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Knoedler L, Knoedler S, Alfertshofer M, Hansen FJ, Schenck T, Sofo G, Obed D, Hollmann K, Siegwart LC, Vollbach FH, Bigdeli AK, Kauke-Navarro M, Pomahac B. Gynecomastia Surgery in 4996 Male Patients Over 14 Years: A Retrospective Analysis of Surgical Trends, Predictive Risk Factors, and Short-Term Outcomes. Aesthetic Plast Surg 2024:10.1007/s00266-024-03927-0. [PMID: 38528130 DOI: 10.1007/s00266-024-03927-0] [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: 12/12/2023] [Accepted: 02/09/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND The high prevalence of benign male breast tissue enlargement (gynecomastia) has resulted in a marked increase of gynecomastia cases. While about one third of male adults experience some form of gynecomastia, gynecomastia surgery (GS) outcome research is limited to small study populations and single-center/-surgeon databases. In this study, we aimed to access the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify preoperative risk factors for complications and investigate postoperative outcomes of GS. METHODS In this retrospective study, we queried the ACS-NSQIP database from 2008 to 2021 to identify male adult patients who underwent GS. Postoperative outcomes involved the occurrence of any, surgical and medical complications, as well as reoperation, readmission, and mortality within a 30-day postoperative time period. Univariable and multivariable assessment were performed to identify risk factors for complications while adjusting for possible confounders. RESULTS The study included 4,996 GS patients with a mean age of 33.7 ± 15 years and BMI of 28.2 ± 5.1 kg/m2. White patients constituted 54% (n = 2713) of the cohort, and 27% (n = 1346) were obese. Except for 2020, there was a steady increase in GS cases over the study period. Outpatient surgeries were most common at 95% (n = 4730), while general surgeons performed the majority of GS (n = 3580; 72%). Postoperatively, 91% (n = 4538) of patients were discharged home; 4.4% (n = 222) experienced any complications. Multivariable analysis identified inpatient setting (p < 0.001), BMI (p = 0.023), prior sepsis (p = 0.018), and bleeding disorders (p = 0.047) as independent risk factors for complications. CONCLUSION In this study, we analyzed 4996 male adult GS patients from the ACS-NSQIP database, revealing an increased caseload and significant general surgeon involvement. Risk factors like bleeding disorders, inpatient status, and prior sepsis were linked to postoperative complications, while BMI was crucial for predicting adverse events. Overall, our findings may aid in enhancing patient care through advanced preoperative screening and closer perioperative management. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Leonard Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA
- Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeriro, Brazil
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frederik J Hansen
- Department of Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Giuseppe Sofo
- Instituto Ivo Pitanguy, Hospital Santa Casa de Misericórdia Rio de Janeiro, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeriro, Brazil
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, 30625, Hannover, Germany
| | - Katharina Hollmann
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Laura C Siegwart
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Felix H Vollbach
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Amir K Bigdeli
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Martin Kauke-Navarro
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Bohdan Pomahac
- Department of Surgery, Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
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Geroin C, Weindelmayer J, Camozzi S, Leone B, Turolo C, Hetoja S, Bencivenga M, Sacco M, De Pasqual CA, Mattioni E, de Manzoni G, Giacopuzzi S. Clinical predictors of postoperative complications in the context of enhanced recovery (ERAS) in patients with esophageal and gastric cancer. Updates Surg 2024:10.1007/s13304-023-01739-6. [PMID: 38358642 DOI: 10.1007/s13304-023-01739-6] [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: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
The overall frequency of postoperative complications in patients with esophageal and gastric cancer diverges between studies. We evaluated the frequency and assessed the relationship between complications and demographic and clinical features. For this observational study, data were extracted from the ERAS Registry managed by the University of Verona, Italy. Patients were evaluated and compared for postoperative complications according to the consensus-based classification and the Clavien-Dindo scale. The study population was 877 patients: 346 (39.5%) with esophageal and 531 (60.5%) with gastric cancer; 492 (56.2%) reported one or more postoperative complications, 213 (61.6%) of those with esophageal and 279 (52.5%) of those with gastric cancer. When stratified by consensus-based classification, patients with esophageal cancer reported general postoperative complications more frequently (p < 0.001) than those with gastric cancer, but there was no difference in postoperative surgical complications between the two groups. Multiple logistic regression models revealed an association between postoperative complications and the Charlson Comorbidity Index (adjusted odds ratio [OR] 1.22; 95% confidence interval [CI] 1.08-1.36), operation time (adjusted OR, 1.08; 95% CI 1.00-1.15), and days to solid diet intake (adjusted OR, 1.39; 95% CI 1.20-1.59). Complications in patients with esophageal and gastric cancer are frequent, even in those treated according to ERAS principles, and are often associated with comorbidities, longer operative time, and longer time to solid diet intake.
