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1.
Kelly Lesperance Matthew J. Martin Ryan Lehmann Lionel Brounts Scott R. Steele 《Journal of gastrointestinal surgery》2009,13(7):1251-1259
Purpose The laparoscopic approach to Crohn’s disease has demonstrated benefits in several small series. We sought to examine its use
and outcomes on a national level.
Methods All admissions with a diagnosis of Crohn’s disease requiring bowel resection were selected from the 2000–2004 Nationwide Inpatient
Sample. Regression analyses were used to compare outcome measures and identify independent predictors of undergoing laparoscopy.
Results Of 396,911 patients admitted for Crohn’s disease, 49,609 (12%) required surgical treatment. They were predominately Caucasian
(64%), female (54%), and with ileocolic disease (72%). Most had private insurance (71%) and had surgery in urban hospitals
(91%). Laparoscopic resection was performed in 2,826 cases (6%) and was associated with lower complications (8% vs. 16%),
shorter length of stay (6 vs. 9 days), lower charges ($27,575 vs. $38,713), and mortality (0.2% vs. 0.9%, all P < 0.01). Open surgery was used more often for fistulas (8% vs. 1%) and when ostomies were required (12% vs. 7%). Independent
predictors of laparoscopic resection were age <35 [odds ratio (OR) = 2.4], female gender (OR = 1.4), admission to a teaching
hospital (OR = 1.2), ileocecal location (OR = 1.5), and lower disease stage (OR = 1.1, all P < 0.05). Ethnic category, insurance status, and type of admission (elective vs. non-elective) were not associated with operative
method (P > 0.05).
Conclusions A variety of patient- and system-related factors influence the utilization of laparoscopy in Crohn’s disease. Laparoscopic
resection is associated with excellent short-term outcomes compared to open surgery.
“The views expressed in the article (book, speech, etc.) are those of the author(s) and do not reflect the official policy
of the Department of the Army, the Department of Defense or the US Government.”
“The investigators have adhered to the policies for protection of human subjects as prescribed in 45 CFR 46.” 相似文献
2.
Andre da Luz Moreira Luca Stocchi Feza H. Remzi Daniel Geisler Jeffery Hammel Victor W. Fazio 《Journal of gastrointestinal surgery》2007,11(11):1529-1533
Introduction The purpose of this study was to compare short and long-term outcomes of laparoscopic colectomy with open colectomy in patients
with Crohn’s disease confined to the colon.
Materials and Methods We reviewed all patients undergoing laparoscopic colectomy for Crohn’s disease at our institution between 1994 and 2005. Laparoscopic
colectomies were matched to open colectomies by patient age, gender, American Society of Anesthesiologists score, type, and
year of surgery. We excluded patients with concomitant small bowel disease.
Results Twenty-seven laparoscopic cases were matched with 27 open cases. There were seven conversions (26%). There was no mortality.
Median operative times were significantly longer after laparoscopic colectomy (240 vs 150 min, P < 0.01), and estimated blood loss was comparable (325 vs 350 ml, P = 0.4). Postoperative complications were similar. Laparoscopic colectomies had shorter median length of stay (5 vs 6 days,
P = 0.07) and median time to first bowel movement (3 vs 4 days, P = 0.4). When overall length of stay included 30-day readmissions, the difference in favor of laparoscopy became statistically
significant (P = 0.02). Recurrent disease requiring surgery was decreased after laparoscopy, although median follow-up was significantly
shorter.
Conclusion Laparoscopic colectomy is a safe and acceptable option for patients with Crohn’s colitis. Longer follow-up is needed to accurately
establish recurrence rates. 相似文献
3.
Eddie K. Abdalla Dario Ribero Timothy M. Pawlik Daria Zorzi Steven A. Curley Andrea Muratore Axel Andres Gilles Mentha Lorenzo Capussotti Jean-Nicolas Vauthey 《Journal of gastrointestinal surgery》2007,11(1):66-72
Purpose: To examine clinical features and outcome of patients who underwent hepatic resection for colorectal liver metastases (LM)
involving the caudate lobe.
Patients and Methods: Consecutive patients who underwent hepatic resection for LM from May 1990 to September 2004 were analyzed from a multicenter
database. Demographics, operative data, pathologic margin status, recurrence, and survival were analyzed.
