Laparoscopy-assisted gastrectomy in the elderly: experience from a UK centre

BACKGROUND Gastric cancer has a high incidence in the elderly in the UK, with a significant number of patients aged 75 years or more. While surgery forms the mainstay of treatment, evidence pertaining to the management of gastric cancer in the Western population in this age group is scarce. METHODS We retrospectively reviewed the outcomes of laparoscopy-assisted total and distal gastrectomies at our centre from 2005 to 2015. Patients aged 70 years or above were included in the elderly group. RESULTS A total of 60 patients underwent laparoscopy-assisted gastrectomy over a 10-year period, with a predominance of male patients. There was no significant difference in the rate of overall surgical and non-surgical complications, in-hospital mortality, operation time and length of hospital stay, between the elderly and non-elderly groups. Univariate analysis, performed for risk factors relating to anastomotic leak and surgical complications, showed that age over 70 years and higher American Association of Anesthesiologists grades are associated with a higher, though not statistically significant, number of anastomotic leaks (P = 1.000 and P = 0.442, respectively) and surgical complications (P = 0.469 and P = 0.162, respectively). The recurrence rate within the first 3 years of surgery was significantly higher in the non-elderly group compared with the elderly group (Log Rank test, P = 0.002). There was no significant difference in survival between the two groups (Log Rank test, P = 0.619). CONCLUSIONS Laparoscopy-assisted gastrectomy is safe and feasible in an elderly population. There is a need for well-designed, prospective, randomised studies with quality of life data to inform our practice in future.

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RA05.09: THE INFLUENCE OF AGE ON OVERALL SURVIVAL AND COMPLICATIONS AFTER IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGEAL SURGERY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra05.09 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 29-29

Author(s):

Nikolaj Baranov ◽

Frans Van Workum ◽

Jolijn Van Der Maas ◽

Ewout Kouwenhoven ◽

Marc Van Det ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Elderly Patients ◽

Surgical Complications ◽

Conflicts Of Interest ◽

Postoperative Mortality ◽

The Elderly ◽

Elderly Group ◽

Ivor Lewis ◽

Significant Difference

Abstract Background Worldwide, the number of elderly patients suffering from esophageal cancer is increasing due to the increasing incidence of esophageal cancer and increasing life expectancy of the general population. The effect of age on morbidity, mortality and survival after Ivor Lewis totally minimally invasive esophagectomy (TMIE) with curative intention are not well known since elderly patients have been excluded in randomized trials. Methods A retrospective analysis of a prospectively documented database from December 2010 to June 2017 was performed, including all patients who underwent Ivor Lewis TMIE with curative intent for esophageal cancer in three Dutch hospitals. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Postoperative complications, in-hospital mortality, 30 and 90 days mortality, long-term complications and survival were compared between these two groups. Results Four hundred and forty-six patients were included, 89 patients in the elderly group and 357 patients in the younger group. In the elderly group, a significantly higher incidence of non-surgical complications (77.5% versus 66.7%; P = 0.048), cardiovascular complications (24.7% versus 14.0%; P = 0.014) and delirium (27.0% versus 11.8%; P = 0.000) was found. There was no significant difference in surgical complications, overall complications, 30-day mortality, 90-day mortality, 1-year survival and 2-year survival. Conclusion Although Ivor Lewis TMIE in elderly patients is associated with a higher rate of non-surgical complications, it can be safely performed without increasing postoperative mortality. Disclosure All authors have declared no conflicts of interest.

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Nutritional assessment and surgical outcomes in very elderly patients undergoing pancreaticoduodenectomy: a retrospective study

10.21203/rs.3.rs-40426/v1 ◽

2020 ◽

Author(s):

Masashi Utsumi ◽

Hideki Aoki ◽

Seichi Nagahisa ◽

Yuta Une ◽

Yuji Kimura ◽

...

