Complications After Pancreaticoduodenectomy for Pancreatic Cancer: A Retrospective Study

2011 ◽  
Vol 96 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Shiyan Ren ◽  
Peng Liu ◽  
Ningxin Zhou ◽  
Jiahong Dong ◽  
Rong Liu ◽  
...  

Abstract Postoperative complications, such as pancreatic fistulae, after pancreaticoduodenectomy for pancreatic cancers are associated with surgical outcomes of patients with pancreatic cancers. A total of 160 patients with pancreatic cancers undergoing pancreaticoduodenectomy were retrospectively analyzed. Patients were grouped into a fistulae group (n  =  34) and a nonfistulae group (n  =  126). The fistulae group had a significantly higher morbidity rate than the nonfistulae group (P < 0.0001), but hospital mortality was not different in both groups (P  =  0.481). There was a higher incidence of intra-abdominal hemorrhage in patients with pancreatic fistulae than in those without fistulae. Two patients in fistulae group underwent reoperation. Patients with pancreatic fistulae had significantly longer hospital stay than those without fistulae. Pancreatic duct diameter, smoking, years of tobaccos consumption, preoperative jaundice, and surgical hours were associated with risk of fistulae on univariate analysis. In a multivariate analysis, diameter of pancreatic duct, surgical hours, and preoperative jaundice were independent risk factors of pancreatic fistulae. Incidence of pancreatic fistulae after pancreaticoduodenectomy is significantly influenced by the size of pancreatic duct diameter, surgical time, and preoperative jaundice. Early postoperative hemorrhage could be cautiously prevented. The survival is not significantly impacted by pancreatic fistulae.

2010 ◽  
Vol 8 (3) ◽  
pp. 0-0
Author(s):  
Paulius Gradauskas ◽  
Stanislovas Maknavičius

Paulius Gradauskas, Stanislovas MaknavičiusVilniaus greitosios pagalbos universitetinės ligoninės Krūtinės chirurgijos skyrius, Šiltnamių g. 29, LT-04130 Vilnius El. paštas: [email protected] Įvadas/tikslas: Didelės kinetinės energijos traumas patyrusiems žmonėms neretai yra sužalojami ir krūtinės ląstos organai. Gydant šiuos ligonius dažnai pasitaiko su kvėpavimo sistema susijusių komplikacijų. Darbo tikslas – nustatyti veiksnius, darančius įtaką dauginę traumą patyrusių pacientų gydymo komplikacijų dažniui ir mirštamumui. Ligoniai ir metodai: Retrospektyviai analizuoti 257 ligonių ligos istorijų duomenys. Vertinant vieno ar kelių veiksnių įtaką komplikacijų atsiradimo ar mirties tikimybei, naudota logistinė regresija. Rezultatai: Veiksniais, galinčiais daryti įtaką komplikacijų vystymuisi ar mirštamumui, buvo įvardyti: pacientų amžius; lytis; suminis sužalojimo sunkumas; krūtinės sužalojimo sunkumas pagal AIS; chirurginės intervencijos atlikimo laikas; chirurginės intervencijos apimtis; lėtinės obstrukcinės plaučių ligos arba bronchinės astmos anamnezė, koronarinės širdies ligos anamnezė, cukrinis diabetas, šokas stacionarizavimo metu, hemotransfuzijos poreikis. Nepriklausomu komplikacijų vystimosi veiksniu buvo nustatytas suminis sužalojimo sunkumas (ISS balas). įtakojančių Mirštamumo, veiksnių nenustatyta. Išvados: Iš sužeistųjų, patyrusių krūtinės ir kitų anatominių sričių uždarą traumą, komplikacijų radosi 39,3 %, o mirštamumas siekė 12,5 %. Suminis sužalojimo sunkumas (ISS balas) buvo nepriklausomas komplikacijų vystymosi dažnio veiksnys. Reikšminiai žodžiai: krūtinės sužalojimas, dauginė trauma, ūminių sužalojimų sunkumas, mirštamumas. Assessment of management results of polytraumas, involving the thorax and other anatomical parts Paulius Gradauskas, Stanislovas MaknavičiusVilnius University Emergency Hospital Thoracic Surgery Unit, Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / oObjective: Thoracic trauma is still one of the leading causes of morbidity and mortality in different countries. The aim of the study was to analyse the results of the management of polytrauma patients suffering from thoracic injuries. Patients and methods: In this retrospective study, the medical charts of 257 patients were reviewed. The risk factors influencing morbidity and mortality were identified. Results: Gender, age, ISS score, AIS score of the thoracic injury, time and invasivness of the surgery, presence of COPD or bronchial asthma, presence of coronary heart disease, diabetes, need of hemotransfusion, and shock at the arrival were analysed as the risk factors. ISS score, need of hemotransfusion and presence of COPD or bronchial asthma were found to be the prognostic factors of morbidity in the univariate analysis. Only the ISS score was found to be an independent risk factor at the multivariate analysis. No risk factors for mortality were identified. Conclusions: The overall morbidity rate was 39.3 %, and the mortality was 12.5 %. The only risk factor independently influencing morbidity was found to be the ISS score. No independent risk factors for mortality were identified. Keywords: thoracic injury, multiple trauma, ISS, mortality.


