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1.
Katherine M. Meister Theadore Hufford Chao Tu Zhamak Khorgami Philip R. Schauer Stacy A. Brethauer Ali Aminian 《Surgery for obesity and related diseases》2018,14(11):1725-1731
Background
Uncontrolled hyperglycemia in patients undergoing surgery has been shown to be a risk factor for postoperative complications.Objective
To assess the clinical significance of perioperative hyperglycemia on infectious complications and clinical outcomes in patients undergoing bariatric surgery.Setting
Single academic center.Methods
Retrospective chart review of all patients who underwent primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2013 and 2016 was performed. The association between any elevated perioperative glucose value (hyperglycemia: ≥126 mg/dL) and level of elevation (≥126 or ≥200 mg/dL) with 30-day infectious complications, reoperation, length of hospital stay, and readmission was assessed. Patients who developed early complications (within 3 d of surgery), which could potentially lead to immediate postoperative hyperglycemia, were not included in the analysis. Outcomes of patients with and without diabetes were separately analyzed.Results
A cohort of 1981 patients was studied, including Roux-en-Y gastric bypass (n?=?1171, 59%) and sleeve gastrectomy (n?=?810, 41%) patients. In patients with diabetes (n?=?751, 38%), perioperative hyperglycemia was independently associated with higher composite infectious complications (defined as presence of any of 6 infectious complications; odds ratio [OR] 3.1, 95% confidence interval [CI] 1.2–8.2, P?=?.018) and higher readmission rate (OR 2.2, 95% CI 1.1–4.6, P?=?.027). In patients without diabetes (n?=?1230, 62%), 19.2% had perioperative hyperglycemia (≥126 mg/dL). Perioperative hyperglycemia in patients without diabetes was associated with higher composite infectious complications (OR 2.6, 95% CI 1.1–5.5, P?=?.018) and prolonged length of stay (OR 3.0, 95% CI 1.5–5.9, P?=?.001).Conclusions
An elevated perioperative glucose value is adversely associated with infectious complications and key clinical outcomes after bariatric surgery. The increased risk is correlated with the extent of glucose elevation (dose-response relationship). Our findings highlight the importance of glucose control during the perioperative period in bariatric surgical patients. 相似文献2.
Monica Terenziani Maria D. De Pasquale Gianni Bisogno Davide Biasoni Renata Boldrini Paola Collini Massimo Conte Patrizia Dall&#x;Igna Alessandro Inserra Fraia Melchionda Fortunato Siracusa Filippo Spreafico Francesco Barretta Paolo D&#x;Angelo 《Urologic oncology》2018,36(11):502.e7-502.e13
Objectives
We report the results of an Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) study on the treatment of testicular germ cell tumors (TGCT) with a pediatric PEB (pPEB) regimen (cisplatin 25 mg/m2 daily on days 1-4; etoposide 100 mg/m2 daily on days 1-4; bleomycin 15 mg/m2 on day 2, once per cycle).Methods and materials
Male patients under 18 years old with malignant TGCT were enrolled for a second national prospective protocol. All patients underwent orchiectomy at diagnosis. Those with Stage I received no chemotherapy; those with Stage II–III disease received three cycles of pPEB; and those with Stage IV received four cycles. After chemotherapy, resection of radiologically-evident residual disease was recommended. The main study end-points were overall survival and relapse-free survival.Results
Ninety-nine boys from 0.5 to 17.8 years old (median 15.4 years) were evaluable, and staged as follows: 58 Stage I (59%), 7 Stage II (7%), 14 Stage III (14%), and 20 Stage IV (20%). With a median follow-up of 59 months (range 4-165 months), 5-year relapse-free survival (95% CI) was 73% (65%-83%) for the whole sample, 65% (53%-79%) for Stage I patients, and 86% (75%-98%) for Stage II-IV patients. Five-year overall survival (95% CI) was 99% (97%-100%).Conclusions
We confirmed a good prognosis for malignant TGCT in children and adolescents. Reducing the number of chemotherapy cycles for Stage II-III disease does not seem to negatively affect survival outcomes. 相似文献3.
