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1.
Aim
To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients.Methods
We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients.Results
Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, ? 7.97 pill; 95% CI, ? 11.28 to ? 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, ? 0.07 mmol/L; 95% CI, ? 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, ? 0.63 to 1.17, p = 0.55).Conclusion
PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.2.
Yushu Wang Sui Zhu Peijuan Gao Juteng Zhou Qing Zhang 《Clinical and experimental nephrology》2018,22(1):99-109
Background
Patients with chronic kidney disease (CKD) have worse adverse cardiovascular outcomes after coronary artery bypass grafting (CABG). However, the adverse cardiovascular outcomes between off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in these patients have been a subject of debate.Methods
We undertook a comprehensive literature search of PubMed, Embase, and the Cochrane Library database to identify all relevant studies comparing techniques between OPCAB and ONCAB in CKD patients. We pooled the odds ratios (ORs) and hazard ratios (HRs) from individual studies and conducted heterogeneity, quality assessment, and publication bias analyses.Results
This meta-analysis includes 17 studies with 201,889 patients. In CKD patients, OPCAB was associated with significantly lower early mortality as compared to ONCAB (OR 0.88; 95% CI 0.82–0.93; p < 0.0001). OPCAB was associated with decreased risk of atrial fibrillation (OR 0.57; 95% CI 0.34–0.97; p = 0.04), cerebrovascular accident (OR 0.46; 95% CI 0.22–0.95; p = 0.04), blood transfusion (OR 0.20; 95% CI 0.08–0.49; p = 0.0005), pneumonia, prolonged ventilation, and shorter hospital stays. No difference was found regarding long-term survival (HR 1.08; 95% CI 0.86–1.36; p = 0.51) or myocardial infarction (OR 0.65; 95% CI 0.30–1.38; p = 0.26).Conclusions
Compared with ONCAB, OPCAB is associated with superior postoperative morbidity and the early mortality in CKD patients. Long-term survival is comparable between the two surgical revascularizations.3.
Background
Individualised risk prediction is crucial if targeted pre-operative risk reduction strategies are to be deployed effectively. Radiologically determined sarcopenia has been shown to predict outcomes across a range of intra-abdominal pathologies. Access to pre-operative cross-sectional imaging has resulted in a number of studies investigating the predictive value of radiologically assessed sarcopenia over recent years. This systematic review and meta-analysis aimed to determine whether radiologically determined sarcopenia predicts post-operative morbidity and mortality following abdominal surgery.Method
CENTRAL, EMBASE and MEDLINE databases were searched using terms to capture the concept of radiologically assessed sarcopenia used to predict post-operative complications in abdominal surgery. Outcomes included 30 day post-operative morbidity and mortality, 1-, 3- and 5-year overall and disease-free survival and length of stay. Data were extracted and meta-analysed using either random or fixed effects model (Revman ® 5.3).Results
A total of 24 studies involving 5267 patients were included in the review. The presence of sarcopenia was associated with a significant increase in major post-operative complications (RR 1.61 95% CI 1.24–4.15 p = <0.00001) and 30-day mortality (RR 2.06 95% CI 1.02–4.17 p = 0.04). In addition, sarcopenia predicted 1-, 3- and 5-year survival (RR 1.61 95% CI 1.36–1.91 p = <0.0001, RR 1.45 95% CI 1.33–1.58 p = <0.0001, RR 1.25 95% CI 1.11–1.42 p = 0.0003, respectively) and 1- and 3-year disease-free survival (RR 1.30 95% CI 1.12–1.52 p = 0.0008).Conclusion
Peri-operative cross-sectional imaging may be utilised in order to predict those at risk of complications following abdominal surgery. These findings should be interpreted in the context of retrospectively collected data and no universal sarcopenic threshold. Targeted prehabilitation strategies aiming to reverse sarcopenia may benefit patients undergoing abdominal surgery.4.
