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Liu Z, Tan Y, Wei Y, Dai D, Zhao R, Li Q, Huang Q, Xu Y, Yang P, Sun J, Liu J, Zuo Q. Textbook Outcomes Among Patients with Aneurysmal Subarachnoid Hemorrhage Following Endovascular Treatment. Neurol Ther 2024; 13:373-387. [PMID: 38263492 PMCID: PMC10951154 DOI: 10.1007/s40120-024-00577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The case fatality rate among patients with aneurysmal subarachnoid hemorrhage (aSAH) has decreased progressively, with numerous patients subjected to contemporary paradigms that minimize the use of agonizing therapeutic processes. The concept of the "Textbook Outcome" (TO), a composite outcome that highlights numerous favorable outcomes, was developed in the context of gastrointestinal tumor surgeries and expeditiously extended across diverse surgical spheres. The aim of this study was to explore the factors hindering the achievement of optimal prognoses in postinterventional aSAH patients, employ textbook outcomes, and establish predictive models. METHODS We conducted a retrospective review of data from 1270 aSAH patients who received endovascular treatment between 2012 and 2018. We delineated an exemplary TO within the aSAH domain, characterized by favorable clinical results, minimal complications, and the absence of retreatments. This TO-oriented approach is explained within the manuscript. RESULTS The findings revealed that preoperative intraventricular hemorrhage (IVH), preoperative Hunt and Hess grade (H&H) ≥ 3, World Federation of Neurosurgical Societies (WFNS) grade ≥ 3, the presence of blebs on the aneurysm, aneurysms situated at branching sites, and non-stent-assisted endovascular intervention were the strongest risk factors for not achieving textbook outcomes (non-"Textbook Outcome" [N-TO]). Decision curve analysis and calibration analyses revealed strong concordance between the predictions of the N-TO nomogram model and the actual observations. CONCLUSIONS Treatment Outcomes hold significant practical value in clinical studies of aSAH patients receiving endovascular treatment. The likelihood of N-TOs was predicted by IVH, H&H grade ≥ 3, WFNS grade ≥ 2, presence o f bleb on the aneurysm, and aneurysms located at branching sites.
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Affiliation(s)
- Zisheng Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
- Panvascular Disease Management Center, Wenzhou Central Hospital, Zhejiang, 325000, Wenzhou, China
| | - Yuhao Tan
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yanpeng Wei
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Dongwei Dai
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Jun Sun
- Panvascular Disease Management Center, Wenzhou Central Hospital, Zhejiang, 325000, Wenzhou, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
| | - Qiao Zuo
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Grégory J, Ronot M, Laurent V, Chabrot P, de Baere T, Chevallier P, Vilgrain V, Aubé C. French Interventional Radiology Centers' Uptake of Transradial Approach and Outpatient Hepatocellular Carcinoma Intra-Arterial Treatments. Cardiovasc Intervent Radiol 2024; 47:432-440. [PMID: 37930400 DOI: 10.1007/s00270-023-03578-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/01/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE This study aims to investigate the uptake of transradial approach (TRA) and outpatient setting for transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of hepatocellular carcinoma (HCC) among French interventional radiology centers. MATERIALS AND METHODS This cross-sectional study was based on a 34-question survey assessing center activity, radial access, and outpatient care. The survey was developed by a working group, tested by two external experts, and distributed to active members of two French radiological societies via a web-based self-reporting questionnaire in March 2022. The survey remained open for eight weeks, with two reminder emails sent to non-responders. Only one answer per center was considered. RESULTS Of the 44 responding centers, 39% (17/44) performed TRA for TACE and/or TARE, with post-procedure patient comfort as main motivation. Among the 27 centers not performing TRA, 33% (9/27) reported a lack of technical experience, but all 27 intended to adopt TRA within two years. Only six centers performed TACE or TARE in an outpatient setting. Reasons limiting its implementation included TACE for HCC not being a suitable intervention (61%, 27/44) and organizational barriers (41%, 18/44). Among centers not performing outpatient TACE or TARE, 34% (13/38) said "No," 34% (13/38) said "Maybe," and 32% (12/38) said "Yes" when asked about adopting it within two years. CONCLUSION French interventional radiologists have low TRA uptake for HCC treatment, but TRA adoption potential exists. Respondents were uncertain about performing TACE or TARE in an outpatient setting within a 2-year horizon.
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Affiliation(s)
- Jules Grégory
- Université Paris Cité, Paris, France.
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France.