Results: Of 580 patients, 40 (7%) had LM involving the caudate. Six had isolated caudate LM and 34 had LM involving the caudate plus
one or more other hepatic segments. Patients with caudate LM were more likely to have synchronous primary colorectal cancer
(63% vs. 36%; P = 0.01), multiple LM (70% vs. 51%; P = 0.02) and required extended hepatic resection more often than patients with non-caudate LM (60% vs. 18%; P < 0.001). Only four patients with caudate LM underwent a vascular resection; three at first operation, one after recurrence
of a resected caudate tumor. All had primary repair (vena cava, n = 3; portal vein, n = 1). Perioperative complications (43% vs. 28%) and 60-day operative mortality (0% vs. 1%) were similar (caudate vs. non-caudate
LM, both P > 0.05). Pathological margins were positive in 15 (38%) patients with caudate LM and in 43 (8%) with non-caudate LM (P < 0.001). At a median follow-up of 40 months, 25 (64%) patients with caudate LM recurred compared with 219 (40%) patients
with non-caudate LM (P = 0.01). Patients with caudate LM were more likely to have intrahepatic disease as a component of recurrence (caudate: 51%
vs. non-caudate: 25%; P = 0.001). No patient recurred on the vena cava or portal vein. Patients with caudate LM had shorter 5-year disease-free and
overall survival than patients with non-caudate LM (disease-free: 24% vs. 44%; P = 0.02; overall: 41% vs. 58%; P = 0.02).
Conclusions: Patients who undergo hepatic resection for caudate LM often present with multiple hepatic tumors and tumors in proximity to
the major hepatic veins. Extended hepatectomy is required in the majority, although vascular resection is not frequently necessary;
when performed, primary repair is usually possible. Despite resection in this population of patients with multiple and bilateral
tumors, and despite close-margin and positive-margin resection in a significant proportion, recurrence on the portal vein
or vena cava was not observed, and long-term survival is accomplished (41% 5-year overall survival).
These data were presented at the American Hepato-Pancreato-Biliary Association 2006 Annual Meeting, Miami, Florida, March
12, 2006. 相似文献
4.
Swee H. Teh Daniel Tseng Brett C. Sheppard 《Journal of gastrointestinal surgery》2007,11(9):1120-1125
The aim of the study is to provide comparisons of the perioperative outcomes between open and laparoscopic distal pancreatic
resection (DPR) for benign pancreatic disease. From 2002 and 2005, there were 28 patients (16 open, 12 laparoscopic) with
a mean age of 52 who had presumptive diagnoses of benign pancreatic lesions. Pathology was neuroendocrine tumor (nine and
five), mucinous cystic neoplasm (three and three), symptomatic pancreatic pseudocyst (two and two), and others (two and two).
The mean operative time was 278 vs 212 min (p = 0.05), the estimated blood lost was 609 vs 193 ml (p = 0.01), and the success rate of preoperative intent for splenic preservation was 17 vs 62% (p = 0.08) in the open and laparoscopic groups, respectively. Two patients (16%) were converted to an open procedure. There
was no perioperative mortality. The mean hospital stay and total perioperative morbidity were 10.6 vs 6.2 days (p = 0.001) and nine vs two events (p = 0.03) in the open and laparoscopic groups, respectively. Ten of 12 patients (83%) with laparoscopic DPR had adequate oral
intake within 72 h post operatively in contrast to 2 of 16 (12.5%) patients in the open DPR group (p = 0.0001). Laparoscopic DPR is technically feasible, safe, and associated with less perioperative morbidity and a shorter
hospital stay than open DPR. In centers with the appropriate expertise, laparoscopic DPR should be considered the procedure
of choice for putative benign lesions of the pancreatic body and tail.
Presented at the AHPBA Spring Meeting, Miami Beach, FL March 9–12, 2006 (oral presentation) 相似文献
5.
Taylor S. Riall Karl A. Eschbach Courtney M. TownsendJr. William H. Nealon Jean L. Freeman James S. Goodwin 《Journal of gastrointestinal surgery》2007,11(10):1242-1252
Background The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.
Objective To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers
(>10 cases/year) in Texas.
Methods Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing
pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently
predicted resection at high-volume centers.
Results A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher
at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from
54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5%
to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having
emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center
(OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center
increased 6% per year.
Conclusions Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time,
37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing
less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured
barriers need to be identified.
Work supported by the Society of University Surgeons_Wyeth Clinical Scholars Award and the Dennis W. Jahnigen Career Development
Scholars Award. 相似文献
6.