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Affiliation(s)
- Christian Geroin
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy.
| | - Jacopo Weindelmayer
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Serena Camozzi
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Barbara Leone
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Cecilia Turolo
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Selma Hetoja
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Maria Bencivenga
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Michele Sacco
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | | | - Eugenia Mattioni
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Giovanni de Manzoni
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy
| | - Simone Giacopuzzi
- General and Upper G.I. Surgery Division, University of Verona, Borgo Trento, Verona, Italy.
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Bates A, West MA, Jack S, Grocott MPW. Preparing for and Not Waiting for Surgery. Curr Oncol 2024; 31:629-648. [PMID: 38392040 PMCID: PMC10887937 DOI: 10.3390/curroncol31020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Cancer surgery is an essential treatment strategy but can disrupt patients' physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, and propose the adoption of personalised prehabilitation to mitigate risk. Perioperative medicine is a growing speciality that aims to improve clinical outcome by preparing patients for the stress associated with surgery. Preparation should begin at contemplation of surgery, with universal screening for established risk factors, physical fitness, nutritional status, psychological health, and, where applicable, frailty and cognitive function. Patients at risk should undergo a formal assessment with a qualified healthcare professional which informs meaningful shared decision-making discussion and personalised prehabilitation prescription incorporating, where indicated, exercise, nutrition, psychological support, 'surgery schools', and referral to existing local services. The foundational principles of prehabilitation can be adapted to local context, culture, and population. Clinical services should be co-designed with all stakeholders, including patient representatives, and require careful mapping of patient pathways and use of multi-disciplinary professional input. Future research should optimise prehabilitation interventions, adopting standardised outcome measures and robust health economic evaluation.
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Affiliation(s)
- Andrew Bates
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Malcolm A. West
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Sandy Jack
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Michael P. W. Grocott
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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4
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Ratti F, Marino R, Catena M, Pascale MM, Buonanno S, De Cobelli F, Aldrighetti L. The failure to rescue factor: aftermath analyses on 224 cases of perihilar cholangiocarcinoma. Updates Surg 2023; 75:1919-1939. [PMID: 37452927 DOI: 10.1007/s13304-023-01589-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
The term "failure to rescue" (FTR) has been recently introduced in the field of hepato-biliary surgery to label cases in which major postoperative complications lead to postoperative fatality. Perihilar cholangiocarcinoma (PHC) surgery has consistently high postoperative morbidity and mortality rates in which factors associated with FTR are yet to be discovered. The primary endpoint of this study is to compare the Rescue with the FTR cohort referencing patients' characteristics and management protocols applied. A cohort of 224 consecutive patients undergoing surgery for PHC, between 2010 and 2021, was enrolled. Perioperative variables were analyzed according to the severity of major postoperative complications (Clavien ≥ 3a). Kaplan-Meier survival analyses were performed to determine complications' impact on survival. Major complications were reported in 86 cases (38%). Among the major complications' cohort, 72 cases (84%) were graded Clavien 3a-4 (Rescue group), while 14 (16%) cases were graded Clavien 5 (FTR group). Number of lymph-node metastases (OR = 1.33 (1.08-1.63) p = 0.006), poorly differentiated (G3) adenocarcinoma (OR = 7.55 (1.24-45.8) p = 0.028, reintervention (OR = 16.47 (2.76-98.08) p = 0.002), and prognostic nutritional index < 40 (OR = 3.01 (2.265-3.654) p < 0.001) rates were independent predictors of FTR. Right resection side (OR 2.4 (1.33-4.34) p = 0.004) increased the odds of major complications but not of FTR. No difference in overall survival was identified. A distinction of perioperative factors associated with postoperative complications' severity is crucial. Patients developing severe outcomes seem to have different biological and nutritional profiles, showing that efficient preoperative protocols are strategic to identify and avert the risk of FTR.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy.