Amirali Salmasi Izak Faiena Jason Wu Anthony E. Sisk Ankush Sachveda Jacob J. Vandel Karim Chamie Leonard S. Marks Robert E. Reiter 《Urologic oncology》2018,36(9):401.e19-401.e25
Background
In the era of increasing scrutiny of delivery of quality care, efforts to decrease surgical overtreatment of insignificant prostate cancer (iCaP) continue.Objective
To quantify the incidence of surgical overtreatment over time among a contemporary series of men diagnosed with CaP.Methods
We retrospectively reviewed the medical records and pathologic specimens for men with CaP who underwent radical prostatectomy between January 2009 and December 2016 at a tertiary referral center. Overtreatment, defined as presence of iCaP in radical prostatectomy specimens, was the primary endpoint. iCaP was defined as a tumor of Gleason score no more than 6 and a tumor diameter ≤10mm (volume <0.5 cc). Independent predictors of iCaP were determined using a multivariable model.Results
A total of 1,283 men were eligible for analysis. Overtreatment was found in 86 (6.7%) patients. The frequency of overtreatment significantly decreased from 15% (24/165) in 2009 to 3% (4/134) of patients in 2016 (P < 0.001). In the multivariable analysis, prostate-specific antigen density ≥0.15 vs. <0.15 (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.15–0.64, P < 0.01), biopsy Gleason score 3+4 vs. 3+3 (OR 0.15, 95% CI 0.08–0.29, P < 0.01), African American vs. White ethnicity (OR 0.13, 95% CI 0.02–0.96, P = 0.045), and year of surgery (OR 0.88, 95% CI 0.77–0.99, P = 0.03) remained significant predictors of iCaP at surgery. Over the years of study, the odds of overtreatment decreased by 12% annually (OR 0.88, 95 CI 0.77–0.99, P = 0.03). At the same time, the pathological evidence of advanced disease at surgery (≥T3a with/without lymph node involvement) remained unchanged.Comment
Surgical overtreatment of CaP has declined to a rate of approximately 3% at this tertiary referral center; further decline is likely. The decline probably has a multifactorial explanation: decreased rate of overdiagnosis, better patient selection for surgery, or change in the referral pattern. 相似文献4.
Ari P. Bernstein Ethan B. Fram Alexander Sankin Evan Kovac Abhishek Srivastava Joseph DiVito Joshua M. Stern 《Urologic oncology》2018,36(11):499.e17-499.e22
Introduction
Recent studies have proposed that nearby fat deposits may have metabolic influence on kidney cancer pathobiology. Both fat quantity and quality may play unique roles in this complex relationship. As such, we investigated whether perinephric fat surface area (PFA), a quantitative measure of fat, or Mayo Adhesive Probability (MAP) score, a qualitative measure, were predictive of malignant pathology or Fuhrman grade in small renal masses.Methods
A total of 317 patients undergoing minimally invasive partial nephrectomy between 2010 and 2016 for renal masses were retrospectively reviewed. Preoperative abdominal CT and MRI scans were measured for PFA and MAP scores. Multiple binary logistic regression models were created to identify predictive factors of malignant disease and Fuhrman grade.Results
A total of 253 patients had malignant masses, while 64 had benign masses. A total of 189 of the malignant masses were T1a, while 64 were designated T1b. A total of 221 patients with malignant masses had reported Fuhrman grades. Of these 211 patients, 143 (64.7%) had low-grade and 78 (35.3%) had high-grade disease. Mean PFA was 18.0 ± 13.3 cm2, while mean MAP score was 2.6 ± 1.2. Binary logistic regression analysis yielded three variables in the best-fit model for predictors of malignant pathology: MAP score (OR?=?1.374, 95% CI: 1.007–1.873, P?=?0.045), male sex (OR?=?2.058, 95% CI: 1.004–4.218, P?=?0.049), and BMI (OR?=?1.064, 95% CI: 0.998–1.135, P?=?0.059). Neither MAP nor PFA was predictive of Fuhrman grade.Conclusions
MAP score, a measure of perinephric fat quality, but not PFA, a qualitative measure of fat quantity, was predictive of malignant pathology, raising the question whether fat quality rather than quantity may be involved in the pathophysiology of RCC in a large and diverse patient population. Understanding the increasing burden of obesity, further studies are needed to elaborate on these findings and to discern the exact relationship between perinephric fat deposits and renal tumorigenesis. 相似文献5.