Recent data suggest that the histologic finding of focal and segmental glomerulosclerosis (FSGS) is increasing among children.
There are, however, limited longitudinal pediatric data on prevalence, demographics, and steroid responsiveness in FSGS. We
identified 201 consecutive nephrotic children diagnosed between 1977 and 2002 with 2 years follow-up; 51% had undergone renal
biopsy due to steroid sequelae or resistance; 48 children with FSGS were diagnosed. Compared with non-FSGS children, FSGS
children were older at diagnosis (6.9 years vs 4.4 years, P < 0.02), more likely girls (54% vs 28%, P < 0.02), Black or Hispanic (42% vs 16%, P < 0.001), and the FSGS was more likely to be steroid resistant (73% vs 10%, P < 0.001). To assess for longitudinal differences, we grouped children by presentation: pre-1985, between 1985 and 1995, and
post-1995. There was no difference in proportion of children biopsied or diagnosed with FSGS during each interval. Among FSGS
children, there was no difference in racial or gender composition in each period, but there was a difference in age at diagnosis
(2.6 vs 5.7 vs 8.5 years; P = 0.01), also observed in the non-FSGS children (2.2 vs 3.9 vs 4.9 years; P = 0.02). In contradistinction to non-FSGS children, there was a marked increase in steroid resistance with FSGS (43% vs 62%
vs 86%; P = 0.03). 相似文献
7.
Iran dos Santos Moraes Jr. Carlos Augusto Scussel Madalosso Luis Amauri Palma Adriana Cristina da Silva Fornari Maria do Socorro Dourado Tiago Scherer Richard Ricachenevsky Gurski Fernando Fornari 《Obesity surgery》2009,19(3):281-286
Background Roux-en-Y gastric bypass (RYGBP) either laparoscopic or open has been increasingly employed in the treatment of patients with
morbid obesity. Laparoscopic approach is believed to be superior over open approach in terms of shorter hospital stay and
easier recovery. We aimed to assess feasibility and safety of open RYGBP with short stay in comparison with laparoscopic RYGBP.
Methods One hundred and ninety consecutive patients were assigned to open (n = 103) or laparoscopic (n = 87) RYGBP. The first 20 patients of the laparoscopic arm were excluded due to procedure learning curve. Patients were treated
by a multidisciplinary team focused on successfully RYGBP with short stay (1 day).
Results Short stay was reached by 90% of patients operated with open approach and 81% by laparoscopy (P = 0.070). Discharge in the second day was reached by 97% of patients in both groups. Procedure length [(median (IQR)] was
faster for open RYGBP [103 (70–180 min) vs. 169 (105–248 min); P < 0.0001]. Thirty-day readmission rate was similar between groups (3% vs. 7%; P = 0.266). There was no death in either group.
Conclusion Short stay (1 day) following open gastric bypass was a feasible and safe procedure. This approach might have economic impact
and might increase patient acceptance for open RYGBP. 相似文献
8.
Peter J. Lamb Jennifer C. Myers Sarah K. Thompson Glyn G. Jamieson 《Journal of gastrointestinal surgery》2009,13(1):61-65
Background A small proportion of patients evaluated with manometry prior to a fundoplication have a high-pressure lower esophageal sphincter
(LES). This paper examines the outcome of laparoscopic fundoplication for these patients.
Material and Methods Between October 1991 and December 2006, 1,886 patients underwent primary laparoscopic fundoplication. Those with a high-pressure
LES on preoperative manometry (LESP ≥30 mm Hg at end expiration) were identified from a prospective database. Long-term outcomes
were determined using analogue symptom scores (0–10) for heartburn, dysphagia, and patient satisfaction and compared to those
of a matched control group.
Results Thirty patients (1.6%), nine men and 21 women, median age 51 years, had a hypertensive LES (mean, 36 mmHg; range, 30–55).
Median follow-up after fundoplication was 99 (12–182) months. These patients had similar mean symptom scores to 30 matched
controls for heartburn (2.3 vs. 2.2, P = 0.541), dysphagia (2.7 vs. 3.1, P = 0.539), and satisfaction (7.4 vs. 7.6, P = 0.546). Five patients required revision for dysphagia compared to no control patients (P = 0.005). These patients had a higher preoperative dysphagia score (6.6 vs. 3.1, P = 0.036).
Conclusion Laparoscopic fundoplication can be performed with good long-term results for patients with reflux and a hypertensive LES.
However, those with preoperative dysphagia have a higher failure rate. 相似文献
9.
