberg ◽  
J P Ruurda
Keyword(s):  
Anastomotic Leakage ◽  
Moving Average ◽  
Minimally Invasive Esophagectomy ◽  
Leakage Rate ◽  
Gastric Conduit ◽  
Robot Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy ◽  
Anastomotic Leakage Rate ◽  
Technical Details

Abstract Aim The aim of this study was to describe a technique that was developed and refined to construct a hand-sewn intrathoracic anastomosis during robot-assisted minimally invasive esophagectomy (RAMIE). Background & Methods Whilst some case series have reported promising results of a hand-sewn intrathoracic anastomosis during RAMIE, the exact techniques were often not described in detail. Therefore, the current single-center retrospective study was designed to provide a detailed and reproducible technical description of a hand-sewn, intrathoracic anastomosis that was developed and refined for patients who underwent RAMIE in a high volume center for esophageal cancer surgery (2016-2018). Video recordings were reviewed to evaluate technical details regarding the anastomosis, including number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Technical details and distances were extracted and measured by using video analysis software. Moving average analyses were performed to evaluate whether the anastomotic leakage rate changed over the consecutive cases. Results A total of 68 patients were included in the study. For creation of the anastomosis, the gastric conduit was opened on a median distance of 19 millimeters (range 0-66) from the gastric conduit tip. After initially performing end-to-end anastomoses, a switch was made to an end-to-side anastomosis for the majority of 55 patients (81%). A median total of 27 sews (range 20-38) were required to close the anastomosis. In the last 22 patients of the cohort (32%), 4 tension release stitches were placed after circular suturing of the anastomosis. A re-inforcing omental wrap was positioned around the anastomosis in 64 patients (94%). The moving average curve for anastomotic leakage started at a rate of 40% (cases 1-10) and ended at 10% (cases 59-68). Conclusion This is the first study to report technical features and outcomes of a hand-sewn intrathoracic anastomosis during RAMIE in detail. Although an acceptable anastomotic leakage rate was observed in the final inclusion phase, a hand-sewn intrathoracic anastomosis during RAMIE may carry a substantial learning curve.

scholarly journals Endoscopic submucosal dissection to relieve a flexure of the gastric conduit after esophagectomy

2018 ◽  
Vol 06 (03) ◽  
pp. E350-E353
Author(s):  
Katsumi Yamamoto ◽  
Hiroshi Noro ◽  
Yu Sato ◽  
Akira Kusakabe ◽  
Nobuyuki Tatsumi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Examination ◽  
Gastric Conduit ◽  
Endoscopic Balloon Dilation ◽  
Effective Treatment Option ◽  
Submucosal Dissection ◽  
First Case ◽  
Posterior Mediastinal ◽  
Endoscopic Balloon

Abstract Background and study aims A 70-year-old-man underwent an esophagectomy and posterior mediastinal reconstruction for esophageal cancer that was curatively resected. Although the patient was allowed to eat after surgery, he repeatedly vomited after drinking water or eating meals and required continuous hospitalization. An upper gastrointestinal series and endoscopic examination revealed an obstruction due to the flexure of the gastric conduit, which was repeatedly treated with endoscopic balloon dilation. Endoscopic balloon dilation was completely ineffective, however, because the obstruction was not due to a small lumen diameter, but rather to severe flexure. We hypothesized that the power of contraction provided by ulcer scar formation after mucosal resection could straighten the flexure, and thus removed a piece of the mucosa 8 cm in diameter on the oral side of the flexure by endoscopic submucosal dissection (ESD) 4 months after the esophagectomy. Endoscopic examination on post-ESD Day 10 revealed that the gastric conduit flexure was straightened due to ulcer scarring, and obstruction at the flexure opened over time. Meals were restarted and the patient could eat without vomiting. He was discharged from the hospital 5 weeks after ESD. This is the first case report of obstruction due to flexure of the gastric conduit after esophagectomy that was successfully treated with mucosectomy using ESD. Mucosectomy using ESD may be an effective treatment option for obstruction due to flexure of the gastric conduit after esophagectomy.

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