Gastric cancer: factors affecting survival

Background and aim: The present multicenter, retrospective study aimed at determining the factors affecting survival in patients who were operated on due to gastric cancer (GC).

Patients and methods: The data of 234 patients, who underwent elective surgery due to GC were retrospectively analyzed. The demographic characteristics, tumor localization and diameter, type of resection and lymph node dissection, experience of the operating surgeon (senior or junior), tumor grade, pT stage, number of lymph nodes harvested, number of lymph nodes with and without metastasis, tumor stage and survival data were recorded.

Results: Survival was better a tumor diameter <4?cm, lower localization, experience of the operating surgeon (senior), without metastatic lymph nodes, tumor grade and decreased invasion depth (p?<?.05). There was no statistically significant difference between D1 LND and D2 LND with respect to survival (p?=?.793). Mortality was higher and survival was lower in patients with metastatic lymph nodes (p?=?.001). A number of harvested lymph nodes of 16 or more increased mortality (p?=?.003). Also, as disease stage increased, there was a decrease in survival and increase in mortality rates (p?=?.001).

Conclusions: Survival outcomes in resectable GCs are affected by the experience of the surgeon and patient-related factors at the time of surgery, including tumor size, T stage, and presence of metastatic lymph nodes.     

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients

Purpose: Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients.

Methods: Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session.

Results: Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p?=?.013) and higher IL-6 (p?=?.032) and hsCRP levels (p?=?.011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan–Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p?=?.055). LTI inversely correlated with age and IL-6 and positively with IGF-1.

Conclusions: Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.     

Prognostic impact of recurrences in patients with electrical storm

Objectives. The study sought to assess the prognostic impact of recurrences of electrical storm (ES-R) on mortality, rehospitalization and major adverse cardiac events (MACE). Background. Data on the prognostic impact of ES-R is rare. Methods. All consecutive ES patients with an implantable cardioverter defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with ES-R were compared to patients without ES-R. The primary endpoint was all-cause mortality, secondary endpoints were in-hospital mortality, rehospitalization and MACE. Results. A total of 87 consecutive ES patients with an ICD were included, of which 26% presented with ES-R at 2.5 years of follow-up. ES-R patients revealed lower LVEF compared to non-ES-R patients (91% vs. 61%; p?=?.081). There was a numerically higher rate of the primary endpoint of all-cause mortality at 2.5 years (50% vs. 32%; log-rank p?=?.137). Furthermore, ES-R was associated with increasing rates of rehospitalization (64% vs. 37%; p?=?.031; HR 1.985; 95% CI 1.025–3.845; log-rank p?=?.042), especially of acute heart failure (32% vs. 12%; p?=?.001; HR 3.262; 95% CI 1.180–9.023; log rank p?=?.023). MACE were higher in ES-R patients (55% vs. 35%; p?=?.113; log rank p?=?.141). ES patients with LVEF ≤35% were 12.4 times more likely to develop ES-R (HR 12.417; 95% CI 1.329–115.997; p?=?.027). Conclusion. At long-term follow-up of 2.5 years, ES-R was associated with numerically higher rates of long-term all-cause mortality and significantly higher rates of rehospitalization due to acute heart failure. LVEF ≤35% was associated with increased risk of ES-R.

Condensed Abstract

This study examined retrospectively the impact of recurrences of electrical storm (ES-R) on survival in 87 patients. ES-R was associated with numerically higher long-term all-cause mortality, whereas significantly higher rates of rehospitalization, respectively of acute heart failure were observed.

• Highlights

• ES-R is associated with numerically higher rates of all-cause mortality at long-term follow-up.

• ES-R is associated with significantly higher rates of rehospitalization and numerically higher rates of MACE at long-term follow-up, mainly due to acute heart failure.

• Patients with LVEF ≤35% were 12.4 times more likely to develop ES-R.

