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1.
N. Lou C.-H. Chi X.-D. Chen C.-J. Zhou S.-L. Wang C.-L. Zhuang X. Shen 《European journal of surgical oncology》2017,43(1):188-195
Background
Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. This study aims to explore the prevalence of sarcopenia in overweight and obese gastric cancer (GC) patients and figured out the impacts of sarcopenia on the postoperative complication of overweight and obese GC patients.Methods
According to the recommended body-mass index (BMI) for Asian populations by WHO, we conducted a prospective study of overweight and obese gastric cancer patients (BMI ≥ 23 kg/m2) under curative gastrectomy from August 2014 to December 2015. Including lumbar skeletal muscle index, handgrip strength and gait speed as the sarcopenic components were measured before surgery. Patients were followed up after gastrectomy to gain the actual clinical outcomes. Factors contributing to postoperative complications were analyzed by univariate and multivariate analysis.Results
Total of 206 overweight or obese patients were enrolled in this study, 14 patients were diagnosed sarcopenia and were demonstrated having significantly association with higher risk of postoperative complications, higher hospital costs, and higher rate of 30-days readmission compared with the non-sarcopenic ones. On the basis of univariate and multivariate analysis, sarcopenia was an independent risk factor for postoperative complication of overweight and obese patients with gastric cancer (P = 0.002).Conclusion
Sarcopenia is an independent predictor of postoperative complications in overweight or obese patients with gastric cancer after radical gastrectomy. 相似文献2.
Won Kyung Cho Doo Ho Choi Won Park Hyejung Cha Seok Jin Nam Seok Won Kim Jeong Eon Lee Jonghan Yu Young-Hyuck Im Jin Seok Ahn Yeon Hee Park Ji-Yeon Kim Soohyun Ahn 《Clinical breast cancer》2018,18(5):e1141-e1147
Purpose
To investigate the effect of body mass index (BMI) on survival in patients with breast cancer according to tumor subtype, metabolic syndrome, and systemic treatment.Patients and Methods
We identified 5668 patients who underwent curative surgery for breast cancer between 1996 and 2013 from the clinical data of a single institution. Disease-free survival (DFS) and overall survival (OS) were calculated and compared between the patients with BMI ≥ 25 kg/m2 and < 25 kg/m2 in all patients and in specific subgroups, including tumor subtype, metabolic syndrome, and systemic treatment.Results
In all patients, BMI ≥ 25 kg/m2 was an unfavorable factor for OS (P = .030) but not for DFS. In the HR+/HER2? subgroup, DFS and OS were longer in patients with BMI < 25 kg/m2 than ≥ 25 kg/m2 (P = .012 and .005, respectively). In patients with more than one metabolic syndrome, BMI was an unfavorable factor for OS (hazard ratio, 2.669; P < .001)Conclusion
BMI ≥ 25 kg/m2 was an unfavorable survival factor, particularly in patients with HR+/HER2? breast cancer. 相似文献3.
Introduction
In recent years, the incidence of thyroid cancer and obesity has increased rapidly worldwide. Many studies have been conducted on the relationship between thyroid cancer and obesity; however, the potential mechanisms are not well understood, and few studies have been performed in Asia. This study aimed to identify the relationship between the risk of thyroid cancer and obesity in the Korean population based on a large cohort of data.Method
We analyzed clinical data from a total of 351,402 individuals (males: 181,709, females: 169,693) aged over 20 years who received medical examinations arranged by the national insurance program from 2003 to 2008. Newly diagnosed thyroid cancer was identified using insurance claims data. The median follow-up duration was 7.01 years.Results
The mean body mass index (BMI) of the subjects was 23.6?±?3.2?kg/m2 (males, 24?±?3; females, 23.1?±?3.3). A total of 3308 individuals (0.94%) developed thyroid cancer during the study period. The risk of thyroid cancer was higher with increasing BMI in both men and women. Hazard ratios (95% confidence interval) for obese (25–29.9?kg/m2) and extremely obese (≥30?kg/m2) groups were 1.23 (1.13–1.34) and 1.26 (1.02–1.50), respectively, compared to the normal group (18.5–22.9?kg/m2). In particular, the association between the risk of thyroid cancer and BMI was more remarkable in the male group than female group.Conclusion
Our findings show that higher BMI is positively associated with the risk of thyroid cancer. Furthermore, this study supports the positive association between obesity and the increased incidence of thyroid cancer. 相似文献4.