2021 ◽  
pp. 159101992110396
Author(s):  
Wei Shang ◽  
Xiaoting Chang ◽  
Xiaotong Wang ◽  
Jun Li ◽  
Yinghui Xu

Background Anterior communicating artery aneurysms are the second most common type of intracranial aneurysm and have a high incidence of rupture. Intraprocedural rupture can lead to a high mortality and morbidity rate, representing a major challenge in emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Methods We performed a retrospective review of 344 consecutive patients with emergency endovascular treatment of ruptured anterior communicating artery aneurysms. Patients were grouped into intraprocedural rupture and non-intraprocedural rupture groups according to whether intraprocedural rupture occurred. Demographic and clinical factors, vessel-related factors and therapy-related factors were compared between the two groups. Results Intraprocedural rupture occurred in 11 patients (3.2%). Univariate analysis showed that hypertension, the occurrence of vasospasm, aneurysm size, aneurysm angle and a high aspect ratio value were significantly associated with intraprocedural rupture ( P < 0.05). Multivariate analysis showed that hypertension odds ratio (OR, 9.799; P = 0.007), the occurrence of vasospasm (OR, 10.121; P = 0.002) and a high aspect ratio value (OR, 10.571; P = 0.006) were independent risk factors for intraprocedural rupture. Conclusions A history of hypertension, the occurrence of vasospasm and a high aspect ratio value are independent risk factors for intraprocedural rupture among patients with ruptured anterior communicating artery aneurysms.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhihao Yu ◽  
Changlin Yang ◽  
Xuesong Bai ◽  
Guibin Yao ◽  
Xia Qian ◽  
...  

Abstract Background The purpose of this study was to assess the risk factors for cholesterol polyp formation in the gallbladder. Methods This was a multicenter retrospective study based on pathology. From January 2016 to December 2019, patients who underwent cholecystectomy and non-polyp participants confirmed by continuous ultrasound follow-ups were reviewed. Patients in the cholesterol polyp group were recruited from three high-volume centers with a diagnosis of pathologically confirmed cholesterol polyps larger than 10 mm. Population characteristics and medical data were collected within 24 h of admission before surgery. The non-polyp group included participants from the hospital physical examination center database. They had at least two ultrasound examinations with an interval longer than 180 days. Data from the final follow-up of the non-polyp group were analyzed. The risk factors for cholesterol polyp formation were analyzed by comparing the two groups. Results A total of 4714 participants were recruited, including 376 cholesterol polyp patients and 4338 non-polyp participants. In univariate analysis, clinical risk factors for cholesterol polyps were age, male sex, higher body mass index (BMI), higher low-density lipoprotein (LDL), lower high-density lipoprotein (HDL), and higher aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels. In multivariate logistic analysis, independent risk factors were age > 50 years (odds ratio [OR] = 3.02, 95% confidence interval [CI] 2.33–3.91, P < 0.001], LDL > 2.89 mmol/L (OR = 1.38, 95% CI 1.08–1.78, P = 0.011), lower HDL (OR = 1.78 95% CI 1.32–2.44, P < 0.001), AST > 40 IU/L (OR = 3.55, 95% CI 2.07–6.07, P < 0.001), and BMI > 25 kg/m 2 (OR = 1.32, 95% CI 1.01–1.72, P = 0.037). Conclusions Age, LDL, HDL, AST, and BMI are strong risk factors for cholesterol polyp formation. Older overweight patients with polyps, accompanied by abnormal lipid levels, are at high risk for cholesterol polyps.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Bocheng Peng ◽  
Rui Min ◽  
Yiqin Liao ◽  
Aixi Yu