     

Risk factors of perioperative morbimortality after laparoscopic sleeve gastrectomy: a club coelio multicenter study

Objectives: Postoperative complications after Laparoscopic sleeve gastrectomy (LSG) can dramatically compromise patient’s outcome. The aim of this study is to analyze the per- and postoperative short-term outcomes after LSG and to assess predictive risk factors of complications.

Methods: The study group consisted of 790 patients (610 women and 180 men) who underwent LSG In 2014. All interventions were performed by 18 experienced surgeons members of the Club Coelio. Data about preoperative work-up, surgical techniques, 30-days postoperative morbidity and mortality were collected. Endpoints were perioperative morbidity and mortality and assessment of potential risk factors for complications.

Results: Mean age and body mass index were respectively 39 years and 41.5kg/m². Ninety-one patients (11.5%) had previous bariatric surgery. Morbidity rate was 4.7% (37/790) including 16 leaks (2.0%) and 9 bleedings (1.1%) and no deaths. Risk factors for leak were: previous adjustable banding (p?=?.0051), with no difference between removal of the banding and LSG in 1 or 2 steps, and type of endostapler (p?=?.0129).

Conclusions: Leakage after Sleeve was rare but still observed even in experienced hands. The leak rate is particularly high when LSG is performed after adjustable gastric banding removal.     

Circulating irisin levels reflect visceral adiposity in non-diabetic patients undergoing hemodialysis

Background: Recent evidence suggests that increased visceral adiposity is a strong independent risk factor for cardiovascular death and all-cause mortality in hemodialysis (HD) patients. Irisin, which is a novel myokine, can play critical roles in diabetes and adiposity. The purpose of our study was to investigate whether serum irisin levels are associated with body mass index, waist circumference (WC), and total fat mass in non-diabetic patients undergoing maintenance HD.

Methods: This cross-sectional study included 108 non-diabetic HD patients and 40 age- and sex-matched apparently healthy subjects. Serum irisin concentrations were determined using an enzyme-linked immunosorbent assay. Body fat composition (TBF-410 Tanita Body Composition Analyzer) was measured and calculated.

Results: Serum irisin levels did not differ between HD patients and the healthy controls (523.50?±?229.32 vs. 511.28?±?259.74, p?=?0.782). Serum irisin levels were associated with age (r?=?0.314; p?=0.006), HOMA-IR (r?=?0.472; p?=?0.003), WC (r?=?0.862; p?r?=?0.614; p?β?=?1.240, p?β?=?0.792, p?=?0.015) were the variables that were significantly associated with irisin concentrations (R^2?=^?0.684, p?Conclusions: These results suggest that serum irisin levels are related to visceral adiposity in non-diabetic HD patients.     

Colorectal cancer in the young: a possible role for immune surveillance?

Background: Younger patients with colorectal cancer (CRC) generally have better survival in spite of worse clinical and pathological features.

Methods: Twenty-six patients under 50 years operated for primary CRC were enrolled and matched 1:2:2 according to stage, tumor site and gender with 52 patients from 50 to 70 years and 52 patients over 70 years old.

Results: Patients under 50 years had a significantly longer overall, cancer specific and disease free survival (p?=?.001, p?=?.007 and p?=?.05, respectively). However, they had more frequently lymphovascular invasion (p?=?.006) and they more frequently developed metachronous CRC at follow-up (p?=?.03). Nevertheless, preoperative lymphocytes blood count/white blood count (LBC/WBC) ratio inversely correlated with age at operation (rho?=??.21, p?=?.04) and it predicted CRC recurrence with an accuracy of 70%, p?p?p?=?.0001 and p?=?.01, respectively).

Conclusions: Patients under 50 years had a significantly longer survival with a higher LBC/WBC ratio. These results could suggest a possible role of immunosurveillance in neoplastic control.     

Cholecystectomy during esophagectomy is safe but unnecessary

Abstract

Background: Prophylactic cholecystectomy has been proposed as a concomitant procedure during upper gastrointestinal surgery. This study evaluates the safety and the need of concurrent cholecystectomy during esophagectomy for cancer.