Keyword(s):

Overall Survival ◽

Retrospective Study ◽

Elderly Patients ◽

Survival Rates ◽

The Elderly ◽

Elderly Group ◽

Rank Test ◽

Elderly Age ◽

Nutritional Factors ◽

Log Rank Test

Abstract Background Conflicting data on the safety of pancreaticoduodenectomy (PD) for elderly patients exist. Therefore, this study aimed to evaluate and compare the nutritional factors and clinical outcomes of PD between elderly and non-elderly patients.Methods A retrospective study of 122 consecutive patients who underwent PD from April 2008 to April 2020 was conducted. Preoperative and postoperative nutritional factors (prognostic nutritional index [PNI]), complication rates, and survival rates were compared between the elderly (age ≥80 years) and non-elderly (age <80 years) patient groups. Furthermore, changes in nutrition markers were evaluated before surgery to 1 year after surgery. Data were analyzed using unpaired Student’s t-test, chi-squared test with Fisher’s exact test, and log-rank test.Results A total of 20 elderly patients (16.4%) and 102 non-elderly patients (83.6%) underwent PD. With respect to preoperative factors, elderly patients had a significantly lower PNI than non-elderly patients. The duration of operation, amount of blood loss, postoperative complication rate, and incidence rate of pancreatic fistula were similar between the two groups. At 3 months postoperatively, elderly patients had a lower albumin level and PNI than non-elderly patients. The median length of hospital stay was significantly longer in the elderly group than in the non-elderly group (39.9 vs. 27 days, P=0.004). The rate of death due to other diseases was relatively higher in the elderly group than in the non-elderly group. Elderly patients had a significantly lower overall survival rate than non-elderly patients (1-/3-/5-year overall survival rates: 78.1%/26.7%/13.3% vs. 87.1%/54.4%/46.7%; log-rank test, P=0.008).Conclusions Elderly patients had a lower nutritional status and lower survival rate than non-elderly patients. Careful patient selection and optimal perioperative care are necessary to determine whether PD is indicated for elderly patients.

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Prognostic Factors in the UK LRF CLL4 Trial.

Blood ◽

10.1182/blood.v108.11.299.299 ◽

2006 ◽

Vol 108 (11) ◽

pp. 299-299 ◽

Cited By ~ 11

Author(s):

David Graham Oscier ◽

Rachel Wade ◽

Jenny Orchard ◽

Zadie Davis ◽

Giles Best ◽

...

Keyword(s):

Risk Group ◽

Univariate Analysis ◽

Treatment Modalities ◽

Rank Test ◽

P Value ◽

Cox Regression Analysis ◽

Log Rank Test ◽

Significant Difference ◽

Trisomy 12 ◽

Vh Genes

Abstract The LRF CLL4 trial randomised 777 previously untreated patients with Binet stage progressive A, B or C disease between January 1999 and October 2004 to receive either Chlorambucil, Fludarabine or Fludarabine and Cyclophosphamide. Interphase FISH for deletions of chromosome 6q, 11q, 13q, 17p and trisomy 12, IgVH gene mutational status (98% cut off), CD38 (7% cut off) and ZAP70 (10% cut off) expression were measured at randomisation on 579, 523, 535 and 478 patients respectively. Leukemic cells from 39 patients utilised the VH3-21 gene of whom 33 had homologous CDR3’s. Among the biological markers, log rank analysis showed that >20% p53 loss, del 11q, unmutated VH genes, high CD38 and high ZAP 70 correlated with disease progression or death (Table 1) but not deletion of chromosome 6q, 13q and trisomy 12 (p=0.7, 0.3 and 0.2 respectively). There was no difference in PFS or response duration between the 52 patients with 5–20% p53 loss and the 494 patients with no p53 loss. Multivariate Cox regression analysis showed that >20% p53 loss (p<0.0001), unmutated IgVH genes (p=0.0001), deletion of 11q (p=0.02) and male gender (p=0.03) were independent risk factors for short PFS. The effects of stage and age were overridden by FISH abnormalities. High ZAP70 expression was only significant when VH gene mutation status was not included in the model. CD38 expression was only significant in univariate analysis. Table 1 Variable Progression or Death/N Univariate p-value(log rank test) Gender Male 384/573 0.002 Female 111/204 17q(p53) No 131/546 <0.00005 Yes 21/33 IgVH Unmutated 105/203 <0.00005 Mutated 225/320 del 11q No 288/463 <0.00005 Yes 87/116 ZAP70 Negative 140/242 0.003 Positive 158/236 CD38 Negative 110/201 0.0001 Positive 227/334 Among the 320 unmutated cases there was no significant difference in PFS between those with 100% homology (227 cases) and those with 99% or 98% homology to the germline sequence (93 cases). Mutated VH3-21 cases were more likely to express ZAP70 than other mutated cases, p=0.004. Excluding patients with >20% p53 loss, patients using the VH3-21 gene had similar progression free survival (PFS) to those remaining patients with unmutated VH genes and an inferior PFS to those with mutated VH genes (2p=0.0001). The adverse prognostic significance of 11q deletions was not clearly evident in an interim analysis presented at ASH ‘05. Patients can now be divided into 3 risk groups (Table 2). This risk stratification provides the basis of evaluating differing treatment modalities for each risk group in subsequent clinical trials. Table 2 Risk Group Definition Progression or Death/N Univariate p-value (log-rank test) 3 yr PFS Poor >20%p53 loss 28/33 0% Standard Unmutated VH or 11q deletion or VH3-21 208/292 <0.00001 24.7% Good Mutated VH(excl VH3–21) 79/161 55.0%

