Effect of body mass index on operative complications after robotic-assisted Ivor-Lewis esophagogastrostomy: Retrospective analysis of 133 cases at a single high-volume tertiary care center.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 109-109
Author(s):  
Matthew R. Thau ◽  
Tobin Joel Crill Strom ◽  
Khaldoun Almhanna ◽  
Nadia Saeed ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Tertiary Care ◽  
Operating Time ◽  
High Volume ◽  
R0 Resection ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Operative Complications ◽  
High Bmi

109 Background: The impact of body weight on robotic-assisted surgical morbidity has not been studied in esophageal cancer. We thus examined operative outcomes in patients according to their body mass index (BMI) following robotic-assisted Ivor-Lewis Esophagogastrostomy (RAIL) at a high-volume tertiary-care referral cancer center and evaluated the safety of robotic surgery in patients with an elevated BMI. Methods: We retrospectively studied patients who underwent RAIL for pathologically confirmed malignancy in the distal esophagus and assessed morbidity and intraoperative outcomes relative to BMI. We evaluated operative complications from surgery to discharge, including average operating time, estimated blood loss (EBL), pneumonia, atrial fibrillation, pulmonary embolism, deep vein thrombosis, wound infection, and surgical leaks. Median ICU days after surgery and 30 day operative mortality was assessed. Wilcoxon Rank-Sum and Spearman Coefficient were used. Results: Of 134 total patients, 106 were male and 28 were female, with an average age of 67 years. Among patients, 76% (N=102) received neoadjuvant therapy. According to BMI, 3 patients were underweight, 35 were normal weight, 62 were overweight, and 34 were obese. All patients had R0 resection, with a median of 19 lymph nodes removed. Among evaluated surgical complications, anastomotic leak rate was significantly higher in patients with high BMI (p=0.01). Median operating time was 407 mins and EBL was 150cc. High BMI was significantly associated with increased operation time and EBL (p=0.01 & p=0.05, respectively). Conclusions: This retrospective study shows that patients with distal esophageal cancer and an elevated BMI undergoing RAIL have increased operative times and EBL during the procedure. An elevated postoperative risk for anastomotic leak also exists and must be carefully monitored. However, BMI does not affect the quality of oncological resection as determined by the number of harvested lymph nodes and rates of R0 resection, suggesting similar outcomes irrespective of BMI among all patients undergoing RAIL at a high volume tertiary center.

Outcomes of 27 gauge pars plana vitrectomy for a variety of posterior segment diseases

2021 ◽  
Vol 71 (11) ◽  
pp. 2570-2575
Author(s):  
Muhammad Amer Awan ◽  
Fiza Shaheen ◽  
Kholood Janjua
Keyword(s):  
Retinal Detachment ◽  
Pars Plana Vitrectomy ◽  
Tertiary Care ◽  
Operating Time ◽  
Retinal Vasculitis ◽  
Posterior Segment ◽  
Care Hospital ◽  
Silicon Oil ◽  
Operative Complications ◽  
Pars Plana

Objective:  To report our experience with 27 gauge (27G) pars plana vitrectomy (PPV) system for a variety of simple to complex posterior segment disorders Methods: Single center, Retrospective, Cohort study. Data of 665 eyes of 574 patients that underwent 27G PPV for a variety of indications from July 2015 to June 2019 at a tertiary care hospital was analyzed. Results: Common surgical indications included; Diabetic tractional retinal detachment (196, 29.5%), vitreous haemorrhage (191, 28.7%), full thickness macular hole (80, 12%), epiretinal membrane (66, 9.9%), endophthalmitis (26, 3.9%), tractional diabetic macular edema (14, 2.1%), ectopia lentis (11, 1.7%), dropped lens matter (13, 2%) and others (68, 10.2%). Mean operating time was 62 ± 37 minutes. With the exception of 2 cases where 20G fragmatome was utilized, no case required conversion to 20 gauge system while a 25G trocar was used for the silicon oil injection. Per-operative complications included; iatrogenic retinal tear (2 eyes, 0.3%) and supra choroidal silicon oil migration (1 eye, 0.15%). Post-operative complications were raised IOP (7 eyes, 1%), endophthalmitis (1 eye, 0.15%), hemorrhagic occlusive retinal vasculitis (1 eye, 0.15%) and retinal detachment (2 eyes, 0.3%). Mean Visual Acuity improved from 1.62 ± 0.68 logarithm of minimum angle of resolution (logMAR) to 0.4 ± 0.38 logMAR (P <0.001). Conclusion: With 3 months follow up time, 27 G PPV has proved to be a safe and effective system for both simpler and complex retinal pathologies requiring significant surgical manipulation. Continuous...