Jun Wang Peng Guo ZhengYan Gao BenGang Zhou Lei Ren Yu Chen Quan Zhou 《International urology and nephrology》2018,50(2):275-287
Aims
Previous studies have indicated the link of bilirubin levels and risk of developing chronic kidney disease (CKD); however, the findings were inconsistent.Methods
We searched for cohort studies examining bilirubin as an exposure and CKD as an outcome in the Medline, EMBASE, and Web of Science databases from inception through November 31, 2016. A generalized least-squares approach was applied to assess the dose–response relationship between them by pooling rate ratios with 95% confidence intervals. Subgroup analyses, sensitivity analysis, meta-regression, and publication bias were also conducted.Results
Seven cohort studies with 1316 cases and 21,076 participants were identified for inclusion in the meta-analysis. The combined RR for the highest versus lowest bilirubin level was 0.36 (95% CI 0.19–0.68; P heterogeneity = 0.001; Power = 0.72; n = 6). In the linear dose–response analysis, each 1-μmol/L increase in bilirubin was associated with a 5% reduced risk of CKD (RR = 0.95; 95% CI 0.92–0.97; P for trend test = 0.113; P heterogeneity = 0.001; Power = 0.99; n = 7). The subgroup analyses and sensitivity analyses showed consistent results, and publication bias may exist.Conclusion
This meta-analysis suggests that elevated bilirubin level may be associated with decreased risk of developing CKD.5.
Background
Robotic-assisted liver resection (RALR) was introduced as procedures of overcoming the limitations of traditional laparoscopic liver resection (LLR). The aim of this review was to evaluate the surgical results of RALR from all published studies and the results of comparative studies of RALR versus LLR for hepatic neoplasm.Methods
Eligible studies involved RALR that published between January 2001 and December 2014 were reviewed systematically. Comparisons between RALS and LLR were pooled and analyzed by meta-analytical techniques using random- or fixed-effects models, as appropriate.Results
In total, 29 studies, involving 537 patients undergoing RALR, were identified. The most common RALR procedure was a wedge resection and segmentectomy (28.67 %), followed by right hepatectomy (17.88 %), left lateral sectionectomy (13.22 %), and bisegmentectomy (9.12 %). The conversion and complication rates were 5.59 and 11.36 %, respectively. The most common reasons for conversion were bleeding (46.67 %) and unclear tumor margin (33.33 %). Intracavitary fluid collections and bile leaks (40.98 %) were the most frequently occurring morbidities. Nine studies, involving 774 patients, were included in meta-analysis. RALR had a longer operative time compared with LLR [mean difference (MD) 48.49; 95 % confidence interval (CI) 22.49–74.49 min; p = 0.0003]. There were no significant differences between the two groups in blood loss [MD 31.53; 95 % CI ?14.74 to 77.79 mL; p = 0.18], hospital stay [MD 0.13; 95 % CI ?0.54 to 0.80 days; p = 0.18], postoperative overall morbidity [odds ratio (OR) 0.76; 95 % CI 0.49–1.19; p = 0.23], and surgical margin status (OR 0.61; 95 % CI 0.33–1.12; p = 0.11); cost was greater than robotic surgery (p = 0.001).Conclusion
RALR and LLR display similar safety, feasibility, and effectiveness for hepatectomies, but further studies are needed before any final conclusion can be drawn, especially in terms of oncologic and cost-effectiveness outcomes.6.
Olivia Trummer Uwe Langsenlehner Sabine Krenn-Pilko Thomas R. Pieber Barbara Obermayer-Pietsch Armin Gerger Wilfried Renner Tanja Langsenlehner 《World journal of urology》2016,34(4):607-611
Purpose
Decreased vitamin D levels have been associated with prostate cancer, but it is unclear whether this association is causal. A functional single-nucleotide polymorphism (SNP) in the group-specific component (GC) gene (T > G, rs2282679) has been associated with 25-hydroxy (25-OH) vitamin D and 1.25 dihydroxy (1.25-OH2) vitamin D levels.Methods
To examine the hypothesized inverse relationship between vitamin D status and prostate cancer, we studied the association between this SNP and prostate cancer outcome in the prospective PROCAGENE study comprising 702 prostate cancer patients with a median follow-up of 82 months.Results
GC rs2282679 genotypes were not associated with biochemical recurrence [hazard ratios (HR) 0.91, 95 % confidence interval (CI) 0.73–1.12; p = 0.36], development of metastases (HR 1.20, 95 % CI 0.88–1.63; p = 0.25) or overall survival (HR 1.10; 95 % CI 0.84–1.43; p = 0.50).Conclusions
A causal role of vitamin D status, as reflected by GC rs2282679 genotype, in disease progression and mortality in prostate cancer patients is unlikely.7.