Tom P. Walsh Stephen J. Quinn Angela M. Evans Alison Yaxley Jacob A. Chisholm Lilian Kow E. Michael Shanahan 《Surgery for obesity and related diseases》2018,14(9):1389-1395
Background
Foot pain is a common manifestation of obesity.Objective
To determine if bariatric surgery is associated with a reduction in foot pain and if body mass index (BMI) or body composition predict a change in foot pain.Setting
University hospital.Methods
Participants with foot pain awaiting bariatric surgery were recruited for this prospective study. Multivariable linear regression was used to determine predictors of change in foot pain between baseline and 6-month follow-up using body composition (fat mass index and fat-free mass index) or BMI, adjusting for, depression, age, sex, and group (surgery versus control).Results
Forty-five participants (38 female), mean ± standard deviation age of 45.7 ± 9.4 years, were recruited for this study. Twenty-nine participants mean ± standard deviation BMI of 44.8 ± 7.0 kg underwent bariatric surgery, while 16 participants mean ± standard deviation BMI of 47.9 ± 5.2 kg were on the waiting list (control). One participant was lost to follow-up. The treatment group lost a mean of 24.3 kg (95% confidence interval [CI] 21.1–27.5), while the control group gained 1.2 kg (95% CI ?2.5 to 4.9), respectively. In multivariable analysis, bariatric surgery was significantly associated with reduced foot pain at 6-month follow-up ?32.6 points (95% CI ?43.8 to ?21.4, P < .001), while fat mass index was significantly associated with increased pain at follow-up 1.5 points (95% CI .2 to 2.8, P?=?.027), after controlling for fat-free mass index, age, sex, and depression.Conclusions
Bariatric surgery was significantly associated with reduced foot pain. Higher baseline fat mass index, but not fat-free mass index or BMI, was predictive of increased foot pain at follow-up. Foot pain may be mediated by metabolic, rather than mechanical, factors in bariatric surgery candidates. 相似文献6.
Helena Dreber Anders Thorell Jarl Torgerson Signy Reynisdottir Erik Hemmingsson 《Surgery for obesity and related diseases》2018,14(9):1319-1326
Background
Young adults display particularly poor weight loss in behavioral obesity treatment; nonetheless, they have seldom been included in bariatric research.Objectives
To compare weight loss, adverse events, and loss to follow-up in young (18–25 yr) versus older (≥26 yr) adults up to 5 years after Roux-en-Y gastric bypass.Setting
Nationwide, register-based study, Sweden.Methods
Prospective registry data (Scandinavian Obesity Surgery Register) were analyzed in young (22.2 yr [standard deviation (SD): 2.1], 81.6% women, mean body mass index 43.7 kg/m2 [SD: 5.4]) and older (42.6 years [SD: 9.6], 82.0% women, mean body mass index 43.4 kg/m2 [SD: 5.0]) adults undergoing Roux-en-Y gastric bypass. Groups were matched for body mass index, sex, and year of surgery. Regression analyses and mixed models were used to compare outcomes between groups.Results
A total of 369 young (37.0% of eligible) and 2210 older (46.1%) adults attended the 5-year follow-up. At this time, weight loss was 31.8% in young and 28.2% in older adults (P < .001), with a serious adverse event (Clavien-Dindo ≥3b) being reported in 52 (14.1%) young and 153 (6.9%) older adults (odds ratio?=?2.06, 95% confidence interval: 1.45–2.92, P < .001). Loss to follow-up was higher in young versus older adults throughout the study period (range of relative risk?=?1.16–1.89, P < .001).Conclusions
While young adults displayed at least equal weight loss as older adults, rates of adverse events were approximately doubled, and loss to follow-up rates were higher. Future studies on the significance of and the etiology behind the higher incidence of serious adverse events are needed. Intensified clinical contact post Roux-en-Y gastric bypass should have the potential to further improve outcomes in young adults. 相似文献7.
Peter J. Goebell Lothar Müller Andreas Hübner Hanns-Detlev Harich Emil Boller Michaela Koska Martina Jänicke Norbert Marschner 《Urologic oncology》2018,36(10):470.e1-470.e9
Objectives
A high body mass index (BMI) is associated with an increased risk for developing renal cell carcinoma (RCC), a higher complication rate after surgery, and a postoperative decline in renal function after nephrectomy. In contrast, a high preoperative BMI has been associated with increased survival in patients with localized RCC. We examined the prognostic impact of the BMI in patients treated for metastatic RCC (mRCC) in daily routine practice in Germany.Patients and Methods
The ongoing prospective, multicenter German clinical cohort study on mRCC (RCC-Registry) has recruited patients from more than 110 oncology/urology outpatient centers and hospitals at initiation of systemic first-line treatment. Data on patients’ demographics, treatment, and outcome in routine practice, so called “real world data”, have been collected. For this analysis, 606 patients were stratified into a low (BMI < 24), medium (24 < BMI < 28), and high (BMI > 28) BMI group. The influence of the BMI on the overall survival (OS) was analyzed using a multivariate Cox proportional hazards model.Results
Median OS was 24.5 (95% confidence interval [CI], 19.3–28.5), 17.9 (95% CI, 15.3–20.8) and 10.9 (95% CI, 7.3–13.4) months in the high, medium, and low BMI patient group, respectively. A significant correlation of BMI with OS, independent of other factors, was found (low vs. high BMI: hazard ratio (HR): 1.94, 95% CI, 1.48–2.54; medium vs. high BMI: HR: 1.40, 95% CI, 1.10–1.78). Memorial Sloan Kettering Cancer Center risk factors were independently correlated with shorter OS.Conclusions
Our analysis showed a significant and independent correlation of a high BMI with longer OS in a prospective German cohort of mRCC routine patients starting first-line systemic treatment. 相似文献8.
