1
|
Harkey K, Kaiser N, Zhao J, Gutnik B, Kelz R, Matthews BD, Reinke C. Utilization of telemedicine to provide post-discharge care: A comparison of pre-pandemic vs. pandemic care. Am J Surg 2023; 226:163-169. [PMID: 36966017 PMCID: PMC10014479 DOI: 10.1016/j.amjsurg.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Due to the COVID-19 pandemic, post-discharge virtual visits transitioned from a novel intervention to standard practice. Our aim was to evaluate participation in and outcomes of virtual post-discharge visits in the early-pandemic timeframe. METHODS Pandemic cohort patients were compared to historical patients. Patient demographics, clinical information, and post-discharge 30-day hospital encounters were compared between groups. RESULTS The historical cohort included 563 patients and the pandemic cohort had 823 patients. There was no difference in 30-day hospital encounters between patients who completed a video vs. telephone visit in the pandemic cohort (3.8% vs. 7.6%, p = 0.11). There was a lower 30-day hospital encounter rate in pandemic video and telephone visits compared to similar historical sub-groups. CONCLUSION Expansion of virtual post-discharge visits to include all patients and telephone calls did not negatively impact rates of 30-day post-discharge hospital encounters. Offering telehealth options for post-discharge follow-up does not appear to have negative impact on healthcare utilization.
Collapse
Affiliation(s)
- Kristen Harkey
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC, 28204, USA.
| | - Nicole Kaiser
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC, 28204, USA.
| | - Jing Zhao
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Avenue, Charlotte, NC, USA.
| | - Bella Gutnik
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, 1300 Scott Avenue, Charlotte, NC, USA.
| | - Rachel Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Brent D Matthews
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC, 28204, USA.
| | - Caroline Reinke
- Carolinas Medical Center, Department of Surgery, 1000 Blythe Blvd, Charlotte, NC, 28204, USA.
| |
Collapse
|
2
|
A Dutch prediction tool to assess the risk of incidental gallbladder cancers after cholecystectomies for benign gallstone disease. HPB (Oxford) 2022; 25:409-416. [PMID: 37028827 DOI: 10.1016/j.hpb.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/28/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the increasing implementation of selective histopathologic policies for post-cholecystectomy evaluation of gallbladder specimens in low-incidence countries, the fear of missing incidental gallbladder cancer (GBC) persists. This study aimed to develop a diagnostic prediction model for selecting gallbladders that require additional histopathological examination after cholecystectomy. METHODS A registration-based retrospective cohort study of nine Dutch hospitals was conducted between January 2004 and December 2014. Data were collected using a secure linkage of three patient databases, and potential clinical predictors of gallbladder cancer were selected. The prediction model was validated internally by using bootstrapping. Its discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC), Nagelkerke's pseudo-R2, and Brier score. RESULTS Using a cohort of 22,025 gallbladders, including 75 GBC cases, a prediction model with the following variables was developed: age, sex, urgency, type of surgery, and indication for surgery. After correction for optimism, Nagelkerke's R2 and Brier score were 0.32 and 88%, respectively, indicating a moderate model fit. The AUC was 90.3% (95% confidence interval, 86.2%-94.4%), indicating good discriminative ability. CONCLUSION We developed a good clinical prediction model for selecting gallbladder specimens for histopathologic examination after cholecystectomy to rule out GBC.
Collapse
|
3
|
Gómez-Meléndez LJ, Acosta Pérez CA, Támara-Prieto JA, Castellanos-Méndez JS, Márquez-Niño AI, Fernández-Ávila DG. Caracterización de la flora bacteriana en los pacientes con colelitiasis y colecistitis atendidos en un centro hospitalario de alta complejidad. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Las infecciones del árbol biliar surgen principalmente por estasis asociada a colecistitis aguda, coledocolitiasis y colecistitis alitiásica, siendo pilar del tratamiento un drenaje apropiado y un régimen antibiótico eficaz. El objetivo de esta investigación fue caracterizar la flora bacteriana de los cultivos de bilis.
