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Magnin J, Bernard A, Cottenet J, Lequeu JB, Ortega-Deballon P, Quantin C, Facy O. Impact of hospital volume in liver surgery on postoperative mortality and morbidity: nationwide study. Br J Surg 2023; 110:441-448. [PMID: 36724824 DOI: 10.1093/bjs/znac458] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/17/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND This nationwide retrospective study was undertaken to evaluate impact of hospital volume and influence of liver transplantation activity on postoperative mortality and failure to rescue after liver surgery. METHODS This was a retrospective study of patients who underwent liver resection between 2011 and 2019 using a nationwide database. A threshold of surgical activities from which in-hospital mortality declines was calculated. Hospitals were divided into high- and low-volume centres. Main outcomes were in-hospital mortality and failure to rescue. RESULTS Among 39 286 patients included, the in-hospital mortality rate was 2.8 per cent. The activity volume threshold from which in-hospital mortality declined was 25 hepatectomies. High-volume centres (more than 25 resections per year) had more postoperative complications but a lower rate of in-hospital mortality (2.6 versus 3 per cent; P < 0.001) and failure to rescue (5 versus 6.3 per cent; P < 0.001), in particular related to specific complications (liver failure, biliary complications, vascular complications) (5.5 versus 7.6 per cent; P < 0.001). Liver transplantation activity did not have an impact on these outcomes. CONCLUSION From more than 25 liver resections per year, rates of in-hospital mortality and failure to rescue declined. Management of specific postoperative complications appeared to be better in high-volume centres.
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Affiliation(s)
- Josephine Magnin
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Alain Bernard
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France.,Department of Thoracic and Cardiovascular Surgery, University Hospital of Dijon, Dijon, France
| | - Jonathan Cottenet
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France
| | - Jean-Baptiste Lequeu
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - Catherine Quantin
- Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Centre, University Hospital of Dijon, Dijon, France
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
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Lequeu JB, Cottenet J, Facy O, Perrin T, Bernard A, Quantin C. Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients. HPB (Oxford) 2021; 23:1410-1417. [PMID: 33622649 DOI: 10.1016/j.hpb.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND FTR appears as a major cause of postoperative mortality (POM). Hospital volume has an impact on FTR in pancreatic surgery but no study has investigated this relationship more specifically in DP. METHODS We analysed patients with DP between 2009 and 2018 through a nationwide database. FTR definition was mortality among patients who experiment major complications. The cutoff between high and low volume centers was 20 pancreatectomies per year. RESULTS Some 10,632 patients underwent DP, 5048 (47.5%) were operated in 602 (95.4%) low volume centers and 5584 (52.5%) in 29 (4.6%) high volume centers. Overall FTR occurred in 11.2% of patients and was significantly reduced in high volume centers compared to low volume centers (10.2% vs 12.5%, p = 0.047). In multivariate analysis, surgery in a high volume center was a protective factor for POM (OR = 0.570, CI95% [0.505-0.643], p < 0.001) and also for FTR (OR = 0.550, CI95% [0.486-0.630], p < 0.001). CONCLUSION Hospital volume has a positive impact on FTR in DP. Patients with higher risk of FTR are men, with high modified Charlson comorbidity index, malignant conditions and open procedures.
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Affiliation(s)
- Jean-Baptiste Lequeu
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France.
| | - Jonathan Cottenet
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
| | - Olivier Facy
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Thomas Perrin
- Dijon University Hospital, Department of Digestive Surgical Oncology, Dijon F-21000, France
| | - Alain Bernard
- Dijon University Hospital, Department of Thoracic Surgery, Dijon F-21000, France
| | - Catherine Quantin
- Dijon University Hospital, Clinical Epidemiology/Clinical Trials Unit, Clinical Investigation Center, Dijon F-21000, France
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Guyot A, Lequeu JB, Dransart-Rayé O, Chevallier O, Nguyen M, Charles PE, Mouillot T, Manfredi S, Degand T. [Management of acute pancreatitis. A literature review]. Rev Med Interne 2021; 42:625-632. [PMID: 33676780 DOI: 10.1016/j.revmed.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/02/2020] [Accepted: 01/09/2021] [Indexed: 12/07/2022]
Abstract
The management of acute pancreatitis is now fairly codified, with specific recommendations developed by expert groups. These recommendations deal in particular with the minimum initial assessment, recognized severity scores, initial medical management with hyperhydration, preventive anticoagulation, early refeeding, delays in imaging and management of complications. In this work, we have tried to bring together the various recommendations, articles and studies dealing with this subject, based more particularly on European recommendations, in order to guide the management of acute pancreatitis in current practice.