Methods: All consecutive esophagectomies for esophageal cancer at the Center for Esophageal Diseases in Padova (Italy) between 1992 and 2011 were included. The safety of concurrent cholecystectomy was evaluated by surgical outcomes (length of stay, postoperative mortality and perioperative complications). The need for concurrent cholecystectomy was evaluated by occurrence of biliary duct stones and of cholelithiasis/cholecystitis after esophagectomy.

Results: Cholecystectomy was performed during 67 out of 1087 esophagectomies (6.2%). Cirrhosis or chronic liver disease was associated with receiving cholecystectomy during esophagectomy (OR: 1.99, 95%C.I. 1.10–3.56). Patients receiving and those not receiving cholecystectomy showed similar length of stay (median 14 days, p?=?.87), postoperative mortality (3.0% vs. 2.5%, p?=?.68), intraoperative complication (4.5% vs. 7.1%, p?=?.62), early complications (52.2% vs. 44.6%, p?=?.25) and late complications (20.9% vs. 24.8%, p?=?.56). Cholelithiasis/cholecystitis after esophagectomy occurred in 61 (6.1%) patients, with only four requiring cholecystectomy during follow-up. The biliary stone occurrence was nil. Only pathologic stage III-IV (OR: 2.17, 95%C.I. 1.19–3.96) was associated with cholelithiasis/cholecystitis after esophagectomy.

Conclusion: Routine prophylactic cholecystectomy during esophagectomy could be safe but unnecessary.     

Serum phosphate level at initiation of dialysis is associated with all-cause mortality: a multicenter prospective cohort study

Introduction: As glomerular filtration rate (GFR) decreases, serum phosphate level increases. Previous reports indicated that serum phosphate level was associated with mortality in patients on dialysis. However, few reports have examined the association using dialysis initiation as the baseline period.

Methods: This was a multicenter prospective cohort analysis including 1492 patients. Patients were classified into four quartiles based on the serum phosphate level at dialysis initiation, with Q1 being the lowest and Q4 the highest. All-cause mortality after dialysis initiation was compared using the log-rank test. The propensity score represented the probability of being assigned to group Q1 or Q2–4. All-cause mortality was compared in propensity score-matched patients by using the log-rank test for Kaplan–Meier curves. All-cause mortality of Q1 was compared with that for Q2–4 using multivariate Cox proportional hazard regression analysis. All-cause mortality was also determined among stratified groups with or without use of phosphate binders.

Results: Significant differences in cumulative survival rates were observed between the four groups (p?p?=?.046). All-cause mortality was significantly higher in the Q1 group after adjustment for history of CAD (hazard ratio [HR]?=?0.76, 95% confidence interval [CI]: 0.58???1.00, p?=?.048). However, there was no significant difference between the two groups after adjustment for estimated GFR.

Conclusion: The serum phosphate level at the time of dialysis initiation was associated with all-cause mortality. However, the serum phosphate level was dependent on the renal function.     

Total parathyroidectomy versus total parathyroidectomy with autotransplantation for secondary hyperparathyroidism: systematic review and meta-analysis

Background: Total parathyroidectomy (tPTX) and total parathyroidectomy with autotransplantation (tPTX?+?AT) are effective and inexpensive treatments for secondary hyperparathyroidism (sHPT), but we do not know which one is the optimal approach. Therefore, we undertook a meta-analysis to compare the safety and efficacy of these two surgical procedures.

Methodology: Studies published in English on PubMed, Embase and the Cochrane Library from inception to 27 September 2016 were searched systematically. Eligible studies comparing tPTX with tPTX?+?AT for sHPT were included and Review Manager v5.3 was used.

