346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
G Nawaz ◽  
M Qayum ◽  
S Hajibandeh ◽  
S Hajibandeh
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Hospital Stay ◽  
Wound Infection ◽  
Bile Leak ◽  
Hepatic Metastases ◽  
Length Of Hospital Stay ◽  
Abdominal Abscess ◽  
Procedure Time ◽  
Perioperative Morbidity

Abstract Aim To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases Method We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p < 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups. Conclusions Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.

Robotic vs. Laparoscopic Splenectomy in Management of Non-traumatic Splenic Pathologies: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 000313482199505
Author(s):  
Pratik Bhattacharya ◽  
Liam Phelan ◽  
Simon Fisher ◽  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Wound Infection ◽  
Laparoscopic Splenectomy ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Procedure Time ◽  
Open Procedure ◽  
Operative Complications ◽  
Post Operative Complications

We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies. A systematic search of electronic databases and bibliographic reference lists were conducted, and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intraoperative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time and length of hospital stay were the evaluated outcome parameters. We identified 8 comparative studies reporting a total of 560 patients comparing outcomes of robotic ( n = 202) and laparoscopic ( n = 258) splenectomies. The robotic approach was associated with significantly lower volume of blood loss (MD: −82.53 mls, 95% CI −161.91 to −3.16, P = .04) than the laparoscopic approach. There was no significant difference in intraoperative complications (OR: 0.68, 95% CI .21-2.01, P = .51), post-operative complications (OR: .91, 95% CI .40-2.06, P = .82), wound infection (RD: -.01, 95% CI -.04-.03, P = .78), haematoma (OR: 0.40, 95% CI .04-4.03, P = .44), conversion to open (OR: 0.63; 95% CI, .24-1.70, P = .36), return to theatre (RD: −.04, 95% CI -.09-.02, P = .16), procedure time (MD: 3.63; 95% CI -16.99-24.25, P = .73) and length of hospital stay (MD: −.21; 95% CI -1.17 - .75, P = .67) between 2 groups. In conclusion, robotic and laparoscopic splenectomies seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intraoperative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes

Overall survival analysis of the FOXFIRE prospective randomized studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3507-3507 ◽  
Author(s):  
Ricky A. Sharma ◽  
Harpreet Singh Wasan ◽  
Guy A. Van Hazel ◽  
Volker Heinemann ◽  
Navesh K. Sharma ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Liver Metastases ◽  
Response Rate ◽  
Objective Response ◽  
Hepatic Metastases ◽  
First Line ◽  
Selective Internal Radiotherapy ◽  
Internal Radiotherapy ◽  
Randomized Studies

3507 Background: The FOXFIRE, SIRFLOX and FOXFIRE-Global (FF-SF-FFG) randomized studies evaluated the efficacy of combining first-line chemotherapy for metastatic colorectal cancer (mCRC) with selective internal radiotherapy (SIRT) using yttrium-90 resin microspheres in patients with liver metastases. The studies were designed for prospective, combined analysis of overall survival (OS). Methods: FF-SF-FFG randomized (1:1) chemotherapy-naïve mCRC patients (performance status 0/1) with liver metastases not suitable for curative resection/ablation. Arm A was oxaliplatin-based chemotherapy (mFOLFOX6/ OxMdG) ± investigator-chosen biologically targeted agent. Arm B was the same systemic therapy (oxaliplatin dose modification) + single treatment SIRT with cycle 1/2 of chemotherapy. Primary tumor in situ and/or limited extra-hepatic metastases were permitted. Minimum sample size was 1075 patients (HR 0.8, 80% power, two-sided 5% significance). Secondary outcomes included PFS, liver-specific PFS and response rate. Apart from safety, outcomes were analysed on intention-to-treat population using meta-analytic methods of pooled individual patient data. Results: Between 2006 and 2014, 1103 patients were randomized in 14 countries. Median age was 63 years (range 23-89); median follow-up 43.3 months. There were 844 deaths. There was no difference in OS (HR 1.04; 95% CI 0.90-1.19, p= 0.609) or PFS (HR 0.90, CI 0.79-1.02, p= 0.108) between Arms. Objective response rate ( p= 0.001) and liver-specific progression (HR 0.51, CI 0.43-0.62, p< 0.001) were significantly more favorable in Arm B. Patients in Arm B had higher risk of non-liver progression as first event (HR 1.98, CI 1.53-2.58, p< 0.001). Grade 3-5 adverse events were more common in Arm B (74.0%) than A (66.5%), p= 0.009. In health status questionnaires, EQ-5D utility scores were not significantly different between Arms at 6, 12 or 24 months. Conclusion: Despite higher response rates and improved liver-specific PFS, the addition of SIRT to first-line oxaliplatin-fluorouracil chemotherapy for patients with liver-only and liver-dominant mCRC did not improve OS or PFS. Clinical trial information: 83867919.