Relationship between bariatric surgery and periodontal status: a systematic review and meta-analysis
Glaciele Maria de Souza Dhelfeson Willya Douglas de Oliveira Frederico Santos Lages Ighor Andrade Fernandes Saulo Gabriel Moreira Falci 《Surgery for obesity and related diseases》2018,14(8):1205-1216
Background
The effects of bariatric surgery can reflect in the oral cavity and can cause alterations in oral health. This high prevalence of oral alterations in the pre and post-operative periods has been highlighted in different studies.Objectives
To investigate the effect of bariatric surgery on periodontal status through a systematic review.Methods
Electronic search was conducted in PubMed, VHL, Web of Science, Science direct, Scopus, and Cochrane databases through May 2017. Manual search, gray literature, and counter-refence of included articles were also conducted. Eligibility criteria included observational studies that reported periodontal outcomes before and after bariatric surgery.Results
Search strategy resulted in 1878 articles. Following the selection process, nine studies were included in the qualitative analysis and five in the meta-analysis. Three cross-sectional studies showed risk of bias score ranging from 5 to 6 stars, and Cohort studies scored from 6 to 9 stars out of 9 possible stars on the Newcastle-Ottawa scale. The quantitative analysis showed that clinical attachment level (MD: 0.07; CI95% ?0.17 to 0.31), gingival index (MD: ?0.28; CI95% ?1.68 to 1.11), percentage of bleeding sites (MD: ?0.21; CI95% ?0.77 to 0.35), and pocket probing depth (MD: 0.08 CI95% ?0.14 to 0.31) were not different before and after bariatric surgery. However, the plaque index was lower after than before bariatric surgery (MD: ?1.29; CI 95% ?2.34 to ?0.24).Conclusions
Plaque index can be improved after bariatric surgery.The present systematic review investigated the association between bariatric surgery and periodontal status from cross-sectional and longitudinal studies. A systematic search strategy was developed until May 2017. The results of this systematic review allowed the conclusion that the plaque index can be improved after bariatric surgery. 相似文献9.
Nuno Rui Paulino Pereira Paul T. Ogink Olivier Q. Groot Marco L. Ferrone Francis J. Hornicek C.N. van Dijk J.A.M. Bramer Joseph H. Schwab 《The spine journal》2019,19(1):144-156
Background Context
Postoperative morbidity may offset the potential benefits of surgical treatment for spine metastatic disease; hence, risk factors for postoperative complications and reoperations should be taken into considerations during surgical decision-making. In addition, it remains unknown whether complications and reoperations shorten these patients' survival.Purpose
We aimed to describe and identify factors associated with having a complication within 30 days of index surgery as well as factors associated with having a subsequent reoperation. Furthermore, we assessed the effect of 30-day complications and reoperations on the patients' postoperative survival, as well as described neurologic changes after surgery.Study Design
Retrospective cohort study.Patient Sample
We included 647 patients 18 years and older who had surgery for metastatic disease in the spine between January 2002 and January 2014 in one of two affiliated tertiary care centers.Outcome Measures
Our primary outcomes were complications within 30 days after surgery and reoperations until final follow-up or death.Methods
We used multivariate logistic regression to identify risk factors for 30-day complications and reoperations. We used the Cox regression analysis to assess the effect of postoperative complications and reoperations on survival.Results
From 647 included patients, 205 (32%) had a complication within 30 days. The following variables were independently associated with 30-day complications: lower albumin levels (odds ratio [OR]: 0.69, 95% confidence interval [CI]=0.49–0.96, p=.021), additional comorbidities (OR=1.42, 95% CI=1.00–2.01, p=.048), pathologic fracture (OR=1.41, 95% CI=0.97–2.05, p=.031), three or more spine levels operated upon (OR=1.64, 95% CI=1.02–2.64, p=.027), and combined surgical approach (OR=2.44, 95% CI=1.06–5.60, p=.036). One hundred and fifteen patients (18%) had at least one reoperation after the initial surgery; prior radiotherapy (OR=1.56, 95% CI=1.07–2.29, p=.021) to the spinal tumor was independently associated with reoperation. 30-day complications were associated with worse survival (hazard ratio [HR]=1.40, 95% CI=1.17–1.68, p<.001), and reoperation was not significantly associated with worse survival (HR=0.80, 95% CI=0.09–1.00, p=.054). Neurologic status worsened in 42 (6.7%), remained stable in 445 (71%), and improved in 140 (22%) patients after surgery.Conclusions
Three or more spine levels operated upon and prior radiotherapy should prompt consideration of a preoperative plastic surgery consultation regarding soft tissue coverage. Furthermore, if time allows, aggressive nutritional supplementation should be considered for patient with low preoperative serum albumin levels. Surgeons should be aware of the increase in complications in patients presenting with pathologic fracture, undergoing a combined approach, and with any additional preoperative comorbidities. Importantly, 30-day complications were associated with worsened survival. 相似文献10.
