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Lv Q, Shu XP, Peng D, Li SQ, Xiang Z. Predictors of complications after prophylactic ileostomy reversal for rectal cancer: A retrospective study. World J Gastrointest Surg 2024; 16:1354-1362. [PMID: 38817282 PMCID: PMC11135311 DOI: 10.4240/wjgs.v16.i5.1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately. AIM To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC. METHODS This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample t tests, while frequency variables are expressed as n (%), and the χ2 test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications. RESULTS The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration (P < 0.01), greater blood loss (P = 0.017), and longer operative times (P < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) (P < 0.01), preoperative comorbid hypertension (P = 0.049), time from primary surgery to ileostomy reversal (P < 0.01) and longer operation time (P = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level (P < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI (P < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal (P < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal. CONCLUSION The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.
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Affiliation(s)
- Quan Lv
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Peng Shu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Si-Qi Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zheng Xiang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Wang D, Yan G, Qiao Y, Sun R. The relationship between perioperative serum albumin and contrast-induced acute kidney injury in patients after percutaneous coronary intervention. BMC Nephrol 2024; 25:173. [PMID: 38773489 PMCID: PMC11106918 DOI: 10.1186/s12882-024-03608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVE Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients undergoing percutaneous coronary intervention (PCI). Studies have shown that perioperative serum albumin levels may play a role in the occurrence of CI-AKI. In this study, we aimed to investigate the effect of perioperative serum albumin (delta albumin or &Alb) levels on the occurrence and long-term prognosis of CI-AKI patients after PCI. METHODS A total of 959 patients who underwent PCI between January 2017 and January 2019 were selected for this study. A receiver operating characteristic curve was used to determine the optimal cut-off value of the &Alb level for predicting CI-AKI after PCI. Patients were divided into two groups based on the optimal cut-off value: the high &Alb group (&Alb ≥ 4.55 g/L) and the control group (&Alb < 4.55 g/L). The incidences of CI-AKI and major adverse cardiac events (MACEs, including all-cause death, nonfatal myocardial infarction, and target vessel revascularization) were compared between the groups. Cox regression analysis was used to identify predictors of long-term prognosis after PCI. RESULTS Of the 959 patients, 147 (15.3%) developed CI-AKI after PCI. The CI-AKI group had a greater level of &Alb than did the non-CI-AKI group [(6.14 (3.90-9.10) versus 3.48 (4.31-6.57), P < 0.01)]. The incidence of CI-AKI in the high &Alb group was significantly greater than that in the low group (23.6% versus 8.3%, P < 0.01). After a 1-year follow-up, the incidence of MACEs was significantly greater in the high &Alb group than in the low group (18.6% versus 14.5%, P = 0.030). Cox regression analysis confirmed that CI-AKI was an independent predictor of MACEs at the 1-year follow-up (HR 1.43, 95% CI 1.04-1.96, P = 0.028). In addition, patients with low preoperative serum albumin levels had s significantly greater incidence of MACEs than did those with high preoperative serum albumin levels (23.2% versus 19.5%, P = 0.013). CONCLUSION In summary, high baseline &Alb levels are an independent risk factor for CI-AKI in patients after PCI. The occurrence of CI-AKI in the perioperative period is also an independent predictor of long-term prognosis after PCI. These findings highlight the importance of monitoring &Alb levels and taking steps to prevent CI-AKI in patients undergoing PCI.
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Affiliation(s)
- Dong Wang
- Department of Cardiology, School of Medicine, Southeast University, Zhongda Hospital, Nanjing, P.R. China
- School of Medicine, Southeast University, Nanjing, P.R. China
| | - Gaoliang Yan
- Department of Cardiology, School of Medicine, Southeast University, Zhongda Hospital, Nanjing, P.R. China
- School of Medicine, Southeast University, Nanjing, P.R. China
| | - Yong Qiao
- Department of Cardiology, School of Medicine, Southeast University, Zhongda Hospital, Nanjing, P.R. China
- School of Medicine, Southeast University, Nanjing, P.R. China
| | - Renhua Sun
- Department of Cardiology, The First people's Hospital of Yancheng, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, P.R. China.
- Jiangsu Key Laboratory for Design and Manufacture of Micro-Nano Biomedical Instruments, Southeast University, Nanjing, P.R. China.
- School of Medicine, Southeast University, Nanjing, P.R. China.
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Hardt J, Seyfried S, Brodrecht H, Khalil L, Büttner S, Herrle F, Reissfelder C, Rahbari NN. Remote ischemic preconditioning versus sham-control for prevention of anastomotic leakage after resection for rectal cancer (RIPAL trial): a pilot randomized controlled, triple-blinded monocenter trial. Int J Colorectal Dis 2024; 39:65. [PMID: 38700747 PMCID: PMC11068831 DOI: 10.1007/s00384-024-04637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Remote ischemic preconditioning (RIPC) reportedly reduces ischemia‒reperfusion injury (IRI) in various organ systems. In addition to tension and technical factors, ischemia is a common cause of anastomotic leakage (AL) after rectal resection. The aim of this pilot study was to investigate the potentially protective effect of RIPC on anastomotic healing and to determine the effect size to facilitate the development of a subsequent confirmatory trial. MATERIALS AND METHODS Fifty-four patients with rectal cancer (RC) who underwent anterior resection were enrolled in this prospectively registered (DRKS0001894) pilot randomized controlled triple-blinded monocenter trial at the Department of Surgery, University Medicine Mannheim, Mannheim, Germany, between 10/12/2019 and 19/06/2022. The primary endpoint was AL within 30 days after surgery. The secondary endpoints were perioperative morbidity and mortality, reintervention, hospital stay, readmission and biomarkers of ischemia‒reperfusion injury (vascular endothelial growth factor, VEGF) and cell death (high mobility group box 1 protein, HMGB1). RIPC was induced through three 10-min cycles of alternating ischemia and reperfusion to the upper extremity. RESULTS Of the 207 patients assessed, 153 were excluded, leaving 54 patients to be randomized to the RIPC or the sham-RIPC arm (27 each per arm). The mean age was 61 years, and the majority of patients were male (37:17 (68.5:31.5%)). Most of the patients underwent surgery after neoadjuvant therapy (29/54 (53.7%)) for adenocarcinoma (52/54 (96.3%)). The primary endpoint, AL, occurred almost equally frequently in both arms (RIPC arm: 4/25 (16%), sham arm: 4/26 (15.4%), p = 1.000). The secondary outcomes were comparable except for a greater rate of reintervention in the sham arm (9 (6-12) vs. 3 (1-5), p = 0.034). The median duration of endoscopic vacuum therapy was shorter in the RIPC arm (10.5 (10-11) vs. 38 (24-39) days, p = 0.083), although the difference was not statistically significant. CONCLUSION A clinically relevant protective effect of RIPC on anastomotic healing after rectal resection cannot be assumed on the basis of these data.
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Affiliation(s)
- Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Steffen Seyfried
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Hannah Brodrecht
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Leila Khalil
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sylvia Büttner
- Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christoph Reissfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Nuh N Rahbari
- Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Areán-Sanz R, Ore AS, Vigna C, Cataldo G, Lynch AW, Cataldo TE, Messaris E. Role of Age as a Predictor of Major Complications After Elective Surgery for Ulcerative Colitis. Am Surg 2024; 90:887-896. [PMID: 38124317 DOI: 10.1177/00031348231216496] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND The incidence of ulcerative colitis (UC) in the elderly population is increasing. The aim of this study was to assess the degree to which age and other factors increase the risk of developing major complications in patients undergoing elective surgery for UC. METHODS Using the ACS-NSQIP database from 2016 to 2020, patients undergoing elective surgery for UC were divided into four categories: younger than 30, 30-49, 50-69, and 70 or older. A composite outcome was created including major complications and multivariable analysis was performed to identify factors associated with composite major complications. RESULTS 5946 patients diagnosed with ulcerative colitis who underwent elective surgery were included in the analysis. 14.1% of all patients developed a major complication. For patients with UC, factors associated with the development of a major complication were age 50-69 (OR 1.31, P = .034), male sex (OR 1.38, P < .001), Black race (OR 1.47, P = .049), dependent status (OR 2.06, P = .028), hypoalbuminemia (OR 1.92, P < .001), preoperative steroid treatment (OR 1.27, P = .038), preoperative transfusion (OR 1.91, P < .001), open surgical approach (OR 1.44, P = .002), and partial colectomy (OR 1.51, P = .007). Specifically in patients aged 70 or older, hypoalbuminemia (OR 3.20, P < .001) and preoperative transfusion (OR 2.78, P = .019) were associated with a major complication. CONCLUSION Age is a risk factor for the development of a major complication in UC patients undergoing elective surgery. However, it is not the only risk factor nor is it the one that increases the risk the most.