Results: Eleven studies were included in this meta-analysis. Ten cohort studies and one randomized controlled trial (RCT) involving 1108 patients with sHPT were identified. There was no significant difference in the prevalence of surgical complications (relative risk [RR], 1.71; 95% confidence interval [CI], 0.77–3.79; p?=?.19), all-cause mortality (RR, 0.68; 95% CI, 0.33–1.39; p?=?.29), sHPT persistence (RR, 3.81; 95% CI, 0.56–25.95; p?=?.17) or symptomatic improvement (RR, 1.02; 95% CI, 0.91–1.13; p?=?.79). tPTX could reduce the risk of sHPT recurrence (RR, 0.19; 95% CI, 0.09–0.41; p?p?=?.01) compared with tPTX?+?AT. Simultaneously, tPTX increased the risk of hypoparathyroidism (RR, 2.63; 95% CI, 1.06–6.51; p?=?.04).

Conclusions: We found tPTX and tPTX?+?AT to be useful methods for sHPT treatment. tPTX was superior for reducing the risk of sHPT recurrence and reoperation than tPTX?+?AT but, due to a lack of high statistical-power RCTs, comparative studies will be needed in the future.     

Impact of acute kidney injury on renal allograft survival

Background: Acute kidney injury (AKI) is one of the major determinants of graft survival in kidney transplantation (KTx). Renal Transplant recipients are more vulnerable to develop AKI than general population. AKI in the transplant recipient differs from community acquired, in terms of risk factors, etiology and outcome. Our aim was to study the incidence, risk factors, etiology, outcome and the impact of AKI on graft survival.

Methods: A retrospective analysis of 219 renal transplant recipients (both live and deceased donor) was done.

Results: AKI was observed in 112 (51.14%) recipients, with mean age of 41.5?±?11.2 years during follow-up of 43.2?±?12.5 months. Etiologies of AKI were infection (47.32%), rejection (26.78%), calcineurin inhibitor (CNI) toxicity (13.39%), and recurrence of native kidney disease (NKD) (4.46%). New Onset Diabetes After Transplant (NODAT) and deceased donor transplant were the significant risk factors for AKI. During follow-up 70.53% (p?=?.004) of AKI recipients progressed to chronic kidney disease (CKD) in contrast to only 11.21% (p?=?.342) of non AKI recipients. Risk factors for CKD were AKI within first year of transplant (HR: 7.32, 95%CI: 4.37–15.32, p?=?.007), multiple episodes of AKI (HR: 6.92, 95%CI: 3.92–9.63, p?=?.008), infection (HR: 3.62, 95%CI: 2.8–5.75, p?=?.03) and rejection (HR: 9.92 95%CI: 5.56–12.36, p?=?.001).

Conclusion: Renal transplant recipients have high risk for AKI and it hampers long-term graft survival.     

Increased serum renalase in hemodialysis patients: is it related to left ventricular hypertrophy?

Introduction: Left ventricular hypertrophy (LVH) is one of the most common cardiac abnormalities in patients with end stage renal disease (ESRD). Hypertension, diabetes, increased body mass index, gender, age, anemia, and hyperparathyroidism have been described as risk factors for LVH in patients on dialysis. However, there may be other risk factors which have not been described yet. Recent studies show that renalase is associated with cardiovascular events. The aim of this study was to reveal the relation between renalase, LVH in patients under hemodialysis (HD) treatment.

Methods: The study included 50?HD patients and 35 healthy controls. Serum renalase levels and left ventricle mass index (LVMI) were measured in all participants and the relation between these variables was examined.

Findings: LVMI was positively correlated with dialysis vintage and C-reactive protein (CRP) (r?=?0.387, p?=?0.005 and r?=?0.597, p?r?=??0.324, p?=?0.022 and r?=??0.499, p?r?=?0.263, p?=?0.065). Serum renalase levels were significantly higher in HD patients (212?±?127?ng/mL) compared to controls (116?±?67?ng/mL) (p?r?=?0.677, p?r?=?0.625, p?Discussion: In our study, LVMI was correlated with dialysis vintage, residual diuresis, CRP, and hemoglobin. LVMI tends to correlate with renalase and this correlation may be significant in studies with more patient numbers. The main parameters affecting renalase levels are dialysis vintage and serum creatinine.     