Raisa S. Pompe Sami-Ramzi Leyh-Bannurah Felix Preisser Georg Salomon Markus Graefen Hartwig Huland Pierre I. Karakiewicz Derya Tilki 《Urologic oncology》2018,36(12):527.e21-527.e28
Objectives
To examine oncological, surgical, and functional outcomes of radical prostatectomy (RP) in patients with history of transurethral resection of the prostate (TUR-P).Materials and methods
Retrospective analysis of 18,681 RP-patients including 470 patients with previous TUR-P at a single institution (2002–2015). Kaplan-Meier as well as multivariable Cox and logistic regression analyses compared surgical, oncological, and functional outcomes between TUR-P and non-TUR-P patients after propensity score matching (nearest neighbor in a 1:3 fashion).Results
After propensity score adjustment, pathological and surgical results were similar between both groups. Specifically, rates of positive surgical margins and nerve-sparing (NS) procedure did not differ between groups (positive surgical margins: 18.5% vs. 17.2%, P = 0.7; nerve-sparing: 89.4% vs. 91.6%, P = 0.5). In addition, there was no difference in mean operating room time (185 vs. 184 minutes, P = 0.6), blood loss (710 vs. 666 ml, P = 0.1), and catheterization time (12 days, P = 0.3). In multivariable analyses, TUR-P patients did not exhibit higher risk of biochemical recurrence, metastatic progression, or mortality (all P > 0.05). However, TUR-P patients exhibited higher risk for urinary incontinence at third month (OR: 1.47; 95% confidence interval [CI] 1.01–2.12, P?=?0.04) and first year (OR: 2.06; 95% CI 1.23–3.42, P?=?0.006) and worse 1-year erectile function recovery (OR: 0.48; 95% CI 0.27–0.86, P?=?0.02).Conclusions
This large series of TUR-P RP patients demonstrated that RP could be safely performed in patients with history of TUR-P without compromising oncological results. However, functional outcomes were worse for patients with previous TUR-P. 相似文献11.
Thomas H. Inge R. Yates Coley Lydia A. Bazzano Stavra A. Xanthakos Kathleen McTigue David Arterburn Neely Williams Rob Wellman Karen J. Coleman Anita Courcoulas Nirav K. Desai Jane Anau Roy Pardee Sengwee Toh Cheri Janning Andrea Cook Jessica Sturtevant Casie Horgan Marc Michalsky 《Surgery for obesity and related diseases》2018,14(9):1374-1386
Background
Bariatric surgery has been used for treatment of severe obesity in adolescents but most studies have been small and limited in follow-up.Objectives
We hypothesized that electronic health record data could be used to compare effectiveness of bariatric procedures in adolescents.Setting
Data were obtained from clinical research networks using a common data model to extract data from each site.Methods
Adolescents who underwent a primary bariatric procedure from 2005 through 2015 were identified. The percent change in body mass index (BMI) at 1, 3, and 5 years was estimated using random effects linear regression for patients undergoing all operations. Propensity score adjusted estimates and 95% confidence intervals were estimated for procedures with >25 patients at each time period.Results
This cohort of 544 adolescents was predominantly female (79%) and White (66%), with mean (±standard deviation) age of 17.3 (±1.6) years and mean BMI of 49.8 (± 7.8) kg/m2. Procedures included Roux-en-Y gastric bypass (RYGB; n?=?177), sleeve gastrectomy (SG; n?=?306), and laparoscopic adjustable gastric banding (n?=?61). For those undergoing RYGB, SG, and laparoscopic adjustable gastric banding, mean (95% confidence interval) BMI changes of ?31% (?30% to ?33%), ?28% (?27% to ?29%), and ?10% (?8% to ?12%), were estimated at 1 year. For RYGB and SG, BMI changes of ?29% (?26% to ?33%) and ?25% (?22% to ?28%) were estimated at 3 years.Conclusions
Adolescents undergoing SG and RYGB experienced greater declines in BMI at 1- and 3-year follow-up time points, while laparoscopic adjustable gastric banding was significantly less effective for BMI reduction. 相似文献12.