Anastomosis level and specimen length in surgery for uncomplicated diverticulitis of the sigmoid 总被引:1,自引:0,他引:1
Background: Extent of bowel resection and level of anastomosis are unsettled issues of surgery for diverticulitis of the sigmoid. The
aim of this study was to compare the adequacy of open colon resection (OCR) with that of laparoscopic colon resection (LCR)
for uncomplicated diverticulitis of the sigmoid (UDS), specifically addressing level of anastomosis and length of specimen.
Methods: Comparisons were made between 40 selected patients undergoing LCR for UDS between 1992 and 1994 and 35 diagnosis-matched
controls who previously underwent OCR by the same surgeons at the same institution.
Results: The OCR and LCR patients were well-matched for age, gender, weight, ASA grade, duration of symptoms, and number of previous
admissions. There were no significant differences, respectively, between OCR and LCR patients in morbidity rates (2 vs. 5,
p= 0.33) and rates of mobilization of the splenic flexure (17:18 vs. 29:11, p < 0.1). Specimen length (18 cm vs. 11 cm, p≪ 0.01), colosigmoid vs. colorectal anastomosis (24:11 vs. 1:39, p≪ 0.01), and presence of inflammatory cells at the proximal resection margin (2 vs. 11, p= 0.02) were significantly different. The OCR patients had statistically longer follow-up than LCR patients (63 months vs.
46 months, p≪ 0.01). Recurrent diverticulitis rates were 9.6% and 2.7% after OCR and LCR, respectively (3 vs. 1, p= 0.73).
Conclusions: Inadequate sigmoid resection should prompt diligence to take down the splenic flexure placing the distal anastomotic margin
on the rectum to ensure adequate surgery.
Received: 12 August 1997/Accepted: 16 November 1997 相似文献
10.
Heng-Li Tian Hao Chen Bing-Shan Wu He-Li Cao Tao Xu Jin Hu Gan Wang Wen-Wei Gao Zai-Kai Lin Shi-Wen Chen 《Neurosurgical review》2010,33(3):359-366
This study sought to describe and evaluate any relationship between D-dimer values and progressive hemorrhagic injury (PHI)
after traumatic brain injury (TBI). In patients with TBI, plasma D-dimer was measured while a computed tomography (CT) scan
was conducted as soon as the patient was admitted to the emergency department. A series of other clinical and laboratory parameters
were also measured and recorded. A logistic multiple regression analysis was used to identify risk factors for PHI. A cohort
of 194 patients with TBI was evaluated in this clinical study. Eighty-one (41.8%) patients suffered PHI as determined by a
second CT scan. The plasma D-dimer level was higher in patients who demonstrated PHI compared with those who did not (P < 0.001. Using a receiver–operator characteristic curve to predict the possibility by measuring the D-dimer level, a value
of 5.00 mg/L was considered the cutoff point, with a sensitivity of 72.8% and a specificity of 78.8%. Eight-four patients
had D-dimer levels higher than the cut point value (5.0 mg/L); PHI was seen in 71.4% of these patients and in 19.1% of the
other patients (P < 0.01). Factors with P < 0.2 on bivariate analysis were included in a stepwise logistic regression analysis to identify independent risk factors
for TBI coagulopathy. Logistic regression analysis showed that the D-dimer value was a predictor of PHI, and the odds ratio
(OR) was 1.341 with per milligram per liter (P = 0.020). The stepwise logistic regression also identified that time from injury to the first CT shorter than 2 h (OR = 2.118,
P = 0.047), PLT counts lesser than 100 × 109/L (OR = 7.853, P = 0.018), and Fg lower than 2.0 g/L (OR = 3.001, P = 0.012) were risk factors for the development of PHI. When D-dimer values were dichotomized at 5 mg/L, time from injury
to the first CT scan was no longer a risk factor statistically while the OR value of D-dimer to the occurrence of PHI elevated
to 11.850(P < 0.001). The level of plasma D-dimer after TBI can be a useful prognostic factor for PHI and should be considered in the
clinical management of patients in combination with neuroimaging and other data. 相似文献
11.
Prakash K Varma D Rajan M Kamlesh NP Zacharias P Ganesh Narayanan R Philip M 《The Indian journal of surgery》2010,72(4):318-322
Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic
surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and
short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term
outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with
a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly
more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy
group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved,
positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in
laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with
laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay.
