|
1
|
Kou HW, Hsu CP, Chen YF, Huang JF, Chang SC, Lee CW, Wang SY, Yeh CN, Yeh TS, Hwang TL, Hsu JT. The Severity of Postoperative Pancreatic Fistula Predicts 30-Day Unplanned Hospital Visit and Readmission after Pancreaticoduodenectomy: A Single-Center Retrospective Cohort Study. Healthcare (Basel) 2022; 10:126. [PMID: 35052290 PMCID: PMC8775671 DOI: 10.3390/healthcare10010126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Unplanned hospital visits (UHV) and readmissions after pancreaticoduodenectomy (PD) impact patients' postoperative recovery and are associated with increased financial burden and morbidity. The aim of this study is to identify predictive factors related to these events and target the potentially preventable UHV and readmissions. METHODS We enrolled 518 patients in this study. Characteristics were compared between patients with or without UHV and readmissions. RESULTS The unplanned visit and readmission rate was 23.4% and 15.8%, respectively. Postoperative pancreatic fistula (POPF) grade B or C, the presence of postoperative biliary drainage, and reoperation were found to be predictive factors for UHV, whereas POPF grade B or C and the presence of postoperative biliary drainage were independently associated with hospital readmission. The most common reason for readmission was an infection, followed by failure to thrive. The overall mortality rate in the readmission group was 4.9%. CONCLUSIONS UHV and readmissions remain common among patients undergoing PD. Patients with grade B or C POPF assessed during index hospitalization harbor an approximately two-fold increased risk of subsequent unplanned visits or readmissions compared to those with no POPF or biochemical leak. Proper preventive strategies should be adopted for high-risk patients in this population to maintain the continuum of healthcare and improve quality.
Collapse
Affiliation(s)
- Hao-Wei Kou
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Chih-Po Hsu
- Department of Surgery, Division of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (C.-P.H.); (J.-F.H.)
| | - Yi-Fu Chen
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Jen-Fu Huang
- Department of Surgery, Division of Trauma and Emergency Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (C.-P.H.); (J.-F.H.)
| | - Shih-Chun Chang
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Chao-Wei Lee
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Shang-Yu Wang
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Chun-Nan Yeh
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Ta-Sen Yeh
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Tsann-Long Hwang
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| | - Jun-Te Hsu
- Department of Surgery, Division of General Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City 333, Taiwan; (H.-W.K.); (Y.-F.C.); (S.-C.C.); (C.-W.L.); (S.-Y.W.); (C.-N.Y.); (T.-S.Y.); (T.-L.H.)
| |
Collapse
|
|
2
|
Lee CM, Lee S, Lee D, Park S. How Does Combined Resection Affect the Clinical Outcomes After Laparoscopic Surgery for Serosa-Positive Gastric Cancer?: A Retrospective Cohort Study to Investigate the Short-Term Outcomes of Laparoscopic Combined Resection in Patients With T4b Gastric Cancer. Front Oncol 2020; 9:1564. [PMID: 32083016 PMCID: PMC7002542 DOI: 10.3389/fonc.2019.01564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Only few surgeons have tried to perform laparoscopic combined resection for T4b gastric cancer. The purpose of this study was to investigate the feasibility of laparoscopic combined resection through a comparison of the clinical outcomes between cT4a and cT4b cases. Methods: We reviewed the medical charts of patients who underwent laparoscopic gastrectomy for clinically T4 gastric cancer from May 2014 and July 2018. During this period, 62 patients with serosa-positive gastric cancer underwent laparoscopic curative surgery. The patients were divided into the following groups: patients who underwent gastrectomy and combined resection for the invaded organs (combined resection group) and those who did not undergo combined organ surgery (gastrectomy only group). Clinical outcomes were compared between the gastrectomy only and combined resection groups. Results: Of 62 patients included in this study, 43 and 19 patients were included in the gastrectomy only and combined resection groups, respectively. The operation time was significantly longer in the combined resection group (364.6 ± 102.5 vs. 247.7 ± 66.1 min; p < 0.001). The incidence of grade ≥ III complications was comparable between the groups (26.3% vs. 11.6%; p = 0.147). The time from the first operation to the initiation of adjuvant chemotherapy showed no statistically significant difference between the groups (48.1 ± 45.4 days vs. 31.6 ± 9.2; p = 0.134). Conclusions: Focusing on the high quality of image and new devices of laparoscopic surgery, it is necessary to re-evaluate the oncologic outcomes of combined resection for T4b gastric cancer.
Collapse
Affiliation(s)
- Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
- Department of Surgery, Korea University Medical Center Ansan Hospital, Ansan, South Korea
| | - San Lee
- Department of Surgery, Korea University Medical Center Ansan Hospital, Ansan, South Korea
| | - Danbi Lee
- Department of Surgery, Korea University Medical Center Ansan Hospital, Ansan, South Korea
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
- Department of Surgery, Korea University Medical Center Anam Hospital, Seoul, South Korea
| |
Collapse
|
|
3
|
Lee CM, Yoon SY, Park S, Park SH. Laparoscopic Whipple's Operation for Locally Advanced Gastric Cancer Invading the Pancreas and Duodenum: a Case Report. J Gastric Cancer 2019; 19:484-492. [PMID: 31897350 PMCID: PMC6928087 DOI: 10.5230/jgc.2019.19.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/24/2019] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
Few surgeons have adopted pancreaticoduodenectomy (PD) for the treatment of advanced gastric cancer (AGC) invading the pancreas or duodenum because it remains controversial whether its prognostic benefits outweigh the high morbidity rates in such advanced cases. However, recent technical advances have revived diverse surgical procedures in minimally invasive approaches. Inspired by this trend, laparoscopic PD procedures have been performed for AGC in our institute since 2014. We recently performed a laparoscopic Whipple's operation in a case of cT4b gastric cancer with invasion of the pancreatic head and duodenum.
Collapse
Affiliation(s)
- Chang Min Lee
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Sam-Youl Yoon
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Sungsoo Park
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Seong-Heum Park
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|