Métodos. Se realizó un estudio observacional, descriptivo, de corte transversal y retrospectivo de pacientes llevados a colecistectomía, colangiopancreatografía retrograda endoscópica y colecistostomía en nuestra institución, a quienes se les tomó cultivo de líquido biliar entre 2017 - 2021.
Resultados. Se incluyeron 119 pacientes intervenidos, de los cuales 55,4 % fueron mujeres y el promedio de edad fue de 63,1 (± 16). La clasificación Tokio 2 fue la más frecuente (55,4 %). El germen aislado con mayor frecuencia fue E. coli (51,2 %). El antibiótico más usado fue ampicilina más sulbactam (44,6 %) seguido de piperacilina tazobactam (40,3 %).
Conclusión. La Escherichia coli es el germen aislado con mayor frecuencia en infecciones del árbol biliar. No hay claridad con respecto al uso de antimicrobianos de manera profiláctica en esta patología, por esto es conveniente generar protocolos para la toma de muestras y cultivos de bilis en esta población, con el fin de establecer la necesidad del uso de antibióticos y conocer los perfiles de resistencia bacteriana.
Collapse
|
4
|
Yang A, Gao F. Effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy. Am J Transl Res 2021; 13:11824-11832. [PMID: 34786111 PMCID: PMC8581921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This research was designed to probe the effect of dexmedetomidine combined with propofol on stress response, hemodynamics, and postoperative complications in patients undergoing laparoscopic cholecystectomy. METHODS Altogether 144 patients who underwent laparoscopic cholecystectomy in the Beibei Traditional Chinese Medical Hospital, the Sixth People's Hospital of Chongqing from January 2018 to July 2020 were research subjects. The control group (CG) (n=68) received propofol continuous pumping sedation, while the research group (RG) (n=76) was given dexmedetomidine combined with propofol continuous pumping sedation. The quality of postoperative recovery and incidence of postoperative complications of the two groups were observed and compared. The hemodynamic indexes (HR, SpO2 and MAP) before anesthesia induction (T0), tracheal intubation (T1), at the commencement of operation (T2), at the end of operation (T3), and extubation (T4) were observed. The stress response indexes (Cortisol, ACTH and norepinephrine, NE) were monitored, and the scores of pain, anxiety and cognitive dysfunction before and after operation were evaluated. RESULTS Compared with the CG, the incidence of postoperative complications in the RG was lower, and the quality of postoperative recovery (time of breathing recovery, eye opening, consciousness and extubation) was better. Besides, the hemodynamic indexes of the RG were more stable, and the levels of stress indexes Cortisol, ACTH, and NE were lower. The RG had VAS and SAS scores that were lower, and MMSE scores were higher. CONCLUSION Dexmedetomidine combined with propofol can effectively alleviate the stress response of patients undergoing laparoscopic cholecystectomy, stabilize perioperative hemodynamics, and reduce postoperative complications.
Collapse
Affiliation(s)
- Anbo Yang
- Department of Anesthesiology, Beibei Traditional Chinese Medical HospitalChongqing 400700, China
| | - Feng Gao
- Department of Anesthesiology, The Sixth People’s Hospital of ChongqingChongqing 400060, China
| |
Collapse
|
5
|
Corten BJGA, de Savornin Lohman EAJ, Leclercq WKG, Roumen RMH, Verhoeven R, van Zwam PH, de Reuver PR, Dejong CHC, Slooter GD. Should all gallbladders be examined routinely or selectively by microscopy after cholecystectomy? Population-based Dutch study over a decade. Br J Surg 2021; 108:e131-e132. [PMID: 33793735 PMCID: PMC10364920 DOI: 10.1093/bjs/znaa161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022]
Abstract
The need for routine histopathological examination of gallbladders after cholecystectomy is debated. This study suggests that selective histopathological examination of the gallbladder may be considered oncologically safe.