Laparoscopic group recovers early and needs less hospital stay 相似文献
12.
John D. Allendorf Margaret Lauerman Aliye Bill Mary DiGiorgi Nicole Goetz Efsevia Vakiani Helen Remotti Beth Schrope William Sherman Michael Hall Robert L. Fine John A. Chabot 《Journal of gastrointestinal surgery》2008,12(1):91-100
Abstract
Background We evaluated the feasibility and efficacy of neoadjuvant chemotherapy and radiation for patients with locally unresectable
pancreatic cancer.
Materials and Methods From October 2000 to August 2006, 245 patients with pancreatic adenocarcinoma underwent surgical exploration at our institution.
Of these, 78 patients (32%) had undergone neoadjuvant therapy for initially unresectable disease, whereas the remaining patients
(serving as the control group) were explored at presentation (n = 167). All neoadjuvant patients received gemcitabine-based chemotherapy, often in conjunction with docetaxal and capecitabine
in a regimen called GTX (81%). Seventy-five percent of neoadjuvant patients also received preoperative abdominal radiation
(5,040 rad).
Results Neoadjuvant patients were younger than control-group patients (60.8 vs 66.2 years, respectively, p < 0.002). Seventy-six percent of neoadjuvant patients were resected as compared to 83% of control patients (NS). Concomitant
vascular resection was required in 76% of neoadjuvant patients but only 20% of NS (p < 0.01). Complications were more frequent in the neoadjuvant group (44.1 vs 30.9%, p < 0.05), and mortality was higher (10.2 vs 2.9%, p < 0.03). Among the neoadjuvant patients, all but one of the deaths were in patients that underwent arterial reconstruction.
Mortality for patients undergoing a standard pancreatectomy without vascular resection was 0.8% in this series. Of patients
resected, negative margins were achieved in 84.7% of neoadjuvant patients and 72.7% of NS. Within the cohort of neoadjuvant
patients, radiation significantly increased the complication rate (13.3 vs 54.6%, p < 0.006), but did not affect median survival (512 vs 729 days, NS). Median survival for patients who received neoadjuvant
therapy (503 days) was longer than NS that were found to be unresectable at surgery (192 days, p < 0.001) and equivalent to NS that were resected (498 days).
Conclusions Resection rate, margin status, and median survivals were equivalent when neoadjuvant patients were compared to patients considered
resectable by traditional criteria, demonstrating equal efficacy. Surgical resection with venous reconstruction following
neoadjuvant therapy for patients with locally advanced pancreatic cancer can be performed with acceptable morbidity and mortality.
This approach extended the boundaries of surgical resection and greatly increased median survival for the “inoperable” patient
with advanced pancreatic cancer.
This work was presented at the American Hepato-Pancreato-Biliary Association Conference in Las Vegas, NV, April 2007. 相似文献
13.
Goswin Y. Meyer‐Rochow Patsy S. H. Soon Leigh W. Delbridge Mark S. Sywak Chris P. Bambach Roderick J. Clifton‐Bligh Bruce G. Robinson Stan B. Sidhu 《ANZ journal of surgery》2009,79(5):367-370
Laparoscopic adrenalectomy is now accepted as the procedure of choice for the resection of benign adrenocortical tumours, but few studies have assessed whether the outcomes of laparoscopic adrenalectomy for adrenal phaeochromocytoma are similar to that of other adrenal tumour types. This is a retrospective cohort study. Clinical and operative data were obtained from an adrenal tumour database and hospital records. A total of 191 patients had laparoscopic adrenalectomy, of which 36 were for phaeochromocytoma, over a 12‐year period. Length of hospital stay (4.8 vs 3.6 days, P= 0.03) and total operating times (183 vs 157 min, P= 0.01) were greater in the laparoscopic phaeochromocytoma resection group. Despite the greater size of the phaeochromocytomas compared to the remaining adrenal tumour types (44 mm vs 30 mm, P < 0.01), however, rate of conversion and morbidity were no different. Laparoscopic adrenalectomy for phaeochromocytoma is a safe procedure with similar outcomes to laparoscopic adrenalectomy for other adrenal tumour types. 相似文献
14.
Eduardo A. Guzman MD Alessio Pigazzi MD PhD Byrne Lee MD Perry A. Soriano MD Rebecca A. Nelson PhD I. Benjamin Paz MD Vijay Trisal MD Joseph Kim MD Joshua D. I. Ellenhorn MD 《Annals of surgical oncology》2009,16(8):2218-2223
Background Laparoscopic gastric resection with extended lymphadenectomy is being evaluated in North America for the surgical treatment
of gastric cancer. The aim of this study is to compare short-term postoperative and oncologic outcomes of laparoscopic and
open resection for gastric cancer at a single cancer center.