Y. Sun Z. Xu H. Lin X. Lu Y. Huang S. Huang X. Wang P. Chi 《European journal of surgical oncology》2017,43(10):1828-1834
Aim
To determine the effect of obesity, measured by body mass index (BMI), on tumor response and surgical outcome in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgery.Method
LARC patients undergoing nCRT and radical surgery from 2008 to 2014 were included and divided into three groups: non-obese (BMI < 25.0 kg/m2), obese I (BMI 25.0–29.9 kg/m2), and obese II (BMI ≥ 30.0 kg/m2). Tumor response, surgical and oncological outcome were compared between groups. Multivariate analyses were performed to identify risk factors for local recurrence.Results
A total of 522 LARC patients were analyzed (407 non-obese, 93 obese I, 22 obese II). Post-operative complications did not differ between groups. Increased BMI was associated with poorer T downstaging and Rectal Cancer Regression Grade (P = 0.116, P = 0.036). With a mean follow-up of 57 months, the 5-year overall survival and distant metastasis rates did not differ between groups (P = 0.861, P = 0.116). The 5-year local recurrence rate in obese II patients was 14.6%, higher than that in non-obese and obese I groups (P = 0.015). Cox regression analysis demonstrated that BMI ≥30 kg/m2 (HR = 6.187, P = 0.010) was significantly associated with increased risk for local recurrence.Conclusion
Obesity was associated with poorer T downstaging and Rectal Cancer Regression Grade, and thus poor local control in LARC following nCRT in Asian patients. More effective treatment strategies to improve treatment outcome for obese patients with LARC are warranted. 相似文献5.
Seok-Soo Byun Eu Chang Hwang Seok Ho Kang Sung-Hoo Hong Jinsoo Chung Tae Gyun Kwon Hyeon Hoe Kim Cheol Kwak Yong-June Kim Won Ki Lee 《Clinical genitourinary cancer》2018,16(1):e173-e179
Introduction
We assessed the prognostic significance of obesity in relation to sex in patients with nonmetastatic clear-cell renal-cell carcinoma (nm-cRCC) in a large multicenter setting in Korea.Patients and Methods
A total of 2097 patients with nm-cRCC who underwent surgery with curative intent were enrolled from 6 institutions in Korea between April 2000 and February 2014. Obesity was determined by body mass index (BMI) before surgery. BMI was used as a continuous variable and was categorized as normal (≥ 18.5 to < 25.0 kg/m2, normal BMI) and overweight or obese (≥ 25 kg/m2, high BMI). The relationships between BMI, sex, recurrence-free survival (RFS), and cancer-specific survival (CSS) were evaluated.Results
Male patients had a greater high BMI ratio than female patients (P = .030). In men, the 5-year RFS and CSS rates in the high BMI group were greater than those in the normal BMI group (P = .003 and .006, respectively). Multivariate analyses revealed that in men, a high BMI was associated with greater RFS or CSS rates (hazard ratio: RFS, 0.901, P = .001; CSS, 0.822, P < .001). In women, there were no significant differences in the 5-year RFS and CSS rates according to BMI (P = .531 and .323, respectively), and high BMI was not associated with RFS or CSS (P = .250 and .180, respectively).Conclusion
In patients with nm-cRCC, obesity was a favorable prognosticator in male but not female patients. Therefore, the association between obesity and nm-cRCC prognosis might differ by sex. 相似文献6.