While the necessity of a routine histopathologic examination of gallbladders after cholecystectomy is debated. This study suggests that a selective histopathologic examination of the gallbladder may be considered as oncologically safe.
Collapse
Affiliation(s)
- B J G A Corten
- Department of Surgery, Máxima Medical Centre, Veldhoven, Eindhoven, the Netherlands.,Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - W K G Leclercq
- Department of Surgery, Máxima Medical Centre, Veldhoven, Eindhoven, the Netherlands
| | - R M H Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Eindhoven, the Netherlands
| | - R Verhoeven
- Netherlands Comprehensive Cancer Organisation, Eindhoven, the Netherlands
| | - P H van Zwam
- Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands
| | - P R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - G D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Eindhoven, the Netherlands
| |
Collapse
|
6
|
DeSimone MS, Goodman M, Pehlivanoglu B, Memis B, Balci S, Roa JC, Jang KT, Jang JY, Hong SM, Lee K, Kim H, Choi HJ, Muraki T, Araya JC, Bellolio E, Sarmiento JM, Maithel SK, Losada HF, Basturk O, Reid MD, Koshiol J, Adsay V. T2 gallbladder cancer shows substantial survival variation between continents and this is not due to histopathologic criteria or pathologic sampling differences. Virchows Arch 2021; 478:875-884. [PMID: 33411027 DOI: 10.1007/s00428-020-02968-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Published data on survival of T2 gallbladder carcinoma (GBC) from different countries show a wide range of 5-year survival rates from 30-> 70%. Recently, studies have demonstrated substantial variation between countries in terms of their approach to sampling gallbladders, and furthermore, that pathologists from different continents apply highly variable criteria in determining stage of invasion in this organ. These findings raised the question of whether these variations in pathologic evaluation could account for the vastly different survival rates of T2 GBC reported in the literature. In this study, survival of 316 GBCs from three countries (Chile n = 137, South Korea n = 105, USA n = 74), all adequately sampled (with a minimum of five tumor sections examined) and histopathologically verified as pT2 (after consensus examination by expert pathologists from three continents), was analyzed. Chilean patients had a significantly worse prognosis based on 5-year all-cause mortality (HR: 1.89, 95% CI: 1.27-2.83, p = 0.002) and disease-specific mortality (HR: 2.41, 95% CI: 1.51-3.84, p < 0.001), compared to their South Korean counterparts, even when controlled for age and sex. Comparing the USA to South Korea, the survival differences in all-cause mortality (HR: 1.75, 95% CI: 1.12-2.75, p = 0.015) and disease-specific mortality (HR: 1.94, 95% CI: 1.14-3.31, p = 0.015) were also pronounced. The 3-year disease-specific survival rates in South Korea, the USA, and Chile were 75%, 65%, and 55%, respectively, the 5-year disease-specific survival rates were 60%, 50%, and 50%, respectively, and the overall 5-year survival rates were 55%, 45%, and 35%, respectively. In conclusion, the survival of true T2 GBC in properly classified cases is neither as good nor as bad as previously documented in the literature and shows notable geographic differences even in well-sampled cases with consensus histopathologic criteria. Future studies should focus on other potential reasons including biologic, etiopathogenetic, management-related, populational, or healthcare practice-related factors that may influence the survival differences of T2 GBC in different regions.