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Affiliation(s)
- A Guyot
- Service d'hépato-gastro-entérologie, CHU de Dijon F.-Mitterrand Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - J B Lequeu
- Chirurgie viscérale, digestive et endocrinienne, CHU de Dijon, Dijon, France.
| | - O Dransart-Rayé
- Département d'anesthésie réanimation, CHU de Dijon, Dijon, France.
| | - O Chevallier
- Département de radiologie diagnostique et thérapeutique, CHU de Dijon, Dijon, France.
| | - M Nguyen
- Département d'anesthésie réanimation, CHU de Dijon, Dijon, France.
| | - P E Charles
- Médecine intensive réanimation, CHU de Dijon, Dijon, France.
| | - T Mouillot
- Service d'hépato-gastro-entérologie, CHU de Dijon F.-Mitterrand Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - S Manfredi
- Service d'hépato-gastro-entérologie, CHU de Dijon F.-Mitterrand Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
| | - T Degand
- Service d'hépato-gastro-entérologie, CHU de Dijon F.-Mitterrand Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21000 Dijon, France.
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Doussot A, Bouvier A, Santucci N, Lequeu JB, Cheynel N, Ortega-Deballon P, Rat P, Facy O. Pancreatic ductal adenocarcinoma and paraaortic lymph nodes metastases: The accuracy of intraoperative frozen section. Pancreatology 2019; 19:710-715. [PMID: 31174978 DOI: 10.1016/j.pan.2019.05.465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/11/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) with paraaortic lymph nodes metastases (PALN +) is associated with poor survival. Still, there are no current guidelines advocating systematic detection of PALN+. METHODS All consecutive patients who underwent surgical exploration/resection with concurrent paraaortic (group 16) lymphadenectomy for PDAC between 2009 and 2016 were considered for inclusion. Resection was systematically aborted in case of intraoperative PALN + detection. Diagnostic performance of preoperative imaging upon blind review and intraoperative PALN dissection with frozen section (FS) for PALN detection were evaluated. Additionally, the prognostic significance of PALN + on overall survival (OS) was analyzed. RESULTS Over the study period, among 129 patients undergoing surgery for PDAC, 113 had intraoperative PALN dissection with FS analysis. Median number of resected PALN was 3 (range, 1-15). Overall, PALN+ was found in 19 patients (16.8%). Upon blind review, preoperative imaging performed poorly for PALN + detection with a low agreement between imaging and final pathology (Kappa-Cohen index<0.2). In contrast, PALN FS showed high detection performances and strong agreement with final pathology (Kappa-Cohen index = 0.783, 95%CI 0.779-0.867, p < 0.001). Regarding survival outcomes, there was no difference between patients with PALN+ and patients not resected in the setting of liver metastases or locally unresectable disease found at exploration (p = 0.708). CONCLUSIONS Before PD for PDAC, intraoperative PALN dissection and FS analysis yields accurate PALN assessment and allows appropriate patient selection. This should be routinely performed and aborting resection should be strongly considered in case of PALN+.
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Affiliation(s)
- Alexandre Doussot
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; Department of Digestive Surgical Oncology - Liver Transplantation Unit, University Hospital of Besançon, France.
| | - Aurélie Bouvier
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | - Nicolas Santucci
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | | | - Nicolas Cheynel
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | | | - Patrick Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
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Santucci N, Facy O, Ortega-Deballon P, Lequeu JB, Rat P, Rat P. CA 19-9 predicts resectability of pancreatic cancer even in jaundiced patients. Pancreatology 2018; 18:666-670. [PMID: 30153902 DOI: 10.1016/j.pan.2018.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/28/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia. AIM OF THE STUDY To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients. METHODS All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19-9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19-9 was calculated. In jaundiced patients, a CA 19-9 adjusted for bilirubinemia was also evaluated. RESULTS Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19-9 as a predictor of resectability was 0.886 (95%CI:[0.832-0.932]); in jaundiced patients it was 0.880 (95% CI [0.798-0.934]. A cut-off in CA 19-9 at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19-9 (r = 0.149). CONCLUSION Serum CA 19-9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease.