Blood-based-inflammation-markers, body mass index, and survival of nonmetastatic esophageal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 324-324
Author(s):  
Wanning Wang ◽  
Joelle Soriano ◽  
Tyler Soberano ◽  
Katrina Hueniken ◽  
M. Catherine Brown ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Esophageal Cancer ◽  
Body Mass ◽  
Cox Regression ◽  
Locally Advanced ◽  
Continuous Variables ◽  
Inflammation Markers ◽  
Lymphocyte Ratio ◽  
Risk Of Death ◽  
High Bmi

324 Background: Blood-based-inflammation-markers (BBIM) and Body Mass Index (BMI) have been associated with overall survival (OS) in a number of cancers. Inflammation and obesity have biological interactions. We evaluated the role of Neutrophil-to-Lymphocyte-Ratio (NLR), Platelet-to-Lymphocyte-Ratio (PLR) and Systemic-Inflammation-Index (SII) in conjunction with BMI as predictors of OS in localized/locally-advanced-esophageal cancer (LEC/LAEC). Methods: LEC/LAEC patients treated from 2006-2014 had the following variables analyzed both as continuous and categorical: BMI (low <25 kg/m2, high ≥25 kg/m2), NLR (low <4, high ≥4), PLR (low <232, high ≥232), and SII (low <1375, high ≥1375), with OS. Univariate (UVA) and Multivariate analysis (MVA) were analyzed using Cox regression (adjusted hazard ratios, aHR; 95% Confidence Intervals, CI). MVA models of OS were built, assessing different categorical combinations of BBIM factors with and without BMI. Results: Of 411 pts, 79% were males, median age was 63.5 years, 67% were adenocarcinomas; Stage I/II/III: 14%, 28%, 59%; Median BMI was 26.5kg/m2 and BMI distribution was: 3% underweight, 40% normal weight, 37% overweight and 20% obese. After a median follow-up of 87 months, 204 pts recurred, and 257 died. In MVA, BMI alone had no impact on OS (aHR 0.89, CI 0.7-1.1, p=0.15); individually as continuous variables, higher SII (p=0.03) and higher NLR (p=0.006) were inversely associated with OS whereas higher PLR was not (p=0.10). In an MVA of categorical combinations of BMI and BBIM on OS, patients in the high-BMI/low-PLR group were at lower risk of death when compared to all other groups (aHR=0.65, 95%CI:0.5-0.8, p=0.007). Similar non-statistically significant trends were shown when SII and NLR were individually combined with BMI (aHR=0.77, 95%CI:0.6-1.0, p=0.09; aHR=0.74, 95%CI:0.5-1.0, p=0.05, respectively). Conclusions: Our results suggest that in LEC/LAEC pts, high BMI and low PLR together are associated with improved OS when compared to pts with low BMI and/or high PLR. NLR and SII alone were associated with OS. Further studies evaluating the underlying mechanisms of BBMI, in particular PLR and inflammation/obesity are warranted.

Safety and oncologic outcomes of robotic-assisted esophagogastrectomy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 93-93
Author(s):  
Sebastian G. De La Fuente ◽  
Jill M. Weber ◽  
Sarah E. Hoffe ◽  
Ravi Shridhar ◽  
Khaldoun Almhanna ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Operating Time ◽  
Surgical Oncology ◽  
Oncologic Outcomes ◽  
Tumor Type ◽  
Robotic Assisted ◽  
Icu Stay ◽  
Estimated Blood Loss ◽  
The Mean

93 Background: The introduction of robotic systems to surgical oncology has allowed improved visualization with more precise manipulation of tissues. In esophageal cancer patients, this is crucial since most patients undergo neoadjuvant therapy (NT) prior to surgical resection. We report our initial experience in patients undergoing robotic-assisted Ivor-Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center. Methods: A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics such as age, gender, and body mass index (BMI) were recorded. Oncologic outcomes include tumor type, location, NT, post-operative tumor margins, and nodal harvest. Immediate 30-day postoperative complications were also recorded. Results: We identified 50 patients who under went RAIL with median age of 66 (42-82 years). The mean BMI was 28.6 ± 0.7, 67% of patients received NT and 54% had an ASA classification of 3. The mean and median number of lymph nodes retrieved during surgery was 20 ± 1.4 and 18.5 (8-63) respectively. R0 resections were achieved in all patients. The mean estimated blood loss was 146 ± 15 ml and there were no conversions to an open procedure. Postoperative complications occurred in 13 (26 %) of patients. Complications included atrial fibrillation 5 (10%), pneumonia 5 (10%), anastamotic leak 1 (2%), conduit staple line leak 1(2%), and chylous thorax 2 (4%). There were no wound infections documented. The median ICU stay and length of hospitalization (LOH) were 2 and 9 days respectively. Total mean operating time calculated from time of skin incision to wound closure was 453 ± 13 minutes. The mean operative time significantly decreased over time (first 23 cases 479 min vs. second 23 cases 428 min, p<0.05). Similarly the frequency of complications decreased significantly after 28 cases: 10 (35%) vs. 3 (13%) p=0.04. There were no in hospital mortalities. Conclusions: We demonstrated that RAIL for esophageal cancer can be performed safely with acceptable oncologic outcomes. RAIL may be associated with fewer complications after a learning curve, and shorter ICU stay and LOH.