The efficacy of low-dose tadalafil in patients undergoing hemodialysis with end-stage renal disease

Background: Erectile dysfunction (ED) is a disorder that is frequently observed in people with chronic kidney disease who undergo hemodialysis (HD). In the context of evidence-based medicine, we aimed to investigate the effect of low-dose tadalafil on sexual function in patients undergoing HD.

Methods: The medical records of 30 males (aged 29–65?years) with end-stage renal disease (ESRD) on a HD program, and who had received 5?mg tadalafil twice weekly, were retrospectively evaluated. Changes in erectile and ejaculatory function were evaluated using the International Erectile Function Index questionnaire, the Erection Hardness Scale (EHS), and the Male Sexual Health Questionnaire (MSHQ).

Results: The mean age of the patients was 47.6?±?10.1?years, their mean body mass index was 24.3?±?4.2?kg/m², their mean hemoglobin was 11.9?±?0.9?g/dL, and their mean creatinine clearance was 5.8?±?1.1?mL/min. At the third month of treatment, 36.6% of the patients had no ED, 40% had mild ED, 10% had mild-to-moderate ED, and 13.3% had moderate ED. The mean MSHQ scores (p?p?=?.001) were significantly improved. There was no significant difference between Beck's Depression Inventory scores (p?>?.05), but Hamilton anxiety rate scores decreased significantly (p?=?.001). The quality-of-life score improved throughout the study period (p?Conclusions: Tadalafil therapy is an effective therapeutic option in patients with ESRD who undergo HD, not only for the treatment of ED, but also for ejaculatory function, with acceptable adverse effects.     

Incisional Hernia Repair of Medium- and Large-Sized Defects: Laparoscopic IPOM Versus Open SUBLAY Technique

Background: Small incisional hernias can be repaired laparoscopically with low morbidity and reasonable recurrence rates. The aim of this study was to compare laparoscopic with open technique in medium- and large-sized defects regarding postoperative complications and recurrence rates.

Methods: Between 2012 and 2016, 102 patients with medium- or large-sized defects according to EHS classification underwent incisional hernia repair. Patients’ characteristics, hernia size and postoperative complications were prospectively recorded. In October 2016, eligible patients were assessed for recurrence.

Results: About 31 patients underwent laparoscopic IPOM and 71 patients open SUBLAY repair. Morbidity rate was significantly lower in IPOM group than in SUBLAY group (19% versus 41%; p?=?.028). Postoperative complications according to Clavien–Dindo classification were significantly lower in the IPOM group (p?=?.021). Duration of surgery (88 versus 114?min; p?=?.009) and length of hospital stay (five versus eight days; p?<?.001) were significantly shorter for IPOM than for SUBLAY. 71 patients were available for follow-up. Recurrence rates showed no significant difference between study groups (13% versus 7%, p?=?.508).

Conclusions: Laparoscopic repair in medium- and large-sized defects is a feasible and safe approach. IPOM compared to SUBLAY significantly reduces postoperative complications and hospital stay; recurrence rates are comparable.     

Improvement of nonalcoholic fatty liver disease in morbidly obese patients after sleeve gastrectomy: association of ultrasonographic findings with lipid profile and liver enzymes

Background: After bariatric surgery an improvement or even complete resolution of nonalcoholic fatty liver disease (NAFLD) in morbidly obese patients is achieved, but little is known about the effect of laparoscopic sleeve gastrectomy (LSG).

Patients and methods: A prospective observational study of patients undergoing LSG was performed. An abdominal ultrasonography and blood sample extraction (investigating liver enzymes and lipid profile) were performed preoperatively and 12 months after surgery.

Results: Fifty patients were included in the study. Preoperatively, 84% of the patients presented liver steatosis. A significant reduction of steatosis could be observed 12 months after surgery (p?p?=?.008) and ALT (p?=?.007) and an inverse correlation with HDL-cholesterol (p?=?.019). The reduction of liver steatosis showed an inverse correlation with the increase of HDL-cholesterol between pre- and postoperative determinations (p?=?.008).

