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1.
Effect of Including Cancer-Specific Variables on Risk-Adjusted Hospital Surgical Quality Comparisons
Ryan P. Merkow MD MS David J. Bentrem MD MS David P. Winchester MD Andrew K. Stewart MA Clifford Y. Ko MD MS MSHS Karl Y. Bilimoria MD MS 《Annals of surgical oncology》2013,20(6):1766-1773
Background
Quality initiatives are increasingly focusing on the quality of oncologic surgery. However, there is concern that a lack of cancer-specific variables may make risk-adjusted hospital quality comparisons inadequate. Our objective was to assess whether hospital quality rankings for cancer surgery are influenced by the addition of cancer-specific variables to the risk-adjusted models.Methods
Patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and National Cancer Data Base (NCDB) who underwent colon or rectal resection for cancer were linked (2006–2008). Hierarchical models were developed predicting ACS NSQIP outcomes based on ACS NSQIP only vs a model using NSQIP and NCDB-derived cancer variables (e.g., stage and neoadjuvant therapy). Changes in hospital quality rankings were compared.Results
A total of 11,405 patients underwent colon (n = 9,678, 146 hospitals) or rectal (n = 1,727, 135 hospitals) resection for cancer (2006–2008). Hospital-level complication rates (and standard deviation) after colon surgery were 2.2 % (±2.7 %) for mortality and 17.2 % (±8.7 %) for serious morbidity. After rectal cancer resection, complication rates were 0.9 % (±3.8 %) for mortality and 22.3 % (±20.4 %) for serious morbidity. When cancer-specific variables were included in risk-adjustment, outlier agreement was very good (kappa >0.85), and hospital odds ratio correlations were nearly identical (R > 0.98) for all outcomes assessed. Median changes in hospital rankings with the addition of the cancer-specific variables ranged from 1 to 2 after colon resection to 2–4 after rectal resection.Conclusions
Addition of the available cancer-specific variables to risk-adjustment models did not affect hospital quality rankings for cancer surgery. Existing ACS NSQIP risk-adjustment variables appears to be sufficient for accurate comparisons of hospital quality. 相似文献2.
Masashi Takaso Toshiyuki Nakazawa Takayuki Imura Masaki Ueno Wataru Saito Ryousuke Shintani Kensuke Fukushima Masahiro Toyama Kouji Sukegawa Takamitsu Okada Michinari Fukuda 《Archives of orthopaedic and trauma surgery》2011,131(2):149-155
Introduction
Routine spinal fusion techniques have involved removal of all soft tissues and articular facets, decortication of all posterior elements, and application of bone graft to the fusion area. Bone grafting has been performed mainly using the patient’s own bone (autograft bone), most commonly from the iliac crest. The use of autograft bone is accompanied by complications or problems because of harvesting and donor-site morbidity. Several studies have already reported the use of allograft bone in scoliosis surgery. However, these studies are small series with short-term follow-up.Method
Twenty-two patients with scoliosis who underwent posterior spinal fusion and pedicle-screw-alone fixation using banked allograft bone obtained from the regional bone bank in Japan were analyzed. The average age at surgery was 13 years 5 months. The average follow-up was 2 years 7 months, and the average age at the last follow-up was 15 years 6 months. Scoliosis curves were divided into two groups (single curve group and double curve group).Results
For the single curve group, the average preoperative coronal curve measured 78° (48°–85°) and the postoperative curve measured 22° (8°–35°), with no loss of correction at the last follow-up. For the double curve group, the average preoperative thoracic curve measured 64° (48°–85°) and the lumbar curve measured 42° (38°–60°). The average postoperative thoracic curve measured 12° (8°–34°) and lumbar curve measured 15° (8°–32°), with no significant loss of correction at the last follow-up. No patients had clinical complaints in the region of surgery at 9 months after surgery and thereafter. There were no complications including loss of correction, nonunion, infection and instrumentation failure. At the last follow-up, patients/parents were interviewed and asked to complete an outcome satisfaction questionnaire. They were asked to rate the outcome as very satisfactory, satisfactory, neither satisfactory nor unsatisfactory, unsatisfactory, or very unsatisfactory. Seventeen patients (77%) were very satisfied, four patients (17%) were satisfied, and one patient (6%) was neither satisfied nor unsatisfied. Autograft bone and banked allograft bone appear to yield comparable results and clinical outcomes.Conclusion
However, in Japan, various expenses accrue to supply a safe and premium quality of banked allograft bone. Financial issue must be resolved as soon as possible. 相似文献3.