Background
The national incidence of adverse events (AEs) in Swedish orthopedic care has never been described. A new national database has made it possible to describe incidence, nature, preventability and consequences of AEs in Swedish orthopedic care.Methods
We used national data from a structured two-stage record review with a Swedish modification of the Global Trigger Tool. The sample was 4,994 randomly selected orthopedic admissions in 56 hospitals during 2013 and 2014. The AEs were classified according to the Swedish Patient Safety Act into preventable or non-preventable.Results
At least one AE occurred in 733 (15 %, 95 % CI 13.7–15.7) admissions. Of 950 identified AEs, 697 (73 %) were judged preventable. More than half of the AEs (54 %) were of temporary nature. The most common types of AE were healthcare-associated infections and distended urinary bladder. Patients ≥65 years had more AEs (p?<?0.001), and were more often affected by pressure ulcer (p?<?0.001) and urinary tract infections (p?<?0.01). Distended urinary bladder was seen more frequently in patients aged 18–64 years (p?=?0.01). Length of stay was twice as long for patients with AEs (p?<?0.001). We estimate 232,000 extra hospital days due to AEs during these 2 years. The pattern of AEs in orthopedic care was different compared to other hospital specialties.Conclusions
Using a national database, we found AEs in 15 % of orthopedic admissions. The majority of the AEs was of temporary nature and judged preventable. Our results can be used to guide focused patient safety work.8.
M. C. Kriegmair P. Mandel A. Moses C. Bolenz M. S. Michel D. Pfalzgraf 《World journal of urology》2016,34(4):545-551
Purpose
The aim of the study was to externally validate the Zonal NePhRO Score (ZNS) published in 2014 as latest and superior nephrometry score in terms of prediction of perioperative complications and outcome of open partial nephrectomies (OPNs).Methods
We identified 200 consecutive patients who underwent OPN. Analysis of preoperative CT or MRI scans and retrospective analysis of the patients’ clinical records were performed. Tumour complexity was stratified according to the ZNS into three categories: low (4–6), moderate (7–9) and high (10–12) complexity. Predictors for perioperative complications and surgical parameters were identified using univariate and multivariate logistic regression.Results
Tumour complexity was graded in 19.8 % of the cases as low, in 50.3 % as moderate and in 29.9 % as high. In the multivariate analysis, ZNS was significantly associated with a higher complication rate (OR 1.25, 95 % CI 1.04–1.49, p = 0.014), longer ischaemia time (IT) (β = 1.19, 95 % CI 0.33–2.05, p = 0.007), postoperative drop of estimated glomerular filtration rate (eGFR) (β = ?1.86, 95 % CI ?3.71 to ?0.01, p = 0.049) and opening of the collecting system (CS) (OR 1.72, 95 % CI 1.40–2.10, p < 0.001). In addition, age and body mass index were identified as independent predictors for complications (OR 1.03, 95 % CI 1.00–1.06, p = 0.043 and OR 1.08, 95 % CI 1.00–1.15, p = 0.031).Conclusion
The present study is the first external validation of the ZNS as a predictor of perioperative complications in patients undergoing OPN. A higher ZNS score was associated with a longer IT, a higher rate of opening the CS and drop of eGFR.9.