Conclusions: Liver steatosis, as measured by ultrasonography, improves after sleeve gastrectomy, achieving a complete resolution in 90% of the cases. Preoperative steatosis correlates directly with AST and ALT levels and inversely with HDL-cholesterol. The postoperative increase of HDL-cholesterol shows an inverse correlation with liver steatosis improvement, suggesting that it could be a good marker for monitoring the postoperative liver status.     

Platelet-to-lymphocyte ratio predicts mortality better than neutrophil-to-lymphocyte ratio in hemodialysis patients

Purpose

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were established showing the poor prognosis in some diseases, such as cardiovascular diseases and malignancies. The risk of mortality in patients with end-stage renal disease (ESRD) was higher than normal population. In this study, we aimed to investigate the relationship between NLR, PLR, and all-cause mortality in prevalent hemodialysis (HD) patients.

Methods

Eighty patients were enrolled in study. NLR and PLR obtained by dividing absolute neutrophil to absolute lymphocyte count and absolute platelet count to absolute lymphocyte count, respectively. The patients were followed prospectively for 24 months. The primary end point was all-cause mortality.

Results

Mean levels of neutrophil, lymphocyte, and platelet were 3904 ± 1543/mm³, 1442 ± 494/mm³, 174 ± 56 × 10³/mm³, respectively. Twenty-one patients died before the follow-up at 24 months. Median NLR and PLR were 2.52 and 130.4, respectively. All-cause mortality was higher in patients with high NLR group compared to the patients with low NLR group (18.8 vs. 7.5 %, p = 0.031) and in patients with higher PLR group compared to patients with lower PLR group (18.8 vs. 7.5 %, p = 0.022). Following adjusted Cox regression analysis, the association of mortality and high NLR was lost (p = 0.54), but the significance of the association of high PLR and mortality increased (p = 0.013).

Conclusion

Although both NLR and PLR were associated with all-cause mortality in prevalent HD patients, only PLR could independently predict all-cause mortality in these populations.

     

The relationship between survival rate and intradialytic blood pressure changes in maintenance hemodialysis patients

Objective: The objective of this study is to investigate the relationship between blood pressure changes and all-cause mortality, and between blood pressure changes and cardiovascular mortality, for maintenance hemodialysis (MHD) patients during dialysis.

Methods: Data regarding general condition, biochemical indices, and survival prognosis of MHD patients who were treated at the Shanghai Jiao Tong University School of Medicine-affiliated Renji Hospital from July 2007 to December 2012 were collected, in order to evaluate the relationship between patients’ blood pressure changes during hemodialysis and mortality.

Results: Among 364 patients, with an average age of 63.07?±?13.93?years, an average dialysis vintage of 76.00 (range, 42.25–134.00) months, and a follow-up time of 54.86?±?19.84?months, there were 85 cases (23.4%) of all-cause death and 46 cases (14.2%) of cardiovascular death. All-cause mortality and cardiovascular mortality were lowest (OR, 0.324 and 0.335; 95% CI, 0.152–0.692 and 0.123–0.911; p value, .004 and .032, respectively) in patients whose systolic blood pressure difference (ΔSBP) before and after dialysis was between 7.09 and 14.25?mmHg. Kaplan–Meier analysis indicated that both all-cause mortality and cardiovascular mortality were markedly increased for patients with ΔSBPless than ?0.25?mmHg (p value, .001 and .044, respectively). Cox regression analysis showed that ΔSBPKt/v and albumin were independent risk factors for all-cause mortality in MHD patients.

Conclusions: MHD patients whose blood pressure increased significantly after hemodialysis had a higher risk of dying; ΔSBP, hemoglobin concentration, Kt/v and albumin were independent risk factors for all-cause mortality in MHD patients.     

Very early withdrawal from treatment in patients starting peritoneal dialysis

Introduction: Very early withdrawal from treatment in patients undergoing peritoneal dialysis (PD) is an increasingly important, but poorly understood, issue. Here, we identified the reasons and risk factors for very early withdrawal from PD.