Giacomo Corrado Enrico Vizza Vito Cela Liliana Mereu Stefano Bogliolo Francesco Legge Francesca Ciccarone Emanuela Mancini Valerio Gallotta Ermelinda Baiocco Giorgia Monterossi Maria Teresa Perri Ashanti Zampa Tina Pasciuto Giovanni Scambia 《European journal of surgical oncology》2018,44(12)
Objective
The aim of this study was to evaluate the surgical and oncological outcome of robotic surgical staging with hysterectomy (RH) plus or less pelvic and aortic lymphadenectomy, compared to the same procedures performed by laparoscopic surgery (LH) in obese patients (BMI≥30?kg/m2) with endometrial cancer.Material and methods
From October 2001 to April 2017, obese patients (BMI?>?30?kg/m2) with primary, histologically confirmed endometrial carcinoma who underwent LH or RH using the Da Vinci Si or Xi Surgical System® (Intuitive Surgical Inc®, 1266 Kifer Road, Building 101 Sunnyvale, CA) were eligible for the study.Results
We identified 655 women with endometrial cancer and BMI >30?kg/m2. Out of 655 patients, 249 (38%) underwent RH and 406 (62%) underwent LH plus or less pelvic and aortic lymphadenectomy. Our study showed that, compared to the 406 patients treated in LPS, 249 patients treated in robotics have a statistically significant difference in terms of increased operating time and a decreased conversion rate. In addition, the rate of pelvic lymphadenectomies in robotic surgeries is twice the one reported in LPS surgeries. Furthermore, a reduction in hospital stay was observed in the robotic group. We observed that the oncological outcomes do not vary according to the surgical approach and BMI variation.Conclusions: robotic surgery in severely obese women with endometrial cancer is feasible, safe, and reproducible and could be a valid alternative to laparoscopy in the treatment of these patients. Prospective studies could confirm our results. 相似文献7.
Zhanlong Shen Yuanpei Lin Yingjiang Ye Kewei Jiang Qiwei Xie Zhidong Gao Shan Wang 《European journal of surgical oncology》2018,44(4):490-495
Objective
To establish predicting models of surgical complications in elderly colorectal cancer patients.Background
Surgical complications are usually critical and lethal in the elderly patients. However, none of the current models are specifically designed to predict surgical complications in elderly colorectal cancer patients.Methods
Details of 1008 cases of elderly colorectal cancer patients (age ≥ 65) were collected retrospectively from January 1998 to December 2013. Seventy-six clinicopathological variables which might affect postoperative complications in elderly patients were recorded. Multivariate stepwise logistic regression analysis was used to develop the risk model equations. The performance of the developed model was evaluated by measures of calibration (Hosmer-Lemeshow test) and discrimination (the area under the receiver-operator characteristic curve, AUC).Results
The AUC of our established Surgical Complication Score for Elderly Colorectal Cancer patients (SCSECC) model was 0.743 (sensitivity, 82.1%; specificity, 78.3%). There was no significant discrepancy between observed and predicted incidence rates of surgical complications (AUC, 0.820; P = .812). The Surgical Site Infection Score for Elderly Colorectal Cancer patients (SSISECC) model showed significantly better prediction power compared to the National Nosocomial Infections Surveillance index (NNIS) (AUC, 0.732; P ? 0.001) and Efficacy of Nosocomial Infection Control index (SENIC) (AUC; 0.686; P?0.001) models.Conclusions
The SCSECC and SSISECC models show good prediction power for postoperative surgical complication morbidity and surgical site infection in elderly colorectal cancer patients. 相似文献8.
W. Petz D. Ribero E. Bertani S. Borin G. Formisano S. Esposito G. Spinoglio P.P. Bianchi 《European journal of surgical oncology》2017,43(11):2060-2066
Introduction
Right-sided colon cancer has a worse prognosis than left-sided colon cancer. Complete mesocolic excision (CME) with central vessels ligation (CVL) reduces local recurrence, but is technically demanding, particularly with a laparoscopic approach.Aim of this study is to describe a new robotic approach to right colectomy with CME and CVL and to report oncologic safety and short term outcomes.Methods
Twenty consecutive patients were included. All patients had a right colon adenocarcinoma and underwent right colectomy with a suprapubic approach. Surgery was realized with the Da Vinci Xi® system and all trocars were placed along a horizontal line 3–6 cm above the pubis. CME with CVL was realized in all the patients.Data analysed were: duration of surgery, conversions to open surgery, intraoperative and postoperative complication by Clavien Dindo classification, margins of resections, length of specimen and number of lymph nodes retrieved.Results
Patients median age was 69 years, median body mass index was 27 kg/m2. Median operative time was 249 min, blood loss was negligible, no conversions to open or laparoscopic surgery occurred. Median hospital stay was six days; two postoperative grade IIIa Clavien–Dindo complications occurred, no 30-days postoperative death was registered. Resection margins were negative in all patients; median tumour diameter was 3.6 cm, median specimen length was 40 cm, median number of harvested lymph nodes was 40.Conclusions
Robotic right colectomy with CME using a suprapubic approach is a feasible and safe technique that allows for an extended lymphadenectomy and provides high quality surgical specimens. 相似文献9.