O. Jannasch A. Udelnow G. Romano A. Dziki D. Pavalkis H. Lippert P. Mroczkowski 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(4):473-479
Purpose
Several European countries are undertaking quality control projects in colorectal cancer. These efforts have led to improvements in survival, but a comparison between different projects reveals questionable results. The aim of this study is the presentation of results from hospitals in three different European countries participating in the International Quality Assurance in Colorectal Cancer (IQACC) project.Methods
For this publication, patients with cancer of the colon or rectum treated in 2009 and 2010 and recorded in the IQACC (Germany, Poland and Italy) were analysed. The comparison included number of patients, age, preoperative diagnostics (CT of the abdomen and thorax, MRI, colonoscopy, ultrasound, tumour markers), surgical approach, metastasis, height of rectal cancer and histopathological examination of a specimen (T stage, N stage and MERCURY classification for rectum resection). For short-term outcomes, general complications, wound dehiscence, tumour-free status at discharge, anastomotic leakage and in-hospital mortality were analysed.Results
A total of 12,691 patients (6,756 with colon cancer, 5,935 with rectal cancer) were included in the analysis. Preoperative diagnostics differed significantly between countries. For pT and pN stages, several quality differences could be demonstrated, including missing stages (colon cancer: pT 5.7–12.5 %, pN 2.5–11.0 %; rectal cancer: pT 1.1–5.6 %, pN 1.1–15.5 %). The most relevant differences for short-term outcomes in colon cancer were found in general complications (4.2–22.8 %) and tumour-free status at discharge (74.5–91.7 %). In-hospital deaths ranged between 2.5 and 4.3 % and did not show significant differences. For rectal cancer, the country with the highest percentage of tumours localised less than 4 cm from the anal verge (16.0 %) showed the lowest frequency of amputation (8.5 %). Outcome differences were found for general complications (3.2–18.8 %), anastomotic leakage (0–4.3 %) and tumour-free status at discharge (72.9–87.6 %). In-hospital deaths ranged between 1.1 and 3.2 %.Conclusion
This study demonstrates the feasibility of an international quality assurance project in colorectal cancer. This concept ensures data analysis based on a comparable data input. Differences in preoperative diagnostics, completeness of histopathological evaluation and short-term outcomes for Germany, Poland and Italy might result from disparities in socioeconomic factors and implementation of existing guidelines. Further activities are necessary to warrant the use of common standards in outcome control. 相似文献4.
Herbert Thomas Maier Felix Aigner Birgit Trenkwalder Matthias Zitt Natalie Vallant Alexander Perathoner Christian Margreiter Patrizia Moser Johann Pratschke Albert Amberger 《World journal of surgery》2014,38(8):2160-2167
Background
Lipocalin-2 (Lcn-2) is expressed in human neutrophils and epithelial cells, particularly in the presence of inflammation or cancer. It was shown to be highly expressed in various human cancers. Increased protein levels were associated with decreased survival of patients with breast or gastric cancer. The main focus of this work was to analyze the implication of Lcn-2 up-regulation in the genesis of colon cancer.Methods
Expression of Lcn-2 was analyzed in colorectal carcinoma cell lines, paired colorectal carcinoma tissues, and regular mucosa by Western blot analysis. Lcn-2 immunohistochemical staining was performed in 192 colorectal carcinoma resection specimens and correlated with clinicopathologic parameters.Results
Western blot analysis of colorectal carcinoma tissues demonstrated Lcn-2 overexpression in carcinomas as compared with regular mucosa. Immunohistochemical staining revealed Lcn-2 expression in 179 (93.2 %) colorectal carcinoma tissues. Intense immunoreactivity was significantly correlated with metastasis (p = 0.042) and UICC stage (p = 0.027). Survival analysis according to the Kaplan–Meier method revealed a significant association between Lcn-2 overexpressing tumors and overall survival (p < 0.001) and disease-free survival (p < 0.001).Conclusions
Our data provide evidence that Lcn-2 expression is up-regulated with tumor progression and was found to be a predictor of overall survival. 相似文献5.
