Symptomatic change and gastrointestinal quality of life after pancreatectomy

Background

Pancreatectomy affects gastrointestinal (GI) symptoms. Our purpose was to assess the quality of life of pancreatectomy patients in relation to GI function.

Methods

Pancreatectomy patients were asked qualitative, open-ended questions about symptoms. They also completed the Gastrointestinal Symptom Rating Scale (GSRS) for reflux syndrome, acute pain syndrome, indigestion syndrome, diarrhoea syndrome and constipation syndrome.

Results

A total of 52 patients participated. Of these, 69% reported an improvement and 31% reported no change in preoperative symptoms. No patients reported a worsening of symptoms. Half (50%) of the patients experienced new, different symptoms. Median GSRS scores were 0 for reflux syndrome [interquartile range (IQR): 0–1.0], 0 for acute pain syndrome (IQR: 0–1.0), 2.0 for indigestion syndrome (IQR: 1.0–4.0), 2.0 for diarrhoea syndrome (IQR: 0.5–4.5), and 0 for constipation syndrome (IQR: 0–1.0). Whipple operation patients scored higher on the reflux syndrome (0.5 vs. 0; P = 0.08) and indigestion syndrome (3.5 vs. 1.5; P = 0.06) domains. A total of 68% of Whipple operation patients experienced new symptoms, compared with 32% of patients who had undergone other types of pancreatectomy (P = 0.002). Scores of patients who had undergone surgery <2 years and >2 years earlier, respectively, did not differ.

Conclusions

Patients who underwent pancreatectomy frequently experienced an improvement in preoperative symptoms, but also experienced new postoperative symptoms. This was more common after Whipple operations. However, these symptoms were relatively mild in severity. These mild symptoms seem to persist over time.     

EPC mobilization after erythropoietin treatment in acute ST-elevation myocardial infarction: the REVEAL EPC substudy

Erythropoietin (EPO) was hypothesized to mitigate reperfusion injury, in part via mobilization of endothelial progenitor cells (EPCs). The REVEAL trial found no reduction in infarct size with a single dose of EPO (60,000 U) in patients with ST-segment elevation myocardial infarction. In a substudy, we aimed to determine the feasibility of cryopreserving and centrally analyzing EPC levels to assess the relationship between EPC numbers, EPO administration, and infarct size. As a prespecified substudy, mononuclear cells were locally cryopreserved before as well as 24 and 48–72 h after primary percutaneous coronary intervention. EPC samples were collected in 163 of 222 enrolled patients. At least one sample was obtained from 125 patients, and all three time points were available in 83 patients. There were no significant differences in the absolute EPC numbers over time or between EPO- and placebo-treated patients; however, there was a trend toward a greater increase in EPC levels from 24 to 48–72 h postintervention in patients receiving ≥30,000 U of EPO (P = 0.099 for CD133⁺ cells, 0.049 for CD34⁺ cells, 0.099 for ALDH^br cells). EPC numbers at baseline were inversely related to infarct size (P = 0.03 for CD133⁺ cells, 0.006 for CD34⁺ cells). Local whole cell cryopreservation and central EPC analysis in the context of a multicenter randomized trial is feasible but challenging. High-dose (≥30,000 U) EPO may mobilize EPCs at 48–72 h, and baseline EPC levels may be inversely associated with infarct size.     

Limitations of Patient-Associated Co-Morbidity Model in Predicting Postoperative Morbidity and Mortality in Pancreatic Operations

Background  

Patient-associated co-morbidities are a potential cause of postoperative complications. The National Surgical Quality Improvement Project (NSQIP) collects data on patient outcomes to provide risk-adjusted outcomes data to participating hospitals. However, operations which may have a high distribution of technically-related complications, such as pancreatic operations, may not be adequately assessed using such predictive models.     

Laparoscopic colectomy significantly decreases length of stay compared with open operation

Introduction  

Current literature tends not to adjust for biases in patient selection attributable to comorbidities that could provide alternate explanations for length of stay differences in laparoscopic versus open colectomy. We hypothesized that utilizing the National Surgical Quality Improvement Program (NSQIP) dataset and acuity adjustment methods would demonstrate an independent improvement in length of stay for laparoscopic colectomy.