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Affiliation(s)
- Rodrigo Areán-Sanz
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana Sofía Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulio Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew W Lynch
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Tang Q, Li X, Sun CR. Predictive value of serum albumin levels on cancer survival: a prospective cohort study. Front Oncol 2024; 14:1323192. [PMID: 38500655 PMCID: PMC10944876 DOI: 10.3389/fonc.2024.1323192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
Background Serum albumin levels and cancer mortality are closely related, yet large-sample studies encompassing a broad spectrum of cancer types are lacking. Methods This study encompassed patients diagnosed with cancer across the continuous 10 cycles of NHANES surveys from 1999 to 2018. The study population was stratified into two groups based on median albumin levels (≤ 4.2g/dL and > 4.2 g/dL) or cancer aggressiveness (well-survived cancers and poorly-survived cancers). Survival rates were estimated using the Kaplan-Meier method. The Cox proportional hazards model was employed to evaluate the association between serum albumin levels and cancer mortality. Restricted cubic spline (RCS) analysis was conducted to assess the nonlinear relationship between serum albumin levels and the risk of cancer mortality. Results Kaplan-Meier curves demonstrated that patients with albumin levels ≤ 4.2 g/dL exhibited lower survival rates compared to those with levels > 4.2 g/dL, irrespective of cancer aggressiveness. Following adjustment for confounders, decreased albumin levels were associated with an elevated risk of cancer mortality across all groups [all cancers, HR (95%CI) = 2.03(1.73, 2.37); well survived cancers, HR (95%CI) = 1.78(1.38, 2.32); and poorly survived cancers, HR (95%CI) = 1.99(1.64, 2.42)]. RCS analyses revealed a stable nonlinear negative association between albumin levels and cancer mortality in all groups, regardless of confounder adjustment. Conclusion Low serum albumin levels predict higher cancer mortality. Furthermore, a nonlinear negative association was observed between serum albumin levels and the risk of cancer mortality.
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Affiliation(s)
- Quan Tang
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Xu Li
- Division of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Rong Sun
- Department of General Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
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Blair WO, Ellis MA, Fada M, Wiggins AA, Wolfe RC, Patel GP, Brockhaus KK, Droege M, Ebbitt LM, Kramer B, Likar E, Petrucci K, Shah S, Taylor J, Bingham P, Krabacher S, Moon JH, Rogoz M, Jean-Jacques E, Cleary RK, Eke R, Findley R, Parrish RH. Effect of Pharmacoprophylaxis on Postoperative Outcomes in Adult Elective Colorectal Surgery: A Multi-Center Retrospective Cohort Study within an Enhanced Recovery after Surgery Framework. Healthcare (Basel) 2023; 11:3060. [PMID: 38063628 PMCID: PMC10706554 DOI: 10.3390/healthcare11233060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The application of enhanced recovery after surgery principles decreases postoperative complications (POCs), length of stay (LOS), and readmissions. Pharmacoprophylaxis decreases morbidity, but the effect of specific regimens on clinical outcomes is unclear. METHODS AND MATERIALS Records of 476 randomly selected adult patients who underwent elective colorectal surgeries (ECRS) at 10 US hospitals were abstracted. Primary outcomes were surgical site infection (SSI), venous thromboembolism (VTE), postoperative nausea and vomiting (PONV), pain, and ileus rates. Secondary outcomes included LOS and 7- and 30-day readmission rates. RESULTS POC rates were SSI (3.4%), VTE (1.5%), PONV (47.9%), pain (58.1%), and ileus (16.1%). Cefazolin 2 g/metronidazole 500 mg and ertapenem 1 g were associated with the shortest LOS; cefotetan 2 g and cefoxitin 2 g with the longest LOS. No SSI occurred with ertapenem and cefotetan. More Caucasians than Blacks received oral antibiotics before intravenous antibiotics without impact. Enoxaparin 40 mg subcutaneously daily was the most common inpatient and discharge VTE prophylaxis. All in-hospital VTEs occurred with unfractionated heparin. Most received rescue rather than around-the-clock antiemetics. Scopolamine patches, spinal opioids, and IV lidocaine continuous infusion were associated with lower PONV. Transversus abdominis plane block with long-acting local anesthetics, celecoxib, non-anesthetic ketamine bolus, ketorolac IV, lidocaine IV, and pregabalin were associated with lower in-hospital pain severity rates. Gabapentinoids and alvimopan were associated with lower ileus rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches were associated with shorter LOS. CONCLUSIONS Significant differences in pharmacotherapy regimens that may improve primary and secondary outcomes in ECRS were identified. In adult ECRS, cefotetan or ertapenem may be better regimens for preventing in-hospital SSI, while ertapenem or C/M may lead to shorter LOS. The value of OA to prevent SSI was not demonstrated. Inpatient enoxaparin, compared to UFH, may reduce VTE rates with a similar LOS. A minority of patients had a documented PONV risk assessment, and a majority used as-needed rather than around-the-clock strategies. Preoperative scopolamine patches continued postoperatively may lower PONV and PDNV severity and shorter LOS. Alvimopan may reduce ileus and shorten LOS. Anesthesia that includes TAP block, ketorolac IV, and pregabalin use may lead to reduced pain rates. Acetaminophen, alvimopan, famotidine, and lidocaine patches may shorten LOS. Given the challenges of pain management and the incidence of PONV/PDNV found in this study, additional studies should be conducted to determine optimal opioid-free anesthesia and the benefit of newer antiemetics on patient outcomes. Moreover, future research should identify latent pharmacotherapy variables that impact patient outcomes, correlate pertinent laboratory results, and examine the impact of order or care sets used for ECRS at study hospitals.
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Affiliation(s)
- William Olin Blair
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Mary Allison Ellis
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Maria Fada
- Heritage School of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA;
| | - Austin Allen Wiggins
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachel C. Wolfe
- Department of Pharmacy Services, Barnes-Jewish Hospital, St. Louis, MO 63110, USA;
| | - Gourang P. Patel
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Kara K. Brockhaus
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Molly Droege
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Laura M. Ebbitt
- Department of Pharmacy, University of Kentucky Medical Center, Lexington, KY 40536, USA; (M.A.E.); (L.M.E.)
| | - Brian Kramer
- Department of Pharmacy Services, OhioHealth/Grant Medical Center, Columbus, OH 43215, USA;
| | - Eric Likar
- Department of Pharmacy Services, West Virginia University Medicine, Morgantown, WV 26506, USA;
| | - Kerilyn Petrucci
- Department of Pharmacy Services, University of Chicago Hospitals, Chicago, IL 60637, USA; (G.P.P.); (K.P.)
| | - Sapna Shah
- Department of Pharmacy Services, Beaumont Hospital—Troy, Troy, MI 48085, USA;
| | - Jerusha Taylor
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Paula Bingham
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Samuel Krabacher
- Department of Pharmacy Services, University of Cincinnati Medical Center, Cincinnati, OH 45219, USA; (M.D.); (P.B.); (S.K.)
| | - Jin Hyung Moon
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Monica Rogoz
- Department of Pharmacy Services, Legacy Good Samaritan Hospital, Portland, OR 97210, USA; (J.T.); (M.R.)
| | - Edson Jean-Jacques
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Robert K. Cleary
- Department of Pharmacy Services and Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, MI 48104, USA; (K.K.B.); (R.K.C.)
| | - Ransome Eke
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
| | - Rachelle Findley
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Richard H. Parrish
- Department of Biomedical Sciences, School of Medicine, Mercer University, Columbus Campus, Columbus, GA 31902, USA; (W.O.B.); (A.A.W.); (J.H.M.); (E.J.-J.); (R.E.)
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Bowcutt JT, Shibuya N, Jupiter DC. Preoperative Serum Albumin and Other Risk Factors Related to 30-Day Postoperative Complications in Total Ankle Arthroplasty. J Foot Ankle Surg 2023; 62:981-985. [PMID: 37549784 DOI: 10.1053/j.jfas.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/08/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
This study investigates effects of preoperative albumin on 30-day total ankle arthroplasty (TAA) outcomes. Additionally, other preoperative risk factors are addressed, including American Anesthesia Society (ASA) class, functional status, chronic obstructive pulmonary disease (COPD), diabetes, smoking status, time of operation, and age. Outcomes assessed were readmission, return to operating room, surgical site infection, wound dehiscence, and total length of stay (TLOS). Data were extracted from the National Surgical Quality Improvement Program database. Bivariate comparisons were analyzed using correlation coefficients, t tests, or chi-squared tests; multivariate comparisons used linear or logistic regression. Our data showed no significant correlation between serum albumin and patients with readmission (odds ratio -0.14, P = 0.06), return to operating room (-0.07, P = 0.61), or surgical site infection (-0.08, P = 0.56). With bivariate analysis, functional status and COPD were significant for readmission (12.67, P < 0.001 and 7.83, P < 0.001, respectively) and dehiscence (30.52, P < 0.001 and 6.74, P = 0.05, respectively), while high ASA class (0.4, P = 0.01), increased age (0.1, P < 0.001), and longer time of operation (0.19, P < 0.001) were associated with longer TLOS. With multivariate analysis, functional status showed higher odds of readmission (7.42, P = 0.02) and dehiscence (20.47, P = 0.01), while COPD showed higher odds for readmission (6.65, P < 0.001) and longer TLOS (0.31, P = 0.05). High ASA class (0.42, P < 0.001) and female sex (0.32, P < 0.001) also had higher odds for longer TLOS. In summary, low albumin was not significant for readmission, return to operating room, or surgical site infection in TAA. COPD, functional status, high ASA class, longer time of operation, increased age, and female sex were all correlated with adverse outcomes in TAA.