Collapse
Affiliation(s)
- Mia S DeSimone
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Burcin Pehlivanoglu
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Bahar Memis
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Serdar Balci
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Hye-Jeong Choi
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Takashi Muraki
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan Carlos Araya
- Department of Pathology, Hospital Dr. Hernan Henriquez Aravena, Temuco, Chile
| | - Enrique Bellolio
- Department of Pathology, Universidad de La Frontera, Temuco, Chile
| | - Juan M Sarmiento
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Hector F Losada
- Department of Surgery, Universidad de La Frontera, Temuco, Chile
| | - Olca Basturk
- Department of Pathology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Michelle D Reid
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jill Koshiol
- Division of Cancer Epidemiology & Genetics, Infections and Immunoepidemiology Branch, National Cancer Institute (NCI), NIH, Rockville, MD, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital and Koç University Research Center for Translational Medicine (KUTTAM), Davutpasa Cad No 4., Topkapi, Istanbul, Turkey.
| |
Collapse
|
7
|
Corten BJGA, Leclercq WKG, van Zwam PH, Roumen RMH, Dejong CH, Slooter GD. Method for adequate macroscopic gallbladder examination after cholecystectomy. Acta Chir Belg 2020; 120:442-450. [PMID: 32701051 DOI: 10.1080/00015458.2020.1785219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder. MATERIALS AND METHODS The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues. RESULTS Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n = 4 during 2006-2011 and 0.26%, n = 6 during 2012-2017). CONCLUSION A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.
Collapse
Affiliation(s)
- Bartholomeus J. G. A. Corten
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Peter H. van Zwam
- Department of Pathology, PAMM laboratory for pathology and medical microbiology, Eindhoven, The Netherlands
| | - Rudi M. H. Roumen
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Cees H. Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Gerrit D. Slooter
- Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| |
Collapse
|
8
|
Hasan A, Nafie K, Aldossary MY, Ismail A, Monazea K, Baheeg M, Rady K, Elhawary R, Ibrahim AA. Unexpected histopathology results following routine examination of cholecystectomy specimens: How big and how significant? Ann Med Surg (Lond) 2020; 60:425-430. [PMID: 33251000 PMCID: PMC7677112 DOI: 10.1016/j.amsu.2020.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Routine histopathological examination (RHPE) of all gallbladder specimens is required to detect the presence of gallbladder carcinoma (GBC) or any other pathology. The work aims to study the incidence and the clinical significance of detecting unusual gallbladder findings upon the RHPE of the referred cholecystectomy specimens to a histopathology laboratory section at a referral hospital in Saudi Arabia during one year period. MATERIALS AND METHODS From May 2019 to May 2020, all histopathology reports of 444 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed and divided into two groups; usual findings and unusual findings which were reviewed blindly by two other pathology consultants. Frequencies, descriptive statistics, normality test, and correlations were run. The Interrater reliability between clinical and histopathological diagnosis was assessed statistically by kappa test. RESULTS The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 296 out of 444 total cases (66.7%), acute cholecystitis in 52 cases (11.7%), and other associated usual findings in 85 cases (19%). Three cases (0.7%) of incidental carcinomas and other three cases (0.7%) of dysplasia. Eosinophilic carcinomas were detected in two cases (0.45%), gallbladder complete septum was found in one case, and one case of Phrygian cap anomaly. All patients with gallbladder carcinoma were diagnosed incidentally during the histopathological examination. CONCLUSIONS RHPE of cholecystectomy materials are required to confirm the final diagnosis and document any other pathology. Failure to detect incidental occult carcinoma may be catastrophic, given the poor prognosis.
Collapse
Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Khalid Nafie
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | | | - Amal Ismail
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Khaled Monazea
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut branch, Egypt
| | - Mohamad Baheeg
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kamal Rady
- Department of Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Reda Elhawary
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel A. Ibrahim
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
9
|
Nagarajan G, Kundalia K. Should every cholecystectomy specimen be sent for histopathology to identify incidental gall bladder cancer? Indian J Cancer 2020; 57:2-3. [PMID: 32129293 DOI: 10.4103/ijc.ijc_1027_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ganesh Nagarajan
- Consultant HPB and GI Surgical Oncologist, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - Kaushal Kundalia
- Fellow in HPB and Liver Transplant Surgery, Kings College London, London, United Kingdom
| |
Collapse
|
10
|
Lundgren L, Henriksson M, Andersson B, Sandström P. Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease. BJS Open 2020; 4:1125-1136. [PMID: 33136336 PMCID: PMC7709377 DOI: 10.1002/bjs5.50325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost‐effectiveness of these different approaches. Methods Four management strategies were evaluated using decision‐analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life‐years were estimated for a lifetime perspective and combined into incremental cost‐effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life‐year for each management strategy. Results In the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life‐years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no
histological assessment, 50 life‐years would be saved and
the ICER was estimated to be €20 708 in a cohort of 10 000
patients undergoing cholecystectomy. Conclusion A macroscopic selective strategy appears to be the most cost‐effective approach.
