scholarly journals GASTRECTOMY IN OCTOGENARIANS WITH GASTRIC CANCER: IS IT FEASIBLE?

2020 ◽  
Vol 33 (4) ◽  
Author(s):  
Francisco Diogo Almeida SILVA ◽  
Marina Alessandra PEREIRA ◽  
Marcus Fernando Kodama Pertille RAMOS ◽  
Ulysses RIBEIRO-JUNIOR ◽  
Bruno ZILBERSTEIN ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Clinical Status ◽  
Subtotal Gastrectomy ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Curative Intent ◽  
Clinical Complications

ABSTRACT Background: The octogenarian population is expanding worldwide and demand for gastrectomy due to gastric cancer in this population is expected to grow. However, the outcomes of surgery with curative intent in this age group are poorly reported and it is unclear what matters most to survival: age, clinical status, disease´s stage, or the extent of the surgery performed. Aim: Evaluate the results of gastrectomy in octogenarians with gastric cancer and to verify the factors related to survival. Methods: From prospective database, patients aged 80 years or older with histologically confirmed adenocarcinoma who had undergone gastrectomy with curative intent were selected. Factors related to postoperative complications and survival were studied. Results: Fifty-one patients fulfilled the inclusion criteria. A total of 70.5% received subtotal gastrectomy and in 72.5% D1 lymphadenectomy was performed. Twenty-five (49%) had complications, in eleven major complications occurred (seven of these were clinical complications). Hospital length of stay was longer (8.5 vs. 17.8 days, p=0.002), and overall survival shorter (median of 1.4 vs. 20.5 months, p=0.009) for those with complications. D2 lymphadenectomy and the presence of postoperative complications were independent factors for worse overall survival. Conclusion: Octogenarians undergoing gastrectomy with curative intent have high risk for postoperative clinical complications. D1 lymphadenectomy should be the standard of care in these patients.

scholarly journals Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: a retrospective observational study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Seung Won Song ◽  
Kyung Yeon Yoo ◽  
Yong Sung Ro ◽  
Taehee Pyeon ◽  
Hong-Beom Bae ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Research Information ◽  
Significant Difference ◽  
Open Lobectomy

Abstract Background Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery. Methods We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group. The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95). Conclusions Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population. Trial registration This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

scholarly journals Surgical results of remnant gastric cancer treatment

2020 ◽  
Vol 47 ◽  
Author(s):  
MARCUS FERNANDO KODAMA PERTILLE RAMOS ◽  
MARIA CLAUDIA MACHADO PEREIRA ◽  
YARA SOUZA OLIVEIRA ◽  
MARINA ALESSANDRA PEREIRA ◽  
LEANDRO CARDOSO BARCHI ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Total Gastrectomy ◽  
Malignant Lesion ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Surgical Results ◽  
Remnant Gastric Cancer ◽  
Significant Difference

ABSTRACT Background: remnant gastric cancer (RGC) develops five years or later after previous resection for benign or malignant lesion. The treatment is performed through completion total gastrectomy (CTG) with radical lymphadenectomy. Some reports consider this procedure may be associated with higher rates of morbidity and mortality. Objective: to evaluate surgical results and survival after CTG in patients with RGC. Methods: 54 patients who underwent CTG between 2009 and 2019 were included in the study. As a comparison group 215 patients with primary gastric cancer (PGC) who underwent total gastrectomy (TG) in the same period were selected. Results: among the initial characteristics, age (68.0 vs. 60.5; p<0.001), hemoglobin values (10.9 vs. 12.3; p<0.001) and body mass index (22.5 vs. 24.6; p=0.005) were different between the RGC and PGC groups, respectively. The most frequent postoperative complications were related to pulmonary complications, infection and fistula in both groups. There was a higher incidence of esophagojejunal fistula in the CTG group (14.8% vs 6.5%, p=0.055). Perioperative mortality was higher in RGC patients (9.3% vs. 5.1%), but without significance (p=0.329). Hospital length of stay, postoperative complications graded by the Clavien-Dindo classification, mortality at 30 and 90 days were not different between groups. There was no significant difference in disease-free and overall survival between RGC and PGC groups. Conclusion: despite previous reports, surgical results and survival were similar between groups. Higher risk of esophagojejunal fistula must be considered.

scholarly journals Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: A retrospective observational study

2020 ◽  
Author(s):  
Seung Won Song ◽  
Kyung Yeon Yoo ◽  
Yong Sung Ro ◽  
Taehee Pyeon ◽  
Hong-Beom Bae ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Hospital Length ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Research Information ◽  
Significant Difference ◽  
Open Lobectomy