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Marco Catena
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Marco Maria Pascale
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Silvia Buonanno
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132, Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy
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5
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van Kooten RT, Algie JPA, Tollenaar RAEM, Wouters MWJM, Putter H, Peeters KCMJ, Dekker JWT. The impact on health-related quality of a stoma or poor functional outcomes after rectal cancer surgery in Dutch patients: A prospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106914. [PMID: 37105868 DOI: 10.1016/j.ejso.2023.04.013] [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] [Received: 01/30/2023] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND As the survival of patients with rectal cancer has improved in recent decades, more and more patients have to live with the consequences of rectal cancer surgery. An influential factor in long-term Health-related Quality of Life (HRQoL) is the presence of a stoma. This study aimed to better understand the long-term consequences of a stoma and poor functional outcomes. METHODS Patients who underwent curative surgery for a primary tumor located in the rectosigmoid and rectum between 2013 and 2020 were identified from the nationwide Prospective Dutch Colorectal Cancer (PLCRC) cohort study. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, and the LARS-score at 12 months, 24 months and 36 months after surgery. RESULTS A total of 1,170 patients were included of whom 751 (64.2%) had no stoma, 122 (10.4%) had a stoma at primary surgery, 45 (3.8%) had a stoma at secondary surgery and 252 (21.5%) patients that underwent abdominoperineal resection (APR). Of all patients without a stoma, 41.4% reported major low-anterior resection syndrome (LARS). Patients without a stoma reported significantly better HRQoL. Moreover, patients without a stoma significantly reported an overall better HRQoL. CONCLUSION The presence of a stoma and poor functional outcomes were both associated with reduced HRQoL. Patients with poor functional outcomes, defined as major LARS, reported a similar level of HRQoL compared to patients with a stoma. In addition, the HRQoL after rectal cancer surgery does not change significantly after the first year after surgery.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - Jelle P A Algie
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Nagarajan G, Doshi P, Bardeskar NS, Kulkarni A, Punamiya A, Tongaonkar H. Association between sarcopenia and postoperative complications in patients undergoing surgery for gastrointestinal or hepato-pancreatico-biliary cancer. J Surg Oncol 2023; 128:682-691. [PMID: 37183521 DOI: 10.1002/jso.27315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite surgical advances, postoperative complications persist, affecting oncologic outcomes and increasing treatment costs. It is important to identify a marker that can predict postoperative complications, which can help prehabilitate patients before surgery. This study evaluated sarcopenia as a predictive marker of postoperative complications in patients undergoing surgery for gastrointestinal (GI) or hepato-pancreatico-biliary (HPB) cancer. METHODS Sarcopenia was assessed using the skeletal muscle index at the third lumbar vertebra on abdominal computed tomography. The predictive ability of sarcopenia was evaluated by adjusting for other clinicopathological factors. RESULTS Of the 210 patients, 81 (38.57%) were sarcopenic. The overall morbidity and mortality were 33.81% and 2.86%, respectively. Major complications (Clavien-Dindo Grade ≥ III) were observed in 10.95% patients and sarcopenic patients were significantly more likely to develop major complications (p = 1.42 × 10-10 ). Sarcopenia (p = 6.13 × 10-6 ; odds ratio = 12.29) independently predicted postoperative complications and prolonged hospital stay (p = 0.01). CONCLUSION Sarcopenia objectively predicted the development of postoperative complications and prolonged hospital stay in patients undergoing surgery for GI or HPB cancer. This may facilitate the prehabilitation of patients planned for surgery to reduce the risk of complications.