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Affiliation(s)
- Jeffrey T Bowcutt
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX
| | - Naohiro Shibuya
- The University of Texas Rio Grande Valley, School of Podiatric Medicine, Edinburg, TX
| | - Daniel C Jupiter
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX; Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX.
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Predictive value of the Naples prognostic score on postoperative outcomes in patients with rectal cancer. Langenbecks Arch Surg 2023; 408:113. [PMID: 36859650 DOI: 10.1007/s00423-023-02851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/21/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE The Naples prognostic score (NPS) is a prognostic index based on the nutritional and inflammatory status. However, its utility in predicting postoperative complications (POCs) has not been examined in rectal cancer (RC). We evaluated the predictive value of the preoperative NPS for POCs in RC. METHODS We retrospectively analyzed 235 patients who underwent surgery for RC. The NPS was calculated based on serum albumin, serum total cholesterol, the neutrophil-to-lymphocyte ratio (NLR) and the lymphocyte-to-monocyte ratio (LMR). Severe POCs were defined as Clavien-Dindo classification grade ≥ III. The optimal cut-off value of the NPS was determined by a receiver operator characteristic (ROC) curve analysis. The NPS, NLR, LMR, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)-to-albumin ratio (CAR), Glasgow prognostic score (GPS), Onodera prognostic nutritional index (PNI) and controlling nutritional status score (CONUT) were investigated as inflammation-based and/or nutritional markers. Predictors of severe POCs were analyzed by logistic regression modeling. RESULTS Severe POCs were observed in 64 patients (27.2%). Male sex, operation time (> 257 min), blood loss (≥ 30 mL), albumin (< 4.0 g/dL), CRP (≥ 1.0 mg/dL), total cholesterol (≤ 180 mg/dL), NPS (≥ 2), LMR (≥ 3.48), PLR (≥ 103.6), CAR (> 0.025), GPS (≥ 1), PNI (< 48.1) and CONUT (≥ 2) were significantly associated with severe POCs. The multivariate analysis revealed that male sex, operation time (> 257 min), and a high NPS (≥ 2) were independent predictors of severe POCs. The ROC curve analysis revealed that the NPS had the greatest predictive value among the inflammation-based and/or nutritional markers. CONCLUSION The NPS is a valuable predictor of severe POCs in RC.
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Zhang Y, Wang LJ, Li QY, Yuan Z, Zhang DC, Xu H, Yang L, Gu XH, Xu ZK. Prognostic value of preoperative immune-nutritional scoring systems in remnant gastric cancer patients undergoing surgery. World J Gastrointest Surg 2023; 15:211-221. [PMID: 36896300 PMCID: PMC9988643 DOI: 10.4240/wjgs.v15.i2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Remnant gastric cancer (GC) is defined as GC that occurs five years or more after gastrectomy. Systematically evaluating the preoperative immune and nutritional status of patients and analyzing its prognostic impact on postoperative remnant gastric cancer (RGC) patients are crucial. A simple scoring system that combines multiple immune or nutritional indicators to identify nutritional or immune status before surgery is necessary.
AIM To evaluate the value of preoperative immune-nutritional scoring systems in predicting the prognosis of patients with RGC.
METHODS The clinical data of 54 patients with RGC were collected and analyzed retrospectively. Prognostic nutritional index (PNI), controlled nutritional status (CONUT), and Naples prognostic score (NPS) were calculated by preoperative blood indicators, including absolute lymphocyte count, lymphocyte to monocyte ratio, neutrophil to lymphocyte ratio, serum albumin, and serum total cholesterol. Patients with RGC were divided into groups according to the immune-nutritional risk. The relationship between the three preoperative immune-nutritional scores and clinical characteristics was analyzed. Cox regression and Kaplan–Meier analysis was performed to analyze the difference in overall survival (OS) rate between various immune-nutritional score groups.
RESULTS The median age of this cohort was 70.5 years (ranging from 39 to 87 years). No significant correlation was found between most pathological features and immune-nutritional status (P > 0.05). Patients with a PNI score < 45, CONUT score or NPS score ≥ 3 were considered to be at high immune-nutritional risk. The areas under the receiver operating characteristic curves of PNI, CONUT, and NPS systems for predicting postoperative survival were 0.611 [95% confidence interval (CI): 0.460–0.763; P = 0.161], 0.635 (95%CI: 0.485–0.784; P = 0.090), and 0.707 (95%CI: 0.566–0.848; P = 0.009), respectively. Cox regression analysis showed that the three immune-nutritional scoring systems were significantly correlated with OS (PNI: P = 0.002; CONUT: P = 0.039; NPS: P < 0.001). Survival analysis revealed a significant difference in OS between different immune-nutritional groups (PNI: 75 mo vs 42 mo, P = 0.001; CONUT: 69 mo vs 48 mo, P = 0.033; NPS: 77 mo vs 40 mo, P < 0.001).
CONCLUSION These preoperative immune-nutritional scores are reliable multidimensional prognostic scoring systems for predicting the prognosis of patients with RGC, in which the NPS system has relatively effective predictive performance.
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Affiliation(s)
- Yan Zhang
- Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
| | - Lin-Jun Wang
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Qin-Ya Li
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Zhen Yuan
- Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
| | - Dian-Cai Zhang
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Hao Xu
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Li Yang
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
| | - Xin-Hua Gu
- Department of Gastrointestinal Surgery, Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School of Nanjing Medical University, Suzhou 215000, Jiangsu Province, China
| | - Ze-Kuan Xu
- Department of General Surgery, Jiangsu Province Hospital, First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
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Hu K, Tan K, Shang Q, Li C, Zhang Z, Huang B, Zhao S, Li F, Zhang A, Li C, Liu B, Tong W. Relative decline in serum albumin help to predict anastomotic leakage for female patients following sphincter-preserving rectal surgery. BMC Surg 2023; 23:38. [PMID: 36803511 PMCID: PMC9938978 DOI: 10.1186/s12893-023-01923-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/27/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Patients with normal preoperative serum albumin still suffer from a significant reduction in serum albumin after major abdominal surgery. The current study aims to explore the predictive value of ∆ALB for AL in patients with normal serum albumin and examine whether there is a gender difference in the prediction of AL. METHODS Medical reports of consecutive patients undergoing elective sphincter-preserving rectal surgery between July 2010 and June 2016 were reviewed. Receiver operating characteristic (ROC) analysis was adopted to examine the predictive ability of ∆ALB and determine the cut-off value according to the Youden index. The logistic regression model was performed identify independent risk factors for AL. RESULTS Out of the 499 eligible patients, 40 experienced AL. Results of the ROC analyses showed that ΔALB displayed a significant predictive value for females, and the AUC value was 0.675 (P = 0.024), with a sensitivity of 93%. In male patients, the AUC was 0.575 (P = 0.22), but did not reach a significant level. In the multivariate analysis, ∆ALB ≥ 27.2% and low tumor location prove to be independent risk factors for AL in female patients. CONCLUSIONS The current study suggested that there may be a gender difference in the prediction of AL and ∆ ALB can serve as a potential predictive biomarker for AL in females. A cut-off value of the relative decline in serum albumin can help predict AL in female patients as early as postoperative day 2. Although our study needs further external validation, our findings may provide an earlier, easier and cheaper biomarker for the detection of AL.
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Affiliation(s)
- Kang Hu
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Ke Tan
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Quanzhen Shang
- grid.484748.3Third Division Hospital, Xinjiang Production and Construction Corps, Xinjiang, China
| | - Chao Li
- grid.5515.40000000119578126Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Zhe Zhang
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Bin Huang
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Song Zhao
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Fan Li
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Anping Zhang
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Chunxue Li
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Baohua Liu
- grid.414048.d0000 0004 1799 2720Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042 China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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11
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Kang B, Zhao ZQ, Liu XY, Cheng YX, Tao W, Wei ZQ, Peng D. Effect of hypoalbuminemia on short-term outcomes after colorectal cancer surgery: A propensity score matching analysis. Front Nutr 2022; 9:925086. [PMID: 36105581 PMCID: PMC9464913 DOI: 10.3389/fnut.2022.925086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose The purpose of our study was to investigate the effect of pre-operative hypoalbuminemia on the short-term outcomes after primary colorectal cancer (CRC) surgery. Materials and methods The retrospective study enrolled CRC patients who underwent primary surgery from January 2011 to December 2021 in a single teaching hospital. The short-term outcomes were compared between the hypoalbuminemia group and the normal group using propensity score matching (PSM). Univariate and multivariate logistic regression analyses were used for analyzing independent predictors of overall complications and major complications. Results A total of 7,072 patients from a single center were enrolled in this study. There were 1,078 (15.2%) patients in the pre-operative hypoalbuminemia group and 5,994 (84.8%) patients in the normal pre-operative albumin group. After 1:1 PSM, there were 1,028 patients in the hypoalbuminemia group and 1,028 patients in the normal group. No significant differences were found in baseline information between the two groups after PSM. In terms of short-term outcomes, the hypoalbuminemia group had a longer operation time (p = 0.003), greater volume of blood loss (p = 0.036), longer hospital stays (p < 0.01), higher proportion of overall complications (p = 0.003), major complications (p = 0.016), higher incidence of pneumonia and abdominal infection (p = 0.001) than the normal group after PSM. Furthermore, hypoalbuminemia was an independent predictor for overall complications (p = 0.008) and major complications (p = 0.016). Conclusion Pre-operative hypoalbuminemia increased overall complications and major complications after primary CRC surgery. Furthermore, hypoalbuminemia was an independent predictor for overall complications and major complications.