Methods The study population consisted of patients with gastric adenocarcinoma who underwent a completely abdominal intervention with
curative intent. Laparoscopic and open gastric resections were compared. A totally laparoscopic technique was employed with
a robotic extended lymphadenectomy in a subset of patients.
Results A total of 78 consecutive patients were evaluated, including 30 laparoscopic and 48 open procedures. An extended lymphadenectomy
was performed in 58 patients and was executed robotically in 16 of these. There was no difference in the mean number of lymph
nodes retrieved by laparoscopic or open approach (24 ± 8 vs. 26 ± 15, P = .66). Laparoscopic procedures were associated with decreased blood loss (200 vs. 383 mL, P = .0009) and length of stay (7 vs. 10 days, P = .0009), but increased operative time (399 vs. 298 minutes, P < .0001).
Conclusion Completely laparoscopic gastric resection yields similar lymph node numbers compared with open surgery for gastric cancer.
It was found to be advantageous in terms of operative blood loss and length of stay. Minimally invasive techniques represent
an oncologically adequate alternative for the surgical treatment of gastric adenocarcinoma. 相似文献
15.
Cholangiocarcinomas (CC) frequently demonstrate lymphatic spread. We investigated lymph node (LN) counts after resection of
extrahepatic CC and survival based on the SEER 1973–2004 database. Out of 20,068 CC patients, 1,518 individuals were selected
based on M0 stage and at least one LN examined. Primary cancer sites included gallbladder (29%), extrahepatic bile ducts (26%),
and intrapancreatic/ampullary bile ducts (45%); 42% of patients were LN-positive. The median number of LNs examined was four
(range 1–39). Median survival was 37 months for LN-negative and 16 months for LN-positive cancers. Multivariate prognostic
variables were the number of positive LNs, primary site, age (all at p < 0.0001), gender (p = 0.002), size (p = 0.005), T category (p = 0.009), and total LN count (or number of negative LNs obtained, p = 0.01). The impact of total LN counts was seen in LN-negative (median survival, 1 vs 10 or more LNs examined: 27 vs 51 months,
p = 0.002) and LN-positive disease (10 vs 22 months, p < 0.0001). Survival prediction of extrahepatic CCs is strongly influenced by total LN counts and numbers of negative LNs
obtained. Although the resulting incremental benefit is small, dissection and examination of 10 or more LNs should be considered
for curative intent resections. 相似文献
16.
Background The prevalence of gastroesophageal reflux disease (GERD) is increasing in Eastern and Western countries. Obesity is recognized
as a risk factor of gastroesophageal reflux disease. However, little information is available on the prevalence of gastroesophageal
reflux disease in morbidly obese Chinese patients. The aim of this study was to compare the prevalence of GERD in Chinese
patients with morbid obesity and age- and sex-matched controls, and we also assessed the effect of Roux-en-Y gastric bypass
on reflux symptoms and erosive esophagitis.
Methods Between November 2006 and February 2008, 150 morbidly obese Chinese patients underwent laparoscopic Roux-en-Y gastric bypass.
Gastroesophageal reflux disease questionnaires and esophagogastroduodenoscopy results were assessed in all cases before surgery.
The prevalence of reflux symptoms and erosive esophagitis was compared with the prevalence in a database of 300 age- and sex-matched
controls. We also compared baseline and postoperative characteristics at 12 months after operation.
Results Patients with morbid obesity had higher frequencies of reflux symptoms (16% vs. 8%, P = 0.01) and erosive esophagitis (34% vs. 17%, P < 0.01) than those of controls. Twelve months after laparoscopic Roux-en-Y gastric bypass, 26 patients received follow-up
evaluations. In addition to substantial weight loss, the prevalence of reflux symptoms and erosive esophagitis decreased significantly
after operation (19.2% vs. 0%, P = 0.05, and 42.3% vs. 3.8%, P < 0.01, respectively).
Conclusions Gastroesophageal reflux disease is pervasive in Chinese patients with morbid obesity and Roux-en-Y gastric bypass substantially
improves not only the reflux symptoms but also the erosive esophagitis. 相似文献
17.
