共查询到20条相似文献，搜索用时 31 毫秒
1.
Eliza W. Beal Ezra Lyon Joe Kearney Lai Wei Cecilia G. Ethun Sylvester M. Black Mary Dillhoff Ahmed Salem Sharon M. Weber Thuy B. Tran George Poultsides Rivfka Shenoy Ioannis Hatzaras Bradley Krasnick Ryan C. Fields Stefan Buttner Charles R. Scoggins Robert C.G. Martin Carl R. Schmidt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1104-1111
Background
The objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma.Methods
Subjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes.Results
The majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not.Conclusions
The ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance. 相似文献2.
Vincent P. Groot Hjalmar C. van Santvoort Steffi J.E. Rombouts Jeroen Hagendoorn Inne H.M. Borel Rinkes Marco van Vulpen Joseph M. Herman Christopher L. Wolfgang Marc G. Besselink I. Quintus Molenaar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(2):83-92
Background
The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients.Methods
A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment.Results
After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively.Conclusion
In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival. 相似文献3.
Santhalingam Jegatheeswaran Minas Baltatzis Saurabh Jamdar Ajith K. Siriwardena 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):483-490
Background
Resection of the superior mesenteric artery (SMA) during pancreatectomy is performed infrequently and is undertaken with the aim of removing non-metastatic locally advanced pancreatic tumours. SMA resection reports also encompass resection of other visceral vessels. The consequences of resection of these different arteries are not necessarily equivalent. This is a focused systematic review of the outcome of SMA resection during pancreatectomy for cancer.Methods
A computerized search of the English language literature was undertaken for the period 1st January 2000 through 30th April 2016. The keywords “Pancreatic surgery” and “Vascular resections” were used. Thirteen studies reported 70 patients undergoing pancreatectomy with SMA resection from 10,726 undergoing pancreatectomy. Individual patient-level outcome data were available for 25.Results
Median (range) accrual period was 132 (48–372) months. Reported peri-operative morbidity ranged from 39% to 91%. There were 5 peri-operative deaths in the 25 patients with individual-outcome data. Median survival was 11 months (95% Confidence interval 9.5–12.5 months; standard error 0.8 months).Conclusions
SMA resection during pancreatectomy is undertaken infrequently incurring high peri-operative morbidity and mortality. Median survival is 11 (95% CI 9.5–12.5) months. In contemporary practice there is no evidence to support SMA resection during pancreatectomy. 相似文献4.
Steffi J.E. Rombouts Willemijn P.M. van Dijck Maarten W. Nijkamp Tyche C. Derksen Lodewijk A.A. Brosens Frederik J.H. Hoogwater Maarten S. van Leeuwen Inne H.M. Borel Rinkes Richard van Hillegersberg Fred H. Wittkampf Izaak Q. Molenaar 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1058-1065
Background
Irreversible electroporation (IRE) by inserting needles around the tumor as treatment for locally advanced pancreatic cancer entails several disadvantages, such as incomplete ablation due to field inhomogeneity, technical difficulties in needle placement and a risk of pancreatic fistula development. This experimental study evaluates outcomes of IRE using paddles in a porcine model.Methods
Six healthy pigs underwent laparotomy and were treated with 2 separate ablations (in head and tail of the pancreas). Follow-up consisted of clinical and laboratory parameters and contrast-enhanced computed tomography (ceCT) imaging. After 2 weeks, pancreatoduodenectomy was performed for histology and the pigs were terminated.Results
All animals survived 14 days. None of the animals developed signs of infection or significant abdominal distention. Serum amylase and lipase peaked at day 1 postoperatively in all pigs, but normalized without signs of pancreatitis. On ceCT-imaging the ablation zone was visible as an ill-defined, hypodense lesion. No abscesses, cysts or ascites were seen. Histology showed a homogenous fibrotic lesion in all pigs.Conclusion
IRE ablation of healthy porcine pancreatic tissue using two plate electrodes is feasible and safe and creates a homogeneous fibrotic lesion. IRE-paddles should be tested on pancreatic adenocarcinoma to determine the effect in cancer tissue. 相似文献5.