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Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

Innovative Surgical Sciences ◽

10.1515/iss-2020-0030 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Andrés Moreno Roca ◽

Luciana Armijos Acurio ◽

Ruth Jimbo Sotomayor ◽

Carlos Céspedes Rivadeneira ◽

Carlos Rosero Reyes ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cohort Study ◽

Survival Time ◽

Univariate Analysis ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

Icd 10 ◽

The Difference ◽

Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

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Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽

10.1186/s12893-021-01153-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuo-meng Xiao ◽

Ping Zhao ◽

Zhi Ding ◽

Rui Xu ◽

Chao Yang ◽

...

Keyword(s):

Gastric Cancer ◽

Proximal Gastrectomy ◽

Operation Time ◽

Nutrition Status ◽

Proximal Gastric Cancer ◽

Double Tract Reconstruction ◽

Significant Difference ◽

Laparoscopic Proximal Gastrectomy ◽

Gastric Cancer Patients ◽

Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

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Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

BMC Cancer ◽

10.1186/s12885-021-07919-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yanrui Liang ◽

Liying Zhao ◽

Hao Chen ◽

Tian Lin ◽

Tao Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

Retrospective Cohort ◽

Stage Iii ◽

Rank Test ◽

Oral Capecitabine ◽

D2 Gastrectomy ◽

Log Rank Test

Abstract Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

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Chemoradiotherapy is an Alternative Choice for Patients with Primary Mediastinal Seminoma

10.21203/rs.3.rs-1197566/v1 ◽

2021 ◽

Author(s):

Yirui Zhai ◽

Bo Chen ◽

Xiaoli Feng ◽

Kan Liu ◽

Shulian Wang ◽

...

Keyword(s):

Univariate Analysis ◽

Progression Free Survival ◽

Poor Performance ◽

Rank Test ◽

Clinicopathologic Characteristics ◽

Cancer Specific Survival ◽

Adjacent Structures ◽

Significant Difference ◽

Mediastinal Seminoma ◽

Alternative Choice

Abstract Background: The low incidence of primary mediastinal seminomas has precluded the development of clinical trials on mediastinal seminomas. We investigated the clinicopathologic characteristics, prognosis of patients with primary mediastinal seminomas as well as the efficiency of nonsurgical treatments compared with treatments containing surgery.Methods: We retrospectively collected data on the clinicopathologic characteristics, treatments, toxicities, and survival of 27 patients from a single center between 2000 and 2018. Patients were divided into two groups according to whether they received operation. Survivals were assessed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test.Results: The median age was 28 (13-63) years. The most common symptoms were chest pain (29.6%), cough (25.9%), and dyspnea (22.2%). There were 13 and 14 patients in surgery and non-surgery group. Patients in the non-surgical group were more likely to be with poor performance scores (100% vs.76.9%) and disease invaded to adjacent structures(100% vs.76.9%) especially great vessels(100% vs.46.2%).The median follow-up period was 32.23 (2.7-198.2) months. There was no significant difference of overall survival (5-year 100% vs 100%), cancer-specific survival (5-year 100% vs.100%), local regional survival (5-year 91.7% vs.90.0%, p=0.948) , distant metastasis survival (5-year 100.0% vs. 90.9%, p=0.340) and progression-free survival (82.5% vs.90.0%, p=0.245) between patients with and without surgery. Conclusions: Primary mediastinal seminoma was with favorable prognosis, even though frequently invasion into adjacent structures brings difficulties to surgery administration. Chemoradiotherapy is an alternative treatment with both efficacy and safety.

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Clinical evaluation of the failure rate of metallic brackets bonded with orthodontic composites

Brazilian Dental Journal ◽

10.1590/s0103-64402012000400015 ◽

2012 ◽

Vol 23 (4) ◽

pp. 399-402 ◽

Cited By ~ 5

Author(s):

Fábio Lourenço Romano ◽

Rodrigo Alexandre Valério ◽

Jaciara Miranda Gomes-Silva ◽

José Tarcísio Lima Ferreira ◽

Gisele Faria ◽

...