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Affiliation(s)
- Bing Kang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Qiang Zhao
- Department of General Surgery, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Dong Peng,
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Ülger G, Sazak H, Baldemir R, Zengin M, Kaybal O, İncekara F, Alagöz A. The effectiveness of ARISCAT Risk Index, other scoring systems, and parameters in predicting pulmonary complications after thoracic surgery. Medicine (Baltimore) 2022; 101:e29723. [PMID: 35905198 PMCID: PMC9333546 DOI: 10.1097/md.0000000000029723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index, which is frequently used in nonthoracic surgery, may not be sufficient to predict postoperative pulmonary complications (PPCs). We aimed to evaluate the effectiveness of the ARISCAT risk index, ASA, preoperative albumin level, neutrophil/lymphocyte ratio (NLR), and other parameters in predicting PPCs after thoracic surgery. Patients undergoing elective thoracic surgery with 1-lung ventilation (OLV) were prospectively analyzed. Demographic data, ARISCAT score, ASA, Nutritional Risk Score-2002, NLR, white blood cell counts, albumin, hemoglobin levels, intraoperative complications, postoperative average visual analogue scale (VAS) score for pain at the 24th-hour, the length of stay in the postoperative intensive care unit, chest tube removal time, postoperative complications, and discharge time were recorded. Patients were assessed for morbidity and mortality on the 90th-day. 120 patients' data were analyzed. PPCs developed in 26 patients. The development of PPCs was statistically significant in patients with high ARISCAT scores (P = .002), high ARISCAT grades (P = .009), and ASA III (P = .002). The albumin level was statistically significantly lower in patients who had mortality within 3 months (P = .007). When scoring systems and laboratory parameters were evaluated together, patients with high ARISCAT grade, Albumin < 35g/L, and ASA III had significantly higher development of PPCs (P = .004). ARISCAT risk index and ASA were found to be significant in predicting PPCs after thoracic surgery. They were also valuable when evaluated in combination with preoperative albumin levels. Additionally; age, male gender, duration of surgery, and duration of OLV were also found to be associated with PPCs.
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Affiliation(s)
- Gülay Ülger
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
- *Correspondence: Gülay Ülger, Department of Anesthesiology and Reanimation, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, University of Health Sciences, Kuscagiz Mah. Sanatoryum Cad. No: 271 06290 Keçiören, Ankara, Turkey (e-mail: )
| | - Hilal Sazak
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Ramazan Baldemir
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Musa Zengin
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Oya Kaybal
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Funda İncekara
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Thoracic Surgery Clinic, Ankara, Turkey
| | - Ali Alagöz
- University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
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Xuan J, Peng J, Wang S, Cai Y. Prognostic significance of Naples prognostic score in non-small-cell lung cancer patients with brain metastases. Future Oncol 2022; 18:1545-1555. [PMID: 35107367 DOI: 10.2217/fon-2021-1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: The authors aimed to evaluate the prognostic value of Naples prognostic score (NPS) in advanced non-small-cell lung cancer patients with brain metastases. Materials & methods: A total of 186 consecutive advanced non-small-cell lung cancer patients were retrospectively analyzed. Kaplan-Meier survival analysis and Cox proportional regression models were used to assess the significance of NPS in overall survival and disease-free survival. Results: Multivariate Cox proportional regression analysis revealed that NPS was a significant independent predictive indicator for overall survival (hazard ratio: 1.897; 95% CI: 1.184-3.041; p = 0.008) and disease-free survival (hazard ratio: 2.169; 95% CI: 1.367-3.44; p = 0.001). Conclusion: NPS was a powerful prognostic indicator for outcome in advanced non-small-cell lung cancer patients with brain metastases.
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Affiliation(s)
- Junmei Xuan
- Department of General medicine, Shaoxing People's Hospital, Shaoxing City, 312000, China
| | - Jianghua Peng
- Department of General medicine, Shaoxing People's Hospital, Shaoxing City, 312000, China
| | - Shuai Wang
- Department of Thoracic surgery, Yidu Central Hospital of Weifang, Weifang City, 261000, China
| | - Yaojie Cai
- Department of Neurology, Zhuji Affiliated Hospital of Shaoxing University, Shaoxing City, 312000, China
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Zhang X, Hou A, Cao J, Liu Y, Lou J, Li H, Ma Y, Song Y, Mi W, Liu J. Association of Diabetes Mellitus With Postoperative Complications and Mortality After Non-Cardiac Surgery: A Meta-Analysis and Systematic Review. Front Endocrinol (Lausanne) 2022; 13:841256. [PMID: 35721703 PMCID: PMC9204286 DOI: 10.3389/fendo.2022.841256] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/12/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although a variety of data showing that diabetes mellitus (DM) (Type 1 or Type 2) is associated with postoperative complication, there is still a lack of detailed studies that go through the specific diabetic subgroups. The goal of this meta-analysis is to assess the relationship between DM and various complications after non-cardiac surgery. METHODS We searched articles published in three mainstream electronic databases (PubMed, EMBASE, Web of science) before November, 2020. A random effects model was conducted since heterogeneity always exist when comparing results between different types of surgery. RESULTS This paper included 125 studies with a total sample size of 3,208,776 participants. DM was a risk factor for any postoperative complication (Odds ratio (OR)=1.653 [1.487, 1.839]). The risk of insulin-dependent DM (OR=1.895 [1.331, 2.698]) was higher than that of non-insulin-dependent DM (OR=1.554 [1.061, 2.277]) for any postoperative complication. DM had a higher risk of infections (OR=1.537 [1.322, 1.787]), wound healing disorders (OR=2.010 [1.326, 3.046]), hematoma (OR=1.369 [1.120, 1.673]), renal insufficiency (OR=1.987 [1.311, 3.013]), myocardial infarction (OR=1.372 [0.574, 3.278]). Meanwhile, DM was a risk factor for postoperative reoperation (OR=1.568 [1.124, 2.188]), readmission (OR=1.404 [1.274, 1.548]) and death (OR=1.606 [1.178, 2.191]). CONCLUSIONS DM is a risk factor for any postoperative complications, hospitalization and death after non-cardiac surgery. These findings underscore the importance of preoperative risk factor assessment of DM for the safe outcome of surgical patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Weidong Mi
- *Correspondence: Jing Liu, ; Weidong Mi,
| | - Jing Liu
- *Correspondence: Jing Liu, ; Weidong Mi,
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Toritani K, Kimura H, Fukuoka H, Watanabe J, Ishibe A, Kunisaki R, Endo I. Preoperative risk factors of incisional surgical site infection in severe or intractable ulcerative colitis. Surg Today 2021; 52:475-484. [PMID: 34387734 DOI: 10.1007/s00595-021-02354-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The present study explored preoperative risk factors (predictors) of incisional surgical site infection (I-SSI) in severe or intractable ulcerative colitis (UC). METHODS This was a retrospective study of 230 consecutive patients who underwent primary surgery for UC. Patients whose surgical indications were UC with cancer or dysplasia were excluded. SSI was defined as an infection according to the Centers for Disease Control and Prevention Guidelines. Preoperative variables were examined by univariate, receiver operating characteristic curve, and multivariate analyses. RESULTS We analyzed 208 patients in this study. In a multivariate logistic analysis, C-reactive protein (CRP) ≥ 1.7 mg/dl [odds ratio (OR) 5.35; 95% confidence interval (CI) 1.50-19.06; p = 0.01), albumin ≤ 2.4 g/dl (OR 5.77; 95% CI 1.41-23.57; p = 0.02), and preoperative blood transfusion (OR 3.21; 95% CI 1.04-9.96; p = 0.04) were predictors of I-SSI. Patients with all predictors had a more than 50% incidence of I-SSI, a higher incidence of all severe complications (13.6% vs. 3.2%; p = 0.02), and a longer postoperative hospital stay (19.5 vs. 17.0 days, p = 0.04) than the other patients. CONCLUSIONS CRP ≥ 1.7 mg/dl, albumin ≤ 2.4 g/dl, and transfusion are predictors of I-SSI in severe or intractable UC. Clinician should carefully evaluate the surgical options before these predictors appear.