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Affiliation(s)
- Ganesh Nagarajan
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Pratik Doshi
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nikhil S Bardeskar
- Nanavati Max Institute of Cancer Care, Nanavati Max Super Speciality Hospital, Mumbai, India
| | - Aniruddha Kulkarni
- Department of Interventional Radiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Aditya Punamiya
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Hemant Tongaonkar
- Department of Surgical Oncology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
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Sliwinski S, Werneburg E, Faqar-Uz-Zaman SF, Detemble C, Dreilich J, Mohr L, Zmuc D, Beyer K, Bechstein WO, Herrle F, Malkomes P, Reissfelder C, Ritz JP, Vilz T, Fleckenstein J, Schnitzbauer AA. A toolbox for a structured risk-based prehabilitation program in major surgical oncology. Front Surg 2023; 10:1186971. [PMID: 37435472 PMCID: PMC10332323 DOI: 10.3389/fsurg.2023.1186971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/17/2023] [Indexed: 07/13/2023] Open
Abstract
Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients' resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3-6 weeks with 3-4 exercises per week that take 30-60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo-Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
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Affiliation(s)
- Svenja Sliwinski
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Elisabeth Werneburg
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Sara Fatima Faqar-Uz-Zaman
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Charlotte Detemble
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Julia Dreilich
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Lisa Mohr
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Dora Zmuc
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Katharina Beyer
- Department of General, Visceral and Vascular Surgery, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Florian Herrle
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Romed Klinik Prien am Chiemsee, Klinik für Allgemein- und Viszeralchirurgie, Prien am Chiemsee, Germany
| | - Patrizia Malkomes
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
| | - Christoph Reissfelder
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joerg P. Ritz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Helios Clinics Schwerin, Department for General and Visceral Surgery, Schwerin, Germany
| | - Tim Vilz
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
- Department of General, Visceral, Thoracic, and Vascular Surgery, University Hospital Bonn, Bonn, Germany
| | - Johannes Fleckenstein
- Institute of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- Department of Pain Medicine, Hospital Landsberg am Lech, Landsberg am Lech, Germany
| | - Andreas A. Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt/Main, Frankfurt/Main, Germany
- German Association for General and Visceral Surgery (DGAV), Surgical Work Force for Perioperative Medicine, Berlin, Germany
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8
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Sadlonova M, Katz NB, Jurayj JS, Flores L, Celano CM, von Arnim CA, Silver JK. Surgical prehabilitation in older and frail individuals: a scoping review. Int Anesthesiol Clin 2023; 61:34-46. [PMID: 36815461 PMCID: PMC10006316 DOI: 10.1097/aia.0000000000000394] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background: Older individuals who are scheduled for elective procedures often have co-morbidities at baseline and may be classified as frail. Both older age and frailty are associated with poor fitness and preoperative deconditioning, which can be predictors of postoperative complications. Prehabilitation aims to improve preoperative health in order to reduce complications and expedite postoperative recovery. To date, the effect of prehabilitation on improving outcomes in older and frail individuals is unclear, and the evidence in support of multi-modal treatments is evolving. Methods: In this scoping review, searches of PubMed and Cochrane Library between August 2012 and August 2022 were performed to identify studies investigating the efficacy of prehabilitation prior to surgical procedures. Results: A total of 36 articles were included in the review. Most of these examined the efficacy of unimodal (n=21) prehabilitation interventions, most commonly exercise therapy. Multimodal prehabilitation programs (n=15) included a variety of intervention components (e.g., exercise training, nutrition, psychological intervention or geriatric consultation). The most commonly studied populations were patients with gastrointestinal cancer (mostly colorectal cancer). Exercise therapy and multimodal interventions are likely to be of greatest impact on postoperative functional decline in patients awaiting total knee or hip arthroplasty, and cancer-related resection surgery (e.g., due to colorectal, gastric or lung cancer) in older and frail patients. Conclusions: Presurgical prehabilitation showed the potential to diminish postoperative outcomes in older and frail patients prior to surgery. However, adequately powered, randomized controlled, assessor blinded intervention trials demonstrating overall benefit of prehabilitation are needed. Aims This scoping review aims to summarize the current literature on the efficacy of prehabilitation in older and frail individuals who are undergoing surgical procedures in order to support clinical protocols and inform future research.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