Anastomotic Leakage is Associated with Poor Long-Term Outcome in Patients After Curative Colorectal Resection for Malignancy 总被引:2,自引:0,他引:2
Wai Lun Law Hok Kwok Choi Yee Man Lee Judy W. C. Ho Chi Leung Seto 《Journal of gastrointestinal surgery》2007,11(1):8-15
The impact of anastomotic leakage on long-term outcomes after curative surgery for colorectal cancer has not been well documented.
This study aimed to investigate the effect of anastomotic leakage on survival and tumor recurrence in patients who underwent
curative resection for colorectal cancer. Prospectively collected data of the 1,580 patients (904 men) of a median age of
70 years (range: 24–94), who underwent potentially curative resection for colorectal cancer between 1996 and 2004, were reviewed.
Cancer-specific survival and disease recurrence were analyzed using Kaplan Meier method, and variables were compared with
log rank test. Cox regression model was used in multivariate analysis. The cancer was situated in the colon and the rectum
in 933 and 647 patients, respectively. Anastomotic leakage occurred in 60 patients (clinical leakage: n = 48; radiological leak: n = 12). The leakage rate was significantly higher in patients with surgery for rectal cancer (6.3 vs 2.0%, p < 0.001). The 5-year cancer-specific survivals were 56.9% in those with leakage and 75.9% in those without leakage (p = 0.012). The 5-year systemic recurrence rates were 48.4 and 22.6% in patients with and without anastomotic leak, respectively
(p = 0.001), whereas the 5-year local recurrence rates were 12.9 and 5.7%, respectively (p = 0.009). Anastomotic leakage remained an independent factor associated with a worse cancer-specific survival (p = 0.043, hazard ratio: 1.63, 95% CI: 1.02–2.60) and a higher systemic recurrence rate (hazard ratio: 1.94, 95% CI: 1.23–3.06,
p = 0.004) on multivariate analysis. In rectal cancer, anastomotic leakage was an independent factor for a higher local recurrence
rate (hazard ratio: 2.55, 95% CI: 1.07–6.06, p = 0.034). In conclusion, anastomotic leakage is associated with a poor survival and a higher tumor recurrence rate after
curative resection of colorectal cancer. Efforts should be undertaken to avoid this complication to improve the long-term
outcome.
This work was presented in the plenary session of the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract
at the Digestive Disease Week in Los Angeles on 22 May 2006. 相似文献
18.
Calogero Iacono Giuseppe Verlato Giuseppe Zamboni Aldo Scarpa Ettore Montresor Paola Capelli Luca Bortolasi Giovanni Serio 《Journal of gastrointestinal surgery》2007,11(5):578-588
Objective To evaluate the prognostic significance of different clinico-pathological and molecular factors, and to compare survival after
standard and extended pancreaticoduodenectomy (PD) in ampulla of Vater adenocarcinoma (AVAC).
Summary Background Data There are discordant data on factors affecting prognosis, and hence therapeutic choices, in AVAC.
Patients and Methods Clinical-pathological factors were evaluated in 59 patients, subjected to PD for AVAC; in 42 subjects information on chromosome
17p and 18q allelic losses (LOH) and microsatellite instability (MSI) was also available. The association between survival
and type of PD was investigated in the 25 patients operated between 1990 and 2001 (16 standard and nine extended).
Results The overall 5- and 10-year tumor-related survival rates were 46% and 33%, respectively. Sixteen patients had T-stages 1–2,
14 T-stage 3, and 29 T-stage 4 cancers. Chromosome 17p and 18q LOH were detected in 23 (55%) and 15 cases (36%), respectively,
and in 12 cases (29%) coexisted. Five cases were MSI-positive (12%). At univariate analysis, poor survival was associated
with cancer ulceration (P = 0.051), poor differentiation (P = 0.008), T-stage 4 (P < 0.001), nodal metastases (P = 0.004), chromosome 17p (P < 0.001) and 18q LOH (P = 0.002), and absence of MSI (P = 0.009). At multivariate analysis, only T-stage (P = 0.002) and 17p LOH (P = 0.001) were independent predictors of survival. All patients with MSI-positive cancers were long-survivors (>12 yrs), whereas
only 30% of MSI-negative cancer patients survived at 5 years. Extended pancreaticoduodenectomy was associated with a 3-year
disease-related survival higher than standard resection (83% vs 31%; P = 0.018).
