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Jessernig A, Anthis AH, Vonna E, Rosendorf J, Liska V, Widmer J, Schlegel AA, Herrmann IK. Early Detection and Monitoring of Anastomotic Leaks via Naked Eye-Readable, Non-Electronic Macromolecular Network Sensors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400673. [PMID: 38775058 PMCID: PMC11304232 DOI: 10.1002/advs.202400673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Indexed: 08/09/2024]
Abstract
Anastomotic leakage (AL) is the leaking of non-sterile gastrointestinal contents into a patient's abdominal cavity. AL is one of the most dreaded complications following gastrointestinal surgery, with mortality rates reaching up to 27%. The current diagnostic methods for anastomotic leaks are limited in sensitivity and specificity. Since the timing of detection directly impacts patient outcomes, developing new, fast, and simple methods for early leak detection is crucial. Here, a naked eye-readable, electronic-free macromolecular network drain fluid sensor is introduced for continuous monitoring and early detection of AL at the patient's bedside. The sensor array comprises three different macromolecular network sensing elements, each tailored for selectivity toward the three major digestive enzymes found in the drainage fluid during a developing AL. Upon digestion of the macromolecular network structure by the respective digestive enzymes, the sensor produces an optical shift discernible to the naked eye. The diagnostic efficacy and clinical applicability of these sensors are demonstrated using clinical samples from 32 patients, yielding a Receiver Operating Characteristic Area Under the Curve (ROC AUC) of 1.0. This work has the potential to significantly contribute to improved patient outcomes through continuous monitoring and early, low-cost, and reliable AL detection.
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Affiliation(s)
- Alexander Jessernig
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H.C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Emilie Vonna
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Jeannette Widmer
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichZürich8091Switzerland
| | - Andrea A. Schlegel
- Transplantation CenterDigestive Disease and Surgery Institute and Department of Immunity and InflammationLerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106USA
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
- The Ingenuity LabUniversity Hospital BalgristBalgrist CampusForchstrasse 340Zurich8008Switzerland
- Faculty of MedicineUniversity of ZurichRämistrasse 74Zürich8006Switzerland
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Stock C, Watkins A, Moffatt-Bruce S, Servais E. Robotic-Assisted Ivor Lewis Esophagectomy. Surg Oncol Clin N Am 2024; 33:519-527. [PMID: 38789194 DOI: 10.1016/j.soc.2023.12.013] [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: 05/26/2024]
Abstract
Robotic-assisted surgery is a safe and effective approach to minimally invasive Ivor Lewis esophagectomy. Outcomes are optimized when surgeons are familiar with the fundamentals of minimally invasive surgery of the esophagus and after gaining sufficient experience with robotic surgical techniques.
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Affiliation(s)
- Cameron Stock
- Thoracic Surgery, Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Ammara Watkins
- Thoracic Surgery, Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Susan Moffatt-Bruce
- Thoracic Surgery, Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Elliot Servais
- Thoracic Surgery, Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
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Levenson G, Coutrot M, Voron T, Gronnier C, Cattan P, Hobeika C, D'Journo XB, Bergeat D, Glehen O, Mathonnet M, Piessen G, Goéré D. Root cause analysis of mortality after esophagectomy for cancer: a multicenter cohort study from the FREGAT database. Surgery 2024; 176:82-92. [PMID: 38641545 DOI: 10.1016/j.surg.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/17/2024] [Accepted: 03/10/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Esophagectomy is associated with significant mortality. A better understanding of the causes leading to death may help to reduce mortality. A root cause analysis of mortality after esophagectomy was performed. METHODS Root cause analysis was retrospectively applied by an independent expert panel of 4 upper gastrointestinal surgeons and 1 anesthesiologist-intensivist to patients included in the French national multicenter prospective cohort FREGAT between August 2014 and September 2019 who underwent an esophagectomy for cancer and died within 90 days of surgery. A cause-and-effect diagram was used to determine the root causes related to death. Death was classified as potentially preventable or non-preventable. RESULTS Among the 1,040 patients included in the FREGAT cohort, 70 (6.7%) patients (male: 81%, median age 68 [62-72] years) from 17 centers were included. Death was potentially preventable in 37 patients (53%). Root causes independently associated with preventable death were inappropriate indication (odds ratio 35.16 [2.50-494.39]; P = .008), patient characteristics (odds ratio 5.15 [1.19-22.35]; P = .029), unexpected intraoperative findings (odds ratio 18.99 [1.07-335.55]; P = .045), and delay in diagnosis of a complication (odds ratio 98.10 [6.24-1,541.04]; P = .001). Delay in treatment of a complication was found only in preventable deaths (28 [76%] vs 0; P < .001). National guidelines were less frequently followed (16 [43%] vs 22 [67%]; P = .050) in preventable deaths. The only independent risk factor of preventable death was center volume <26 esophagectomies per year (odds ratio 4.71 [1.55-14.33]; P = .006). CONCLUSIONS More than one-half of deaths after esophagectomy were potentially preventable. Better patient selection, early diagnosis, and adequate management of complications through centralization could reduce mortality.
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Affiliation(s)
- Guillaume Levenson
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France.
| | - Maxime Coutrot
- Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Département d'anesthésie réanimation et centre de traitement des brûlés, Paris, France
| | - Thibault Voron
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Chirurgie Générale et Digestive, Paris, France; Sorbonne Université, Paris, France. https://www.twitter.com/ThibaultVORON
| | - Caroline Gronnier
- Unité de Chirurgie Œsogastrique et Endocrinienne, Service de Chirurgie Digestive et Endocrinienne, Centre Médico-Chirurgical Magellan, Centre Hospitalo-Universitaire de Bordeaux, Pessac, France; Faculté de Médecine, Université Bordeaux-Segalen, Bordeaux, France
| | - Pierre Cattan
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France
| | - Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, APHP, Clichy, Paris-Cité University, Paris, France; UMR Inserm 1275 CAP Paris-Tech, Lariboisière Hospital, Paris, Paris-Cité University, Paris, France
| | - Xavier Benoît D'Journo
- Department of Thoracic Surgery, Aix-Marseille University, North Hospital, Marseille, France
| | - Damien Bergeat
- Service de Chirurgie Hépatobiliaire et Digestive, Hôpital Pontchaillou, Centre Hospitalier Universitaire (CHU Rennes), Université de Rennes 1 Centre, Rennes, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; EMR 3738 Lyon Sud Charles Mérieux Faculty, Claude Bernard University Lyon 1, Oullins, France
| | - Muriel Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Avenue Martin Luther King, Limoges Cedex, France
| | - Guillaume Piessen
- Centre Hospitalo-Universitaire Lille, Service de Chirurgie Digestive et Oncologique, Lille, France; University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer, Heterogeneity Plasticity and Resistance to Therapies, Lille, France. https://www.twitter.com/PiessenG
| | - Diane Goéré
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Service de Chirurgie Viscérale, Cancérologique et Endocrinienne, Paris, France; Université Paris Cité, Paris, France
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