- Department of Cardiovascular and Thoracic Surgery, University of Göttingen Medical Center, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Nicole B. Katz
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Jane S. Jurayj
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Laura Flores
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Christopher M. Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
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9
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van Kooten RT, Ravensbergen CJ, van Büseck SCD, Grootjans W, Peeters KCMJ, Holman FA, Heemskerk JWT, Wouters MWJM, Navas Cañete A, Tollenaar RAEM. Computed tomography-based preoperative muscle measurements as prognostic factors for anastomotic leakage following oncological sigmoid and rectal resections. J Surg Oncol 2023; 127:823-830. [PMID: 36620908 DOI: 10.1002/jso.27200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 01/01/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oncological sigmoid and rectal resections are accompanied with substantial risk of anastomotic leakage. Preoperative risk assessment and patient selection remain difficult, highlighting the importance of finding easy-to-use parameters. This study evaluates the prognostic value of contrast-enhanced (CE) computed tomography (CT)-based muscle measurements for predicting anastomotic leakage. METHODS Patients that underwent oncological sigmoid and rectal resections in the LUMC between 2016 and 2020 were included. Preoperative CE-CT scans, were analyzed using Vitrea software to measure total abdominal muscle area (TAMA) and total psoas area (TPA). Muscle areas were standardized using patient's height into: psoas muscle index (PMI) and skeletal muscle index (SMI) (cm2 /m2 ). RESULTS In total 46 patients were included, of which 13 (8.9%) suffered from anastomotic leakage. Patients with anastomotic leakage had a significantly lower PMI (22.1 vs. 25.1, p < 0.01) and SMI (41.8 vs. 46.6, p < 0.01). After adjusting for confounders (age and comorbidity), lower PMI (odds ratio [OR]: 0.85, 95% confidence interval [CI] 0.71-0.99, p = 0.03) and SMI (OR: 0.93, 95%CI 0.86-0.99, p = 0.02) were both associated with anastomotic leakage. CONCLUSION This study showed that lower PMI and SMI were associated with anastomotic leakage. These results indicate that preoperative CT-based muscle measurements can be used as prognostic factor for risk stratification for anastomotic leakage.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Cor J Ravensbergen
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabian A Holman
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan W T Heemskerk
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Ana Navas Cañete
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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10
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Strijker D, Meijerink WJHJ, van Heusden-Schotalbers LAG, van den Berg MGA, van Asseldonk MJMD, Drager LD, de Wilt JHW, van Laarhoven KJHM, van den Heuvel B. Multimodal Prehabilitation in Patients Undergoing Complex Colorectal Surgery, Liver Resection, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Pilot Study on Feasibility and Potential Efficacy. Cancers (Basel) 2023; 15:cancers15061870. [PMID: 36980756 PMCID: PMC10047129 DOI: 10.3390/cancers15061870] [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: 02/10/2023] [Revised: 03/10/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Surgery for complex primary and metastatic colorectal cancer (CRC), such as liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), in academic settings has led to improved survival but is associated with complications up to 75%. Prehabilitation has been shown to prevent complications in non-academic hospitals. This pilot study aimed to determine the feasibility and potential efficacy of a multimodal prehabilitation program in patients undergoing surgery in an academic hospital for complex primary and metastatic CRC. METHODS All patients awaiting complex colorectal surgery, liver resection, or HIPEC from July 2019 until January 2020 were considered potentially eligible. Feasibility was measured by accrual rate, completion rate, adherence to the program, satisfaction, and safety. To determine potential efficacy, postoperative outcomes were compared with a historical control group. RESULTS Sixteen out of twenty-five eligible patients (64%) commenced prehabilitation, and fourteen patients fully completed the intervention (88%). The adherence rate was 69%, as 11 patients completed >80% of prescribed supervised trainings. No adverse events occurred, and all patients expressed satisfaction with the program. The complication rate was significantly lower in the prehabilitation group (37.5%) than the control group (70.2%, p = 0.020). There was no difference in the type of complications. CONCLUSION This pilot study illustrates that multimodal prehabilitation is feasible in the majority of patients undergoing complex colorectal cancer, liver resection, and HIPEC in an academic setting.