Aung Ko Win MBBS MPH Susan Parry MB ChB FRACP Bryan Parry MD FRACS Matthew F. Kalady MD Finlay A. Macrae MBBS MD FRACP FRCP AGAF Dennis J. Ahnen MD AGAF Graeme P. Young MBBS MD FRACP FTSE AGAF Lara Lipton PhD FRACP Ingrid Winship MB ChB MD FRACP Alex Boussioutas MBBS PhD FRACP Joanne P. Young PhD Daniel D. Buchanan PhD Julie Arnold RN Loïc Le Marchand MD PhD Polly A. Newcomb PhD Robert W. Haile DrPH Noralane M. Lindor MD Steven Gallinger MD MSc FRCSC John L. Hopper PhD Mark A. Jenkins PhD 《Annals of surgical oncology》2013,20(6):1829-1836
Background
Despite regular surveillance colonoscopy, the metachronous colorectal cancer risk for mismatch repair (MMR) gene mutation carriers after segmental resection for colon cancer is high and total or subtotal colectomy is the preferred option. However, if the index cancer is in the rectum, management decisions are complicated by considerations of impaired bowel function. We aimed to estimate the risk of metachronous colon cancer for MMR gene mutation carriers who underwent a proctectomy for index rectal cancer.Methods
This retrospective cohort study comprised 79 carriers of germline mutation in a MMR gene (18 MLH1, 55 MSH2, 4 MSH6, and 2 PMS2) from the Colon Cancer Family Registry who had had a proctectomy for index rectal cancer. Cumulative risks of metachronous colon cancer were calculated using the Kaplan–Meier method.Results
During median 9 years (range 1–32 years) of observation since the first diagnosis of rectal cancer, 21 carriers (27 %) were diagnosed with metachronous colon cancer (incidence 24.25, 95 % confidence interval [CI] 15.81–37.19 per 1,000 person-years). Cumulative risk of metachronous colon cancer was 19 % (95 % CI 9–31 %) at 10 years, 47 (95 % CI 31–68 %) at 20 years, and 69 % (95 % CI 45–89 %) at 30 years after surgical resection. The frequency of surveillance colonoscopy was 1 colonoscopy per 1.16 years (95 % CI 1.01–1.31 years). The AJCC stages of the metachronous cancers, where available, were 72 % stage I, 22 % stage II, and 6 % stage III.Conclusions
Given the high metachronous colon cancer risk for MMR gene mutation carriers diagnosed with an index rectal cancer, proctocolectomy may need to be considered. 相似文献6.
Marko Simunovic MD Wesley Stephen MD Stephen Kelly MD Shawn Forbes MD Margherita Cadeddu MD Lehana Thabane PhD Vanja Grubac BSc Peter Lovrics MD Franco DeNardi MD Dwight Prodger MD Scott Tsai MD Angela Coates MEd 《Annals of surgical oncology》2013,20(13):4067-4072
Background
Stakeholders suggest that integrating end users into the planning and execution of quality improvement interventions may more effectively close quality gaps. We tested if such an approach could improve the quality of colorectal cancer surgery in a large geographic region (i.e., LHIN4) in Ontario, Canada.Methods
All LHIN4 surgeons who provide colorectal cancer surgery were invited to an October 2006 inaugural QICC-L4 workshop and subsequent workshops in 2008, 2010, and 2012. At workshops, surgeons selected clinically relevant quality markers for targeted improvement and interventions to achieve improvements. Selected markers included rates of colon and rectal radiology imaging, rate of pathology reporting of rectal radial margin distance, and rate of positive rectal radial margins. To date, implemented interventions have included audit and feedback, tailoring interviews to identify barriers and facilitators to optimal quality, and preoperative internet-based patient reviews. Hospital and regional cancer centre charts provide audit data for annual feedback reports to surgeons.Results
Participating surgeons at workshops and surgeon participants in preoperative reviews treated approximately 70 % of all LHIN4 patients undergoing colorectal surgery. For years 2006–2012, the rate of radiology imaging for colon and rectal cases increased from 70 to 91 % and from 71 to 91 %, respectively. For rectal cases, the rate of reporting radial margins increased (55–93 %), and the rate of positive radial margins decreased (14–6 %).Conclusions
Initiation of the integrated knowledge translation QICC-L4 project in a large geographic region was associated with marked improvements in relevant colorectal cancer surgery quality markers. 相似文献7.