Jin Hong Lim Joon Seong Park Dong Sup Yoon 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):388-395
Background
The clinical relevance of fibrosis with regard to tumor progression is supported by the correlation between fibrosis and poor outcomes. Fecal elastase-1 (FE-1) level has been used to assess exocrine dysfunction of the pancreas and to predict pancreas fibrosis. The aim of this study was to assess the impact of FE-1 on the survival of pancreatic cancer patients.Methods
Between January 2006 and December 2014, 136 patients with pancreatic adenocarcinoma underwent R0 resection at Gangnam Severance Hospital, Korea. Preoperative FE-1 levels were available in 94 patients who were enrolled in the study. Patients were classified into two groups according to preoperative FE-1: “normal” (≥200 μg/g) or “reduced” (<200 μg/g).Results
Median preoperative FE-1 level was 130.1 μg/g (IQR 32.0; 238.3). 62 patients (66.0%) had reduced pancreatic function and 32 patients (34.0%) had normal pancreatic function. The two groups had significantly different disease-free survival (P < 0.001). On multivariate analysis, normal FE-1, no lymph node metastasis and completion of adjuvant chemotherapy were found to be independent prognostic factors for better DFS (P = 0.001, P = 0.017, P = 0.038, respectively).Conclusion
FE-1 is a simple and non-invasive predictive clinical marker for prognosis of pancreatic cancer after attempted curative resection. 相似文献6.
7.
Caroline Williamsson Daniel Ansari Roland Andersson Bobby Tingstedt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(5):436-442
Background
One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs.Methods
The local registry comprising all pancreatic resections at Skåne University Hospital, Lund, Sweden, was searched for PDs from 2005 to 2015. The patients were analysed in three groups: low-volume, high-volume and after introduction of an enhanced recovery program. Only the clinically relevant POPF grades B and C (CR-POPF) were investigated.Results
322 consecutive patients were identified. The annual operation volume increased almost threefold and the postoperative length of stay and total hospital cost decreased concurrently. The incidence of CR-POPF did not decrease over time. The group with CR-POPF had more complications and prolonged length of stay. The cost was 1.5 times higher for patients with CR-POPF and the cost did not decline despite the increase of hospital volume.Conclusion
Centralization of pancreatic surgery did not decrease the rate of CR-POPF nor its subsequent impact on LOS and costs. Further efforts must be made to reduce the incidence of CR-POPF. 相似文献8.
Quyen D. Chu Meijiao Zhou Prakash Peddi Kaelen L. Medeiros Gazi B. Zibari Hosein Shokouh-Amiri Xiao-Cheng Wu 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1046-1057
Introduction
Although a volume-outcome relationship has been well established for pancreatectomy, little is known about differences in mortality by facility type. The objective of this study is to evaluate the impact of facility type on short-term and long-term survival outcomes for patients with pancreatic adenocarcinoma who underwent pancreatectomy and identify determinants of overall survival (OS).Methods
A cohort of 33,382 patients with Stage I–III pancreatic adenocarcinoma diagnosed between 1998 and 2011 were evaluated from the National Cancer Data Base. Clinicopathological, sociodemographic and treatment variables were compared among three facility types where patients received resection: (i) community cancer program (CCP), (ii) comprehensive community cancer program (CCCP), and (iii) academic research program (ARP). 5-year OS was calculated using the Kaplan–Meier method.Results
Despite ARP having significantly higher percentage of poorly differentiated tumors, higher T-stage tumors, more positive lymph nodes, and greater circle distance compared to the other facilities, it had the highest 5-yr OS. The 5-yr OS for CCP, CCCP, and ARP was 11.2%, 13.2%, and 16.6%, respectively (P < 0.0001) and the median survival time (months) was 12.4, 15.6 and 19.1, respectively.Conclusion
Patients receiving pancreatic resection at an ARP yielded a higher 5-year OS compared to CCP or CCCP. 相似文献9.
Claudio Bassi Stefano Andrianello 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):178-181
Background
Indicators of effectiveness and quality of care are of greatest importance in gauging the direct benefit of a new surgical technique, such as minimally-invasive pancreatic resections, when being compared with established approaches.Methods
Current expert opinion on minimally-invasive pancreatic resection (MIPR) was presented at the first MIPR state of the art conference during 12th world congress of the International Hepato-Pancreato-Biliary Association.Results
Studies exploring outcome of the minimally-invasive approach, alone or compared with open surgery, should consider all the necessary indicators of quality ensuring a high level of clinical care. Such studies should be implemented in a context that guarantees the correct indication for surgery, lower mortality rates, a low burden of post-operative morbidity through early recognition of adverse events and prevention of predictable complications, high standards of oncological “radicality”, prompt recovery with access to adjuvant therapy as soon as possible, and reduction of health-care related costs.Discussion
Only by integrating MIPR with the outcome-improving effect of a dedicated pancreatic team will it be possible to assess more precisely the putative benefits of this minimally-invasive approach. 相似文献10.