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Affiliation(s)
- Dieuwke Strijker
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | | | - Manon G A van den Berg
- Department of Gastroenterology and Hepatology-Dietetics and Intestinal Failure, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Monique J M D van Asseldonk
- Department of Gastroenterology and Hepatology-Dietetics and Intestinal Failure, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Luuk D Drager
- Department of Operating Rooms, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Baukje van den Heuvel
- Department of Operating Rooms, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
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11
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Cui H, Zhao D, Jian J, Zhang Y, Jian M, Yu B, Hu J, Li Y, Han X, Jiang L, Wang X. Risk factor analysis and construction of prediction models for short-term postoperative complications in patients undergoing gastrointestinal tract surgery. Front Surg 2023; 9:1003525. [PMID: 36684321 PMCID: PMC9845637 DOI: 10.3389/fsurg.2022.1003525] [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: 07/26/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose To identify risk factors associated with short-term postoperative complications in patients with gastrointestinal cancer and develop and validate prediction models to predict the probability of complications. Methods A total of 335 patients enrolled in the primary cohort of this study were divided into training and validation sets in a chronological order. Using univariate and multivariate logistic regression analyses, the risk factors for postoperative complications were determined, and nomogram prediction models were constructed. The performance of the nomogram was assessed with respect to the receiver operator characteristic and calibration curves. Results Patients with complications had a stronger postoperative stress response and a longer duration of daily fluid intake/output ratio >1 after surgery. Logistic analysis revealed that body mass index (BMI), body temperature on POD4 (T.POD4), neutrophil percentage on POD4 (N.POD4), fasting blood glucose on POD4 (FBG.POD4), and the presence of fluid intake/output ratio <1 within POD4 were risk factors for POD7 complications, and that BMI, T.POD7, N.POD7, FBG.POD4, FBG.POD7, and the duration of daily fluid intake/output ratio >1 were risk factors for POD30 complications. The areas under the curve of Nomogram-A for POD7 complications were 0.867 and 0.833 and those of Nomogram-B for POD30 complications were 0.920 and 0.918 in the primary and validation cohorts, respectively. The calibration curves showed good consistency in both cohorts. Conclusion This study presented two nomogram models to predict short-term postoperative complications in patients with gastrointestinal cancer. The results could help clinicians identify patients at high risk of complications within POD7 or POD30.
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Affiliation(s)
- Hongming Cui
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Dawei Zhao
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jingren Jian
- Department of Surgical Department, Jinxiang Hongda Hospital Affiliated to Jining Medical University, Jining, China
| | - Yifei Zhang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Mi Jian
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Bin Yu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jinchen Hu
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yanbao Li
- Department of Surgical Department, Yantai Yeda Hospital, Yantai, China
| | - Xiaoli Han
- Department of Surgical Department, Yantai Yeda Hospital, Yantai, China
| | - Lixin Jiang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Department of Surgical Department, Yantai Yeda Hospital, Yantai, China,Correspondence: Lixin Jiang Xixun Wang
| | - Xixun Wang
- Department of Gastrointestinal Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China,Correspondence: Lixin Jiang Xixun Wang
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12
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van Kooten RT, Elske van den Akker-Marle M, Putter H, Meershoek-Klein Kranenbarg E, van de Velde CJH, Wouters MWJM, Tollenaar RAEM, Peeters KCMJ. The Impact of Postoperative Complications on Short- and Long-Term Health-Related Quality of Life After Total Mesorectal Excision for Rectal Cancer. Clin Colorectal Cancer 2022; 21:325-338. [PMID: 36210321 DOI: 10.1016/j.clcc.2022.07.004] [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: 01/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Survival for rectal cancer patients has improved over the past decades. In parallel, long-term health-related quality of life (HRQoL) is gaining interest. This study focuses on the effect of complications following rectal cancer surgery on HRQoL and survival. METHODS The TME-trial (1996-1999) randomized patients with operable rectal cancer between surgery with preoperative short-course radiotherapy and surgery. Questionnaires including the Rotterdam Symptom Checklist were sent at 6 time points within the first 24 months and after 14 years the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Differences in HRQoL and survival between patients with and without complications were analyzed. RESULTS A total of 1207 patients were included, of which 482 (39.9%) patients experienced complications, surgical complications occurred in 177 (14.6%) patients, non-surgical complications in 197 (16.3%) and 108 patients (8.9%) had a combination of both types of complications. Three months after surgery, patients with a combination of surgical- and non-surgical complications, especially patients with anastomotic leakage, had the worst HRQoL. Twelve months postoperative HRQoL returned to a similar level as before surgery, regardless of complications. In patients who survived 14 years, no significant differences in HRQoL were seen between patients with and without complications. However, patients with complications did have lower overall survival. CONCLUSION This study shows that survival and short-term HRQoL are negatively affected by complications. Twelve months after surgery HRQoL had returned to the preoperative level regardless, of complications. Also, in patients that survived 14 years, there was no effect of complications on HRQoL detected.