Purpose
Insulin-like growth factor 1 (IGF1) gene single nucleotide polymorphism (rs5742612) has been associated with adolescent idiopathic scoliosis (AIS) in several studies with limited sample size and inconsistent outcomes. So we perform this meta-analysis to assess the precise association between IGF1 gene single nucleotide polymorphism (rs5742612) and AIS.Methods
We systematically searched Pubmed, Embase, Web of Science and Cochrane Library up to January 19, 2016 to obtain relevant studies using our research strategy. Four articles all belonging to case–control studies were included in our meta-analysis.Results
A total of four studies containing 763 cases and 559 controls satisfied the inclusion criteria after judgment by two reviewers. No significant associations were detected between IGF1 gene single nucleotide polymorphism (rs5742612) and AIS (T vs. C, OR = 1.10, 95 % CI 0.91–1.34, p = 0.32; TT vs. CC: OR = 1.28, 95 % CI 0.82–2.02, p = 0.28; TC vs. CC: OR = 1.29, 95 % CI 0.82–2.06, p = 0.27; TT/TC vs. CC: OR = 1.28, 95 % CI 0.83–1.98, p = 0.27; TT vs. TC/CC: OR = 1.06, 95 % CI 0.82–1.36, p = 0.66).Conclusions
IGF1 gene single nucleotide polymorphism (rs5742612) is not significant associated with susceptibility to AIS in either Asian or Caucasian populations. However, IGF1 gene rs5742612 may be associated with severity of AIS. Further studies with larger sample size and different population groups involving the relationship are required to confirm the potential association.10.
Adeel Aqil Fahad Hossain Hassaan Sheikh Joseph Aderinto George Whitwell Harish Kapoor 《Journal of orthopaedics and traumatology》2016,17(3):207-213
Background
The UK hip fracture best practice tariff (BPT) aims to deliver hip fracture surgery within 36 h of admission. Ensuring that delays are reserved for conditions which compromise survival, but are responsive to medical optimisation, would help to achieve this target. We aimed to identify medical risk factors of surgical delay, and assess their impact on mortality.Materials and methods
Prospectively collected patient data was obtained from the National Hip Fracture Database (NHFD). Medical determinants of surgical delay were identified and analysed using a multivariate regression analysis. The mortality risk associated with each factor contributing to surgical delay was then calculated.Results
A total 1361 patients underwent hip fracture surgery, of which 537 patients (39.5 %) received surgery within 36 h of admission. Following multivariate analyses, only hyponatraemia was deduced to be a significant risk factor for delay RR = 1.24 (95 % CI 1.06–1.44). However, following a validated propensity score matching process, a Pearson chi-square test failed to demonstrate a statistical difference in mortality incidence between the hypo- and normonatraemic patients [χ 2 (1, N = 512) = 0.10, p = 0.757].Conclusions
Hip fracture surgery should not be delayed in the presence of non-severe and isolated hyponatraemia. Instead, surgical delay may only be warranted in the presence of medical conditions which contribute to mortality and are optimisable.Level of evidence
III11.
Hang Zhang XiangHu Wu Feng Zhu Ming Shen Rui Tian ChengJian Shi Xin Wang GuangQin Xiao XingJun Guo Min Wang RenYi Qin 《Surgical endoscopy》2016,30(12):5173-5184
Backgrounds and objective
The technique of minimally invasive pancreatic surgeries has evolved rapidly, including minimally invasive pancreaticoduodenectomy (MIPD). However, controversy on safety and feasibility remains when comparing the MIPD with the open pancreaticoduodenectomy (OPD); therefore, we aimed to compare MIPD and OPD with a systemic review and meta-analysis.Methods
Multiple electronic databases were systematically searched to identify studies (up to February 2016) comparing MIPD with OPD. Intra-operative outcomes, oncologic data, postoperative complications and postoperative recovery were evaluated.Results
Twenty-two retrospective studies including 6120 patients (1018 MIPDs and 5102 OPDs) were included. MIPD was associated with a reduction in estimated blood loss (WMD ?312.00 ml, 95 % CI ?436.30 to ?187.70 ml, p < 0.001), transfusion rate (OR 0.41, 95 % CI 0.30–0.55, p < 0.001), wound infection (OR 0.37, 95 % CI 0.20–0.66, p < 0.001) and length of hospital stay (WMD ?3.57 days, 95 % CI ?5.17 to ?1.98 days, p < 0.001). Meanwhile, MIPD group has a higher R0 resection rate (OR 1.47, 95 % CI 1.18–1.82, p < 0.001) and more lymph nodes harvest (WMD 1.74, 95 % CI 1.03–2.45, p < 0.001). However, it had longer operation time (WMD 83.91 min, 95 % CI 36.60–131.21 min, p < 0.001). There were no significant differences between the two procedures in morbidities (p = 0.86), postoperative pancreatic fistula (p = 0.17), delayed gastric empting (p = 0.65), vascular resection (p = 0.68), reoperation (p = 0.33) and mortality (p = 0.90).Conclusions
MIPD can be a reasonable alternative to OPD with potential advantages. However, further large-volume, well-designed RCTs with extensive follow-ups are suggested to confirm and update the findings of our analysis.12.