Kazuhiro Watanabe MD PhD Norio Saito MD PhD Masanori Sugito MD PhD Masaaki Ito MD PhD Akihiro Kobayashi MD PhD Yusuke Nishizawa MD PhD 《Annals of surgical oncology》2013,20(4):1374-1380
Purpose
To assess the actuarial incidence of pulmonary metastases as the first site of metastasis after R0 resection of colon cancer and to clarify predictive factors for pulmonary metastases as the first site of metastasis.Methods
Data for 746 patients who underwent R0 resection for colon cancer from 2000 to 2006 were reviewed. The mean duration of follow-up was 56.9 months.Results
Pulmonary metastases developed in 35 patients. Mean duration from colon surgery to identification of pulmonary metastases was 20.0 months. The overall occurrence rates of 5-year pulmonary metastasis according to Union for International Cancer Control (UICC) stage were 0.6 % (stage I), 2.2 % (stage II), 9.8 % (stage III), and 24.6 % (stage IV), respectively. Surgery for pulmonary metastases was performed first 18 patients (51.4 %), and 16 (88.9 %) of these 18 patients achieved R0 surgery. Multivariate analysis revealed that presence of regional lymph node involvement and preoperative serum carcinoembryonic antigen level (≥5 ng/ml) were significant independent risk factors for pulmonary metastases. Five-year actuarial incidence of pulmonary metastases increased significantly with increased number of risk factors (0 factors, 2.2 %; 1 factor, 6.6 %; 2 factors, 18.4 %).Conclusions
The present study clearly demonstrated predictive factors for pulmonary metastases after R0 resection of colon cancer. Actuarial incidence of pulmonary metastases was significantly related to the number of risk factors present. The data should facilitate the establishment of novel algorithms for predicting pulmonary metastases after resection of colon cancer, which may lead to the appropriate surveillance strategies after colon surgery. 相似文献8.
Purpose
Locked plate (LP) and retrograde intramedullary nail (RIN) are the most commonly used treatment options for periprosthetic femur fracture above total knee arthroplasty (TKA). Controversy still exists regarding which is better. Therefore we performed a meta-analysis to compare their clinical results.Methods
A comprehensive search was conducted through PubMed, EMBase and the Cochrane Collaboration Library. Six comparative studies (265 patients) were included for the meta-analysis.Results
No statistically significant differences were found between the LP group and RIN group in terms of six month union rate (OR, 1.19; 95 % CI, 0.52–2.69; P?=?0.68), union time (WMD, 0.22; 95 % CI, ?0.41 to 0.84; P?=?0.50), operation time (WMD, 0.54; 95 % CI, ?13.09 to 14.17; P?=?0.94) or complication rate (OR, 0.79; 95 % CI, 0.22–2.91; P?=?0.73). The LP fixation may have a relatively higher re-operation rate (OR, 5.17; 95 % CI, 1.02–26.27; P?=?0.05) compared with RIN. The mean union time was 4.0 months in the LP group and 3.7 months in the RIN group.Conclusion
This meta-analysis found no statistically significant difference in six month union rate, union time, operation time and complication rate between the LP group and RIN group. The RIN fixation may have a potential of lower re-operation rate compared with LP. The mean union time was 4.0 months in the LP group and 3.7 months in the RIN group.9.