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Affiliation(s)
- Nicolas Santucci
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France.
| | - Olivier Facy
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
| | | | - Paul Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France
| | - Patrick Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, France; INSERM Unit 866, Dijon, France
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Desiderio J, Jiang ZW, Nguyen NT, Zhang S, Reim D, Alimoglu O, Azagra JS, Yu PW, Coburn NG, Qi F, Jackson PG, Zang L, Brower ST, Kurokawa Y, Facy O, Tsujimoto H, Coratti A, Annecchiarico M, Bazzocchi F, Avanzolini A, Gagniere J, Pezet D, Cianchi F, Badii B, Novotny A, Eren T, Leblebici M, Goergen M, Zhang B, Zhao YL, Liu T, Al-Refaie W, Ma J, Takiguchi S, Lequeu JB, Trastulli S, Parisi A. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer-IMIGASTRIC. BMJ Open 2015; 5:e008198. [PMID: 26482769 PMCID: PMC4611863 DOI: 10.1136/bmjopen-2015-008198] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. METHODS AND ANALYSIS A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. ETHICS AND DISSEMINATION This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. TRIAL REGISTRATION NUMBER NCT02325453; Pre-results.
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Affiliation(s)
- Jacopo Desiderio
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
| | - Zhi-Wei Jiang
- Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Ninh T Nguyen
- Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Shu Zhang
- Department of General Surgery, Jinling Hospital, Medical School, Nanjing University, Nanjing, China
| | - Daniel Reim
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Orhan Alimoglu
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Juan-Santiago Azagra
- Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Pei-Wu Yu
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Natalie G Coburn
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Feng Qi
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Patrick G Jackson
- Division of General Surgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Lu Zang
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Steven T Brower
- Department of Surgical Oncology and HPB Surgery, Englewood Hospital and Medical Center, Englewood, New Jersey, USA
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Olivier Facy
- Service de chirurgie digestive et cancérologique CHU Bocage. Dijon, France
| | - Hironori Tsujimoto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Andrea Coratti
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Mario Annecchiarico
- Division of Oncological and Robotic Surgery, Department of Oncology, Careggi University Hospital, Florence, Italy
| | - Francesca Bazzocchi
- Department of General Surgery, Division of General, Gastroenterologic and Minimally Invasive Surgery, GB Morgagni Hospital, Forlì, Italy
| | - Andrea Avanzolini
- Department of General Surgery, Division of General, Gastroenterologic and Minimally Invasive Surgery, GB Morgagni Hospital, Forlì, Italy
| | - Johan Gagniere
- Digestive and Hepatobiliary Surgery Department, University of Auvergne, University Hospital Estaing, Clermont-Ferrand, France
| | - Denis Pezet
- Digestive and Hepatobiliary Surgery Department, University of Auvergne, University Hospital Estaing, Clermont-Ferrand, France
| | - Fabio Cianchi
- Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Florence, Italy
| | - Benedetta Badii
- Department of Surgery and Translational Medicine, Center of Oncological Minimally Invasive Surgery (COMIS), University of Florence, Florence, Italy
| | - Alexander Novotny
- Chirurgische Klinik und Poliklinik, Klinikum Rechts der Isar der Technischen Universität München, München, Germany
| | - Tunc Eren
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Metin Leblebici
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Martine Goergen
- Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE), Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Ben Zhang
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Yong-Liang Zhao
- Department of General Surgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Tong Liu
- Department of Gastrointestinal Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Waddah Al-Refaie
- Division of General Surgery, Medstar Georgetown University Hospital, Washington DC, USA
| | - Junjun Ma
- Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Stefano Trastulli
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
| | - Amilcare Parisi
- Department of Digestive Surgery, St Mary's Hospital, University of Perugia, Terni, Italy
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