13.
Knowledge on health and back care education related to physical activity and exercise in adolescents
Purpose
The aim of this study was to analyze the relationship between the specific level of knowledge on health and back care-related physical activity practice and exercise with low back pain (LBP) in adolescents.Methods
This is a cross-sectional study. The sample consisted of a total of 576 adolescents aged 13–18 years (mean age 15.5, SD 1.4). Self-reported questionnaires were used to record specific knowledge on health and back care and LBP in healthy adolescents.Results
The prevalence of LBP was 46.3 % [95 % confidence interval (CI) 44.9–47.8]. Students with LBP scored slightly higher than non-sufferers, getting non-significant values. The level of specific knowledge increased with age (F = 7.308; p = 0.002). Stepwise logistic regression analysis showed that older girls group (>16 years old) was significantly associated with LBP odds ratio (OR) 2.9 (95 % CI 1.77–4.74; p = 0.000).Conclusions
High school students have a low level of specific knowledge. Back care education in the school curriculum is recommended.14.
Katie S. Murray Emily C. Zabor Massimiliano Spaliviero Paul Russo Wassim M. Bazzi John E. Musser A. Ari Hakimi Melanie L. Bernstein Guido Dalbagni Jonathan A. Coleman Helena Furberg 《World journal of urology》2016,34(12):1667-1672
Purpose
To examine the incidence of secondary primary malignancies in patients with renal cortical neoplasms.Methods
Between January 1989 and July 2010, 3647 patients underwent surgery at our institution for a renal cortical neoplasm and were followed through 2012. Occurrence of other malignancies was classified as antecedent, synchronous, or subsequent. All patients with antecedent malignancies (n = 498) and a randomly selected half of those with synchronous malignancies (n = 83) were excluded. The expected number of second primaries was calculated by multiplying Surveillance, Epidemiology, and End Results Program incidence rates of renal cortical neoplasms by person-years at risk within categories of age, sex, and year of diagnosis. The standardized incidence ratio (SIR) was calculated as observed cancers divided by expected incidence of the cancer, with approximation to the exact Poisson test used to obtain confidence intervals (CI) and p values.Results
Of 3066 patients with renal cortical neoplasms, 267 had a second primary cancer; the five most common in men were prostate, colorectal, bladder, lung, and non-Hodgkin’s lymphoma; the five most common in women were breast, colorectal, lung, endometrium, and thyroid. Men demonstrated higher than expected thyroid cancer rate (SIR 5.0; 95 % CI 1.83–10.88, p = 0.002), and women had higher than expected rates of stomach cancer (SIR 5.0; 95 % CI 1.61–11.67, p = 0.004) and thyroid cancer (SIR 4.62; 95 % CI 1.69–10.05, p = 0.003).Conclusions
The incidence of certain types of second malignancies may be higher in patients after diagnosis of renal cortical neoplasms compared to the general population. These observations can inform clinical follow-up in kidney cancer survivorship and future research studies.15.
Kohei Shigeta Koji Okabayashi Hideo Baba Hirotoshi Hasegawa Masashi Tsuruta Kazuo Yamafuji Kiyoshi Kubochi Yuko Kitagawa 《Surgical endoscopy》2016,30(2):543-550
Background
The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer.Methods
The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software.Results
Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4 % [95 % confidence interval (CI) 1–6 %], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95 % CI 0.16–0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95 % CI 0.07–0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95 % confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger’s test; anastomotic leakage: p = 0.056, re-operation: p = 0.681).Conclusions
Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.16.