Length of Hospital Stay is an Independent Predictor of Overall Survival in Patients with systemic AL Amyloidosis

2017 ◽  
Vol 17 (1) ◽  
pp. e109
Author(s):  
Ahmed Mohamed Abdel Shafì ◽  
Carol Whelan ◽  
Marianna Fontana ◽  
Cristina Quarta ◽  
Shameem Mahmood ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hospital Stay ◽  
Independent Predictor ◽  
Length Of Hospital Stay ◽  
Al Amyloidosis

scholarly journals Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study (Preprint)

2020 ◽  
Author(s):  
Sung-Yeon Cho ◽  
Sung-Soo Park ◽  
Min-Kyu Song ◽  
Young Yi Bae ◽  
Dong-Gun Lee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
High Risk ◽  
Hospital Stay ◽  
Risk Score ◽  
Validation Cohort ◽  
Length Of Hospital Stay ◽  
Risk Groups ◽  
Prognosis Score ◽  
Very High

BACKGROUND As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. OBJECTIVE In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. METHODS We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. RESULTS Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count &lt;1000/mm<sup>3</sup>. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (<i>P</i>&lt;.001). The length of hospital stay and disease severity were directly associated with overall survival (<i>P</i>&lt;.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). CONCLUSIONS The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic.

Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

2020 ◽  
Vol 138 (5) ◽  
pp. 407-413
Author(s):  
Isabel Pinto Amorim das Virgens ◽  
Ana Lúcia Miranda de Carvalho ◽  
Yasmim Guerreiro Nagashima ◽  
Flavia Moraes Silva ◽  
Ana Paula Trussardi Fayh
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Length Of Hospital Stay ◽  
Colorectal Cancer Patients

Hepatic Arterial Infusion Versus Systemic Therapy for Hepatic Metastases From Colorectal Cancer: A Randomized Trial of Efficacy, Quality of Life, and Molecular Markers (CALGB 9481)

2006 ◽  
Vol 24 (9) ◽  
pp. 1395-1403 ◽  
Author(s):  
Nancy E. Kemeny ◽  
Donna Niedzwiecki ◽  
Donna R. Hollis ◽  
Heinz-Josef Lenz ◽  
Robert S. Warren ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colorectal Cancer ◽  
Overall Survival ◽  
Molecular Markers ◽  
Systemic Therapy ◽  
Systemic Treatment ◽  
Hepatic Metastases ◽  
Hepatic Arterial Infusion ◽  
Arterial Infusion

Purpose Hepatic metastases derive most of their blood supply from the hepatic artery; therefore, for patients with hepatic metastases from colorectal cancer, hepatic arterial infusion (HAI) of chemotherapy may improve outcome. Methods In a multi-institutional trial, 135 patients were randomly assigned to receive HAI versus systemic bolus fluorouracil and leucovorin. The primary end point was survival; secondary end points were response, recurrence, toxicity, quality of life, cost, and the influence of molecular markers. Results Overall survival was significantly longer for HAI versus systemic treatment (median, 24.4 v 20 months; P = .0034), as were response rates (47% and 24%; P = .012) and time to hepatic progression (THP; 9.8 v 7.3 months; P = .034). Time to extrahepatic progression (7.7 v 14.8 months; P = .029) was significantly shorter in the HAI group. Quality-of-life measurements showed improved physical functioning in the HAI group at the 3- and 6-month follow-up assessments. Toxicity included grade ≥ 3 neutropenia (2% and 45%; P < .01), stomatitis (0% and 24%; P < .01), and bilirubin elevation (18.6% and 0; P < .01) in the HAI and systemic treatment groups, respectively. A greater proportion of men versus women receiving HAI experienced biliary toxicity (37% and 15%, respectively; P = .05). For HAI patients with thymidylate synthase levels in tumor less than or ≥ 4, the median survival was 24 and 14 months, respectively (P = .17). Conclusion HAI therapy increased overall survival, response rate, THP, and was associated with better physical functioning compared with systemic therapy. Additional studies need to address the overall benefit and cost of new chemotherapy agents versus HAI alone or the combination of HAI with new agents.

Sign in / Sign up

Export Citation Format

Share Document