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Affiliation(s)
- Kenichiro Toritani
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hironori Fukuoka
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Jiang W, Feng M, Zheng J, Wang G, Xu S, Zhou L, Zhuo S, Yan J. Association of the collagen score with anastomotic leakage in rectal cancer patients after neoadjuvant chemoradiotherapy. Surgery 2021; 170:1331-1341. [PMID: 34116856 DOI: 10.1016/j.surg.2021.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/25/2021] [Accepted: 05/15/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Collagen changes in the extracellular matrix caused by neoadjuvant chemoradiotherapy are a potential mechanism of anastomotic leakage. We aimed to construct a fully quantitative collagen score to describe collagen structure changes in the extracellular matrix and then develop and validate a prediction model to identify patients who are at a high risk of postoperative anastomotic leakage. METHODS This is a retrospective study in which 372 patients were enrolled, and their baseline clinicopathological characteristics were collected. Anastomotic distal and proximal "doughnut" specimens underwent second harmonic generation imaging, and collagen features were extracted. A LASSO regression was used to select significant predictors, and the collagen score was constructed. A prediction model based on collagen score was developed and internally and externally validated. RESULTS The primary cohort included 214 consecutive patients, and the anastomotic leakage rate was 8.9%. The validation cohort comprised 158 consecutive patients, and the anastomotic leakage rate was 10.1%. The collagen score was significantly related to anastomotic leakage in both cohorts (P < .001). Multivariate analysis revealed that tumor location, preoperative albumin, and collagen score were independent predictors of anastomotic leakage. These 3 predictors were incorporated into the prediction model, and a nomogram was established. The model showed good discrimination in the primary (area under the curve: 0.954) and validation (area under the curve: 0.928) cohorts. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSION The collagen score is associated with anastomotic leakage, and the collagen nomogram based on the collagen score is useful for individualized prediction of anastomotic leakage in rectal cancer patients with neoadjuvant chemoradiotherapy after surgery.
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Affiliation(s)
- Wei Jiang
- Department of General Surgery, Nanfang Hospital, Southern Medical University & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Guangzhou, China; School of Science, Jimei University, Xiamen, Fujian, China. https://twitter.com/DocJiangwei
| | - Mingyuan Feng
- Department of General Surgery, Nanfang Hospital, Southern Medical University & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Guangzhou, China. https://twitter.com/FengmingyuanN
| | - Jixiang Zheng
- Department of General Surgery, Nanfang Hospital, Southern Medical University & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Guangzhou, China. https://twitter.com/ZhengjixiangN
| | - Guangxing Wang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou, China. https://twitter.com/PGuangxingwang
| | - Shuoyu Xu
- Department of General Surgery, Nanfang Hospital, Southern Medical University & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Guangzhou, China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong China. https://twitter.com/shevashuoyu
| | - Linghong Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China. https://twitter.com/LinghongZhou
| | - Shuangmu Zhuo
- School of Science, Jimei University, Xiamen, Fujian, China.
| | - Jun Yan
- Department of General Surgery, Nanfang Hospital, Southern Medical University & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Guangzhou, China.
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Risk factors for anastomotic leakage after gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a retrospective case-control study. JOURNAL OF BIO-X RESEARCH 2021. [DOI: 10.1097/jbr.0000000000000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wiedermann CJ. Hypoalbuminemia as Surrogate and Culprit of Infections. Int J Mol Sci 2021; 22:4496. [PMID: 33925831 PMCID: PMC8123513 DOI: 10.3390/ijms22094496] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/23/2021] [Accepted: 04/24/2021] [Indexed: 02/07/2023] Open
Abstract
Hypoalbuminemia is associated with the acquisition and severity of infectious diseases, and intact innate and adaptive immune responses depend on albumin. Albumin oxidation and breakdown affect interactions with bioactive lipid mediators that play important roles in antimicrobial defense and repair. There is bio-mechanistic plausibility for a causal link between hypoalbuminemia and increased risks of primary and secondary infections. Serum albumin levels have prognostic value for complications in viral, bacterial and fungal infections, and for infectious complications of non-infective chronic conditions. Hypoalbuminemia predicts the development of healthcare-associated infections, particularly with Clostridium difficile. In coronavirus disease 2019, hypoalbuminemia correlates with viral load and degree of acute lung injury and organ dysfunction. Non-oncotic properties of albumin affect the pharmacokinetics and pharmacodynamics of antimicrobials. Low serum albumin is associated with inadequate antimicrobial treatment. Infusion of human albumin solution (HAS) supplements endogenous albumin in patients with cirrhosis of the liver and effectively supported antimicrobial therapy in randomized controlled trials (RCTs). Evidence of the beneficial effects of HAS on infections in hypoalbuminemic patients without cirrhosis is largely observational. Prospective RCTs are underway and, if hypotheses are confirmed, could lead to changes in clinical practice for the management of hypoalbuminemic patients with infections or at risk of infectious complications.
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Affiliation(s)
- Christian J. Wiedermann
- Institute of General Practice, Claudiana–College of Health Professions, 39100 Bolzano, Italy;
- Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, 6060 Hall in Tyrol, Austria
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Baik H, Bae KB. Low albumin level and longer interval to closure increase the early complications after ileostomy closure. Asian J Surg 2021; 44:352-357. [DOI: 10.1016/j.asjsur.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/17/2020] [Accepted: 09/01/2020] [Indexed: 01/26/2023] Open
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Konopke R, Schubert J, Stöltzing O, Thomas T, Kersting S, Denz A. [Palliative Surgery in Colorectal Cancer - Which Factors Should Influence the Choice of the Surgical Procedure?]. Zentralbl Chir 2020; 146:44-57. [PMID: 33296936 DOI: 10.1055/a-1291-8293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The surgical procedure for patients with colorectal cancer (CRC) in the palliative situation cannot be adequately standardised. The present study was initiated to identify criteria for the decision for resection of the malignancy with or without anastomosis. PATIENTS/MATERIAL AND METHODS In a unicentric retrospective analysis, 103 patients after palliative resection with or without anastomosis due to CRC were examined. Using univariate and logistic regression analysis, the influence of a total of 40 factors on postoperative morbidity and mortality was assessed. RESULTS In 46 cases, resection with primary anastomosis and in 57 cases a discontinuity resection was performed. Postoperative morbidity was 44.7% and mortality 17.5%. After one-stage resection with anastomosis, nicotine abuse (OR 4.2; p = 0.044), hypalbuminaemia (OR 4.0; p = 0.012), ASA score > 2 (OR 3.7; p = 0.030) and liver remodelling/cirrhosis (OR 3.6; p = 0.031) increased the risk for postoperative complications. Hypalbuminaemia (OR 1.8; p = 0.036), cachexia (OR 1.8; p = 0.043), anaemia (OR 1.5; p = 0.038) and known alcohol abuse (OR 1.9; p = 0.023) were identified as independent risk factors for early postoperative mortality. After discontinuity resection, renal failure (OR 2.1; p = 0.042) and cachexia (OR 1.5; p = 0.045) led to a significant increase in the risk of postoperative morbidity, alcohol abuse (OR 1.8; p = 0.041) in mortality. Hypalbuminaemia (OR 2.8; p = 0.019) and an ASA score > 2 (OR 2.6; p = 0.004) after resection and reconstruction increased the risk of major complications according to Clavien-Dindo, while pre-existing renal failure (OR 1.6; p = 0.023) increased the risk after discontinuity resection. In univariate analysis, an ASA score > 2 (p = 0.038) after simultaneous tumour resection and reconstruction, and urgent surgery in both groups with or without primary anastomosis were additionally identified as significant parameters with a negative influence on mortality (p = 0.010 and p = 0.017). CONCLUSION Palliative resections of colorectal carcinomas have high morbidity and mortality. Especially in cases of pre-existing alcohol abuse and/or urgent indication for surgery, more intensive monitoring should be performed. In the case of anaemia, cachexia, hypalbuminemia and an ASA score > 2, discontinuity resection may be the more appropriate procedure.
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Affiliation(s)
- Ralf Konopke
- Zentrum für Allgemein- und Viszeralchirurgie, Elblandklinikum Riesa, Deutschland
| | - Jörg Schubert
- Klinik für Innere Medizin 2, Elblandklinikum Riesa, Deutschland
| | - Oliver Stöltzing
- Zentrum für Allgemein- und Viszeralchirurgie, Elblandklinikum Riesa, Deutschland
| | - Tina Thomas
- Medizinische Klinik I, Universitätsklinikum Dresden, Deutschland
| | - Stephan Kersting
- Klinik und Poliklinik für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, Greifswald, Deutschland
| | - Axel Denz
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Erlangen, Deutschland
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21
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Aday U, Böyük A, Akkoç H. The prognostic significance of serum lactate dehydrogenase-to-albumin ratio in colorectal cancer. Ann Surg Treat Res 2020; 99:161-170. [PMID: 32908848 PMCID: PMC7463043 DOI: 10.4174/astr.2020.99.3.161] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/20/2020] [Accepted: 07/16/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose The purpose of our study was initially to explore the prognostic role of LDH-to-albumin ratio in patients with colorectal carcinoma (CRC) undergoing curative resection. Methods The retrospective study included 295 CRC patients that underwent curative resection. According to time-dependent receiver operating characteristics (ROC) analysis, the optimal cutoff value for pretreatment LDH-to-albumin ratio was 52.7. Cox regression univariate and multivariate analyses were utilized to analyze the prognostic factors for disease-free survival (DFS) and overall survival (OS). Results The 295 participants included 117 women (39.7%) and had an overall mean age of 55.8 ± 14.1 years. The median follow-up period was 31.8 ± 21 months (range, 6–78 months) and 53 patients (18.0%) died from cancer during the follow-up period. The 5-year DFS and OS rates were 65.4% and 68.5% in patients with LDH-to-albumin ratio <52.7 (n = 152), and were 55.2% and 55.4% in patients with LDH-to-albumin ratio ≥52.7 (n = 143), respectively. Kaplan-Meier curves showed that LDH-to-albumin ratio ≥52.7 was significantly associated with worse DFS and OS (P = 0.003 and P < 0.001, respectively). Multivariate analyses revealed that LDH-to-albumin ratio was an independent predictor of resectable CRC (odds ratio, 2.104; 95% confidence interval, 1.112–3.982; P = 0.022). Conclusion Our study revealed that high pretreatment LDH-to-albumin ratio level was an unfavorable prognosticator in patients with CRC undergoing curative resection. LDH-to-albumin ratio is a candidate to be a prognostic biomarker in clinical practice.