Matthew T. McMillan Giuseppe Malleo Claudio Bassi Michael H. Sprys Brett L. Ecker Jeffrey A. Drebin Charles M. Vollmer 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(6):515-524
Introduction
Clinically relevant postoperative pancreatic fistula (CR-POPF) is a morbid complication following pancreatoduodenectomy (PD). It is unclear how pancreatic surgeons perceive risk for this complication, and the implications thereof.Methods
A web-based survey was distributed to members of 22 international GI surgical societies. CR-POPF risk factors were categorized as follows: (i) patient factors, (ii) pancreatic gland characteristics, (iii) intraoperative variables, (iv) perioperative mitigation techniques, or (v) institutional features.Results
Surveys were completed by 897 surgeons worldwide. The most commonly cited contributors to CR-POPF risk were gland characteristics (90.7%), while patient and intraoperative factors were selected 71.2 and 69.3% of the time, respectively. Conversely, institutional features (31.7%) and perioperative mitigation techniques (21.3%) were rarely recognized. Eighty percent of surgeons use drain amylase concentration to guide drain removal decision-making; however, only 45.2% of surgeon remove drains early based upon drain amylase values. When evaluating clinical scenarios, surgeons were able to identify both negligible and high risk scenarios but struggled to differentiate between low and moderate CR-POPF risk.Conclusion
This international study analyzed how surgeons discern CR-POPF risk for PD. There was considerable variability in surgeons' perceptions of risk, which may have an adverse effect on the clinical use of risk adjustment measures. 相似文献11.
Kartik S. Jhaveri Sandra E. Fischer Hooman Hosseini-Nik Boraiah Sreeharsha Ravi J. Menezes Steven Gallinger Carol-Anne E. Moulton 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):992-1000
Objective
To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan.Methods
51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation.Results
151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients.Conclusion
Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection. 相似文献12.
Jony van Hilst Thijs de Rooij Mohammed Abu Hilal Horacio J. Asbun Jeffrey Barkun Uggo Boggi Olivier R. Busch Kevin C.P. Conlon Marcel G. Dijkgraaf Ho-Seong Han Paul D. Hansen Michael L. Kendrick Andre L. Montagnini Chinnusamy Palanivelu Bård I. Røsok Shailesh V. Shrikhande Go Wakabayashi Herbert J. Zeh Marc G.H. Besselink 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(3):190-204
Background
The introduction of minimally invasive pancreatic resection (MIPR) into surgical practice has been slow. The worldwide utilization of MIPR and attitude towards future perspectives of MIPR remains unknown.Methods
An anonymous survey on MIPR was sent to the members of six international associations of Hepato-Pancreato-Biliary (HPB) surgery.Results
The survey was completed by 435 surgeons from 50 countries, with each surgeon performing a median of 22 (IQR 12–40) pancreatic resections annually. Minimally invasive distal pancreatectomy (MIDP) was performed by 345 (79%) surgeons and minimally invasive pancreatoduodenectomy (MIPD) by 124 (29%). The median total personal experience was 20 (IQR 10–50) MIDPs and 12 (IQR 4–40) MIPDs. Current superiority for MIDP was claimed by 304 (70%) and for MIPD by 44 (10%) surgeons. The most frequently mentioned reason for not performing MIDP (54/90 (60%)) and MIPD (193/311 (62%)) was lack of specific training. Most surgeons (394/435 (90%)) would consider participating in an international registry on MIPR.Discussion
This worldwide survey showed that most participating HPB surgeons value MIPR as a useful development, especially for MIDP, but the role and implementation of MIPD requires further assessment. Most HPB surgeons would welcome specific training in MIPR and the establishment of an international registry. 相似文献13.