Julia B. Kössler-Ebs Kathrin Grummich Katrin Jensen Felix J. Hüttner Beat Müller-Stich Christoph M. Seiler Phillip Knebel Markus W. Büchler Markus K. Diener 《World journal of surgery》2016,40(10):2319-2330
Background
Incisional hernias are one of the most common long-term complications associated with open abdominal surgery. The aim of this review and meta-analysis was to systematically assess laparoscopic versus open abdominal surgery as a general surgical strategy in all available indications in terms of incisional hernia occurrence.Methods
A systematic literature search was performed to identify randomized controlled trials comparing incisional hernia rates after laparoscopic versus open abdominal surgery in all indications. Random effects meta-analyses were calculated and presented as risk differences (RD) with their corresponding 95 % confidence intervals (CI).Results
24 trials (3490 patients) were included. Incisional hernias were significantly reduced in the laparoscopic group (RD ?0.06, 95 % CI [?0.09, ?0.03], p = 0.0002, I 2 = 75). The advantage of the laparoscopic procedure persisted in the subgroup of total-laparoscopic interventions (RD ?0.14, 95 % CI [?0.22, ?0.06], p = 0.001, I 2 = 87 %), whereas laparoscopically assisted procedures did not show a significant reduction of incisional hernias compared to open surgery (RD ?0.01, 95 % CI [?0.03, 0.01], p = 0.31, I 2 = 35 %). Wound infections were significantly reduced in the laparoscopic group (RD ?0.06, 95 % CI [?0.09, ?0.03], p < 0.0001, I 2 = 35 %); overall postoperative morbidity was comparable in both groups (RD ?0.06, 95 % CI [?0.13, 0.00], p = 0.06; I 2 = 64 %). Open abdominal surgery showed a significantly longer hospital stay compared to laparoscopy (RD ?1.92, 95 % CI [?2.67, ?1.17], p < 0.00001, I 2 = 87 %). At short-term follow-up, quality of life was in favor of laparoscopy.Conclusions
Incisional hernias are less frequent using the total-laparoscopic approach instead of open abdominal surgery. Whenever possible, the less traumatic access should be chosen.17.
Propensity Score Analysis of an Enhanced Recovery Programme in Upper Gastrointestinal Cancer Surgery
A. Karran J. Wheat D. Chan P. Blake R. Barlow W. G. Lewis 《World journal of surgery》2016,40(7):1645-1654
Introduction
The aim of this study was to examine the influence of an enhanced recovery programme (ERP) on outcomes of upper gastrointestinal (UGI) cancer surgery by means of propensity score-matched analysis.Methods
Three hundred consecutive patients diagnosed with UGI cancer were studied prospectively before and after the introduction of an ERP. Multiple regression models, including propensity scores, were developed to assess confounding variables associated with undergoing surgery, and the risk adjusted association between treatment and length of hospital stay (LOHS).Results
After regression for confounding factors, a cohort of 252 patients was available of whom 160 received ERP [median age 66 years (IQR 58–73), 119 male, 81 oesophageal, 79 gastric cancer] and 92 control [66 years (IQR 58–74), 74 male, 58 oesophageal, 34 gastric cancer]. ERP operative morbidity (Clavien–Dindo ≥3) and mortality were 13.8 and 3.1 % compared with 17.4 (p = 0.449) and 2.2 % (p = 0.658) in controls. Median ERP critical care and total LOS were 1 (IQR 0–1) and 13 (IQR 10–17) days, compared with 1 (IQR 1–2, p = 0.009) and 16 (IQR 13–26, p < 0.001) days. Multivariable analysis revealed ERP (HR 1.477, 95 % CI 1.084–2.013, p = 0.013), tumour location (HR 2.420, 95 % CI 1.624–3.606, p < 0.001), operative procedure (HR 1.143, 95 % CI 1.032–1.265, p = 0.010), and operative morbidity (HR 0.277, 95 % CI 0.179–0.429, p < 0.001) to be associated with LOHS.Conclusion
An ERP in UGI cancer surgery was feasible, safe, and effective.18.