Keyword(s):

Failure Rate ◽

Orthodontic Treatment ◽

Color Change ◽

Rank Test ◽

Initial Alignment ◽

Bond Failure ◽

Log Rank Test ◽

Significant Difference ◽

Mandibular Teeth

The purpose of the present study was to evaluate in vivo the failure rate of metallic brackets bonded with two orthodontic composites. Nineteen patients with ages ranging from 10.5 to 38.7 years needing corrective orthodontic treatment were selected for study. The enamel surfaces from second premolars to second premolars were treated with Transbond Plus-Self Etching Primer (3M Unitek). Next, 380 orthodontic brackets were bonded on maxillary and mandibular teeth, as follows: 190 with Transbond XT composite (3M Unitek) (control) and 190 with Transbond Plus Color Change (3M Unitek) (experimental) in contralateral quadrants. The bonded brackets were light cured for 40 s, and initial alignment archwires were inserted. Bond failure rates were recorded over a six-month period. At the end of the evaluation, six bond failures occurred, three for each composite. Kaplan-Meyer method and log-rank test (Mantel-Cox) was used for statistical analysis, and no statistically significant difference was found between the materials (p=0.999). Both Transbond XT and Transbond Plus Color Change composites had low debonding rates over the study period.

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Behavior of gastric cancer in Brazilian population

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202009000100007 ◽

2009 ◽

Vol 22 (1) ◽

pp. 29-32 ◽

Cited By ~ 7

Author(s):

Carlos Eduardo Jacob ◽

Claudio Bresciani ◽

Joaquim José Gama-Rodrigues ◽

Osmar Kenji Yagi ◽

Donato Mucerino ◽

...

Keyword(s):

Gastric Cancer ◽

Gastric Resection ◽

Gastric Wall ◽

Age Groups ◽

Sao Paulo ◽

São Paulo ◽

Gender Ratio ◽

Male Predominance ◽

Number Of Patients ◽

Significant Difference

BACKGROUND: Gastric cancer (GC) is a predominately male disease. Usually for every female that suffers from this condition there are two males and occurred an increase in the number of females in last decades. Brazil is poor in data about this issue. AIM: To verify if in Brazil it happened: a) a change in the gender ratio and on the average age of the patients; b) an increase in the number of patients with 70 years of age or more suffering from this disease; c) changes in the gender ratio and in the average age in the several gastric locations during the period of study. METHODS: The medical history of patients diagnosed with primary gastric adenocarcinoma, between 1971 and 1998 were obtained at Hospital das Clínicas of the University of São Paulo, São Paulo, SP, Brazil. Exclusion criteria were: patients suffering from a non epithelial gastric malignancy; adenocarcinoma from the intestinal metaplasia in the distal esophagus invading the proximal stomach and patients submitted to a gastric resection, due to a benign or malignant tumor during the last five years prior to the surgical procedure analyzed in this study. The patients were divided into 10 years age groups and also divided in three groups, according to their ages and time intervals. Interrelationships between gender and age, and with tumor´s location on gastric wall were analyzed. RESULTS: From 1971 to 1998, 1578 patients with GC were hospitalized. Among them, 1021 were treated with gastric resection, corresponding to 64.7% of all patients. There was an increase in the proportion of patients older than 70 years, and decrease between 41 and 70 years. There was no statistical significant difference among the average ages and the different locations. There were significant differences for the locations favoring proximal third and stump, both more prevalent in males. CONCLUSIONS: a) Occurred modifications in the ratio between genders: greater number of women and an increase in the number of male patients in the age group between 41 and 70 years; b) it was proved the greater number of occurrences in patients over 70 years of age; c) there was a greater increase in the male predominance in the tumors located in the stomach´s proximal third.

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Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.11.peds13394 ◽

2014 ◽

Vol 13 (2) ◽

pp. 140-144 ◽

Cited By ~ 19

Author(s):

Jordan D. Lane ◽

John Mugamba ◽

Peter Ssenyonga ◽

Benjamin C. Warf

Keyword(s):

Cohort Study ◽

Low Income ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Shunt Infection ◽

Low Income Countries ◽

Rank Test ◽

Log Rank Test ◽

Significant Difference ◽

Chi Square Analysis

Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

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