Background
Overuse of laboratory investigations is widely prevalent in hospitalized patients, leads to discomfort, and increases direct and indirect costs.Objective
We implemented a simple, inexpensive, mindfulness strategy on our inpatient medical clinical teaching unit to reduce unnecessary laboratory orders through education, a forcing function, and daily structured laboratory “time outs.”Methods
On a 26-bed unit in an academic hospital center, the per-period laboratory costs per patient were compared pre- and postintervention using segmented regression analysis of an interrupted time series.Results
The average cost per admitted patient decreased from $117 to $66, with an estimated savings of $50,657 over 985 admissions. After adjusting for fiscal period and the presence of our intervention, there was a significant reduction in the per-patient number of total tests, complete blood counts, and electrolyte panels performed (P <.001 for all level and time trend changes).Conclusion
This trainee-designed and -led intervention, centered around structured, mindfulness-based laboratory test ordering, was successful at decreasing the overuse of common daily blood work in hospitalized patients. 相似文献14.
Sean Bennett Laura K. Baker Guillaume Martel Risa Shorr Timothy M. Pawlik Alan Tinmouth Daniel I. McIsaac Paul C. Hébert Paul J. Karanicolas Lauralyn McIntyre Alexis F. Turgeon Jeffrey Barkun Dean Fergusson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(4):321-330
Background
Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature.Methods
The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion. Outcomes were mortality, complications, and cancer survival.Results
Twenty-two studies involving 6832 patients were included. All studies were retrospective, with no clinical trials. No studies were scored as low risk of bias. The overall proportion of patients transfused was 38.3%. After multivariate analysis, 1 of 5 studies demonstrated an association between transfusion and increased mortality; 5 of 6 demonstrated an association between transfusion and increased complications; and 10 of 18 demonstrated an association between transfusion and decreased cancer survival.Conclusion
This review supports the evidence linking perioperative blood transfusions to negative outcomes. The most convincing association was with post-operative complications, some association with long-term cancer outcomes, and no convincing association with mortality. These findings support the initiation, and further study, of restrictive transfusion protocols. 相似文献15.
Hryhoriy Lapshyn Louisa Bolm Ilona Kohler Martin Werner Franck G. Billmann Dirk Bausch Ulrich T. Hopt Frank Makowiec Uwe A. Wittel Tobias Keck Peter Bronsert Ulrich F. Wellner 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(1):67-74
Background
Mesenterico-portal vein resection (PVR) during pancreatoduodenectomy for pancreatic head cancer was established in the 1990s and can be considered a routine procedure in specialized centers today. True histopathologic portal vein invasion is predictive of poor prognosis. The aim of this study was to examine the relationship between mesenterico-portal venous tumor infiltration (PVI) and features of aggressive tumor biology.Methods
Patients receiving PVR for pancreatic ductal adenocarcinoma of the pancreatic head were identified from a prospectively maintained database. Immunohistochemical staining of tumor tissue was performed for the markers of epithelial–mesenchymal transition (EMT) E-Cadherin, Vimentin and beta-Catenin. Morphology of cancer-associated fibroblasts (CAFs) was assessed as inactive or activated. Statistical calculations were performed with MedCalc software.Results
In total, 41 patients could be included. Median overall survival was 25 months. PVI was found in 17 patients (41%) and was significantly associated with loss of membranous E-Cadherin in tumor buds (p = 0.020), increased Vimentin expression (p = 0.03), activated CAF morphology (p = 0.046) and margin positive resection (p = 0.005).Conclusion
Our findings suggest that PVI is associated with aggressive tumor biology and disseminated growth less amenable to margin-negative resection. 相似文献16.
Aitua Salami Nkosi H. Alvarez Amit R.T. Joshi 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(11):1008-1015
Background
Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown.Methods
The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.Results
A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status.Conclusion
Significant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes. 相似文献17.
Ibrahim Nassour Sam C. Wang Alana Christie Ali A. Mokdad Matthew R. Porembka Michael A. Choti Mathew M. Augustine Adam C. Yopp Xian-Jin Xie John C. Mansour Rebecca M. Minter Patricio M. Polanco 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(12):1037-1045
Background
Despite the development of pathways to enhance recovery and discharge to home, a significant proportion of patients are discharged to inpatient facilities after pancreaticoduodenectomy (PD). The aim of this study was to determine the rate of non-home discharge (NHD) following PD in a national cohort of patients and to develop predictive nomograms for NHD.Methods
The National Surgical Quality Improvement Program was used to construct and validate pre- and postoperative nomograms for NHD following PD.Results
A total of 6856 patients who underwent PD were identified, of which 927 (13.5%) had an NHD. The independent preoperative predictors of NHD were being female, older age, higher BMI, low serum albumin, >10% weight loss, ASA class III/IV, and being diagnosed with a bile duct/ampullary neoplasm or neuroendocrine tumor. A preoperative nomogram was constructed with a concordance index of 0.77. When postoperative variables were added to the model, the concordance index increased to 0.82. The postoperative predictors of NHD were return to the operating room, length of stay of ≥14 days, and any inpatient complications.Conclusions
These nomograms could be useful risk assessment tools to predict NHD after PD and therefore facilitate patient counseling and improve resource utilization and discharge planning. 相似文献18.