Manfred Odermatt Danilo Miskovic Najaf Siddiqi Jim Khan Amjad Parvaiz 《World journal of surgery》2013,37(10):2458-2467
Background
Case series suggest the feasibility and safety of emergency resection of colon cancer by laparoscopy. The present study compares short- and long-term outcomes of laparoscopic and open resection for colon cancers treated as emergencies.Methods
The study was a propensity score-matched design based on a prospective database. From October 2006 to December 2011, emergency laparoscopic colon cancer resections were 1:2 propensity score-matched to open cases. Covariates for match-estimation were age, gender, American Society of Anesthesiologists grade, procedure type, tumor site, and reason for emergency surgery. Short-term outcomes included oncological quality surrogates (lymph node harvest and R stage), need for a stoma, length of hospital stay, and postoperative complications. For long-term outcomes, overall and recurrence-free survival rates were analyzed with Kaplan–Meier curves.Results
During the study period, a total of 217 colon cancers were resected (181 open and 36 laparoscopic) as emergencies. The laparoscopic cases were matched to 72 open cases. Median follow-up was 3.6 [95 % confidence interval (CI) 2.3–4.3] years. The overall 3-year survival rate was 51 % (95 % CI 35–76) in the laparoscopic group versus 43 % (95 % CI 32–58) in the open group (p = 0.24). The 3-year recurrence-free survival rate in the laparoscopic group was 35 % (95 % CI 20–60) versus 37 % (95 % CI 27–50) in the open group (p = 0.53). Median lymph node harvest (17 vs. 13 nodes; p = 0.041) and median length of hospital stay (7.5 vs. 11.0 days; p = 0.019) favored laparoscopy.Conclusions
Our data suggest that selective emergency laparoscopy for colon cancer is not inferior to open surgery with regard to short- and long-term outcomes. Laparoscopy resulted in a shorter length of hospital stay. 相似文献10.
11.
Sargent DJ Resnick MB Meyers MO Goldar-Najafi A Clancy T Gill S Siemons GO Shi Q Bot BM Wu TT Beaudry G Haince JF Fradet Y 《Annals of surgical oncology》2011,18(12):3261-3270
Purpose
The prognostic significance of guanylyl cyclase C (GCC) gene expression in lymph nodes (LNs) was evaluated in patients with stage II colon cancer who were not treated with adjuvant chemotherapy. We report a planned analysis performed on 241 patients.Methods
GCC mRNA was quantified by RT-qPCR using formalin-fixed LN tissues from patients with untreated stage II colon cancer who were diagnosed from 1999–2006 with at least ten LNs examined and blinded to clinical outcomes. Lymph node ratio (LNR) is the number of GCC-positive nodes divided by total number of informative LNs. Risk categories of low (0–0.1) and high (> 0.1) for LNR were chosen by significance using Cox regression models. The data were tested for association with time to recurrence.Results
Twenty-nine patients (12%) had a disease recurrence or cancer death. The LNR significantly predicted higher recurrence risk for 84 patients (34.9%) classified as high risk (hazard ratio (HR), 2.38; P = 0.02). The estimated 5-year recurrence rates were 10% and 27% for the low- and high-risk groups, respectively. After adjusting for age, T stage, number of nodes assessed, and MMR status, a significant association remained (HR, 2.61; P = 0.02). In a subset of patients (n = 181) with T3 tumor, ≥ 12 nodes examined and negative margins, a significant association between the GCC LNR and recurrence risk also was observed (HR, 5.06; P = 0.003).Conclusions
Our preliminary results suggest that detection of GCC mRNA in LNs is associated with risk of disease recurrence in patients with untreated stage II colon cancer. A larger validation study is ongoing. 相似文献12.
Heather B. Neuman MD Jennifer M. Weiss MD MS Glen Leverson PhD Erin S. O’Connor MD MS David Y. Greenblatt MD MS Noelle K. LoConte MD Caprice C. Greenberg MD MPH Maureen A. Smith MD PhD MPH 《Annals of surgical oncology》2013,20(5):1427-1435
Background
Individuals ≥80 years of age represent an increasing proportion of colon cancer diagnoses. Selecting these patients for elective surgery is challenging because of diminished overall health, functional decline, and limited data to guide decisions. The objective was to identify overall health measures that are predictive of poor survival after elective surgery in these oldest-old colon cancer patients.Methods
Medicare beneficiaries ≥80 years who underwent elective colectomy for stage I–III colon cancer from 1992–2005 were identified from the Surveillance, Epidemiology and End Results(SEER)-Medicare database. Kaplan–Meier survival analysis determined 90-day and 1-year overall survival. Multivariable logistic regression assessed factors associated with short-term postoperative survival.Results
Overall survival for the 12,979 oldest-old patients undergoing elective colectomy for colon cancer was 93.4 and 85.7 %, at 90 days and 1 year. Older age, male gender, frailty, increased hospitalizations in prior year, and dementia were most strongly associated with decreased survival. In addition, AJCC stage III (vs stage I) disease and widowed (vs married) were highly associated with decreased survival at 1 year. Although only 4.4 % of patients were considered frail, this had the strongest association with mortality, with an odds ratio of 8.4 (95 % confidence interval, 6.4–11.1).Conclusions
Although most oldest-old colon cancer patients do well after elective colectomy, a significant proportion (6.6 %) die by postoperative day 90 and frailty is the strongest predictor. The ability to identify frailty through billing claims is intriguing and suggests the potential to prospectively identify, through the electronic medical record, patients at highest risk of decreased survival. 相似文献13.