End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

2022 ◽  
Author(s):  
Giovanni Capovilla ◽  
Edin Hadzijusufovic ◽  
Evangelos Tagkalos ◽  
Caterina Froiio ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Primary Outcome ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Mortality ◽  
The Other ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

scholarly journals P-OGC81 The learning curve for robotic assisted abdominal phase in two stage oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Patrick McQuillan ◽  
Salman Ahmed ◽  
Mazair Navidi ◽  
Shajahan Wahed ◽  
Arul Immanual
Keyword(s):  
Learning Curve ◽  
Operating Time ◽  
Open Group ◽  
R0 Resection ◽  
Two Stage ◽  
Nodal Count ◽  
Robotic Assisted ◽  
Significant Difference ◽  
Phase Group ◽  
The Mean

Abstract Background Robotic assisted oesophagectomy (RAO) is increasingly being utilised in the management of oesophageal cancer. RAO implementation into practice has an inevitable learning curve. As oesophagectomy usually involves at least 2 stages, a staggered approach to training and introduction of RAO can be done. A major advantage of this is that the surgeon can concentrate on overcoming the learning curve in one phase of the procedure at a time, whilst the remaining phase can be completed by an established technique. This study looks at the learning curve of a robotic assisted abdominal phase for two-stage oesophagectomy compared to an open abdominal phase to achieve parity. Methods This study uses a prospectively maintained database to retrospectively analyse the abdominal phase of the first 17 RAO compared to the previous 20 open abdominal phase procedures. The cases are sequential, done by a single surgeon at a large UK oesophagogastric referral centre. Operating time, nodal count, and R0 rate were reviewed to determine the number of cases on the learning curve to reach parity with the open procedure. Results The open abdominal phase group had a similar age (65.6 vs 65.7), pre-op anaerobic threshold (13.9 vs 14.6 p = 0.3) but a higher BMI (mean 30.6 vs 24.6 p &lt; 0.05) then the RAO group. All cases were T3 adenocarcinoma except for 2 cases in the robotic group (one HGD and one T2 adenocarcinoma). No RAO cases were converted to open. The mean time for the abdominal phase in the open group was 175.4 minutes with an average nodal count of 32.9. After 8 robotic assisted cases the mean operating time decreased from 267 minutes to 197 minutes, which was when a non-significant difference to the open group (p = 0.094) became apparent. The mean nodal count in the first 8 robotic assisted cases was 29.5 and increased to 38.4 in the subsequent cases. All patients had a R0 resection. Conclusions The multi-phase nature of oesophagectomy allows for modular implementation of a robotic programme. We have found that the learning curve for robotic assisted abdominal is around 8 cases. This allows for parity to open abdominal phase to be achieved regarding operative time, nodal count and R0 resection.

scholarly journals Is first trimester body mass index of antenatal mothers associated with selected feto-maternal outcomes?

2019 ◽  
Vol 8 (3) ◽  
pp. 1030
Author(s):  
Chanchal Arora ◽  
Smitha Thadathil ◽  
Rejani R. ◽  
Punita A. Sharma
Keyword(s):  
Body Mass Index ◽  
Birth Weight ◽  
Body Mass ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
First Trimester ◽  
New Born ◽  
Low Bmi ◽  
Study Participants ◽  
High Bmi

Background: Mothers are the creators and sustainers of progeny. The health and wellbeing of children is intimately linked with the health, nutrition, education and well-being of their mothers because she is both the seed as well as the soil where in the baby is nurtured for 9 months. Hence the present study was conducted to determine the association between first trimester body mass index (BMI) of antenatal mothers with the mode of delivery, birth weight and APGAR scores of new born babies at birth in a tertiary care hospital.Methods: A cross-sectional study was conducted amongst 115 antenatal mothers who reported to the Labor room in a tertiary care hospital of Pune during the period of Nov. 2017 to Feb. 2018, to determine the association between first trimester body mass index (BMI) of antenatal mothers with the mode of delivery, birth weight and APGAR scores of new born babies.Results: The findings were suggestive of increased odds of APGAR of <7 at 1 min of birth among new born babies born to the study participants of low BMI group as compared to the new born babies born to the high BMI group; Increased odds of birth weight of  >3.5 kg and gestational weight gain of >14 kg and greater odds of complications among new born babies born to the study participants of high BMI group than the new born babies born to the low BMI group.Conclusions: The study concluded that birth weight of the new born babies shows a clinically significant increasing trend in association with the increasing first trimester BMI of their mothers.