Methods: Incident PD patients from The First Affiliated Hospital of Sun Yat-sen University above 18?years who started treatment between January 1 2006 and December 31 2011 were included. Cessation of PD therapy within the first 90?days after beginning dialysis was classified as very early withdrawal.

Results: Totally 1444 patients were enrolled. Of these, 71 (4.9%) withdrew from PD therapy during the first 90?days. Primary reasons for very early withdrawal included death (34 patients, 47.9%), transplantation (21 patients, 29.6%) and transfer to hemodialysis (14 patients, 19.7%). The leading reasons for death were cardiovascular and infectious disease, accounting for 41.2% (14 patients) and 23.5% (8 patients) of total deaths, respectively. Dialysate leakage (six patients, 42.9%) and catheter dysfunction (five patients, 35.7%) were the main reasons for transfer to hemodialysis. In multivariate analysis, predictors for very early PD withdrawal were older age (per decade increasing; hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.03–1.45; p?=?.019), higher systolic blood pressure (per 10?mmHg increasing; HR, 1.35; 95% CI, 1.20–1.50; p?p?p?=?.001) and lower residual urine volume (per 100?ml/d increasing; HR, 0.90; 95% CI, 0.84–0.95; p?=?.001).

Conclusions: Death was the primary reason for very early withdrawal from PD. Risk factors for very early withdrawal from PD were older in age, had higher systolic blood pressure, lower hemoglobin, lower high-density lipoprotein cholesterol and lower residual urine volume.     

Comparison of wound closure techniques in median sternotomy scars in children: subcuticular suture versus Steri-Strip™ S

Objectives: The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip? S in closing median sternotomy incisions in children with regard to wound healing and scar formation.

Methods: Fifty-three children and adolescents were enrolled in this study who all underwent a median sternotomy at age 0–18?years and had their presternal cutaneous wounds closed with either a running subcuticular suture (Group 1) or Steri-Strip? S (Group 2). Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcome measures were the scar measurements and the incidence of wound problems post-surgery.

Results: A significant difference was found between both groups in median POSAS observer scale scores for the items thickness (p?=?.027), pliability (p?=?.045), surface area (p?=?.045) and the total score (p?=?.048). All in favor of the subcuticular suture group. There were no significant differences concerning the POSAS patient scale scores. Middle parts of scars of patients in Group 2 were significantly broader (p?=?.001) than scars of patients in Group 1. No significant differences concerning wound problems were found.

Conclusions: There are, according to our results, no significant differences in wound healing of median sternotomy incisions in children closed with either a subcuticular suture or Steri-Strip? S. Significant differences do exist regarding scar formation and final cosmetic results of the scars, in favor of subcuticular closure.     

Completeness of pathology reports in stage II colorectal cancer

Introduction: The completeness of the pathological examination of resected colon cancer specimens is important for further clinical management. We reviewed the pathological reports of 356 patients regarding the five factors (pT-stage, tumor differentiation grade, lymphovascular invasion, tumor perforation and lymph node metastasis status) that are used to identify high-risk stage II colon cancers, as well as their impact on overall survival (OS).

Methods: All patients with stage II colon cancer who were included in the first five years of the MATCH study (1 July 2007 to 1 July 2012) were selected (n?=?356). The hazard ratios of relevant risk factors were calculated using Cox Proportional Hazards analyses.

Results: In as many as 69.1% of the pathology reports, the desired information on one or more risk factors was considered incomplete. In multivariable analysis, age (HR: 1.07, 95%CI 1.04–1.10, p?p?=?.003) and well (HR 0.11, 95%CI 0.01–0.89, p?=?.038) differentiated tumors were significantly associated with OS.

Conclusions: Pathology reports should better describe the five high-risk factors, in order to enable proper patient selection for further treatment. Chemotherapy may be offered to stage II patients only in select instances, yet a definitive indication is still unavailable.