Youri Q.M. Poelemeijer Niki Lijftogt Robin Detering Marta Fiocco Rob A.E.M. Tollenaar Michel W.J.M. Wouters 《European journal of surgical oncology》2018,44(12):1849-1857
Background
Obesity is an increasing problem worldwide that can influence perioperative and postoperative outcomes. However, the relationship between obesity and treatment-related perioperative and short-term postoperative morbidity after colorectal resections is still subject to debate.Study
Patients were selected from the DCRA, a population-based audit including 83 hospitals performing colorectal cancer (CRC) surgery. Data regarding primary resections between 2009 and 2016 were eligible for analyses. Patients were subdivided into six categories: underweight, normal weight, overweight and obesity class I, II and III.Results
Of 71,084 patients, 17.7% with colon and 16.4% with rectal cancer were categorized as obese. Significant differences were found for the 30-day overall postoperative complication rate (p < 0.001), prolonged hospitalization (p < 0.001) and readmission rate (colon cancer p < 0.005; rectal cancer p < 0.002) in obese CRC patients. Multivariate analysis identified BMI ≥30 kg/m2 as independent predictor of a complicated postoperative course in CRC patients. Furthermore, obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate. No significant differences in performance were observed in postoperative outcomes of morbidly obese CRC patients between hospitals performing bariatric surgery and hospitals that did not.Conclusion
The real-life data analysed in this study reflect daily practice in the Netherlands and identify obesity as a significant risk factor in CRC patients. Obesity-related comorbidities were associated with higher postoperative morbidity, prolonged hospitalization and a higher readmission rate in obese CRC patients. No differences were observed between hospitals performing bariatric surgery and hospitals that did not. 相似文献10.
Ricard Ramos Ernest Nadal Inma Peiró Cristina Masuet-Aumatell Ivan Macia Francisco Rivas Gabriela Rosado Pau Rodriguez Anna Ureña Susana Padrones Samantha Aso Carlos Deniz Arturo Navarro Ignacio Escobar 《European journal of surgical oncology》2018,44(9):1419-1424
Background
As nutritional status plays an important role in outcomes after surgery, this study evaluated the association between preoperative nutritional status (NS) and postoperative outcomes after major resection for lung cancer.Methods
We identified 219 patients with a diagnosis of cancer who underwent pulmonary resection from 2010 to 2012. Preoperative NS was assessed by anthropometric and biological parameters, body mass index (BMI), and the Nutritional Risk Index (NRI). We stratified this population into 4 BMI groups: underweight, normal weight, overweight and obese and 4 NRI groups: well-nourished; mildly malnourished; moderately malnourished and severely malnourished. The outcomes measured were postoperative complications; 30-day postoperative mortality; hospital length of stay (LOS), overall survival (OS) and disease-free survival (DFS). We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables.Results
Mean BMI and NRI were, respectively, 26.5 ± 4.3 and 112.4 ± 3.3. There were no significant differences between BMI categories and resection type, pathological stage, or overall postoperative complications. By contrast, significant differences (p < 0.05) in postoperative complications were observed among the NRI groups. LOS was longer in underweight and/or malnourished patients. In terms of OS, we found no significant differences according to NRI and BMI; however, patients with underweight had significantly shorter DFS compared with patients with overweight and obesity (log-rank p-value = 0.001).Conclusion
NS as measured by the NRI is an independent predictor of the risk of postsurgical complications, regardless of clinicopathologic characteristics. NRI might therefore be an useful tool for identifying early-stage lung cancer patients at risk for postoperative complications. 相似文献11.