13.
Philipp Gild Stephanie A. Wankowicz Akshay Sood Nicolas von Landenberg David F. Friedlander Shaheen Alanee Felix K.H. Chun Margit Fisch Mani Menon Quoc-Dien Trinh Joaquim Bellmunt Firas Abdollah 《Urologic oncology》2018,36(10):469.e1-469.e11
Objectives
To examine the impact of race on quality of care and overall survival (OS) among patients with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) in the U.S.Materials & Methods
Our cohort consisted of 12,652 patients receiving RC for MIBC within the National Cancer Database from 2004 to 2012. Patients were stratified by race (Black non-Hispanic vs. White non-Hispanic) and imbalances in patient characteristics mitigated using propensity score weighting. Logistic and Cox regressions examined the impact of race on quality of care metrics (receipt of pelvic lymph node dissection (PLND), lymph node count, hospital volume, length of stay, delay of treatment) and on OS. The difference in OS was expressed as Delta, and stratified by facility-type, hospital volume, and region.Results
Blacks were less likely to receive PLND (odds ratio [OR] 0.70, 95% confidence interval [CI]: 0.55–0.91), or to have a greater number of lymph nodes removed (OR 0.76, 95%CI: 0.64–0.90). They exhibited greater length of stay (OR 1.34, 95%CI: 1.13–1.59), and delay of RC among recipients of neoadjuvant chemotherapy (OR 2.59, 95%CI: 1.77–3.85) (all P ≤ 0.001). Notably, utilization of neoadjuvant chemotherapy in advanced disease stages was more common in blacks (OR 2.82, 95%CI: 1.93–4.13, P < 0.001). Additionally, Black race was associated with inferior OS (Hazard ratio 0.87, 95%CI: 0.79–0.97, P < 0.014). Disparities in OS varied based on facility type and geographical region, but not hospital volume. Specifically, Blacks had worse OS when treated in a community cancer program (Delta 0.42, 95%CI: 0.28–0.57,P < 0.001), or within New England/Middle Atlantic region (Delta 0.16, 95% CI: 0.07–0.24,P < 0.001).Conclusion
Black race is an independent predictor of inferior quality of care and OS in patients undergoing RC for MIBC. Survival disparities vary based on geographical region and facility type. Notably, the OS disparity appears to have narrowed in comparison to previous studies. 相似文献14.
Zubadiah Nor Hanipah Michael J. Mulcahy Gautam Sharma Suriya Punchai Karen Steckner Raed Dweik Ali Aminian Philip R. Schauer Stacy A. Brethauer 《Surgery for obesity and related diseases》2018,14(10):1581-1586
Background
Data regarding the outcomes of bariatric surgery in patients with pulmonary hypertension (PH) is limited. The aim of this study was to review our experience on bariatric surgery in patients with PH.Setting
An academic medical center.Methods
Patients with PH who underwent either a primary or revisional bariatric surgery between 2005 and 2015 and had a preoperative right ventricle systolic pressure (RVSP) ≥35 mm Hg were included.Results
Sixty-one patients met the inclusion criteria. Fifty (82%) were female with the median age of 58 years (interquartile range [IQR] 49–63). The median body mass index was 49 kg/m2 (IQR 43–54). Procedures performed included the following: Roux-en-Y gastric bypass (n?=?33, 54%), sleeve gastrectomy (n?=?24, 39%), adjustable gastric banding (n?=?3, 5%), and banded gastric plication (n?=?1, 2%). Four patients (7%) underwent revisional bariatric procedures. Median operative time and length of stay was 130 minutes (IQR 110–186) and 3 days (IQR 2–5), respectively. The 30-day complication rate was 16% (n?=?10) with pulmonary complications noted in 4 patients. There was no 30-day mortality. One-year follow-up was available in 93% patients (n?=?57). At 1 year, median body mass index and excess weight loss were 36 kg/m2 (IQR 33–41) and 51% (IQR 33–68), respectively. There was significant improvement in the RVSP after bariatric surgery at a median follow-up of 22 months (IQR 10–41). The median RVSP decreased from 44 (IQR 38–53) to 40 mm Hg (IQR 28–54) (P?=?.03).Conclusion
Bariatric surgery can be performed without prohibitive complication rates in patients with PH. In our experience, bariatric patients with PH achieved significant weight loss and improvement in RVSP. 相似文献15.