Ignazio Tarantino Kristjan Ukegjini Rene Warschkow Bruno M. Schmied Thomas Steffen Alexis Ulrich Sascha A. Müller 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(6):841-849
Purpose
The aim of this study was to assess the putative impact of perioperative blood transfusions on overall survival in patients undergoing curative resection for stage III colon cancer by applying propensity scoring methods.Methods
In a single-center study, a total of 309 patients who underwent open curative resection for stages I–III colon cancer from 1996–2008 were assessed. The mean follow-up period was 47?±?38 months. Transfused and non-transfused patients were compared using both Cox regression and propensity score analyses.Results
Overall, 148 patients (47.9 %) received blood transfusions. The patient characteristics were highly biased toward transfusions (propensity score 0.68?±?0.22 vs. 0.30?±?0.22, p <0.001). In the unadjusted analysis, blood transfusions were associated with a 90 % increased risk of overall mortality (hazard ratio 1.90, 95 % CI: 1.19–3.04, p?=?0.001). The 5-year survival for patients receiving blood transfusions was 64.5 % (95 % CI: 56.0–74.3 %) compared with 80.1 % (95 % CI: 72.8–88.2 %) in those not receiving blood transfusions. In the propensity score-adjusted Cox regression analysis (hazard ratio: 0.85, 95 % CI?=?0.53–1.37, p?=?0.501), blood transfusions did not increase the risk of overall mortality. After risk adjustment, the 5-year survival rate for patients receiving blood transfusions was 66.6 % (95 % CI: 57.4–77.3 %) compared with 61.8 % (95 % CI: 51.9–73.7 %) for those who did not.Conclusion
This study is the first propensity score-based analysis that provides evidence that poor oncological outcomes after curative colon cancer resection in patients receiving perioperative blood transfusions are due to the clinical circumstances that require the transfusions and are not due to the blood transfusions. 相似文献14.
Sha’Shonda L. Revels MD MS MA Sandra L. Wong MD MS Mousumi Banerjee PhD Huiying Yin MS John D. Birkmeyer MD 《Annals of surgical oncology》2014,21(7):2129-2135
Objective
To evaluate adherence to perioperative processes of care associated with major cancer resections.Background
Mortality rates associated with major cancer resections vary across hospitals. Because mechanisms underlying such variations are not well-established, we studied adherence to perioperative care processes.Methods
There were 1,279 hospitals participating in the National Cancer DataBase (2005–2006) ranked on a composite measure of mortality for bladder, colon, esophagus, stomach, lung, and pancreas cancer operations. We sampled hospitals from among those with the lowest and highest mortality rates, with 19 low-mortality hospitals [(LMHs), risk-adjusted mortality rate of 2.84 %] and 30 high-mortality hospitals [(HMHs), risk-adjusted mortality rate of 7.37 %]. We then conducted onsite chart reviews. Using logistic regression, we examined differences in perioperative care, adjusting for patient and tumor characteristics.Results
Compared to LMHs, HMHs were less likely to use prophylaxis against venous thromboembolism, either preoperative or postoperatively [adjusted relative risk (aRR) 0.74, 95 % CI 0.50–0.92 and aRR 0.80, 95 % CI 0.56–0.93, respectively]. The two hospital groups were indistinguishable with respect to processes aimed at preventing surgical site infections, such as the use of antibiotics prior to incision (aRR, 0.99, 95 % CI 0.90–1.04), and processes intended to prevent cardiac events, including the use of β-blockers (1.00, 95 % CI 0.81–1.14). HMHs were significantly less likely to use epidurals (aRR, 0.57, 95 % CI 0.32–0.93).Conclusions
HMHs and LMHs differ in several aspects of perioperative care. These areas may represent opportunities for improving cancer surgery quality at hospitals with high mortality. 相似文献15.