Background
Tamoxifen is commonly used to prevent breast cancer recurrence. Studies have confirmed the association between tamoxifen and nonalcoholic fatty liver disease (NAFLD), with the results indicating the need for aggressive management of this side effect. We assessed the potential risk factors for and identified the possible protective factors of tamoxifen-related fatty liver.Materials and Methods
We enrolled patients with a history of breast cancer, aged 20 to 70 years, who had received with tamoxifen treatment within the past 5 years. We obtained the initial data and performed a follow-up blood test and ultrasound examination to compare the differences before and after tamoxifen treatment. The patients were divided into relatively normal and fatty liver groups.Results
Of the 266 enrolled tamoxifen-treated patients, 143 (53.8%) and 123 (46.2%) were in the relatively normal and fatty liver groups, respectively. The initial body weight (57.6 ± 9.3 kg vs. 60.9 ± 10.3 kg; P = .006) and body mass index (BMI; 23.4 ± 3.8 kg/m2 vs. 25.0 ± 4.2 kg/m2; P < .001) were lower in the relatively normal group. An initial BMI of ≥ 22 kg/m2 was a potential risk factor for tamoxifen-related NAFLD (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.00-2.48; P = .048). In contrast, a weekly exercise duration of ≥ 150 minutes reduced the risk (HR, 0.47; 95% CI, 0.31-0.69; P < .001).Conclusion
The results from our study suggest that a BMI of ≥ 22 kg/m2 is a potential risk factor for tamoxifen-related fatty liver and exercise is a possible protective factor. 相似文献12.
Angelina Cistaro Laura Cassalia Cinzia Ferrara Natale Quartuccio Laura Evangelista Maurizio Bianchi Franca Fagioli Gianni Bisi Sergio Baldari Alessandro Zanella Marta Pillon Pietro Zucchetta Marta Burei Alessandra Sala Luca Guerra Priscilla Guglielmo Roberta Burnelli Stefano Panareo Giuseppe Rubini 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(6):e267-e273
Introduction
The present study investigated the utility of fluorine-18 (18F) fluoro-2-deoxy-d-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing bone marrow involvement (BMI) compared with bone marrow biopsy (BMB) in newly diagnosed pediatric Hodgkin lymphoma (HL).Patients and Methods
A total of 224 pediatric patients with HL underwent 18F-FDG PET/CT at staging. BMB or follow-up imaging was used as the standard of reference for the evaluation of BMI.Results
18F-FDG PET/CT was negative for BMI in 193 cases. Of the 193 patients, the findings for 16 were originally reported as doubtful and later interpreted as negative for BMI, with negative findings on follow-up imaging and BMB. At BMB, 1 of the 16 patients (6.25%) had BMI. Of the 193 patients, 192 (99.48%) had negative BMB findings. Thus, the 18F-FDG PET/CT findings were truly negative for 192 patients and falsely negative for 1 patient for BMI.Conclusion
18F-FDG PET/CT showed high diagnostic performance in the evaluation of BMI in pediatric HL. Thus, BMB should be ideally reserved for patients presenting with doubtful 18F-FDG PET/CT findings for BMI. 相似文献13.
D. Badrudin L. Sideris F.A. Leblond V. Pichette A.S. Cloutier P. Drolet P. Dubé 《Surgical oncology》2018,27(2):275-279
Background
Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (OX) is the standard of care for selected patients with peritoneal carcinomatosis of colorectal origin. Because 5-FU is mandatory to improve efficacy of OX when used by systemic route, several teams now empirically combine intravenous (IV) 5-FU with HIPEC OX, but this practice has yet to be supported by preclinical data. Using a murine model, we studied the impact of IV 5-FU on peritoneal absorption of HIPEC OX.Methods
Under general anesthesia, 24 Sprague-Dawley rats were submitted to 4 different doses of IV 5-FU (0, 100, 400 and 800?mg/m2) and a fixed dose of HIPEC OX (460?mg/m2) perfused at 40?°C during 25?min. At 25?min, samples in different compartments were harvested (peritoneum, portal vein and systemic blood) and the concentrations of 5-FU and OX were measured by high performance liquid chromatography.Results
Peritoneal absorption of OX was significantly higher (17.0, 20.1, 34.9 and 38.1?nmol/g, p?<?0.0001) with increasing doses of 5-FU (0, 100, 400 and 800?mg/m2, respectively). Peritoneal absorption of OX reached a plateau between 400 and 800?mg/m2 of IV 5-FU.Conclusion
IV 5-FU enhances peritoneal absorption of HIPEC OX. The most efficient dose of IV 5-FU to be used in combination with HIPEC OX seems to be 400?mg/m2. 相似文献14.