Yung Lee Michał Pędziwiatr Piotr Major Karanbir Brar Aristithes G. Doumouras Dennis Hong 《Surgery for obesity and related diseases》2018,14(11):1766-1782
Background
Excess visceral adipose tissue has been identified as an important risk factor for obesity-related co-morbidities. Conflicting information exists on whether omentectomy added to bariatric surgery is beneficial to metabolic variables.Objective
To evaluate the impact of omentectomy added to bariatric surgery on metabolic outcomesSetting
University Hospital, Canada.Methods
MEDLINE, EMBASE, and PubMed were searched up to May 2018. Studies were eligible for inclusion if they were randomized controlled trials comparing omentectomy added to bariatric surgery with bariatric surgery alone. Primary outcome measures were absolute change in metabolic variables (body mass index, insulin, glucose, cholesterol, lipoproteins, and triglycerides); secondary outcomes were changes in adipocytokines. Pooled mean differences (mean deviation; MD) were calculated using random effects meta-analyses, and heterogeneity was quantified using the I2 statistic.Results
Ten trials involving a total of 366 patients met the inclusion criteria with a median follow-up time of 1 year after surgery. Adding omentectomy to bariatric surgery demonstrated a minimal but statistically significant decrease in body mass index compared with bariatric surgery alone (MD 1.29, 95% confidence interval .35–2.23, P?=?.007, I2?=?0%, 10 trials). Conversely, patients who underwent bariatric surgery alone had significant increases in high-density lipoprotein (MD ?2.12, 95% confidence interval ?4.13 to ?.11, P?=?.04, I2?=?0%, 6 trials). Other metabolic outcomes and adipocytokines showed no significant difference between procedures.Conclusion
The addition of omentectomy to bariatric surgery results in minimal reduction of body mass index. Considering no overall improvement in metabolic outcomes and the time and effort required, the therapeutic use of omentectomy added to bariatric surgery is not warranted. 相似文献16.
MN Kolodzynski BTJA van Hoorn M Kon CC Breugem 《Journal of plastic, reconstructive & aesthetic surgery》2018,71(10):1476-1480
Introduction
Microtia is a congenital malformation of the auricle, ranging in severity. It can be isolated or associated with (craniofacial) anomalies. Most of these anomalies together are described as being part of the oculo-auriculo-vertebral spectrum (OAVS). Velar abnormalities have been described to occur in patients with OAVS; however, the incidence in patients with microtia without OAVS is largely unknown. The primary purpose of this study was to examine the prevalence of velar palsy in patients with isolated microtia and patients with microtia and signs of OAVS. The secondary purpose was to identify possible risk factors associated with the presence of velar palsy.Methods
All patients with microtia presented to our department between January 2015 and March 2017 were retrospectively reviewed. Medical images, information of the palate, and demographic data were extracted from the patients’ medical files.Results
Velar palsy was present in 18 out of 42 patients with isolated microtia (43%; no signs of OAVS) and in 33 out of 41 patients with microtia and signs of OAVS (80%). Patients with signs of OAVS were found to be independently associated with a higher prevalence of velar palsy (OR: 4.8; 95% CI: 1.7–13).Conclusion
This study demonstrates a clear relationship between abnormal velar movement and microtia. We believe that isolated microtia should not be seen as a separate entity but as a part of OAVS. Abnormal velar movement can lead to velopharyngeal insufficiency (VPI), which can affect speech development in children. Physicians should examine the palate in all patients with microtia and not restrict to those with speech difficulties. 相似文献17.
Maria S. Altieri Aurora Pryor Andrew Bates Salvatore Docimo Mark Talamini Konstantinos Spaniolas 《Surgery for obesity and related diseases》2018,14(9):1368-1372
Background
With the rise of obesity in adolescents, there is an exponential increase in bariatric procedures in this patient population.Objectives
The purpose of our study was to examine perioperative outcomes after bariatric surgery in this cohort.Setting
University hospital, involving a large database in New York State.Methods
The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file was queried to identify all adolescent patients (age <19 years) undergoing primary laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2015. We assessed 30-day postoperative complications.Results
We identified 1072 patients who underwent Roux-en-Y gastric bypass (n?=?279) or SG (n?=?793). The majority were Caucasian (n?=?790) and female (n?=?857) with mean body mass index and age of 47.9 ± 8.1 kg/m2 and 18.2 ± 1 years, respectively, preoperative hypertension, type 2 diabetes, and obstructive sleep apnea were present in 90 (8.4%), 139 (13%), and 165 (15.4%) of patients, respectively. There was significant difference in preoperative gastroesophageal reflux disease (18.6% versus 13.4%, P?=?.033), obstructive sleep apnea (19.7% versus 13.9%, P?=?.02), and body mass index (48.6 ± 7.9 versus 47.6 ± 8.2 kg/m2, P?=?.03) between patients undergoing Roux-en-Y gastric bypass and SG, respectively. Thirty-day reoperation, readmission, and reintervention were reported in 1.5%, 3.3%, and 1.6% of the adolescent cohort, respectively. Four patients (.4%) developed a staple line/anastomotic leak, and 1 patient (.09%) died within 30 days; 93.9% of all adolescent patients experienced an uneventful 30-day recovery. Uneventful recovery was significantly more likely for patients undergoing SG (95.3% versus 90%, P?=?.001; adjusted odds ratio 2.2, 95% confidence interval 1.31–3.69).Conclusion
Perioperative safety of bariatric surgery in adolescents in accredited centers is safer than previously reported with low rate of 30-day events. SG is a safer procedure in this patient population. 相似文献18.