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Affiliation(s)
- Ulaş Aday
- Department of Gastrointestinal Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Abdullah Böyük
- Department of Gastrointestinal Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Hasan Akkoç
- Department of Gastrointestinal Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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22
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Hayama T, Ozawa T, Okada Y, Tsukamoto M, Fukushima Y, Shimada R, Nozawa K, Matsuda K, Fujii S, Hashiguchi Y. The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients undergoing resection for colorectal cancer. Sci Rep 2020; 10:13239. [PMID: 32764671 PMCID: PMC7413386 DOI: 10.1038/s41598-020-70252-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
The Controlling Nutritional Status (CONUT) score is a marker of nutrition and is associated with poor survival in various kinds of cancers. However, no reports have yet compared risk factors for colorectal cancer recurrence using a nutritional index. We assessed the predictive value of the CONUT score compared with the modified Glasgow Prognostic Score (mGPS) and Prognostic Nutritional Index (PNI) in colorectal cancer (CRC) patients. We performed a retrospective cohort study of the medical records of 336 consecutive patients with stage I-I I I CRC who underwent curative resection at a single institution in 2012–2017. Univariate and multivariate analyses were conducted to identify prognostic factors associated with relapse-free survival (RFS) and overall survival (OS). The low CONUT score group exhibited higher RFS and longer OS compared to the high CONUT score group (82.2% vs. 63.3%, p = 0.002 and 95.5% and 86.2%, p = 0.005, respectively). The Akaike’s information criterion values of each index for RFS and OS were superior in CONUT score (723.71 and 315.46, respectively) compared to those of PNI (726.95 and 316.52) and mGPS (728.15 and 318.07, respectively). The CONUT score was found to be a good predictor of RFS and OS in patients with resectable CRC.
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Affiliation(s)
- Tamuro Hayama
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yuka Okada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mitsuo Tsukamoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yoshihisa Fukushima
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Ryu Shimada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | | | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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23
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Issangya CE, Msuya D, Chilonga K, Herman A, Shao E, Shirima F, Naman E, Mkumbi H, Pyuza J, Mtui E, Sanga LA, Abdul S, Leyaro BJ, Chugulu S. Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania. BMC Surg 2020; 20:155. [PMID: 32664910 PMCID: PMC7362485 DOI: 10.1186/s12893-020-00820-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/08/2020] [Indexed: 01/02/2023] Open
Abstract
Background Albumin is an important protein that transports hormones, fatty acids, and exogenous drugs; it also maintains plasma oncotic pressure. Albumin is considered a negative active phase protein because it decreases during injuries and sepsis. In spite of other factors predicting surgical outcomes, the effect of pre and postoperative serum albumin to surgical complications can be assessed by calculating the percentage decrease in albumin (delta albumin). This study aimed to explore perioperative serum albumin as a predictor of adverse outcomes in major abdominal surgeries. Methods All eligible adult participants from Kilimanjaro Christian Medical Centre Surgical Department were enrolled in a convenient manner. Data were collected using a study questionnaire. Full Blood Count (FBP), serum albumin levels preoperatively and on postoperative day 1 were measured in accordance with Laboratory Standard Operating Procedures (SOP). Data was entered and analyzed using STATA version 14. Association and extent of decrease in albumin levels as a predictor of surgical site infection (SSI), delayed wound healing and death within 30 days of surgery was determined using ordinal logistic regression models. In determining the diagnostic accuracy, a Non-parametric Receiver Operating Curve (ROC) model was used. We adjusted for ASA classification, which had a negative confounding effect on the predictive power of the percent drop in albumin to adverse outcomes. Results Sixty one participants were studied; the mean age was 51.6 (SD16.3), the majorities were males 40 (65.6%) and post-operative adverse outcomes were experienced by 28 (45.9%) participants. In preoperative serum albumin values, 40 (67.8%) had lower than 3.4 g/l while 51 (91%) had postoperative albumin values lower than 3.4 g/l. Only 15 (27.3%) had high delta albumin with the median percentage value of 14.77%. Delta albumin was an independent significant factor associated with adverse outcome (OR: 6.68; 95% CI: 1.59, 28.09); with a good predictive power and area under ROC curve (AUC) of 0.72 (95% CI 0.55 0.89). The best cutoff value was 11.61% with a sensitivity of 76.92% and specificity of 51.72%. Conclusion Early perioperative decreases in serum albumin levels may be a good, simple and cost effective tool to predict adverse outcomes in major abdominal surgeries.
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Affiliation(s)
- Christian Ephata Issangya
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania. .,Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania.
| | - David Msuya
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Kondo Chilonga
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Ayesiga Herman
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Elichilia Shao
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Febronia Shirima
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Elifaraja Naman
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Henry Mkumbi
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Jeremia Pyuza
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of Medical Laboratory, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
| | - Emmanuel Mtui
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Leah Anku Sanga
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | - Seif Abdul
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania
| | | | - Samuel Chugulu
- Kilimanjaro Christian Medical University College, P.O Box 2240, Moshi, Tanzania.,Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O Box 3010, Moshi, Tanzania
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24
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Qi J, Liu C, Chen L, Chen J. Postoperative Serum Albumin Decrease Independently Predicts Delirium in the Elderly Subjects after Total Joint Arthroplasty. Curr Pharm Des 2020; 26:386-394. [PMID: 31880243 DOI: 10.2174/1381612826666191227153150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/23/2019] [Indexed: 12/30/2022]
Abstract
Background:
Postoperative delirium (POD), a neurobehavioral syndrome induced by dysfunction of
neural activity, is a common and serious complication. This current study aimed to investigate independent predictors
for POD in elderly subjects after total joint arthroplasty (TJA).
Methods:
Eligible elderly patients (≥65 years) who underwent elective unilateral primary hip or knee arthroplasty
under epidural anesthesia from October 2016 to January 2019 were consecutively enrolled. POD was diagnosed
following the guidance of the 5th edition of Diagnostic and Statistical Manual of Mental Disorders, (DSM V,
2013). The relative change in serum Alb (ΔAlb) was defined as the absolute value of (preoperative Alb value–
nadir value within postoperative day 2)/preoperative Alb ×100%. The predictive value of ΔAlb for POD was
evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate logistic regression
analyses were used for evaluating risk factors for POD.
Results:
A total of 328 patients were enrolled in the analysis, of which 68 (20.7%, 68/328) patients developed
POD within postoperative 7 days. ΔAlb was an effective predictor for POD with an area under the curve (AUC)
of 0.821, a sensitivity of 76.15% and a specificity of 70.59%, respectively (P<0.001). Univariate and multivariate
logistic regression analyses indicated that ΔAlb was the only independent risk factor for POD (OR: 2.43, 95%CI:
1.17–4.86, P=0.015).
Conclusions:
ΔAlb was an independent risk factor for POD in elderly subjects after TJA.
