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Perioperative,short-, and long-term outcomes of gastric cancer surgery: Propensity score-matched analysis of patients with or without prior solid organ transplantation

《European journal of surgical oncology》2021,47(12):3105-3112

BackgroundDetails of perioperative outcomes and survival after gastric cancer surgery in prior transplant recipients have received minimal research attention.MethodsWe performed an observational cohort study using the database of 20,147 gastric cancer patients who underwent gastrectomy at a single gastric cancer center in Korea. Forty-one solid organ recipients [kidney (n = 35), liver (n = 5), or heart (n = 1)] were matched with 205 controls using propensity score matching.ResultsOperation time, blood loss, and postoperative pain were similar between groups. Short-term complication rates were similar between transplantation and control groups (22.0% vs. 20.1%, P = 0.777). Transplantation group patients with stage 1 gastric cancer experienced no recurrence, while those with stage 2/3 cancer had significantly higher recurrence risk compared to the controls (P = 0.049). For patients with stage 1 cancer, the transplantation group had a significantly higher rate of non-gastric cancer-related deaths compared to the controls (19.2% vs. 1.4%, P = 0.001). For those with stage 2/3 cancer, significantly lower proportion of the transplantation group received adjuvant chemotherapy compared to the control group (26.7% vs. 80.3%, P < 0.001). The transplantation group had a higher (albeit not statistically significant) rate of gastric cancer-related deaths compared to the controls (40.0% vs. 18.0%, P = 0.087).ConclusionTransplant recipients and non-transplant recipients exhibited similar perioperative and short-term outcomes after gastric cancer surgery. From long-term outcome analyses, we suggest active surveillance for non-gastric cancer-related deaths in patients with early gastric cancer, as well as strict oncologic care in patients with advanced cancer, as effective strategies for transplant recipients. 相似文献

Cryotherapy in reducing pain,trismus, and facial swelling after third-molar surgery: Systematic review and meta-analysis of randomized clinical trials

Edmundo Marques do Nascimento-Júnior Gustavo Marques Sobral dos Santos Mário Luis Tavares Mendes Maximiliano Cenci Marcos Britto Correa Tatiana Pereira-Cenci Paulo Ricardo Saquete Martins-Filho 《Journal of the American Dental Association (1939)》2019,150(4):269-277.e1

Background

The aim of this systematic review and meta-analysis was to evaluate the efficacy of cryotherapy in reducing pain, trismus, and facial swelling in patients undergoing third-molar surgery.

Types of Studies Reviewed

The authors searched for randomized clinical trials in PubMed, Web of Science, SCOPUS, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, and OpenThesis. Eligibility criteria were population: patients submitted to removal of impacted third molars; intervention and comparison: postoperative cryotherapy versus no cold therapy; and outcomes: primary outcome was postoperative pain, and secondary outcomes were facial swelling and trismus. Eligible studies must have reported at least 1 of the outcomes of interest. After extracting data and assessing quality, the authors performed the meta-analyses.

Results

The authors included 6 studies in the quantitative synthesis analysis. Differences in pain intensity were found on postoperative day 2 (weighted mean difference, ?0.72; 95% confidence interval, ?1.45 to 0.01; P = .05) and postoperative day 3 (weighted mean difference, ?0.36; 95% confidence interval, ?0.59 to ?0.13; P = .002). No evidence was found that cryotherapy was effective in reducing trismus and facial swelling. The quality of evidence was graded as low.

Conclusions and Practical Implications

Evidence suggests that cryotherapy may have a small benefit in reducing pain after third-molar surgery, but it is not effective on facial swelling and trismus. Owing to the lack of standardization of cold application, effective evidence-based treatment protocols for cryotherapy after third-molar surgery still need to be established. 相似文献

Risk Factors Predisposing to Prolonged Air Leak After Video-Assisted Thoracoscopic Surgery for Spontaneous Pneumothorax

Lei JiangGening Jiang MD Yuming ZhuWang Hao MD Lei Zhang 《The Annals of thoracic surgery》2014

相似文献

Early postoperative fever workup in children: utilization and utility

Kristine S. Corkum Catherine J. Hunter Julia E. Grabowski Timothy B. Lautz 《Journal of pediatric surgery》2018,53(7):1295-1300

Background

Early postoperative fever is common. Adult data indicate that workup is unnecessary in the early postoperative period, but comparable data in children is limited. The objectives are to determine the incidence of fever and the utilization and yield of tests ordered in children.

Methods

Single-institution, retrospective analysis of surgical patients undergoing an elective inpatient/observational surgery between 2011 and 2015 was performed. Early fever was defined > 38.0 °C within two days post-procedure. Encounters were queried for all blood cultures (BC), urinalysis (UA), urine cultures (UC), chest radiographs (CXR), and respiratory viral panels (RVP) obtained.

Results

We identified 6943 patients, of whom 30.6% developed fever. UA was positive in 19.8% of patients tested. UC was positive in 15.7% of patients and 92.0% had a urinary catheter during surgery. BC was positive in 0.69% of patients, all with a central venous catheter. CXRs were considered infectious in 3.0% of patients tested. Patients with PICU stay and/or fever ≥ 38.9 °C were more likely to undergo BC and UC, but no more likely to have a positive result compared those without PICU stay and/or fever < 38.9°.

Conclusion

Early postoperative fever is common in pediatric surgical populations and rarely associated with an infectious source. Workup should be applied selectively.

Level of evidence

Level IV. 相似文献

The rate of hepatic artery complications is higher in pediatric liver transplant recipients with metabolic liver diseases than with biliary atresia

Suk Kyun Hong Nam-Joon Yi Hak Chang Sung-Woo Ahn Hyo-Sin Kim Kyung Chul Yoon Hyeyoung Kim Seong Oh Park Ung Sik Jin Kyung Won Minn Kwang-Woong Lee Kyung-Suk Suh 《Journal of pediatric surgery》2018,53(8):1516-1522

Background

Liver transplantation (LT) is an excellent treatment option for patients with biliary atresia (BA) who fail portoenterostomy surgery. LT is also increasingly performed in patients with metabolic liver diseases. This study compared the outcomes in pediatric patients who underwent LT for metabolic liver diseases and BA.

Basic procedures

Data from 237 pediatric patients who underwent primary LT at Seoul National University Hospital from 1988 to 2015, including 33 with metabolic liver diseases and 135 with BA, were retrospectively analyzed.

Main findings

Compared with children with BA, children with metabolic liver diseases were significantly older at the time of LT (121.3 vs. 37.3?months; P?<?0.001), and had lower Child–Pugh (7.1 vs. 8.4; P?=?0.010) and Pediatric End-stage Liver Disease (6.5 vs. 12.8; P?=?0.042) scores. Overall survival rates were similar (87.8% vs. 90.8%; P?=?0.402), but hepatic artery (HA) complications were significantly more frequent in children with metabolic liver diseases (12.1% vs. 1.5%; P?=?0.014).