Collapse
Affiliation(s)
- L Lundgren
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| | - M Henriksson
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - B Andersson
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| |
Collapse
|
11
|
Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
Collapse
Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
12
|
Corten B, Leclercq W, Roumen R, van Zwam P, Dejong C, Slooter G. Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified. Eur J Surg Oncol 2020; 46:572-576. [DOI: 10.1016/j.ejso.2019.11.497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 01/24/2023] Open
|
13
|
Bastiaenen VP, Corten BJ, de Savornin Lohman EA, de Jonge J, Kraima AC, Swank HA, van Vliet JL, van Acker GJ, van Geloven AA, In 't Hof KH, Koens L, de Reuver PR, van Rossem CC, Slooter GD, Tanis PJ, Terpstra V, Dijkgraaf MG, Bemelman WA. Safety and cost analysis of selective histopathological examination following appendicectomy and cholecystectomy (FANCY study): protocol and statistical analysis plan of a prospective observational multicentre study. BMJ Open 2019; 9:e035912. [PMID: 31874901 PMCID: PMC7008446 DOI: 10.1136/bmjopen-2019-035912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Routine histopathological examination following appendicectomy and cholecystectomy has significant financial implications and comprises a substantial portion of the pathologists' workload, while the incidence of unexpected pathology is low. The aim of the selective histopathological examination Following AppeNdicectomy and CholecystectomY (FANCY) study is to investigate the oncological safety and potential cost savings of selective histopathological examination based on macroscopic assessment performed by the surgeon. METHODS AND ANALYSIS This is a Dutch multicentre prospective observational study, in which removed appendices and gallbladders will be systematically assessed by the operating surgeon for macroscopic abnormalities suspicious for malignant neoplasms. After visual inspection and digital palpation of the removed specimen, the operating surgeon will report whether macroscopic abnormalities suspicious for a malignant neoplasm are present, and if he or she believes additional microscopic examination by the pathologist is indicated. Regardless of the surgeon's assessment, all specimens will be sent for histopathological examination. In this way, routine histopathological examination can be compared with a hypothetical situation in which specimens are routinely examined by surgeons and only sent to the pathologist on indication. The two main outcomes are oncological safety and potential cost savings of a selective policy. Oncological safety of selective histopathological examination will be assessed by calculating the number of patients in whom a histopathological diagnosis of an appendiceal neoplasm or gallbladder cancer with clinical consequences benefitting the patient would have been missed. A cost analysis will be performed to quantify the potential cost savings. ETHICS AND DISSEMINATION The study protocol was reviewed by the Institutional Review Board of the Amsterdam UMC, location AMC, which decided that the Dutch Medical Research Involving Human Subjects Act is not applicable. In all participating centres, approval for execution of the FANCY study has been obtained from the local Institutional Review Board before the start of inclusion of patients. The study results will be disseminated through peer-reviewed publications and conference presentations. Guidelines will be revised according to the findings of the study. TRIAL REGISTRATION NUMBER NCT03510923.