Konstantinos I. Votanopoulos MD Katrina Swett MS Aaron U. Blackham MD Chukwuemeka Ihemelandu MD Perry Shen MD John H. Stewart MD Edward A. Levine MD 《Annals of surgical oncology》2013,20(4):1088-1092
Background
Cytoreductive surgery (CS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is the treatment most likely to achieve prolonged survival in peritoneal carcinomatosis (PC). Yet the efficacy of HIPEC in rectal patients is controversial because of the retroperitoneal location of the primary tumor. Therefore, we reviewed our experience in patients with PC from a rectal primary tumor.Methods
A retrospective analysis of a prospective database of 950 HIPEC procedures was performed. Performance status, age, albumin level, prior surgical score, resection status, morbidity, mortality, and survival were reviewed.Results
A total of 13 and 204 patients with PC from rectal and colon cancer, respectively, were identified. Median follow-up was 40.1 and 88.1 months, respectively. Eastern Cooperative Oncology Group (ECOG) score was zero or one for 92 % of patients with rectal cancer and 83 % for colon, while R1 resection was achieved in 54 and 51 %. The 30-day mortality was 5 % for colon cancer. There were no deaths in the rectal group. The morbidity for the colon and rectal groups was 57 and 46 %, respectively, with a 23 % 30-day readmission rate. In univariate analysis, age, ECOG, prior surgical score, albumin level, and node and resection status were not statistically significant in predicting survival for the rectal cancer patients. Median survival for the rectal and colon groups was 14.6 versus 17.3 months, while the 3-year survival was 28.2 versus 25.1 %.Conclusions
Our data demonstrate similar 3-year survival for patients with rectal and colon cancer PC treated with CS/HIPEC. This can be attributed to patient selection bias. Selected rectal cancer PC patients should not be excluded from an attempted cytoreduction and HIPEC. 相似文献16.
Jennifer M. Weiss MD MS Jessica Schumacher PhD Glenn O. Allen MPH Heather Neuman MD MS Erin O’Connor Lange MD MSPH Noelle K. LoConte MD Caprice C. Greenberg MD MPH Maureen A. Smith MD MPH PhD 《Annals of surgical oncology》2014,21(6):1781-1791
Background
Survival benefit from adjuvant chemotherapy is established for stage III colon cancer; however, uncertainty exists for stage II patients. Tumor heterogeneity, specifically microsatellite instability (MSI), which is more common in right-sided cancers, may be the reason for this observation. We examined the relationship between adjuvant chemotherapy and overall 5-year mortality for stage II colon cancer by location (right- vs left-side) as a surrogate for MSI.Methods
Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified Medicare beneficiaries from 1992 to 2005 with AJCC stage II (n = 23,578) and III (n = 17,148) primary adenocarcinoma of the colon who underwent surgery for curative intent. Overall 5-year mortality was examined with Kaplan–Meier survival analysis and Cox proportional hazards regression with propensity score weighting.Results
It was found that 18 % of stage II patients (n = 2941) with right-sided cancer and 22 % (n = 1693) with left-sided cancer received adjuvant chemotherapy. After adjustment, overall 5-year survival benefit from chemotherapy was observed only for stage III patients (right-sided: hazard ratio [HR], 0.64; 95 % CI, 0.59–0.68; p < .001 and left-sided: HR, 0.61; 95 % CI, 0.56–0.68; p < .001). No survival benefit was observed for stage II patients with either right-sided (HR, 0.97; 95 % CI, 0.87–1.09; p = .64) or left-sided cancer (HR, 0.97; 95 % CI, 0.84–1.12; p = .68).Conclusions
Among Medicare patients with stage II colon cancer, a substantial number receive adjuvant chemotherapy. Adjuvant chemotherapy did not improve overall 5-year survival for either right- or left-sided colon cancers. Our results reinforce existing guidelines and should be considered in treatment algorithms for older adults with stage II colon cancer. 相似文献17.
IMP3 Is a Novel Prognostic Marker that Correlates with Colon Cancer Progression and Pathogenesis 总被引:1,自引:0,他引:1
Dawei Li MD PhD Dongwang Yan MD PhD Huamei Tang MD Chongzhi Zhou MD PhD Junwei Fan MD PhD Shuxia Li MD PhD Xiaoliang Wang MD PhD Jun Xia MD PhD Fei Huang MD Guoqiang Qiu MD Zhihai Peng MD PhD 《Annals of surgical oncology》2009,16(12):3499-3506
18.