David G. Brauer Matthew S. Strand Dominic E. Sanford Vladimir M. Kushnir Kian-Huat Lim Daniel K. Mullady Benjamin R. Tan Andrea Wang-Gillam Ashley E. Morton Marianna B. Ruzinova Parag J. Parikh Vamsi R. Narra Kathryn J. Fowler Majella B. Doyle William C. Chapman Steven S. Strasberg William G. Hawkins Ryan C. Fields 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(2):133-139
Background & objectives
Multidisciplinary tumor boards (MDTBs) are frequently employed in cancer centers but their value has been debated. We reviewed the decision-making process and resource utilization of our MDTB to assess its utility in the management of pancreatic and upper gastrointestinal tract conditions.Methods
A prospectively-collected database was reviewed over a 12-month period. The primary outcome was change in management plan as a result of case discussion. Secondary outcomes included resources required to hold MDTB, survival, and adherence to treatment guidelines.Results
Four hundred seventy cases were reviewed. MDTB resulted in a change in the proposed plan of management in 101 of 402 evaluable cases (25.1%). New plans favored obtaining additional diagnostic workup. No recorded variables were associated with a change in plan. For newly-diagnosed cases of pancreatic ductal adenocarcinoma (n = 33), survival time was not impacted by MDTB (p = .154) and adherence to National Comprehensive Cancer Network guidelines was 100%. The estimated cost of physician time per case reviewed was $190.Conclusions
Our MDTB influences treatment decisions in a sizeable number of cases with excellent adherence to national guidelines. However, this requires significant time expenditure and may not impact outcomes. Regular assessments of the effectiveness of MDTBs should be undertaken. 相似文献19.
Richard A. Burkhart Ammar A. Javed Sean Ronnekleiv-Kelly Michael J. Wright Katherine E. Poruk Frederic Eckhauser Martin A. Makary John L. Cameron Christopher L. Wolfgang Jin He Matthew J. Weiss 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2017,19(9):825-831
Background
Rates of superficial surgical site infection (SSI) following pancreaticoduodenectomy remain high. Following resection for cancer, complications such as SSI impact adjuvant therapy delivery and portend worse survival. An incisional negative pressure dressing (iVAC) has been demonstrated to reduce SSI in other high-risk cohorts.Methods
Following a comprehensive effort to identify patients at high risk for SSI, the practice patterns at a single academic center shifted and iVAC use increased. SSI rates were tracked in a prospectively maintained database and are reported.Results
394 patients underwent pancreaticoduodenectomy over 21 months. 120 patients (30.5%) had an iVAC applied. The overall rate of SSI was 19.8%. On multivariate analysis, increased risk for SSI was associated with neoadjuvant therapy, preoperative biliary interventions and prior abdominal surgery. iVAC use decreased the rate of SSI (OR 0.45, p = 0.015). In the highest-risk patients, SSI rate declined from 50% in patients without an iVAC to 19.1% with iVAC use (p = 0.015).Conclusion
The use of an iVAC following pancreaticoduodenectomy is associated with decreased SSI rates. This is particularly true for patients at highest risk as defined by a previously established risk scoring system in patients undergoing open pancreaticoduodenectomy. 相似文献20.
Frederick L. Grover Sreekanth Vemulapalli John D. Carroll Fred H. Edwards Michael J. Mack Vinod H. Thourani Ralph G. Brindis David M. Shahian Carlos E. Ruiz Jeffrey P. Jacobs George Hanzel Joseph E. Bavaria E. Murat Tuzcu Eric D. Peterson Susan Fitzgerald Matina Kourtis Joan Michaels Barbara Christensen David R. Holmes 《Journal of the American College of Cardiology》2017,69(10):1215-1230