Collapse
Affiliation(s)
- Vivian P Bastiaenen
- Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| | - Bartholomeus Jga Corten
- Department of Surgery, Maxima Medical Centre - Location Veldhoven, Veldhoven, Noord-Brabant, Netherlands
| | | | - Joske de Jonge
- Department of Surgery, Tergooi Hospitals, Hilversum, North Holland, Netherlands
| | - Anne C Kraima
- Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| | - Hilko A Swank
- Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| | - Jaap Lp van Vliet
- Department of Surgery, Medical Centre Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Gijs Jd van Acker
- Department of Surgery, Medical Centre Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Anna Aw van Geloven
- Department of Surgery, Tergooi Hospitals, Hilversum, North Holland, Netherlands
| | - Klaas H In 't Hof
- Department of Surgery, Flevo Hospital, Almere, Flevoland, Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| | | | | | - Gerrit D Slooter
- Department of Surgery, Maxima Medical Centre - Location Veldhoven, Veldhoven, Noord-Brabant, Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| | - Valeska Terpstra
- Department of Pathology, Medical Centre Haaglanden, Den Haag, Zuid-Holland, Netherlands
| | - Marcel Gw Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC - Location AMC, Amsterdam, North Holland, Netherlands
| |
Collapse
|
14
|
Olthof PB, Metman MME, Roos D, Dekker JWT. Authors' Reply: Routine Pathology and Postoperative Follow-Up are not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease. World J Surg 2019; 43:1184. [PMID: 30761405 DOI: 10.1007/s00268-019-04949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pim B Olthof
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands. .,Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
| | - Madelon M E Metman
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | |
Collapse
|
15
|
Garg PK. Letter to Editor: Routine Pathology and Postoperative Follow-Up are Not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease. World J Surg 2019; 43:1182-1183. [PMID: 30680500 DOI: 10.1007/s00268-019-04919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Dilshad Garden, Delhi, 110095, India.
| |
Collapse
|
16
|
Wang Z, Zhao X, Ma Z, Liu L, Wang B, Li Y. Modulation on gallbladder carcinoma by TGF-β1 via IGFBP-2. Cancer Biomark 2018:CBM181895. [PMID: 30614799 DOI: 10.3233/cbm-181895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gallbladder carcinoma (GC) occupies more than 90% of all cancers in biliary tract with an increasing incidence. Most patients with GC are already at terminal stage at the time of primary diagnosis, causing unfavorable prognosis and high mortality. Transformation growth factor-beta (TGF-β) is up-regulated in GC. However, the mechanism by how TGF-β is involved in GC remains unclear. The aim of this study was to investigate the effect and mechanism of TGF-β in GC using GC cell line NOZ cells.In vitro cultured NOZ cell was randomly assigned into control, si-NC and TGF-β1 siRNA groups and were transfected with siRNA negative control (NC) or TGF-β1 siRNA followed by analysis of TGF-β1 expression by Real-time PCR, cell proliferation by MTT assay, cell apoptosis and cell invasion, as well as expression of proteins in epithelial-mesenchymal transition (EMT), p38, Smad2/3 and Smad4 phosphorylation by Western blot, Insulin-like growth factor-binding protein-2 (IGFBP-2) level by ELISA. After transfecting TGF-β1 siRNA into NOZ cells, TGF-β1 expression was suppressed and cell proliferation and invasion were inhibited, together with enhanced Caspase-3 activity. Meanwhile, E-cadherin expression was increased, with decreased Vimentin, IGFBP-2, p38, Smad2/3 and Smad4 phosphorylation (P< 0.05 comparing to control group). In conclusion, inhibition of TGF-β1 expression facilitates GC cell apoptosis, inhibits GC cell proliferation, invasion and EMT occurrence.
Collapse
Affiliation(s)
- Zhibin Wang
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| | - Xuan Zhao
- Department of Operation Room, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| | - Zhiming Ma
- Department of Operation Room, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| | - Li Liu
- Department of Pharmacy, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| | - Bin Wang
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| | - Yuan Li
- Department of Oncology, The Fifth Hospital of Wuhan, Wuhan, Hubei 430000, China
| |
Collapse
|