Hongzhou Cai Weizhang Xu Bin Yu Xiao Li Liangjun Zhu Zicheng Xu Jin Zhou Yuxiao Zheng Qing Zou Yun Zeng Xinwei Wang Ting Xu 《Clinical genitourinary cancer》2018,16(4):e899-e901
Introduction
Metastatic extramammary Paget disease (EMPD) as a rare intraepithelial carcinoma is fatal. However, no standardized chemotherapy has been established. We provided docetaxel combined with cisplatin to EMPD patients.Patients and Methods
A total of 8 patients with metastatic EMPD were included in this study between July 2010 and July 2015 (mean age, 64.4 years); they underwent a mean of 9.4 cycles of chemotherapy. All the patients were treated with chemotherapy (docetaxel 60 mg/m2 on day 1; cisplatin 25 mg/m2 on days 1-3) as first-line treatment for > 6 cycle (at least 21 days per cycle). Data on tumor response, time to progression, overall survival, and adverse events were collected.Results
After 2 cycles of chemotherapy, 4 patients experienced partial remission and 4 stable disease. The mean overall survival was 28.9 months, and the mean progression-free survival was 9.9 months.Conclusion
Docetaxel combined with cisplatin might be a treatment option for metastatic EMPD, with high disease control rate and good overall survival. 相似文献15.
Background
Surgical management remains the cornerstone of treatment for many cancers, but is associated with a high rate of postoperative complications, which are linked to poor preoperative functional capacity. Prehabilitation may have beneficial effects on functional capacity and postoperative outcomes. We evaluated the effects of prehabilitation combining endurance and resistance training (CT) on physical fitness, quality of life (QoL) and postoperative outcomes in cancer patients undergoing tumour resection surgery.Methods
We performed a literature search in PubMed, PEDro, EMBASE (via Scopus) and the Cochrane library for clinical trials until September 2017. Randomised controlled trials investigating the effects of CT in adult cancer patients undergoing surgery were included when at least one of the following outcomes was reported: physical capacity, muscle strength, QoL, length of stay (LOS), postoperative complications and mortality.Results
Ten studies (360 patients) were retrieved and included patients with lung, colorectal, bladder and oesophageal cancer. No adverse effects of CT were reported. Compared with the control group, CT improved physical capacity (3 of 5 studies), muscle strength (2 of 3 studies) and some domains of QoL (2 of 4 studies), shortened LOS (1 of 6 studies) and reduced postoperative pulmonary complications (2 of 6 studies).Conclusions
The benefits of CT in cancer population are demonstrated. CT may improve physical fitness and QoL and decrease LOS and postoperative pulmonary complications. However, our conclusions are limited by the heterogeneity of the preoperative CT programs, patient characteristics and measurement tools. Future research is required to determine the optimal composition of CT. 相似文献16.
Isabella Reccia Jayant Kumar Tomokazu Kusano Alexandros Giakoustidis Artur Zanellato Phil Retsas Nagy Habib Long Jiao Duncan Spalding Madhava Pai 《Surgical oncology》2018,27(3):415-420
Background
Radiofrequency (RF)-assisted liver resection allows non-anatomical liver resection with reduced blood loss and offers the opportunity for a combination of resection and ablation. However, there are still concerns with regard to postoperative complications related to this technique. In the present study, we discuss the technical aspects of RF-assisted liver resections and analyse the rate of perioperative complications, focusing on post-hepatectomy liver failure (PLF), bile leak and abscess, and mortality.Methods
Between 2001 and 2015, 857 consecutive open and laparoscopic elective RF-assisted liver resections for benign and malignant liver tumours were reviewed retrospectively to assess perioperative outcomes.Results
Median intraoperative blood loss was 130?mL, with 9.8% of patients requiring blood transfusion. Intra-abdominal collections requiring percutaneous drainage developed in 8.7% of all patients, while bile leak at resection margin developed in 2.8% of the cases. Major liver resection was performed in 34% of patients and the incidence of PLF was 1.5% with one directly related mortality (0.1%).Conclusion
RF-assisted liver resection has evolved into a feasible and safe technique of liver resection with an acceptable incidence of perioperative morbidity and a low incidence of PLF and related mortality. 相似文献17.