Abstract Background: Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce postoperative complications and thereby reduce hospital length of stay (LOS) after lung surgery. Methods: We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group.The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for prolonged LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results: Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95) and resulted in a shorter LOS in patients without a prolonged LOS). Among patients undergoing open lung lobectomy for lung cancer, compared to pyridostigmine, neuromuscular reversal with sugammadex resulted in a short hospital LOS and a lower incidence of postoperative complications, but showed a similar mortality. Conclusions: Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population.Trial registration: This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).

scholarly journals Laparoscopy in Liver Transplantation: The Future Has Arrived

HPB Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Quirino Lai ◽  
Rafael S. Pinheiro ◽  
Giovanni B. Levi Sandri ◽  
Gabriele Spoletini ◽  
Fabio Melandro ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Scientific Progress ◽  
Laparoscopic Approach ◽  
Standard Of Care ◽  
Radical Change ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Therapeutic Laparoscopy ◽  
Stage Disease ◽  
End Stage

In the last two decades, laparoscopy has revolutionized the field of surgery. Many procedures previously performed with an open access are now routinely carried out with the laparoscopic approach. Several advantages are associated with laparoscopic surgery compared to open procedures: reduced pain due to smaller incisions and hemorrhaging, shorter hospital length of stay, and a lower incidence of wound infections. Liver transplantation (LT) brought a radical change in life expectancy of patients with hepatic end-stage disease. Today, LT represents the standard of care for more than fifty hepatic pathologies, with excellent results in terms of survival. Surely, with laparoscopy and LT being one of the most continuously evolving challenges in medicine, their recent combination has represented an astonishing scientific progress. The intent of the present paper is to underline the current role of diagnostic and therapeutic laparoscopy in patients waiting for LT, in the living donor LT and in LT recipients.

Postoperative Complications and Functional Results After Subtotal Gastrectomy with Billroth II Reconstruction for Primary Gastric Cancer

2007 ◽  
Vol 52 (8) ◽  
pp. 1757-1763 ◽  
Author(s):  
Corrado Pedrazzani ◽  
Daniele Marrelli ◽  
Bernardino Rampone ◽  
Alfonso De Stefano ◽  
Giovanni Corso ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Subtotal Gastrectomy ◽  
Functional Results ◽  
Billroth Ii ◽  
Primary Gastric Cancer ◽  
Billroth Ii Reconstruction

Abstract 16744: MR Lymphatic Burden in Fontan Correlates With Outcomes

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Aswathy Vaikom House ◽  
Dawn R David ◽  
Julien Aguet ◽  
Anne I Dipchand ◽  
Osami Honjo ◽  
...  
Keyword(s):  
Clinical Status ◽  
Maximum Intensity Projection ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Non Invasive ◽  
Lymphatic Circulation ◽  
Patient Status ◽  
Projection Image ◽  
Fontan Failure ◽  
Fontan Patients

Introduction: The importance of the lymphatic circulation in Fontan physiology is incompletely understood and may have implications in Fontan ‘failure’. Non-invasive imaging of the lymphatic system with heavily T2-weighted MRI sequences could be a useful tool for patient surveillance and prognostication. We sought to quantify lymphatic burden in Fontan patients and correlate with clinical status. Methods: Consecutive pediatric Fontan patients, <18 years-old with clinical cardiac MRI that had routine acquisition of lymphatic 3D T2 FSE imaging performed from May 2017 to Oct 2019 were included. ‘Lymphatic burden’ was quantified by thresholding-based segmentation of the 3D T2 FSE maximum intensity projection image (fig), generating a surrogate measurement of lymphatic volume, and was performed by 2 independent readers blinded to patient status. Spearman correlation and Mann-Whitney tests were used. Results: There were 48 patients (27 males) with median age at MRI of 12.9 (9.4-14.7) years, age at Fontan of 3.3 (2.9-3.8) years, and time from Fontan at MRI of 9.2 (5.9-10.4) years. Inter-rater agreement for lymphatic burden was excellent (ICC 0.96 [0.94-0.98]). Greater lymphatic burden correlated with hospital length of stay and duration of chest tube drainage post-Fontan (r =0.423, p=0.003 and r=0.419, p=0.003). Median lymphatic burden was greater in patients that had chylous effusions post-Fontan (286 (157-492) ml vs 123 (60-271) ml, p=0.011) and in patients with composite adverse outcome (n=12) defined by heart failure (n=3), transplant assessment (n=2), recurrent effusions (n=8), Fontan thrombus (n=2), and/or PLE (n=6) post-Fontan; (458 (266-2016) ml vs 130 (272-256) ml, p=0.005). Pre-Fontan mean PA pressure and time from Fontan did not correlate with lymphatic burden (r=0.062, p=0.676 and r=0.139, p= 0.343). Conclusion: Quantification of MR lymphatic burden is a reliable tool to assess lymphatic status post-Fontan and is associated with clinical outcomes.