scholarly journals Intra-operative and Immediate Post-operative Complications in a High Volume Cataract Surgery Center

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Muhammad Ali Haider ◽  
Uzma Sattar ◽  
Muhammad Amjad
Keyword(s):  
Cataract Surgery ◽  
Anterior Chamber ◽  
Tertiary Care ◽  
Corneal Edema ◽  
High Volume ◽  
Ocular Lens ◽  
Operative Complications ◽  
Quasi Experimental ◽  
Capsular Rupture ◽  
Post Operative Complications

Purpose:  To find out the frequency of complications in a high volume phacoemulsification set up at a tertiary care eye hospital in Lahore. Study Design:  Quasi experimental study. Place and Duration of Study:  Al-Ehsan Eye Hospital, Lahore, from July 2017 to June 2019. Methods:  Surgical outcomes of 6902 patients who had undergone phacoemulsification were included. Patients were excluded if they had ocular infections, lid margin diseases, adnexal diseases, those requiring a secondary anterior chamber surgery and those unfit for the procedure due to medical grounds. Every patient underwent a detailed history and complete clinical examination. All patients underwent the standard phacoemulsification technique and at the end of each surgery, subconjunctival injections of dexamethasone and gentamycin were given to the patients. Complications encountered during high volume cataract surgery were recorded and their percentages were calculated. Results:  A total of 6902 patients underwent cataract surgery with 2.66% intra-operative and 6.94% immediate post-operative complications. The most common intra-operative complication was posterior capsular rupture (1.15%).  In patients with capsular rupture the intra ocular lens was implanted within the sulcus in 61 cases (0.88%) while in 12 cases (0.17%) anterior chamber lens was implanted because of lack of capsular support. During the surgery intra ocular lens could not be implanted in 7 cases (0.10%) and they were left aphakic. The commonest immediate post-operative adverse outcome was corneal edema with striate keratopathy and decements folds in 197 cases (2.85%). Conclusion:  High volume cataract surgery using appropriate techniques and sterilization does not compromise the quality of outcomes. Key Words:  Cataract, Phacoemulsification, Vitreous loss.

scholarly journals Laparoscopic versus conventional open appendicectomy: a prospective comparative analytical study in a tertiary care set up

2019 ◽  
Vol 7 (7) ◽  
pp. 2536
Author(s):  
Anurag Shrivastava ◽  
Anurag Jain ◽  
Rajiv Jain
Keyword(s):  
Operative Time ◽  
Tertiary Care ◽  
Operating Time ◽  
Open Appendectomy ◽  
Laparoscopic Appendicectomy ◽  
Open Appendicectomy ◽  
Open Procedure ◽  
Diagnostic Potential ◽  
Operative Complications ◽  
Set Up

Background: Present study outlines the outcomes of laparoscopic appendicectomy compared to open conventional appendicectomy in a tertiary care set up with aim to validate advantages and shortcomings of both procedures.Methods: A series of 80 cases above 18 years of age with clinical diagnosis of appendicitis having Alvarado score of seven and above were studied prospectively under the two groups after proper written consent: Open appendectomy-40 cases, Laparoscopic appendectomy-40 cases. Both groups were compared on grounds of intra-operative complications, additional diagnostic potential, operative time, postoperative analgesia, post-operative complications, length of hospital stay, subjective cosmesis, and return to routine normal activities. Values obtained were statistically analyzed.Results: The median operative time in Laparoscopic Appendicectomy was 58.22 minutes (range 32.68-85.46 min) as compared to open procedure which took 43.65 minutes (30.36-65.48min) (P<0.05). Conversion to open procedure was done in 10% (n=4) of laparoscopic cases. Mean value of postoperative pain by visual analogue scale was low in Laparoscopic Appendicectomy (LA) compared to Open Appendicectomy (OA) (P<0.05). Mean post-operative stay (3.2±0.34 days versus 2.3±0.24 days) and surgical site infection was recorded in 10 patients (25%) in OA group and 5 (13.9%) in LA group (P<0.05).Conclusions: It can be concluded that laparoscopic surgery is safe with greater diagnostic potential for additional pathologies and better Subjective cosmesis . But all these merits were at the price of longer operating time and a specialized set up needed for laparoscopy.

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