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991.
Takeshi Aoyama Susumu Kunisawa Kiyohide Fushimi Teiji Sawa Yuichi Imanaka 《Journal of cardiothoracic surgery》2018,13(1):129
Background
In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.Methods
Data of patients aged 80?years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.Results
The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p?<?0.001; 16.7% vs. 31.6%, p?<?0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p?=?0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p?=?0.61) with reference to conservative treatment.Conclusions
All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.992.
Background Appropriate management of cystic lesions of the pancreas is controversial. Major pancreatectomies (pancreaticoduodenectomy
or distal pancreatectomy with splenectomy) are the commonly used procedures, even though most cystic lesions are noninvasive
neoplasms. We tested the adequacy of limited pancreatectomies in the treatment of pancreatic cystic lesions.
Methods Data from 109 patients who underwent surgical resection of a pancreatic cystic lesion at National Taiwan University Hospital
from 2001 to 2007 were retrospectively reviewed. Major pancreatomies (n = 79) constituted pancreaticoduodenectomy and total/distal
pancreatectomies, while other resection procedures (n = 30) represented limited pancreatectomies. Clinicopathologic features
were compared between the major and limited groups.
Results There were no statistically significant differences in sex, age, presence of symptoms, cyst diameter, minor or major treatment
complications, or pancreatic leakage between the two groups. Cystic lesions located in the neck/body/tail rather than in the
head/uncinate process were significantly more often treated with limited pancreatectomy (P = .02). Both groups had similar pathologic distribution of cystic lesions, with the exception of nine invasive neoplasms.
The latter were treated with major pancreatectomy. No recurrence was noted in 100 patients with noninvasive cystic neoplasms
after major or limited pancreatectomy.
Conclusions Noninvasive pancreatic cystic neoplasms can be safely and effectively treated by limited pancreatectomy. 相似文献
993.
Ryu KW Kim YW Lee JH Nam BH Kook MC Choi IJ Bae JM 《Annals of surgical oncology》2008,15(6):1625-1631
Background Information on surgical complications of laparoscopy-assisted distal gastrectomy (LADG) and their risk factors is limited
in the literature despite increasing popularity of this procedure. This study was performed to identify the surgical complications
and their associated risk factors of LADG in early gastric cancer.
Methods LADG was performed in 347 gastric cancer patients from January 2002 to December 2006 at the Korean National Cancer Center
by four surgeons with ample experience of open gastric surgery before LADG. LADG indications for cases of gastric cancer at
our institution are preoperatively diagnosed cT1N0 or cT1N1, except in cases with an absolute indication for endoscopic resection.
Lymph node dissection of more than D1 + β was performed in all patients. Intraoperative and postoperative complications were
reviewed and their risk factors were retrospectively analyzed by prospective database information.
Results Forty complications occurred in 34 patients (9.8%), but there was no mortality. Intraoperative complications occurred in nine
patients (2.6%), and open conversion was performed in eight (2.3%) of these patients. Early and late postoperative complications
occurred in 21 (6.1%) and 10 (2.9%) patients, respectively. The most serious complication was vascular injury resulting in
bleeding or organ ischemia, which occurred in seven patients. Degree of lymph node dissection and surgical inexperience were
found to be risk factors of surgical complication (P = .023, odds ratio 2.832, 95% confidence interval 1.155–6.946 vs. P = .028, odds ratio 2.975, 95% confidence interval 1.127–7.854).
Conclusions Lymph node dissection during LADG should be performed cautiously to prevent surgical complications like vascular injuries,
especially during the surgeon’s early learning period. 相似文献
994.
Takagawa R Fujii S Ohta M Nagano Y Kunisaki C Yamagishi S Osada S Ichikawa Y Shimada H 《Annals of surgical oncology》2008,15(12):3433-3439
Background We evaluated the prognostic value of the preoperative serum carcinoembryonic antigen (CEA) level in patients with colorectal
cancer (CRC).
Patients and Methods The study group comprised 638 patients. The optimal cutoff value for the preoperative serum CEA level was determined. Predictive
factors of recurrence were evaluated using multivariate analyses. The relapse-free time was investigated according to the
CEA level.
Results All patients underwent potentially curative resection for CRC without distant metastasis, classified as stage I, II, or III.
The optimal cutoff value for preoperative serum CEA level was 10 ng/ml. Elevated preoperative serum CEA level was observed
in 92 patients. Multivariate analysis identified tumor–node–metastasis (TNM) stage and preoperative serum CEA level as independent
predictive factors of recurrence. The relapse-free survival between CEA levels >10 ng/ml and <10 ng/ml significantly differed
in patients with stage II and III. However, there was no significant difference in relapse-free survival between CEA levels
>10 ng/ml and <10 ng/ml in patients with stage I.