Ahmad Assalia Anat Ilivitzki Amos Ofer Alain Suissa Elias Manassa Iyad Khamaysi Ahmad Mahajna 《Surgery for obesity and related diseases》2018,14(8):1093-1098
Background
Laparoscopic sleeve gastrectomy (LSG) is considered as a first line treatment for morbid obesity around the globe. Leakage and subsequent gastric fistula is the most dreadful complication, which may lead to serious morbidity and even mortality.Objectives
To assess the safety and efficacy of fibrin glue application in the setting of gastric fistula after LSG.Setting
University hospital, Israel.Methods
Twenty-four morbidly obese patients (mean age?=?42.2 yr, mean body mass index?=?42 kg/m2) developed gastric fistula after LSG. The fistula was acute in 10 patients, subacute in 9, and chronic in 5. Sixteen patients (67%) have had previous failed endoscopic interventions. Fibrin glue was applied percutaneously with fluoroscopic guidance, under endoscopic visualization. A pigtail drain was left in the distal tract to monitor and manage possible continuous leakage.Results
There were no complications except abdominal pain in 2 patients associated with fever in 1. Both resolved within 1 to 2 days. Fistula closure was achieved in all patients but 1 (95.8%). Closure was accomplished after a single application in 9 patients (39%), 2 applications in 8, 3 applications in 3, 5 applications in 2, and 6 applications in 1. All patients were followed with a mean time of 42.3 months (range, 20–46).Conclusions
Although in most patients there was a need for multiple applications, our experience indicates that percutaneous fluoroscopic application of Fibrin glue under endoscopic visualization proved to be a simple, tolerable, and highly effective method for the treatment of selected patients with gastric fistula after LSG. 相似文献19.
Amihai Rottenstreich Gabriel Levin Geffen Kleinstern Misgav Rottenstreich Uriel Elchalal Ram Elazary 《Surgery for obesity and related diseases》2018,14(12):1795-1803
Background
The optimal timing of pregnancy after bariatric surgery has not been established, with data limited regarding laparoscopic sleeve gastrectomy (LSG), currently the most common bariatric operation performed.Objectives
We explored associations of the surgery-to-conception interval with pregnancy outcomes after LSG.Setting
A university hospital.Methods
We assessed pregnancy outcomes in relation to the surgery-to-conception interval for all women who underwent LSG and delivered during 2006 to 2018.Results
Of 154 patients, 67 (43.5%) conceived within the first 18 months postoperatively (early-pregnancy group), whereas 87 (56.5%) conceived later (late-pregnancy group). The median surgery-to-conception interval was 390 (interquartile range 247–459) days in the early-pregnancy group and 1104 (8527–1548) days in the late-pregnancy group. Compared with the early-pregnancy group, the late-pregnancy group had higher gestational weight gain (median 11 versus 8 kg, P < .001) and lower hemoglobin levels in early pregnancy (12.3 versus 12.6 g/dL, P?=?.03) and after delivery (10.0 versus 10.4 g/dL, P?=?.02). Other maternal and perinatal outcomes were similar between the groups, including the proportion of small-for-gestational-age infants (11.9% versus 14.9%, P?=?.64) for those who conceived within or later than 18 months after surgery. Similar rates of small-for-gestational-age infants were found between those who conceived within or ≥12 months after surgery (P?=?1.0).Conclusions
Timing of pregnancy after LSG was found not to be associated with pregnancy outcomes. Together with documentations of a similar safety profile of pregnancy occurring earlier or later in the postoperative course, these data should reassure women who do not wish to delay conception after surgery. 相似文献20.
Rafael Alvarez Niki Matusko Amanda L. Stricklen Rachel Ross Colleen M. Buda Oliver A. Varban 《Surgery for obesity and related diseases》2018,14(12):1903-1910