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Affiliation(s)
- Jianmin Qi
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Cheng Liu
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Li'an Chen
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
| | - Junping Chen
- Department of anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, Beijing, China
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25
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Feng Y, Liu L, Zhu Y. Systemic inflammation score in locally advanced rectal cancer patients following total mesorectal excision. Onco Targets Ther 2019; 12:6617-6622. [PMID: 31695404 PMCID: PMC6707432 DOI: 10.2147/ott.s213720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/30/2019] [Indexed: 01/17/2023] Open
Abstract
Objective The objective of the study was to evaluate whether any association exists between systemic inflammation score (SIS) and adverse events (AEs) and survival of locally advanced rectal cancer patients treated with total mesorectal excision (TME) followed by adjuvant chemoradiotherapy. Patients and methods All of the 109 rectal cancer patients recruited between May 2008 and June 2015 were treated with TME followed by adjuvant chemoradiotherapy. The prognostic ability of SIS for overall survival (OS) was calculated by the receiver operating characteristic (ROC) curves. Results According to the classification of the SIS, 22 (20.2%), 59 (54.1%) and 28 (25.7%) patients were classified as a score of 2, 1 and 0, respectively. With an area under the curve (AUC) of 0.616, the SIS score of 1 was defined as the optimal cut-off value. Therefore, we divided the patients into the SIS-low group (SIS score of 1 or 0, n=87) and SIS-high group (SIS score of 2, n=22). Multivariate analysis indicated that SIS was associated with OS (HR 0.390, 95% CI 0.186–0.817, P=0.012). The 5-year OS rate in patients without adjuvant chemotherapy was lower than the patients with adjuvant chemotherapy (53.3% vs 75.8%, P=0.010). Multivariate analysis showed that adjuvant chemotherapy was associated with OS (HR 0.217, 95% CI 0.089–0.529, P=0.001). A marginal statistically significant difference was observed in terms of leukopenia during adjuvant chemoradiotherapy between the SIS-low group and the SIS-high group (P=0.05). Conclusion These results suggest that SIS might serve as an independent biomarker for predicting AEs and prognosis in locally advanced rectal cancer treated with TME followed by adjuvant chemoradiotherapy. Strengthening treatment may be administered to locally advanced rectal cancer with high SIS score obtained before adjuvant chemoradiotherapy. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/4HtmAq1WMAE
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Affiliation(s)
- Yanru Feng
- Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Luying Liu
- Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
| | - Yuan Zhu
- Department of Radiation Oncology, Zhejiang Key Laboratory of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China
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26
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Galata C, Vassilev G, Haas F, Kienle P, Büttner S, Reißfelder C, Hardt J. Clinical, oncological, and functional outcomes of Da Vinci (Xi)-assisted versus conventional laparoscopic resection for rectal cancer: a prospective, controlled cohort study of 51 consecutive cases. Int J Colorectal Dis 2019; 34:1907-1914. [PMID: 31642968 DOI: 10.1007/s00384-019-03397-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Despite the increasing use of telemanipulators in colorectal surgery, an additional benefit in terms of improved perioperative results is not proven. The aim of the study was to compare clinical, oncological, and functional results of Da Vinci (Xi)-assisted versus conventional laparoscopic (low) anterior resection for rectal cancer. METHODS Monocenter, prospective, controlled cohort study with a 12-month follow-up of bladder and sexual function using the validated questionnaires International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index. RESULTS Fifty-one patients were included (18, Da Vinci (Xi) assisted; 33, conventional laparoscopy). Conversion to an open approach was more common in the Da Vinci cohort (p = 0.012). In addition, surgery and resumption of a normal diet took longer in the robotic group (p = 0.005; p = 0.042). Surgical morbidity and oncological quality did not differ. There was no difference in most functional domains, except for worsened ability to orgasm (p = 0.047) and sexual satisfaction (p = 0.034) in women after conventional laparoscopy. Moreover, we found a higher rate of improved bladder function in the conventional laparoscopy group (p = 0.023) and less painful sexual intercourse among women in the robot-assisted group (p = 0.049). CONCLUSION In contrast to the ROLARR trial, a higher conversion rate was found in the robotic cohort, which may in part be explained by a learning curve effect. Nevertheless, the Da Vinci-assisted approach showed favorable results regarding sexual function.
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Affiliation(s)
- C Galata
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - G Vassilev
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F Haas
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Kienle
- Department of Surgery, Theresienkrankenhaus Mannheim, Mannheim, Germany
| | - S Büttner
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. .,Department of Surgery, University Hospital Mannheim, Faculty of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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27
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Hu WH, Eisenstein S, Parry L, Ramamoorthy S. Preoperative malnutrition with mild hypoalbuminemia associated with postoperative mortality and morbidity of colorectal cancer: a propensity score matching study. Nutr J 2019; 18:33. [PMID: 31253199 PMCID: PMC6598281 DOI: 10.1186/s12937-019-0458-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 06/11/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition with hypoalbuminemia (albumin < 35 g/L) is an important factor in predicting risks associated with colorectal cancer surgery. However, there is limited data about the effects of mild hypoalbuminemia with small decreases in albumin on postoperative complications. METHODS This is a retrospective study using the multi-institutional, nationally validated database of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) to investigate mild hypoalbuminemia and its association with postoperative mortality and morbidity by using a propensity score matching method. RESULTS In a group of 30,676 colorectal cancer patients who received surgery, 5230 had mild hypoalbuminemia (< 35 and > =30 g/L) and 21,310 had normal albumin levels (> = 35 g/L). Significant differences were noted in 21 clinical characteristics between the two groups. After 1:2 propensity score matching postoperative mortality was significantly associated with mild hypoalbuminemia (OR = 1.74; p < 0.001). There were significant associations between mild hypoalbuminemia and 11 postoperative morbidities including deep vein thrombosis, pulmonary embolism, superficial and deep surgical site infection, pneumonia, septic shock, ventilator> 48 h, blood transfusion, return to operating room, stroke and re-intubation. Mild hypoalbuminemia was also associated with overall complication (B = 0.064, p < 0.001) and length of total hospital stay (B = 2.236, p < 0.001). CONCLUSIONS In colorectal cancer, this is the first propensity score matching study of malnutrition with mild hypoalbuminemia which demonstrates that a mild decrease in serum albumin contributes significantly to poor postoperative outcome.
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Affiliation(s)
- Wan-Hsiang Hu
- Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA.,Department of Surgery and Rebecca and John Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, San Diego, CA, 92093, USA
| | - Samuel Eisenstein
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA
| | - Lisa Parry
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA
| | - Sonia Ramamoorthy
- Department of Surgery, University of California, San Diego Health System, La Jolla, San Diego, CA, USA. .,Department of Surgery and Rebecca and John Moores Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, San Diego, CA, 92093, USA.
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28
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Risk factors for early postoperative complications in patients with Crohn's disease after colorectal surgery other than ileocecal resection or right hemicolectomy. Int J Colorectal Dis 2019; 34:293-300. [PMID: 30460473 DOI: 10.1007/s00384-018-3196-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate risk factors for early postoperative complications in patients with Crohn's disease (CD) after extensive colorectal resection excluding mere ileocecal resection or right hemicolectomy at a university center. METHODS A retrospective analysis of the prospectively maintained database for surgical patients with CD at our institution was performed. All consecutive patients operated between December 2009 and December 2017 were included. RESULTS In total, 126 patients were eligible for this study. Most common types of operations performed were subtotal colectomy or proctocolectomy (37.3%) and resections of the rectum (34.1%) or the sigmoid colon (14.3%). Major postoperative complications occurred in 29 patients (23.0%). The rate of local septic complications (anastomotic leak, postoperative abscess) was 11.1%. In univariate analysis, low preoperative albumin, elevated preoperative C-reactive protein (CRP), and emergency surgery were factors associated with major postoperative complications. When multivariable analysis was performed, low preoperative albumin was the only independent risk factor for the occurrence of major postoperative complications (p = 0.0033; OR 0.899). The cut-off value for albumin was 32.6 g/L. CONCLUSIONS In this large cohort of consecutive patients undergoing surgery of the colorectum in CD, the rate of major postoperative complications was considerably higher compared to our recently published data from patients with ileocecal resection or right hemicolectomy. Preoperative albumin is the only independent risk factor for the occurrence of major postoperative complications. Preoperative albumin levels > 32.6 g/L significantly reduce the risk for postoperative complications.
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29
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Li S, Xu H, Wu C, Wang W, Jin W, Gao H, Li H, Zhang S, Xu J, Zhang W, Xu S, Li T, Ni Q, Yu X, Liu L. Prognostic value of γ-glutamyltransferase-to-albumin ratio in patients with pancreatic ductal adenocarcinoma following radical surgery. Cancer Med 2019; 8:572-584. [PMID: 30632317 PMCID: PMC6382708 DOI: 10.1002/cam4.1957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/15/2018] [Accepted: 12/16/2018] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a devastating malignancy with poor prognosis. Many preoperative biomarkers can predict postoperative survival of PDAC patients. In this study, we created a novel ratio index based on preoperative liver function test, γ‐glutamyltransferase‐to‐albumin ratio (GAR), and evaluated its prognostic value in predicting clinical outcomes of PDAC patients following radical surgery. We retrospectively enrolled 833 PDAC patients who had underwent radical surgery at our institution between January 2010 and January 2017. Patients were divided into two groups according to the cut‐off value of GAR. Univariate and multivariate survival analysis between the groups were evaluated. TNM stage, GAR, preoperative serum carbohydrate antigen 19‐9 (CA19‐9) and tumor differentiation were combined to generate a more accurate prognostic model. The optimal cut‐off value of GAR was 0.65. Significant correlations were found between GAR and tumor location, tumor size, vascular invasion, obstructive jaundice, biliary drainage and parameters of liver function test. Univariate and multivariate analysis showed that high level of GAR independently predicted poorer postoperative overall survival (OS, P < 0.001) and recurrence‐free survival (RFS, P < 0.001). Subgroup analysis demonstrated that GAR was predictive of survival in patients without biliary obstruction or severely impaired liver function. In addition, integration of GAR, preoperative serum CA19‐9, and tumor differentiation into TNM staging system could better stratify the prognosis for PDAC patients compared with TNM stage alone. Our study demonstrates that preoperative GAR is an independent prognostic factor for prediction of surgical outcomes in PDAC patients. Combination of TNM stage, GAR, preoperative serum CA19‐9, and tumor differentiation can enhance the prognostic accuracy.