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Affiliation(s)
- Robert T van Kooten
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Hein Putter
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Michel W J M Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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13
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Gao B, Li X, Chen W, Wang S, He J, Liu Y, Ding C, Chen X. The associations between lipid profiles and visceral obesity among gastrointestinal cancer patients: a cross-sectional study. Lipids Health Dis 2022; 21:102. [PMID: 36242019 PMCID: PMC9563782 DOI: 10.1186/s12944-022-01707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Visceral obesity is associated with cancer incidence and prognosis. Altered lipid profiles are frequently seen in visceral obese patients. The blood test of lipid profiles is more convenient and has no radical side effects than computed tomography (CT), which is presently the most accurate way to measure visceral fat area. This article aims to investigate the associations between lipid profiles and visceral obesity in gastrointestinal cancer patients. Methods In total, 399 patients newly diagnosed with gastrointestinal cancer were enrolled in this observational study. Lipid profiles were obtained from blood samples, and visceral fat mass area (VFA) was measured by CT. VFA ≥ 100 cm2 was considered visceral obesity. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate the prognostic powers of lipid parameters for viscerally obese gastrointestinal cancer patients. Results Patients who had visceral obesity had higher triglyceride (TG) levels (1.20 ± 0.60 vs. 0.87 ± 0.57 mmo/L, P < 0.001), total cholesterol (TC) levels (3.57 ± 0.84 vs. 3.40 ± 0.82, P = 0.044), and low-density lipoprotein (LDL-C) levels (2.08 ± 0.66 vs. 1.94 ± 0.66, P = 0.047) and lower high-density lipoprotein (HDL-C) levels (0.88 ± 0.24 vs. 1.00 ± 0.26, P < 0.001) than those in the normal group. TG was positively correlated with VFA (r = 0.299, P < 0.001), while HDL-C was inversely correlated with VFA (r = -0.237, P < 0.001). TG and HDL-C had predictive capacity for visceral obesity at cutoff levels of 0.92 mmol/L (AUROC 0.700, 95% CI, 0.653–0.745, P < 0.001) and 0.98 mmol/L (AUROC 0.700, 95% CI, 0.585–0.682, P < 0.001), respectively. TG > 0.92 mmol/L with HDL-C < 0.98 mmol/L was linked with an increased risk of visceral obesity (OR = 4.068, 95% CI, 2.338—7.079, P < 0.001). Conclusions Lipid profiles were significantly correlated with VFA. Gastrointestinal cancer patients with TG > 0.92 mmol/L and HDL-C < 0.98 mmol/L were at elevated risk of visceral obesity in the Chinese population. Identifying visceral obesity and taking proper actions in gastrointestinal cancers are helpful for overall tumor prognosis.
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Affiliation(s)
- Bo Gao
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Xiangrui Li
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Wenqing Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Shu'an Wang
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China
| | - Jian He
- Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China
| | - Yu Liu
- Department of Gynecology and Obstetrics, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 1 Tianfei Road, Qinhuai District, Nanjing, China
| | - Chao Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Gulou District, 321 Zhongshan Road, Nanjing, China.
| | - Xiaotian Chen
- Department of Clinical Nutrition, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Gulou District, Nanjing, China.