Purpose
To evaluate if the widespread adoption of a minimally invasive approach to radical nephrectomy has affected short- and long-term patient outcomes in the modern era.Methods
A retrospective cohort study of patients who underwent radical nephrectomy from 2001 to 2012 was conducted using the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program and Medicare insurance program database. Patients who underwent open surgery were compared to those who underwent minimally invasive surgery using propensity score matching.Results
10,739 (85.9%) underwent open surgery and 1776 (14.1%) underwent minimally invasive surgery. Minimally invasive surgery increased from 18.4% from 2001–2004 to 43.5% from 2009 to 2012. After median follow-up of 57.1 months, minimally invasive radical nephrectomy conferred long-term oncologic efficacy in terms of overall (HR 0.84; 95% CI 0.75–0.95) survival and cancer-specific (HR 0.68; 95% CI 0.54–0.86) survival compared to open radical nephrectomy. Minimally invasive surgery was associated with lower risk of inpatient death [risk ratio (RR) 0.45 with 95% CI: (0.20–0.99), p = 0.04], deep vein thrombosis [RR: 0.35 (0.18–0.69), p = 0.002], respiratory complications [RR: 0.73 (0.60–0.89), p = 0.001], infectious complications [RR: 0.35 (0.14–0.90), p = 0.02], acute kidney injury [RR: 0.66 (0.52–0.84), p < 0.001], sepsis [RR: 0.55 (0.31–0.98), p = 0.04], prolonged length of stay (18.6 vs 30.0%, p < 0.001), and ICU admission (19.7 vs 26.3%, p < 0.001). Costs were similar between the two approaches (30-day costs $15,882 vs $15,564; p = 0.70).Conclusion
After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.19.
Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse
Brian J. Linder Sherif A. El-Nashar Alain A. Mukwege Amy L. Weaver Michaela E. McGree Deborah J. Rhodes John B. Gebhart Christopher J. Klingele John A. Occhino Emanuel C. Trabuco 《International urogynecology journal》2018,29(6):803-810
Introduction and hypothesis
The aim of this study was to compare outcomes after uterosacral ligament suspension (USLS) or sacrocolpopexy for symptomatic stage IV apical pelvic organ prolapse (POP) and evaluate predictors of prolapse recurrence.Methods
The medical records of patients managed surgically for stage IV apical POP from January 2002 to June 2012 were reviewed. A follow-up survey was sent to these patients. The primary outcome, prolapse recurrence, was defined as recurrence of prolapse symptoms measured by validated questionnaire or surgical retreatment. Survival time free of prolapse recurrence was estimated using the Kaplan–Meier method, and Cox proportional hazards models evaluated factors for an association with recurrence.Results
Of 2633 women treated for POP, 399 (15.2%) had stage IV apical prolapse and were managed with either USLS (n = 355) or sacrocolpopexy (n = 44). Those managed with USLS were significantly older (p < 0.001) and less likely to have a prior hysterectomy (39.7 vs 86.4%; p < 0.001) or prior apical prolapse repair (8.2 38.6%; p < 0.001). Median follow-up was 4.3 years [interquartile range (IQR) 1.1–7.7]. Survival free of recurrence was similar between USLS and sacrocolpopexy (p = 0.43), with 5-year rates of 88.7 and 97.6%, respectively. Younger age [adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI) 1.12–2.13; p = 0.008] and prior hysterectomy (aHR 2.8, 95% CI 1.39–5.64; p = 0.004) were associated with the risk of prolapse recurrence, whereas type of surgery approached statistical significance (aHR 2.76, 95% CI 0.80–9.60; p = 0.11).Conclusions
Younger age and history of prior hysterectomy were associated with an increased risk of recurrent prolapse symptoms. Notably, excellent survival free of prolapse recurrence were obtained with both surgical techniques.20.