Objective. To determine the novel proposed nomogram model accuracy in the prediction of the lower-extremity amputations (LEA) risk in diabetic foot ulcer (DFU). Methods and Materials. In this retrospective study, data of 125 patients with diabetic foot ulcer who met the research criteria in Zhongnan Hospital of Wuhan University from January 2015 to December 2019 were collected by filling in the clinical investigation case report form. Firstly, univariate analysis was used to find the primary predictive factors of amputation in patients with diabetic foot ulcer. Secondly, single factor and multiple factor logistic regression analysis were employed to screen the independent influencing factors of amputation introducing the primary predictive factors selected from the univariate analysis. Thirdly, the independent influencing factors were applied to build a prediction model of amputation risk in patients with diabetic foot ulcer by using R4.3; then, the nomogram was established according to the selected variables visually. Finally, the performance of the prediction model was evaluated and verified by receiver working characteristic (ROC) curve, corrected calibration curve, and clinical decision curve. Results. 7 primary predictive factors were selected by univariate analysis from 21 variables, including the course of diabetes, peripheral angiopathy of diabetic (PAD), glycosylated hemoglobin A1c (HbA1c), white blood cells (WBC), albumin (ALB), blood uric acid (BUA), and fibrinogen (FIB); single factor logistic regression analysis showed that albumin was a protective factor for amputation in patients with diabetic foot ulcer, and the other six factors were risk factors. Multivariate logical regression analysis illustrated that only five factors (the course of diabetes, PAD, HbA1c, WBC, and FIB) were independent risk factors for amputation in patients with diabetic foot ulcer. According to the area under curve (AUC) of ROC was 0.876 and corrected calibration curve of the nomogram displayed good fitting ability, the model established by these 5 independent risk factors exhibited good ability to predict the risk of amputation. The decision analysis curve (DCA) indicated that the nomogram model was more practical and accurate when the risk threshold was between 6% and 91%. Conclusion. Our novel proposed nomogram showed that the course of diabetes, PAD, HbA1c, WBC, and FIB are the independent risk factors of amputation in patients with DFU. This prediction model was well developed and behaved a great accurate value for LEA so as to provide a useful tool for screening LEA risk and preventing DFU from developing into amputation.


Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 29
Author(s):  
Chia-Ying Ho ◽  
Yu-Chien Wang ◽  
Shy-Chyi Chin ◽  
Shih-Lung Chen

Deep neck infection (DNI) is a serious disease of deep neck spaces that can lead to morbidities and mortality. Acute epiglottitis (AE) is a severe infection of the epiglottis, which can lead to airway obstruction. However, there have been no studies of risk factors in patients with concurrent DNI and AE. This study was performed to investigate this issue. A total of 502 subjects with DNI were enrolled in the study between June 2016 and August 2021. Among these patients, 30 had concurrent DNI and AE. The relevant clinical variables were assessed. In a univariate analysis, involvement of the parapharyngeal space (OR = 21.50, 95% CI: 2.905–158.7, p < 0.001) and involvement of the submandibular space (OR = 2.064, 95% CI: 0.961–4.434, p < 0.001) were significant risk factors for concurrent DNI and AE. In a multivariate analysis, involvement of the parapharyngeal space (OR = 23.69, 95% CI: 3.187–175.4, p = 0.002) and involvement of the submandibular space (OR = 2.465, 95% CI: 1.131–5.375, p < 0.023) were independent risk factors for patients with concurrent DNI and AE. There were no differences in pathogens, therapeutic managements (tracheostomy, intubation, surgical drainage), or hospital staying period between the 30 patients with concurrent DNI and AE and the 472 patients with DNI alone (all p > 0.05). However, we believe it is significant that DNI and AE are concurrent because both DNI and AE potentially cause airway obstruction, and concurrence of these two diseases make airway protection more difficult. The infections in critical spaces may cause the coincidence of these two diseases. Involvement of the parapharyngeal space and involvement of the submandibular space were independent risk factors associated with concurrent DNI and AE. There were no differences in pathogens between the concurrent DNI and AE group and the DNI alone group.


2021 ◽  
Vol 20 (1) ◽  
pp. 10-16
Author(s):  
Yu. E. Vaganov ◽  
V. V. Veselov ◽  
A. A. Likutov ◽  
E. A. Khomyakov ◽  
S. V. Chernyshov ◽  
...  

