1
|
Lunca S, Morarasu S, Rouet K, Ivanov AA, Morarasu BC, Roata CE, Clancy C, Dimofte GM. Frailty Increases Morbidity and Mortality in Patients Undergoing Oncological Liver Resections: A Systematic Review and Meta-analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15571-8. [PMID: 38856830 DOI: 10.1245/s10434-024-15571-8] [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: 04/08/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Considered to reflect a patients' biological age, frailty is a new syndrome shown to predict surgical outcomes in elderly patients. In view of the increasing age at which patients are proposed oncological liver surgery and the morbidity associated with it, we attempted to perform a systematic review and meta-analysis to compare morbidity and mortality between frail and nonfrail patients after liver resections. METHODS The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining surgical outcomes after liver resections between frail and nonfrail patients. RESULTS Ten studies were included based on the selection criteria with a total of 71,102 patients, split into two groups: frail (n = 17,167) and the control group (n = 53,928). There were more elderly patients with a lower preoperative albumin level in the frail group (p = 0.02, p = 0.001). Frail patients showed higher rates of morbidity with more major complications and a higher incidence of postoperative liver failure (p < 0.001). Mortality (p < 0.001) and readmission rate (p = 0.021) also was higher in frail patients. CONCLUSIONS Frailty seems to be a solid predictive risk factor of morbidity and mortality after liver surgery and should be considered a selection criterion for liver surgery in at-risk patients.
Collapse
Affiliation(s)
- Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Stefan Morarasu
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania.
| | - Kevin Rouet
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Andreea Antonina Ivanov
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Bianca Codrina Morarasu
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
- Department of Internal Medicine and Toxicology, Saint Spiridon University Regional Emergency Hospital, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Gabriel-Mihail Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| |
Collapse
|
2
|
Langenfeld SJ, Davis BR, Vogel JD, Davids JS, Temple LKF, Cologne KG, Hendren S, Hunt S, Garcia Aguilar J, Feingold DL, Lightner AL, Paquette IM. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement. Dis Colon Rectum 2024; 67:18-31. [PMID: 37647138 DOI: 10.1097/dcr.0000000000003057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Sean J Langenfeld
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bradley R Davis
- Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Jon D Vogel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Larissa K F Temple
- Colorectal Surgery Division, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Kyle G Cologne
- Department of Surgery, Division of Colorectal Surgery, University of Southern California, Los Angeles, California
| | - Samantha Hendren
- Division of Colon and Rectal Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Steven Hunt
- Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Julio Garcia Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel L Feingold
- Department of Surgery, Rutgers University, New Brunswick, New Jersey
| | - Amy L Lightner
- Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ian M Paquette
- Department of Surgery, Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
3
|
Marciuc D, Morarasu S, Morarasu BC, Marciuc EA, Dobrovat BI, Pintiliciuc-Serban V, Popescu RM, Bida FC, Munteanu V, Haba D. Dental Appliances for the Treatment of Obstructive Sleep Apnea in Children: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1447. [PMID: 37629737 PMCID: PMC10456847 DOI: 10.3390/medicina59081447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: Obstructive sleep apnea (OSA) in children is a debilitating disease, difficult to treat. Dental appliances have been proposed as a valid therapy for improving functional outcomes with good compliance rates. Herein, we aimed to perform a meta-analysis comparing clinical outcomes between OSA children treated with dental appliances versus controls. Materials Methods: The study was registered with PROSPERO. A systematic search was performed for all comparative studies examining outcomes in pediatric patients who underwent treatment of OSA with oral appliances versus controls. Data was extracted and analyzed using a random effects model via Rev Man 5.3. Results: Six studies including 180 patients were analyzed split into two groups: patients treated with dental appliances (n = 123) and the controls (n = 119). Therapy with dental appliances was shown to significantly improve the apnea-hypopnea index (p = 0.009) and enlarge the superior posterior airway space (p = 0.02). Maxilla-to-mandible measurements were not significantly different between the two groups, nor was the mean SO2 (p = 0.80). Conclusions: This is the most updated meta-analysis assessing the role of dental appliances for OSA in children; it shows that such devices can improve functional outcomes by decreasing the apnea-hypopnea index.
Collapse
Affiliation(s)
- Daniel Marciuc
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Bianca Codrina Morarasu
- Department of Internal Medicine and Toxicology, “Saint Spiridon” University Regional Emergency Hospital, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Emilia Adriana Marciuc
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Bogdan Ionut Dobrovat
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| | - Veronica Pintiliciuc-Serban
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Roxana Mihaela Popescu
- Surgery Department, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (D.M.); (V.P.-S.); (R.M.P.)
| | - Florinel Cosmin Bida
- Department of Implantology, Removable Prostheses, Dental Prostheses Technology, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Valentin Munteanu
- Department of Intensive Care Unit, “Saint Mary” Emergency Children Hospital, 700309, Faculty of Medical Bioengineering, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Danisia Haba
- Department of Radiology, Emergency Hospital “Prof. Dr. Nicolae Oblu”, Faculty of Dental Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.I.D.); (D.H.)