Anne Warren Peled MD Chetan S. Irwin MD E. Shelley Hwang MD Cheryl A. Ewing MD Michael Alvarado MD Laura J. Esserman MD 《Annals of surgical oncology》2014,21(1):37-41
Background
Total skin-sparing mastectomy (TSSM) with preservation of the nipple–areolar complex skin has become increasingly accepted as an oncologically safe procedure. Oncologic outcomes after TSSM in BRCA mutation carriers have not been well-studied.Methods
We identified 53 BRCA-positive patients who underwent bilateral TSSM for prophylactic (26 patients) or therapeutic indications (27 patients) from 2001 to 2011. Cases were age-matched (for prophylactic cases) or age- and stage-matched (for therapeutic cases) with non-BRCA-positive patients. Outcomes included tumor involvement of resected nipple tissue, the development of new breast cancers in patients who underwent risk-reducing TSSM, and local–regional recurrence in patients who underwent therapeutic TSSM.Results
Outcomes from 212 TSSM procedures in 53 cases and 53 controls were analyzed. In patients undergoing TSSM for prophylactic indications, in situ cancer was found in one (1.9 %) nipple specimen in BRCA-positive patients versus two specimens (3.8 %) in the non-BRCA-positive cohort (p = 1). At a mean follow-up of 51 months, no new cancers developed in either cohort. In patients undergoing TSSM for therapeutic indications, in situ or invasive cancer was found in zero of the nipple specimens in BRCA-positive patients versus two specimens (3.7 %) in the non-BRCA-positive cohort (p = 0.49). At a mean follow-up of 37 months, there were no local–regional recurrences in the BRCA-positive cohort and 1 (3.7 %) in the non-BRCA-positive cohort.Conclusions
TSSM is an oncologically safe procedure in BRCA-positive patients. In patients undergoing TSSM as a risk-reducing strategy, 4-year follow-up demonstrates no increased risk of developing new breast cancers; longer-term follow-up is ongoing. 相似文献19.
Naoki Ishii Toshiyuki Itoh Noriyuki Horiki Michitaka Matsuda Takeshi Setoyama Shoko Suzuki Masayo Uemura Yusuke Iizuka Katsuyuki Fukuda Koyu Suzuki Yoshiyuki Fujita 《Surgical endoscopy》2010,24(8):1941-1947
Background
Large superficial neoplasias of the ileocecal region pose an increased degree of complexity for endoscopic resection. This study aimed to evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) for large superficial colorectal neoplasias including ileocecal lesions.Methods
A total of 33 superficial colorectal neoplasias, including eight neoplasias in the ileocecal region, were treated with ESD from December 2005 to April 2009. Therapeutic efficacy, complications, and follow-up results were retrospectively evaluated among three groups: ileocecal region, colon, and rectum.Results
The mean size of all resected neoplasias was 35 ± 15 mm (range, 20–80 mm) and that of all resected specimens was 41 ± 15 mm (range, 23–82 mm). The mean procedural time was 121 ± 90 min (range, 22–420 min). The difference in mean values among the three groups was not significant. The overall rate of en bloc resection was 91% (30/33). Histopathologically, both the lateral and vertical margins in the specimens resected en bloc tested negative (30/30). The rate for en bloc resection in the ileocecal region did not differ significantly from that for the other two groups (p = 0.20 compared with the rate for the colon and p = 0.12 compared with the rate for the rectum). Complications such as perforation and postoperative bleeding did not occur in the ileocecal group. No recurrence was observed in any cases during the mean follow-up period of 20 ± 12 months (range, 4–44 months).Conclusions
The ESD approach is safe and effective for treating large superficial neoplasias of the ileocecal region such as other colorectal neoplasias. 相似文献20.
Satoru Motoyama Mario Jin Tamotsu Matsuhashi Hiroshi Nanjo Koichi Ishiyama Yusuke Sato Kei Yoshino Tomohiko Sasaki Akiyuki Wakita Hajime Saito Yoshihiro Minamiya Hirohide Ohnishi Jun-ichi Ogawa 《Surgery today》2013,43(6):638-642