共查询到3条相似文献，搜索用时 0 毫秒
1.
Stephanie Kerlakian Vikrom K. Dhar Daniel E. Abbott David A. Kooby Nipun B. Merchant Hong J. Kim Robert C. Martin Charles R. Scoggins David J. Bentrem Sharon M. Weber Shishir K. Maithel Syed A. Ahmad Sameer H. Patel 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):482-488
Background
Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with “high risk stigmata” (HRS) or “worrisome features” (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC).Methods
Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines.Results
168 (61%) patients had head/uncinate cysts, while 107 (39%) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55% vs. 40%), had at least one HRS (24% vs. 11%), and more often harbored HGD or IC(49% vs. 27%)[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02).Discussion
Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs. 相似文献2.
Jay J. Idrees Brad F. Rosinski Katiuscha Merath Qinyu Chen Fabio Bagante Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):291-300
Background
Objectives were to determine the causes of readmission and assess the cost-effectiveness of high (HQ) and low quality (LQ) hospitals in performing pancreatic resection, by using readmission rates as the measure of quality.Methods
We identified 53,572 pancreatic resection cases from National Readmission Database from 2010 through 2014. Hospitals were risk adjusted and ranked based on readmission. Top 20% HQ hospitals having the lowest readmission rates were compared to the bottom 20% LQ hospitals with the highest readmission rates.Results
The 90-day readmission rate was 27.2% (HQ: 25.7%, LQ: 30.9%, p < 0.001). Compared to LQ, HQ hospitals had lower mortality (2.1% vs 10.2%, p < 0.001) and major complication (10.5% vs 53%, p < 0.001). Major complication during index operation was a major predictor of readmission (RR: 1.6, 95% CI: 1.6–1.7, p < 0.001). The optimal cut point of hospital volume associated with low mortality was 70 or more cases/year. Per year of survival benefit at HQ hospitals, the costs were lower by $9,293 with cost-savings of $6.98 million/year.Conclusion
HQ hospitals were cost-effective at performing pancreatic resection and achieved substantial cost-savings by avoiding major complications during index operation and having lower rates of readmissions. Hospital readmission rate is a strong marker of quality of care. 相似文献3.
Andrea Ruzzenente Fabio Bagante Francesca Ratti Eliza W. Beal Sorin Alexandrescu Katiuscha Merath Eleftherios A. Makris George A. Poultsides Georgios A. Margonis Matthew J. Weiss Irinel Popescu Luca Aldrighetti Alfredo Guglielmi Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(9):1230-1239
BackgroundProgression of colorectal liver metastasis (CRLM) on preoperative chemotherapy has been associated with a worse prognosis compared with patients who have responsive disease. Defining response can be challenging as traditional criteria largely assess only tumor size.MethodsPatients who underwent hepatectomy between 2010 and 2017 were identified using a multi-centric database. This study aimed to define the impact of preoperative chemotherapy response relative to initial tumor burden score (TBS) and determine impact of clinico-pathological variables on overall survival (OS).ResultsAmong 784 patients who received preoperative chemotherapy, the regimen was oxaliplatin- (66%) or irinotecan-based (34%). Among patients with a TBS<6 at diagnosis, genetic status was the most important prognostic variable. Patients with a TBS<6, 5-year OS was 55%, 35%, and 0% for patients with KRAS/NRAS/BRAF wild-type, KRAS/NRAS, and BRAF mutations, respectively. Among patients who presented with CRLM with a TBS≥6, only Δ-TBS was prognostically important and patients with a Δ-TBS ≥ ?10% had a 5-year OS of 27% compared with 49% for patients with a Δ-TBS < ?10%.ConclusionsPrognostic stratification of patients with CRLM receiving preoperative chemotherapy should be multi-faceted and include consideration of initial tumor burden, change in tumor burden due to chemotherapy, and tumor genetic status. 相似文献