Conclusion MSI and chromosome 17p status allow to better define prognosis within ampullary cancers at the same stage. Surgery alone resulted
curative in MSI-positive cancer patients, whereas it was inadequate in patients showing allelic losses, who might benefit
from adjuvant therapy. In this observational study, extended PD was associated with increased survival compared to standard
procedures.
Presented at the 2006 Annual Meeting of the American Hepato-Pancreato-Biliary Association, Miami Beach, Florida, March 9–12,
2006 相似文献
19.
Hiroko Kunitake Richard Hodin Paul C. Shellito Bruce E. Sands Joshua Korzenik Liliana Bordeianou 《Journal of gastrointestinal surgery》2008,12(10):1730-1737
Purpose The impact of infliximab (IFX) on postoperative complications in surgical patients with Crohn’s disease (CD) and ulcerative
colitis (UC) is unclear. We examined a large patient cohort to clarify whether a relationship exists between IFX and postoperative
complications.
Methods A total of 413 consecutive patients—188 (45.5%) with suspected CD, 156 (37.8%) with UC, and 69 (16.7%) with indeterminate
colitis—underwent abdominal surgery at the Massachusetts General Hospital between January 1993 and June 2007. One hundred
one (24.5%) had received preoperative IFX ≤ 12 weeks before surgery. These patients were compared to those who did not receive
IFX with respect to demographics, comorbidities, presence of preoperative infections, steroid use, and nutritional status.
We then compared the cumulative rate of complications for each group, which included deaths, anastomotic leak, infection,
thrombotic complications, prolonged ileus/small bowel obstruction, cardiac, and hepatorenal complications. Potential risk
factors for infectious complications including preexisting infection, pathological diagnosis, and steroid or IFX exposure
were further evaluated using logistic regression analysis.
Results Patients were similar with respect to gender (IFX = 40.6% men vs. non-IFX = 51.9%, p = 0.06), age (36.1 years vs.37.8, p = 0.43), Charlson Comorbidity Index (5.3 vs. 5.7, p = 0.25), concomitant steroids (75.3% vs. 76.9%, p = 0.79), preoperative albumin level (3.3 vs. 3.2, p = 0.36), and rate of emergent surgery (3.0% vs. 3.5%, p = 1.00). IFX patients had higher rates of CD (56.4% vs. 41.9%, p = 0.02), concomitant azathioprine/6-mercaptopurine use (34.6% vs. 16.6%, p < 0.0001), and lower rates of intra-abdominal abscess (3.9% vs. 11%, p < 0.05). After surgery, the two groups had similar rates of death (2% vs. 0.3% p = 0.09), anastomotic leak (3.0% vs. 2.9%, p = 0.97), cumulative infections (5.97% vs. 10.1%, p = 1), thrombotic complications (3.6% vs. 3.0%, p = 0.06), prolonged ileus/small bowel obstructions (3.9 vs. 2.8, p = 0.59), cardiac complications (1% vs. 0.6%, p = 0.42), and hepatic or renal complications (1.0 vs. 0.6% p = 0.72). A logistic regression model was then created to assess the impact of IFX, as well as other potential risk factors,
on the rates of cumulative postoperative infections. We found that steroids (odds ratio [OR] = 1.2, p = 0.74), IFX (OR 2.5, p = 0.14), preoperative diagnosis of CD (OR = 0.7, p = 0.63) or UC (OR = 0.6, p = 0.48), and preoperative infection (OR = 1.2, p = 0.76) did not affect rates of clinically important postoperative infections.
Conclusions Preoperative IFX was not associated with an increased rate of cumulative postoperative complications.
Dr. Sands has received research grants and honoraria for lecturing and consulting from Centocor. 相似文献
20.
Subhashini M. Ayloo Nicolas C. Buchs Pietro Addeo Francesco M. Bianco Pier C. Giulianotti 《Obesity surgery》2011,21(7):815-819
In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving
obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize
the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes
of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing
either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to
121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar
patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years
for standard; P = 0.002). There were no statistical differences for operative time (78 vs. 76 min, P = 0.69), blood loss (8.4 vs. 9 ml, P = 0.76), pain score (0.81 vs. 0.84 at 1 week, P = 0.95) or complication rates (12% vs. 14%, P = 1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P = 0.02). The mean operative cost for the LESS banding was 20,502/case vs.20,502/case vs. 20,346/case for the standard LAGB, with no statistically
significant difference between the approaches (P = 0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB
procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic
advantage and comparable complication rate. 相似文献