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14
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Sekiguchi K, Matsuda A, Yamada M, Matsumoto S, Sakurazawa N, Kawano Y, Yamada T, Miyashita M, Yoshida H. The utility of serum osteopontin levels for predicting postoperative complications after colorectal cancer surgery. Int J Clin Oncol 2022; 27:1706-1716. [PMID: 35951171 DOI: 10.1007/s10147-022-02225-6] [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: 03/09/2022] [Accepted: 07/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND/AIM Osteopontin (OPN) is a secretory glycoprotein, which is expressed not only in osteoblasts, but immune cells including macrophages and activated T cells. Its pleiotropic immune functions, such as bone remodeling, cancer progression, immune response, and inflammation have been reported previously. However, the association between OPN and postoperative complications (POC) after colorectal cancer (CRC) surgery has not been studied, so far. METHODS Peripheral blood samples were collected before (pre) and immediately after surgery (post), and on postoperative days (POD) 1, 3, 5, and 7. Serum OPN levels were measured by ELISA. In total, 78 patients who underwent elective CRC surgery were divided into the No-POC (n = 54) and POC (n = 24) groups. RESULTS The POC group had significantly higher OPN levels than the No-POC group throughout the postoperative observation period. The maximum OPN levels from pre- to postsurgical samples showed the best predictive potential for POCs (cut off: 20.75 ng/mL, area under the curve: 0.724) and were correlated with length of postoperative stays. OPN values were significantly correlated with C-reactive protein on POD3 and were identified as an independent predictive marker for POCs (odds ratio: 3.88, 95% CI: 1.175-12.798, P = 0.026). The severity of POCs was reflected in increased OPN levels. CONCLUSION Increased postoperative OPN was associated with increased postoperative inflammatory host responses and POC after CRC surgery. Serum OPN level may be a useful biomarker for early prediction of POC and it may provide additional information for treatment decisions to prevent POC.
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Affiliation(s)
- Kumiko Sekiguchi
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan.,Department of Surgery, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo, 206-8512, Japan
| | - Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan. .,Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Marina Yamada
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan.,Faculty of Medical Science, Nippon Sport Science University, 1221-1 Kamoshida-cho, Aoba-ku, Yokohama, Kanagawa, 227-0033, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan
| | - Nobuyuki Sakurazawa
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan.,Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Youichi Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Masao Miyashita
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari , Inzai, Chiba, 270-1694, Japan
| | - Hiroshi Yoshida
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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15
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Algie JPA, van Kooten RT, Tollenaar RAEM, Wouters MWJM, Peeters KCMJ, Dekker JWT. Stoma versus anastomosis after sphincter-sparing rectal cancer resection; the impact on health-related quality of life. Int J Colorectal Dis 2022; 37:2197-2205. [PMID: 36156128 PMCID: PMC9560940 DOI: 10.1007/s00384-022-04257-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical resection is the mainstay of curative treatment for rectal cancer. Post-operative complications, low anterior resection syndrome (LARS), and the presence of a stoma may influence the quality of life after surgery. This study aimed to gain more insights into the long-term trade-off between stoma and anastomosis. METHODS All patients who underwent sphincter-sparing surgical resection for rectal cancer in the Leiden University Medical Center and the Reinier de Graaf Gasthuis between January 2012 and January 2016 were included. Patients received the following questionnaires: EORTC-QLQ-CR29, EORTC-QLQ-C30, EQ-5D-5L, and the LARS score. A comparison was made between patients with a stoma and without a stoma after follow-up. RESULTS Some 210 patients were included of which 149 returned the questionnaires (70.9%), after a mean follow-up of 3.69 years. Overall quality of life was not significantly different in patients with and without stoma after follow-up using the EORTC-QLQ-C30 (p = 0.15) or EQ-5D-5L (p = 0.28). However, after multivariate analysis, a significant difference was found for the presence of a stoma on global health status (p = 0.01) and physical functioning (p < 0.01). Additionally, there was no difference detected in the quality of life between patients with major LARS or a stoma. CONCLUSION This study shows that after correction for possible confounders, a stoma is associated with lower global health status and physical functioning. However, no differences were found in health-related quality of life between patients with major LARS and patients with a stoma. This suggests that the choice between stoma and anastomosis is mainly preferential and that shared decision-making is required.
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Affiliation(s)
- Jelle P. A. Algie
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Robert T. van Kooten
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Rob A. E. M. Tollenaar
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
| | - Michel W. J. M. Wouters
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands ,Department of Surgery, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Koen C. M. J. Peeters
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, J10-71, 2333 ZA Leiden, The Netherlands
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