Aim: to identify risk factors for neoplasms recurrence removed by endoscopic mucosal resection (EMR).Patients and methods: the single-center retrospective observational study included 207 patients with 260 benign colon neoplasms. There were 95 (45.9%) males and 112 (54.1%) females. The median age of the patients was 67 (27-80) years. The results obtained were assessed using following criteria: morbidity rate, complication type, hospital stay, tumor site, number of neoplasms in colon, lateral growth, fragmentation rate, technical difficulties (mucosal fold convergence)during surgery, grade of dysplasia, recurrence rate.Results: intraoperative fragmentation of the neoplasms during mucosectomy occurred in 48/260 (18.5%) cases. Postoperative complications within the period of up to 30 days occurred in 13/207 (6.3%) patients. The most frequent 9 (4.2%) postoperative complication arising after mucosectomy was post-polypectomy syndrome. Another 4 (2.0%) patients produced bleeding after the surgery, which required repeated endoscopic procedure. No mortality occurred. The tumor size exceeding 25 mm (Exp (B) = 0.179; 95% CI = 0.05-0.7; p = 0.014), severe dysplasia (Exp (B) = 0.113; 95% CI = 0.03-0.4; p = 0.001) and fold convergence (Exp (B) = 0.2; 95% CI = 0.07-0.7; p = 0.015) are independent risk factors for disease recurrence.Conclusion: mucosectomy is indicated for colon adenomas if its size does not exceed 25 mm and can be removed en bloc.


2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.


2019 ◽  
Vol 68 (04) ◽  
pp. 294-300
Author(s):  
Gaku Uchino ◽  
Takeshi Yoshida ◽  
Bunpachi Kakii ◽  
Masato Furui

Background Aortic enlargement after hemiarch replacement (HAR) for acute type A aortic dissection (AAAD) is a serious problem. We reviewed our experience and analyzed the risk factors for aortic enlargement. Methods During April 2005 to December 2017, 364 patients underwent HAR for AAAD. Seventy-three patients fulfilled the inclusion criteria. We analyzed the change in aortic diameter, aortic growth rate, and major adverse aortic events (MAAEs) and their association with luminal communication of the aortic arch. Results Anastomotic communication, supra-aortic communication (SAC), and distal aortic communication were found in 34 (46.6%), 28 (38.4%), and 20 (27.4%) patients, respectively. The aortic growth rate was high because of the presence of SAC, distal aortic communication, and the number of coexisting aortic communication. Univariate analysis showed that the presence of SAC and an initial aortic diameter > 35 mm at 20 mm distal to the left subclavian artery and at the pulmonary artery bifurcation (PAB) were risk factors for MAAEs. Multivariate analysis showed that SAC and an initial aortic diameter > 35 mm at the PAB were independent risk factors for MAAEs. Conclusion SAC, distal aortic communication, and the number of coexisting aortic communication are significant risk factors for aortic enlargement after HAR for AAAD. SAC and an initial aortic diameter > 35 mm at the PAB are independent risk factors for MAAEs after this procedure.


2015 ◽  
Vol 32 (2) ◽  
pp. 82-89 ◽  
Author(s):  
Yuan-da Zhou ◽  
Hui-kai Li ◽  
Yun-long Cui ◽  
Ti Zhang ◽  
Qiang Li

Aims: This study was conducted in order to investigate the indications for hepatecomy for multinodular hepatocellular carcinoma (MNHCC) in single institution. Methods: We retrospectively analyzed the medical records from 55 MNHCC patients, mainly with Child-Pugh A liver function, who underwent hepatectomy from January 2006 to December 2008. Both short- and long-term outcomes were analyzed. In addition, the prognostic significance of clinicopathological factors on overall survival (OS) was investigated by univariate analysis using the log-rank test. A Cox proportional hazards model was used in a subsequent multivariate analysis. Results: The perioperative morbidity rate (grade II or higher) was 18.2% (n = 10), and the in-hospital mortality rate was 3.6%. The median OS was 23.9 months (range, 2.5-84 months), whereas the median disease-free survival was 8.75 months (range, 1-65 months). Independent prognostic risk factors of 5-year OS included the number of tumors >2 (p = 0.032) and gross morphology indicating multiple tumor nodules scattered throughout the liver (p = 0.009). Conclusions: The postoperative morbidity and mortality rates were acceptable. The number of tumors >2 and gross morphology indicating multiple tumor nodules scattered throughout the liver were independent prognostic risk factors for patients with MNHCC after hepatectomy. Patients with both of these features had a very poor prognosis and were not considered suitable for surgery.


2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Da Shang ◽  
Qionghong Xie ◽  
Bin Shang ◽  
Min Zhang ◽  
Li You ◽  
...  

Background.Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly.Methods.Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients.Results.70 patients recruited to our study were split into a noninitiation group (n=37) and an initiation group (n=33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments.Conclusions.Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients.


Sign in / Sign up

Export Citation Format

Share Document