| |
Collapse
|
4
|
Morarasu S, Clancy C, Gorgun E, Yilmaz S, Ivanecz A, Kawakatsu S, Musina AM, Velenciuc N, Roata CE, Dimofte GM, Lunca S. Laparoscopic versus open resection of primary colorectal cancers and synchronous liver metastasis: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:90. [PMID: 37017766 PMCID: PMC10076361 DOI: 10.1007/s00384-023-04375-z] [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: 03/17/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Combined resection of primary colorectal cancer and associated liver metastases is increasingly common. This study compares peri-operative and oncological outcomes according to surgical approach. METHODS The study was registered with PROSPERO. A systematic search was performed for all comparative studies describing outcomes in patients that underwent laparoscopic versus open simultaneous resection of colorectal primary tumours and liver metastases. Data was extracted and analysed using a random effects model via Rev Man 5.3 RESULTS: Twenty studies were included with a total of 2168 patients. A laparoscopic approach was performed in 620 patients and an open approach in 872. There was no difference in the groups for BMI (mean difference: 0.04, 95% CI: 0.63-0.70, p = 0.91), number of difficult liver segments (mean difference: 0.64, 95% CI:0.33-1.23, p = 0.18) or major liver resections (mean difference: 0.96, 95% CI: 0.69-1.35, p = 0.83). There were fewer liver lesions per operation in the laparoscopic group (mean difference 0.46, 95% CI: 0.13-0.79, p = 0.007). Laparoscopic surgery was associated with shorter length of stay (p < 0.00001) and less overall postoperative complications (p = 0.0002). There were similar R0 resection rates (p = 0.15) but less disease recurrence in the laparoscopic group (mean difference: 0.57, 95% CI:0.44-0.75, p < 0.0001). CONCLUSION Synchronous laparoscopic resection of primary colorectal cancers and liver metastases is a feasible approach in selected patients and does not demonstrate inferior peri-operative or oncological outcomes.
Collapse
Affiliation(s)
- Stefan Morarasu
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland.
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, USA
| | - Sumeyye Yilmaz
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic Main Campus, Cleveland, USA
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Shoji Kawakatsu
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Gabriel Mihail Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania
- Grigore T, Popa University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
5
|
O'Brien L, Morarasu S, Morarasu BC, Neary PC, Musina AM, Velenciuc N, Roata CE, Dimofte MG, Lunca S, Raimondo D, Seracchioli R, Casadio P, Clancy C. Conservative surgery versus colorectal resection for endometriosis with rectal involvement: a systematic review and meta-analysis of surgical and long-term outcomes. Int J Colorectal Dis 2023; 38:55. [PMID: 36847868 DOI: 10.1007/s00384-023-04352-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE The optimal surgical approach for removal of colorectal endometrial deposits is unclear. Shaving and discoid excision of colorectal deposits allow organ preservation but risk recurrence with associated functional issues and re-operation. Formal resection risks potential higher complications but may be associated with lower recurrence rates. This meta-analysis compares peri-operative and long-term outcomes between conservative surgery (shaving and disc excision) versus formal colorectal resection. METHODS The study was registered with PROSPERO. A systematic search was performed on PubMed and EMBASE databases. All comparative studies examining surgical outcomes in patients that underwent conservative surgery versus colorectal resection for rectal endometrial deposits were included. The two main groups (conservative versus resection) were compared in three main blocks of variables including group comparability, operative outcomes and long-term outcomes. RESULTS Seventeen studies including 2861 patients were analysed with patients subdivided by procedure: colorectal resection (n = 1389), shaving (n = 703) and discoid excision (n = 742). When formal colorectal resection was compared to conservative surgery there was lower risk of recurrence (p = 0.002), comparable functional outcomes (minor LARS, p = 0.30, major LARS, p = 0.54), similar rates of postoperative leaks (p = 0.22), pelvic abscesses (p = 0.18) and rectovaginal fistula (p = 0.92). On subgroup analysis, shaving had the highest recurrence rate (p = 0.0007), however a lower rate of stoma formation (p < 0.00001) and rectal stenosis (p = 0.01). Discoid excision and formal resection were comparable. CONCLUSION Colorectal resection has a significantly lower recurrence rate compared to shaving. There is no difference in complications or functional outcomes between discoid excision and formal resection and both have similar recurrence rates.
Collapse
Affiliation(s)
- Luke O'Brien
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Stefan Morarasu
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland. .,2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania. .,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania.
| | | | - Paul C Neary
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| | - Ana Maria Musina
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Natalia Velenciuc
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Ene Roata
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Mihail Gabriel Dimofte
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Sorinel Lunca
- 2nd Department of Surgical Oncology, Regional Institute of Oncology, Iasi, Romania.,Grigore T Popa, University of Medicine and Pharmacy, Iasi, Romania
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Paolo Casadio
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Cillian Clancy
- Department of Colorectal Surgery, Tallaght University Hospital, Dublin 24, Ireland
| |
Collapse
|