Trauma Attending Physician Continuity: Does it Make a Difference?

2010 ◽  
Vol 76 (1) ◽  
pp. 48-54
Author(s):  
David G. Jacobs ◽  
Jennifer L. Sarafin ◽  
Karen E. Head ◽  
A Britt Christmas ◽  
Toan Huynh ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Trauma Service ◽  
Retrospective Comparison ◽  
Scale Scores ◽  
Attending Physician

Continuity of care is important in achieving optimal outcomes in trauma patients, but the optimal length of the trauma attending (TA) rotation is unknown. We hypothesize that longer TA rotations provide greater continuity, and therefore improve outcomes. We did a retrospective comparison of trauma patient outcomes from two consecutive 6-month periods during which we transitioned from a 1-month TA rotation to a 1-week TA rotation. The Wilcoxon rank sum test, and the χ2 were used for statistical analysis. Over the 12-month study period 1924 patients were admitted to the Trauma Service. The two groups were similar with regard to age, gender, injury mechanism, Injury Severity Score and Glasgow Coma Scale scores, and Abbreviated Injury Scores for the chest, abdomen, and extremities. Although mortality, patient charges, and violations of the standard of care were similar between the two groups, overall morbidity was lower (18.6% vs 23.2%), and hospital length of stay higher (9.07 days vs 8.41 days) in the 1-week TA group compared with the 1-month TA group. A one-week TA rotation was associated with a longer hospital length of stay, but improved morbidity. Longer TA rotations do not necessarily provide improved continuity or improved outcomes.

Docetaxel plus FOLFOX4 compared with FOLFOX4 as adjuvant chemotherapy for gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 181-181
Author(s):  
Chun-Xia Du ◽  
Xiao-Yan Liu ◽  
Hong-Gang Zhang ◽  
Ai-Ping Zhou
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Survival Rates ◽  
Subtotal Gastrectomy ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Ptnm Stage ◽  
Gastric Cancer Patients

181 Background: To compare the efficacy of docetaxel plus FOLFOX4 to FOLFOX4 as adjuvant chemotherapy for gastric cancer patients. Methods: 320 patients with stage IB-IV (M0) gastric cancer were enrolled into the retrospective study. All patients received a total or subtotal gastrectomy with at least D1 lymph nodes dissection. 193 patients received FOLFOX4 as adjuvant chemotherapy. 127 patients received biweekly docetaxel plus FOLFOX4 (DOF regimen) as adjuvant chemotherapy. Docetaxel was administered at 40 mg/m2 on day 1, followed by FOLFOX4 regimen. Both of the regimens were repeated every 2 weeks for a maximum of 12 cycles. Results: In comparison with patients in FOLFOX4 group, patients in DOF group were relatively younger (p=.001), with more advanced disease in pN stage (p=.035) and pTNM stage (p=.031), received more cycles of adjuvant chemotherapy (p=.004), and had a higher percentage of adjuvant radiation (p =.002). After adjustment of unbalanced variables as mentioned above, no statistical difference was observed between DOF group and FOLFOX4 group in terms of 3-year disease-free survival (54% vs 69%, p = 0.100, HR 1.362, 95% CI (0.943-1.967)) and 3-year overall survival(70% vs 72%, p = 0.810, HR 1.049, 95% CI (0.711-1.548)). Stratified analysis according to clinicopathologic characters showed that there were almost no statistical differences of 3-year overall survival rates between two groups, except the primary site (middle 1/3) (p =.025) and pTNM stage (IIb stage) (p =.035) in favor of FOLFOX4 group. The incidences of grade 3/4 adverse events were obviously higher in DOF group than in FOLFOX4 group,including decreased appetite (18.1% V 10.4%, P = 0.046), diarrhea (4.7% V 0%, p=0.004 ), hypersensitivity reactions to oxaliplatin (3.1% V 0%, p=0.024) and neutropenia (47.3% V 31.6%, p=0.004). Conclusions: Compared to FOLFOX4 regimen, adjuvant docetaxel plus FOLFOX4 did not show significant survival advantages in gastric cancer patients. However, a more serious toxicity profile was observed in docetaxel plus FOLFOX4 arm. Further studies are needed to decide whether triplet regimen is appropriate as adjuvant chemotherapy of gastric cancer.

scholarly journals Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 73
Author(s):  
Cahyo Wibisono Nugroho ◽  
Satriyo Dwi Suryantoro ◽  
Yuliasih Yuliasih ◽  
Alfian Nur Rosyid ◽  
Tri Pudy Asmarawati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Critically Ill ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Eligibility Criteria ◽  
All Cause Mortality ◽  
Clinical Benefits

Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.

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