- Inserm INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France.
| | - Maxime Ronot
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Université de Lorraine, 54500, Vandoeuvre-Lès-Nancy, France
| | - Pascal Chabrot
- Department of Radiology, University Hospital Center, Hospital Gabriel Montpied, 58, Rue Montalembert, 63000, Clermont-Ferrand, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave RoussyUniversité Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Patrick Chevallier
- Department of Diagnosis and Interventional Imaging, University Hospital of Nice, 151 Route de Saint Antoine de Ginestière, 06200, Nice, France
| | - Valérie Vilgrain
- Université Paris Cité, Paris, France
- Radiology Department, Hôpital Beaujon, AP-HP.Nord, FHU MOSAIC, 100 boulevard du Général Leclerc, 92210, Clichy, France
- Centre de Recherche sur L'Inflammation, Inserm, U1149, 75006, Paris, France
| | - Christophe Aubé
- Département de Radiologie, centre hospitalier universitaire d'Angers, 4 rue Larrey, 49 933, Angers, France
- Laboratoire HIFIH, UPRES 3859, Université d'Angers, 49 045, Angers, France
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Sędłak K, Rawicz-Pruszyński K, Mlak R, Van Sandick J, Gisbertz S, Pera M, Dal Cero M, Baiocchi GL, Celotti A, Morgagni P, Vittimberga G, Hoelscher A, Moenig S, Kołodziejczyk P, Richter P, Gockel I, Piessen G, Da Costa PM, Davies A, Baker C, Allum W, Romario UF, De Pascale S, Rosati R, Reim D, Santos LL, D'ugo D, Wijnhoven B, Degiuli M, De Manzoni G, Kielan W, Frejlich E, Schneider P, Polkowski WP. Textbook Oncological Outcome in European GASTRODATA. Ann Surg 2023; 278:823-831. [PMID: 37555342 DOI: 10.1097/sla.0000000000006054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVE To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in the European population based on the GASTRODATA registry. BACKGROUND TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer, TOO was proposed as a quality and optimal multimodal treatment parameter. METHODS TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with the addition of perioperative chemotherapy compliance. RESULTS Of the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy [odds ratio (OR) = 1.33, 95% CI: 1.04-1.70] and D2 or D2+ lymphadenectomy (OR = 1.55, 95% CI: 1.15-2.10) had a positive impact on TO achievement. Older age (OR = 0.73, 95% CI: 0.54-0.94), pT3/4 (OR = 0.79, 95% CI: 0.63-0.99), ASA 3/4 (OR = 0.68, 95% CI: 0.54-0.86) and total gastrectomy (OR = 0.56, 95% CI: 0.45-0.70), had a negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR = 0.37, 95% CI: 0.27-0.53), pT3 or pT4 (OR = 0.52, 95% CI: 0.39-0.69), and ASA 3 or 4 (OR = 0.58, 95% CI: 0.43-0.79) had a negative impact on TOO achievement. CONCLUSIONS Despite successively improved surgical outcomes, stage-appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of gastric cancer remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.
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Affiliation(s)
- Katarzyna Sędłak
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | - Radosław Mlak
- Department of Preclinical Sciences, Body Composition Research Laboratory, Medical University of Lublin, Lublin, Poland
| | - Johanna Van Sandick
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Suzanne Gisbertz
- Department of Surgery, University Medical Center, Amsterdam, The Netherlands
| | - Manuel Pera
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Mariagiulia Dal Cero
- Department of Digestive Surgery, Hospital Universitario del Mar, Barcelona, Spain
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Andrea Celotti
- Department of Clinical and Experimental Sciences, Surgical Clinic, University of Brescia, and Third Division of General Surgery, Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Morgagni
- Department of General Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy
| | | | | | - Stefan Moenig
- Department of General, Visceral and Thoracic Surgery, Agaplesion Markus Hospital, Frankfurt, Germany
| | | | - Piotr Richter
- Department of Surgery, Jagiellonian University Medical College
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, University Lille, and Claude Huriez University Hospital, Lille, France
| | | | - Andrew Davies
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - Cara Baker
- Department of Upper Gastrointestinal and General Surgery, Guy's and St Thomas' Hospital, London, UK; School of Cancer and Pharmaceutical Sciences, King's College; Department of Molecular Medicine and Surgery and Upper Gastrointestinal Surgery, Karolinska Institute, Stockholm, Sweden, London, UK
| | - William Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Ricccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Hospital, Milan, Italy
| | - Daniel Reim
- Department of Surgery, TUM School of Medicine, Technical University of Munich, Germany
| | - Lucio Lara Santos
- Department of Surgical Oncology, Experimental Pathology and Therapeutics Group, Portuguese Institute Of Oncology, Porto, Portugal
| | - Domenico D'ugo
- Department of General Surgery, Fondazione Policlinico Gemelli, Rome, Italy
| | - Bas Wijnhoven
- Department of General Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maurizio Degiuli
- Surgical Oncology and Digestive Surgery, Department of Oncology, University of Turin, San Luigi University Hospital, Orbassano, Turin 10049, Italy
| | - Giovanni De Manzoni
- Department of Surgery, General and Upper G.I. Surgery Division, University of Verona, Verona, Italy
| | - Wojciech Kielan
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ewelina Frejlich
- Department of General and Oncological Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Paul Schneider
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
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