Francesca De Felice Karen Llange Filippo Rubini Nadia Bulzonetti Rossella Caiazzo Daniela Musio Vincenzo Tombolini 《Clinical colorectal cancer》2018,17(1):e77-e81
Introduction
We report the treatment compliance, toxicity rates, and long-term clinical outcomes of elderly patients who received intensified neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC).Patients and Methods
We identified a retrospective cohort of patients aged ≥ 70 years with LARC who received intensified neoadjuvant CRT, followed by surgery and adjuvant chemotherapy, from 2007 to 2014. Intensified neoadjuvant CRT consisted of radiotherapy (total dose, 50.4/54 Gy) with concomitant oxaliplatin (50 mg/m2/wk) and 5-fluorouracil (200 mg/m2 in 5 daily continuous infusion).Results
A total of 26 patients were included. All patients completed the programmed CRT. Severe acute toxicity was recorded in 19.2% of cases. Conservative surgery was performed in 16 patients, and a pathologic complete response was achieved in 19.2%. Overall, 26.9% of the patients died. The 5-year overall survival and disease-free survival rates were 70.6% and 65.5%, respectively.Conclusions
Intensified neoadjuvant CRT is an efficacious and safe treatment option for LARC in elderly patients. 相似文献18.
Björn Bolmstrand Per J. Nilsson Torbjörn Holm Christian Buchli Gabriella Palmer 《European journal of surgical oncology》2018,44(10):1513-1517
Background
Multi-visceral resection, including parts of the urinary tract, is sometimes warranted to achieve cancer clear resection margins and optimize survival in patients with locally advanced colorectal and anal cancer. The aim of this study was to assess morbidity after urinary tract reconstruction dictated by colorectal and anal malignancy and to identify potential predictors of urological complications.Methods
All patients undergoing surgery for colorectal or anal malignancy, including urinary tract resection and synchronous reconstruction, performed at the Karolinska University Hospital during 2004–2015 were included in this retrospective cohort study. Data was collected from medical records with follow-up until at least one year after the index surgery. Complications were graded according to the Clavien-Dindo classification system of surgical complications.Results
The study included 189 patients; 121 underwent cystectomy and 68 partial ureter resection. The rate of high grade urological complications was 22%. The risk of major urological complications was significantly higher in patients subjected to ureter resection compared to after cystectomy (OR 2.60, 95% CI 1.23–5.49). Also, preoperative radiotherapy and intestinal anastomotic dehiscence significantly increased the risk of high grade urological complications.Conclusion
To achieve potentially curative resections with uninvolved margins in patients with locally advanced colorectal and anal cancer, multi-visceral resection including urinary tract reconstruction can be performed with reasonable morbidity. 相似文献19.
Nina Ommundsen Arild Nesbakken Torgeir Bruun Wyller Eva Skovlund Arne Olav Bakka Marit Slaaen Jordhøy Siri Rostoft 《European journal of surgical oncology》2018,44(10):1542-1547
Background
The incidence of postoperative complications after colorectal cancer surgery varies between publications. Complications occurring after discharge from hospital are often not reported. The aims of this study were to investigate the proportion of frail older colorectal cancer patients who developed complications only after discharge, the severity of post-discharge complications, and the time point at which the most frequent complications occurred.Methods
Patients were included if they were 65 years and older, screened positively for frailty and were scheduled for colorectal cancer surgery. Included patients were followed prospectively both in hospital and after discharge for 30 days after surgery, and complications were graded according to the Clavien-Dindo classification.Results
We included 114 patients. Median age was 79 years. Twenty-two patients (19%) were discharged without complications, but developed complications after discharge. These patients had shorter length of stay (6.5 versus 10 days), were more often discharged to their own home without assistance, and had higher 5-year survival (76% vs 54%) than patients who developed complications in hospital. Post-discharge complications were most frequently grade II. The most common types of complications that occurred late in the postoperative course were urinary tract infections and superficial surgical site infections.Conclusions
Complications after colorectal cancer surgery in frail older patients frequently arise after discharge from hospital. Doctors should be aware of this and inform their patients. This is increasingly important as length of stay after surgery decreases. When complications are used as a quality measure, it should be clear whether only in-hospital complications are registered. 相似文献20.
Tina Fransgaard Ismail Pinar Lau Caspar Thygesen Ismail Gögenur 《Surgical oncology》2018,27(2):177-184