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Affiliation(s)
- Shuo Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Huaxiang Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Chuntao Wu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Wenquan Wang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Wei Jin
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Heli Gao
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Hao Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Shirong Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Jinzhi Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Wuhu Zhang
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Shuaishuai Xu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Tianjiao Li
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Quanxing Ni
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Xianjun Yu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
| | - Liang Liu
- Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Shanghai Pancreatic Cancer Institute, Shanghai, China.,Pancreatic Cancer Institute, Fudan University, Shanghai, China
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Prognostic Significance of Serum Lactic Acid, Lactate Dehydrogenase, and Albumin Levels in Patients with Metastatic Colorectal Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1804086. [PMID: 30627541 PMCID: PMC6304480 DOI: 10.1155/2018/1804086] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022]
Abstract
Aim To identify the population of patients with high risk of distant metastasis and the poor prognosis before treatment, so as to provide early intervention and better treatment decision. Method 69 patients with nonmetastatic colorectal cancer (non-mCRC) and 57 with metastatic CRC (mCRC) were enrolled to evaluate the prognostic value of serum albumin (ALB), serum lactate (SLA), and lactate dehydrogenase (LDH) in patients with metastatic CRC. We then followed up the 57 patients with mCRC. The T test, Chi square test, Kaplan-Meier survival analysis model, and Multivariate Cox proportional hazards regression model were applied to assess the prognostic significance of SLA, LDH, and serum ALB on the patients with mCRC. Results Compared with the non-mCRC group, the patients with mCRC had an elevated level of blood lactate (P=0.01) and LDH (P<0.01) and a reduced level of ALB (P<0.01). Multivariable analysis showed the elevated LDH combined with elevated SLA (HR=2.922, 95%CI=0.971-8.793, P=0.056), the reduced ALB (HR=0.417, 95%CI=0.230-0.754, P=0.004), and the elevated CA199 (HR=2.072, 95%CI=1.125-3.816, P=0.019) were independent prognostic factors for PFS of patients with mCRC. The elevated LDH (HR=2.204, 95%CI=1.000-4.858, P=0.050), reduced ALB (HR=0.459, 95%CI=0.236-0.892, P=0.022), elevated LDH combined with elevated SLA (HR=3.187, 95%CI=1.019-9.970, P=0.046), and the primary site of tumor (HR=0.359, 95%CI=0.174-0.740, P=0.006) were independent prognostic factors for OS of patients with mCRC. Conclusions Taken together, our results implicate that the elevated LDH combined with elevated SLA and the reduced ALB are prognostic indicators for patients with mCRC.
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Hersh EH, Sarkiss CA, Ladner TR, Lee N, Kothari P, Lakomkin N, Caridi JM. Perioperative Risk Factors for Thirty-Day Morbidity and Mortality in the Resection of Extradural Thoracic Spine Tumors. World Neurosurg 2018; 120:e950-e956. [DOI: 10.1016/j.wneu.2018.08.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
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Müller C, Stift A, Argeny S, Bergmann M, Gnant M, Marolt S, Unger L, Riss S. Delta albumin is a better prognostic marker for complications following laparoscopic intestinal resection for Crohn's disease than albumin alone - A retrospective cohort study. PLoS One 2018; 13:e0206911. [PMID: 30422980 PMCID: PMC6233913 DOI: 10.1371/journal.pone.0206911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Purpose Little is known about the perioperative dynamic of albumin and its effect on surgical outcome in Crohn’s disease. Thus, we aimed to assess postoperative changes of albumin levels and their potentially predictive role for complications after laparoscopic intestinal resections. Methods We identified 182 patients who underwent laparoscopic intestinal resection for symptomatic Crohn´s disease between 2000 and 2014 for this retrospective cohort study. Pre- and postoperative serum albumin levels (within 4 days) were recorded retrospectively and proportional postoperative reduction (delta (Δ) albumin) was calculated. Complications were defined according to the Clavien-Dindo classification. Univariate and multivariate analysis describing an eventful postoperative course were conducted. Results Complications were found in 22.5% (n = 41), 6% (n = 11) developed major complications defined as Clavien Dindo III-V and 16.5% (n = 30) had minor complications (Clavien Dindo I-II). The median Δ albumin was 22.75% (range: -18.46–47.14%). Delta albumin was found to be significantly higher in patients who developed complications after surgery (p = 0.03). Notably, neither preoperative (p = 0.28) nor postoperative albumin levels (p = 0.41) taken as absolute numerical values correlated with an eventful course following intestinal resection. In the multivariate analysis, based on a cut-off of 24.27%, Δ albumin remained an independent factor for surgical complications (p = 0.04, OR 2.232) next to conversion rate (p<0.001, OR 5.577) and the presence of an inflammatory mass (p = 0.003, OR 0.280). Conclusion Δ albumin is a better prognostic marker for an eventful postoperative course after laparoscopic surgery in patients with Crohn’s disease in comparison to albumin alone.
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Affiliation(s)
- Catharina Müller
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Anton Stift
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Stanislaus Argeny
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Bergmann
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Gnant
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Sebastian Marolt
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Lukas Unger
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
| | - Stefan Riss
- Department of Surgery, Division of General Surgery and Comprehensive Center for Perioperative Medicine, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Li P, Li J, Lai Y, Wang Y, Wang X, Su J, Che G. Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study. J Thorac Dis 2018; 10:5755-5763. [PMID: 30505483 DOI: 10.21037/jtd.2018.09.113] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background A decrease in serum albumin is commonly observed after lung cancer surgery, however, whether it is associated with postoperative outcomes is unknown. The objective of this study was to evaluate whether the reduction of serum albumin (ΔALB) on postoperative day one could serve as a predictor of postoperative pulmonary complications (PPCs) after thoracoscopic anatomical resection in lung cancer patients. Methods Patients characteristics were compared between groups of whether they experienced PPCs or not. The cutoff value of ΔALB was examined by receiver operating characteristic curve to find out the threshold value of ΔALB in predicting PPCs. Logistic regression analysis was conducted to identify potential risk factors for PPCs. Results Totally 533 patients were included into analysis, and among them, 52 experienced PPCs. The ΔALB was significant in the PPCs group than in the non-PPCs group (P<0.001), and ΔALB was observed an independent risk factor for PPCs (OR =2.268, 95% CI: 1.153-4.460). The cutoff value of ΔALB in predicting PPCs was 14.97%. Patients with ΔALB ≥14.97% were more likely to have PPCs (P<0.001). Conclusions A reduction of serum albumin with a cut-off value of 14.97% can be served as a predictor to identify patients at high risk of developing PPCs following thoracosopic anatomical lung cancer surgery.
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Affiliation(s)
- Pengfei Li
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China.,West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jue Li
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China.,West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China.,West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Yan Wang
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China.,West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xin Wang
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China.,West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Jianhua Su
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, West China Hospital, Sichuan University, Chengdu 610041, China
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Schreckenbach T, Zeller MV, El Youzouri H, Bechstein WO, Woeste G. Identification of factors predictive of postoperative morbidity and short-term mortality in older patients after colorectal carcinoma resection: A single-center retrospective study. J Geriatr Oncol 2018; 9:649-658. [PMID: 29779798 DOI: 10.1016/j.jgo.2018.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/23/2018] [Accepted: 05/01/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study is to investigate the effect of age on patient outcome after colorectal carcinoma (CRC) resection in patients over 65 years of age. METHODS This study included patients aged 65 years and older who underwent CRC resection between 2003 and 2013 at a single-center institution. Patients were divided into two groups: Group A (65-74 years old) and Group B (≥75 years old). RESULTS Multivariable logistic analysis of 415 patients revealed serum albumin levels on the third postoperative day (POD) (Odds Ratio (OR), 0.44; 95% CI, 0.21-0.94; P = 0.03) and C-reactive protein (CRP) levels (OR, 1.05; 95% CI, 1.00-1.01; P = 0.04) in patients with colon cancer as predictive factors for morbidity. In addition, the multivariable logistic analysis revealed serum albumin levels (OR, 0.27; 95% CI, 0.08-0.87; P = 0.03) in patients with rectal cancer as predictive factors for morbidity. The multivariate Cox Proportional Hazards Model identified re-intervention for colon cancer (Hazard Ratio (HR), 4.57; 95% CI, 1.36-15.4 P = 0.01) and for rectal cancer (HR, 11.8; 95% CI, 1.08-129 P = 0.04) as a predictive factor for 30-day mortality. Serum albumin level on the third POD was predictive of 30-day mortality (HR, 0.30; 95% CI, 0.13-0.71; P = 0.01) and of 1-year mortality (HR, 0.34; 95% CI, 0.17-0.66; P < 0.01) in patients with colon cancer. CONCLUSION Age is not predictive of postoperative morbidity and mortality in patients with CRC. Serum albumin levels on the third POD can predict morbidity and mortality for colon and rectal carcinoma in older patients undergoing colorectal resections.
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Affiliation(s)
- Teresa Schreckenbach
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
| | - Matthias Valentin Zeller
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Hanan El Youzouri
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Wolf Otto Bechstein
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
| | - Guido Woeste
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General and Visceral Surgery, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany
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