Conclusion Preoperative serum CEA is a reliable predictive factor of recurrence after curative surgery in CRC patients and a useful indicator
of the optimal treatment after resection, particularly for cases classified as stage II or stage III. 相似文献
995.
Aneurysms of the visceral arteries, especially of the pancreaticoduodenal artery, are rare. They show a wide clinical spectrum, ranging from asymptomatic incidental findings to rupture-inducing catastrophic bleedings. Since growth progression and the risk of rupture cannot be foreseen and there is no relation between the size of the aneurysm and propensity to rupture, rupture unfortunately carries a high mortality, >50%. Thus, all aneurysms of the pancreaticoduodenal artery should be treated. The therapy of choice, either operative intervention or catheter embolization, is determined by many factors. Among these are localization, size, relation to other vessels and neighboring organs, the urgency of intervention, and the experience of the therapist. Surgical therapy should be favored in patients with pancreaticoduodenal artery aneurysm due to celiac trunk occlusion. We report here our experience in the surgical treatment of pancreaticoduodenal artery aneurysms in association with celiac trunk occlusion or stenosis over the last 5 years. 相似文献
996.
Daltro C Gregorio PB Alves E Abreu M Bomfim D Chicourel MH Araújo L Cotrim HP 《Obesity surgery》2007,17(6):809-814
Background Obesity is the most important risk factor for obstructive sleep apnea. It is estimated that 70% of sleep apnea patients are
obese. In the morbidly obese, the prevalence may reach 80% in men and 50% in women. The aim of this study was to determine
the prevalence and severity of sleep apnea in a group of morbidly obese patients, leading to bariatric surgery.
Methods In a cross-sectional study developed in Bahia, northeastern Brazil. 108 patients (78 women and 30 men) from the Obesity Treatment
and Surgery Center - “Núcleo de Tratamento e Cirurgia da Obesidade” underwent standard polysomnography. Patients with an apnea-hypopnea
index (AHI) ≥ 5 events/hour were considered apneic.
Results Mean ± SD for age and BMI were 37.1 ± 10.2 years and 45.2 ± 5.4 kg/m2, respectively. The calculated AHI ranged widely from
2.5 to 128.9 events/hour. Sleep apnea was detected in 93.6% of the sample, wherein 35.2% had mild, 30.6% moderate and 27.8%
severe apnea. Oxyhemoglobin desaturation was directly related to the AHI and was more severe in men.
Conclusion There was a high frequency of sleep apnea in this group of morbidly obese patients, for whom it was very important to request
polysomnography, thus enabling therapeutic management and prognostication. 相似文献
997.
Inflammatory Pseudotumor of the Spleen: Report of a Case 总被引:1,自引:0,他引:1
We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions. 相似文献
998.
Nigel Balfour Jamieson Alan K. Foulis Karin A. Oien Euan J. Dickson Clem W. Imrie Ross Carter Colin J. McKay 《Journal of gastrointestinal surgery》2011,15(3):512-524
Background
Following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC), identification of peripancreatic fat tumor invasion promotes a tumor to stage T3. We sought to understand better the impact of histological peripancreatic fat invasion on prognosis and site of recurrence in a cohort of patients with PDAC. 相似文献999.
Background Cancer patients undergoing major abdominal or pelvic surgery are at considerable risk of venous thromboembolism (VTE). The
genesis of thromboses in malignancy is complicated, and reflects the interaction and derangement of multiple molecular pathways.
Furthermore, the nature and location of the cancer, as well as the type surgery involved, are thought to affect the level
of VTE risk. These considerations may therefore affect treatment decisions.
Methods We performed multiple Medline searches with terms including but not limited to VTE, cancer, surgery, abdominal, colorectal,
unfractionated heparin (UFH), and low-molecular-weight heparin (LMWH) to identify reviews, meta-analyses, nonrandomized and
randomized controlled trials, and clinical guidelines relating to management of VTE in patients with abdominal cancer.
Results VTE incidence in patients with malignancy varied according to cancer type, location, stage of progression, and the use of
catheters and/or chemotherapy. Thromboprophylaxis with UFH or LMWH reduces the risk of developing VTE in these patients. However,
LMWHs have a favorable risk-benefit profile over UFH and extending the duration prophylaxis may improve outcomes.
Conclusion A number of recommendations can be made for the prevention of VTE in patients undergoing abdominal or pelvic surgery for cancer:
(1) risk-stratify all patients according to defined evidence-based guidelines; (2) for most abdominal surgical oncology patients
at risk, use of both an anticoagulant and mechanical means are indicated and beneficial; and (3) consider extended-duration
prophylaxis (up to 28 days) in those patients with major abdominal/pelvic operations and impaired mobility, preferably with
LMWH. 相似文献
1000.