Showing papers in "Annals of Surgery in 2016"
TL;DR: This is the largest review of LLR available to date and suggests that LLR may offer improved patient short-term outcomes compared with OLR, and improving levels of evidence, standardized reporting of outcomes, and assuring proper training are the next challenges of laparoscopic liver surgery.
Abstract: Objective:To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses.Summary Background Data:There are no updated pooled data since 2009 about the current status and short-term out
569 citations
TL;DR: Utilization of a goal-directed, TEG-guided MTP to resuscitate severely injured patients improves survival compared with an MTP guided by CCA and utilizes less plasma and platelet transfusions during the early phase of resuscitation.
Abstract: Background
Massive transfusion protocols (MTPs) have become standard of care in the management of bleeding injured patients, yet strategies to guide them vary widely. We conducted a pragmatic, randomized clinical trial (RCT) to test the hypothesis that an MTP goal directed by the viscoelastic assay thrombelastography (TEG) improves survival compared with an MTP guided by conventional coagulation assays (CCA).
479 citations
TL;DR: LADG for patients with clinical stage I gastric cancer is safe and has a benefit of lower occurrence of wound complication compared with conventional ODG.
Abstract: Objective:To determine the safety of laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with clinical stage I gastric cancer in Korea.Background:There is still a lack of large-scale, multicenter randomized trials regarding the safety of LADG.Method
467 citations
TL;DR: Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.
Abstract: Background and Objective:The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph
389 citations
TL;DR: Reference centers are critical to outcomes of RPS patients, as the management strategy requires specific expertise, and Histologic subtype predicts patterns of recurrence and should inform management decision.
Abstract: Background:Retroperitoneal sarcomas (RPS) are rare tumors composed of several well defined histologic subtypes. The aim of this study was to analyze patterns of recurrence and treatment variations in a large population of patients, treated at reference centers.Methods:All consecutive patients with p
367 citations
TL;DR: Folfirinox seems to be the most effective protocol resulting in a significantly better secondary resection rate and overall survival than other treatments and should be considered in all patients fit for this regimen and consecutive surgical exploration.
Abstract: Objective:For patients with locally advanced and unresectable pancreatic cancer (PDAC), neodadjuvant treatment and consecutive surgical exploration have been studied during the last decade with various neoadjuvant therapies including chemotherapy and combinations with radiation. Aim of the study was
365 citations
TL;DR: Clip placement in the biopsy-proven node at diagnosis and evaluation of resected specimens for the clipped node should be considered when conducting SLN surgery in this setting.
Abstract: Background The American College of Surgeons Oncology Group Z1071 trial reported a false-negative rate (FNR) of 12.6% with sentinel lymph node (SLN) surgery after neoadjuvant chemotherapy in women presenting with node-positive breast cancer. One proposed method to decrease the FNR is clip placement in the positive node at initial diagnosis with confirmation of clipped node resection at surgery. Methods Z1071 was a multi-institutional trial wherein women with clinical T0-T4,N1-N2,M0 breast cancer underwent SLN surgery and axillary dissection (ALND) after neoadjuvant chemotherapy. In cases with a clip placed in the node, the clip location at surgery (SLN or ALND) was evaluated. Results A clip was placed at initial node biopsy in 203 patients. In the 170 (83.7%) patients with cN1 disease and at least 2 SLNs resected, clip location was confirmed in 141 cases. In 107 (75.9%) patients where the clipped node was within the SLN specimen, the FNR was 6.8% (confidence interval [CI]: 1.9%-16.5%). In 34 (24.1%) cases where the clipped node was in the ALND specimen, the FNR was 19.0% (CI: 5.4%-41.9%). In cases without a clip placed (n = 355) and in those where clipped node location was not confirmed at surgery (n = 29), the FNR was 13.4% and 14.3%, respectively. Conclusions Clip placement at diagnosis of node-positive disease with removal of the clipped node during SLN surgery reduces the FNR of SLN surgery after neoadjuvant chemotherapy. Clip placement in the biopsy-proven node at diagnosis and evaluation of resected specimens for the clipped node should be considered when conducting SLN surgery in this setting.
338 citations
TL;DR: The ImmunoScore (IS) could markedly improve the prediction of postsurgical survival and chemotherapeutic benefits in gastric cancer (GC) and complemented the prognostic value of the TNM staging system.
Abstract: Objective:We postulated that the ImmunoScore (IS) could markedly improve the prediction of postsurgical survival and chemotherapeutic benefits in gastric cancer (GC).Summary Background Data:A prediction model for GC patients was developed using data from 879 consecutive patients.Methods:The expressi
302 citations
TL;DR: A multicenter prospective randomized controlled trial comparing pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy was conducted in this paper.
Abstract: Objectives:To assess pancreatic fistula rate and secondary endpoints after pancreatogastrostomy (PG) versus pancreatojejunostomy (PJ) for reconstruction in pancreatoduodenectomy in the setting of a multicenter randomized controlled trial.Background:PJ and PG are established methods for reconstruction in pancreatoduodenectomy. Recent prospective trials suggest superiority of the PG regarding perioperative complications.Methods:A multicenter prospective randomized controlled trial comparing PG with PJ was conducted involving 14 German high-volume academic centers for pancreatic surgery. The primary endpoint was clinically relevant postoperative pancreatic fistula. Secondary endpoints comprised perioperative outcome and pancreatic function and quality of life measured at 6 and 12 months of follow-up.Results:From May 2011 to December 2012, 440 patients were randomized, and 320 were included in the intention-to-treat analysis. There was no significant difference in the rate of grade B/C fistula after PG versus PJ (20% vs 22%, P = 0.617). The overall incidence of grade B/C fistula was 21%, and the in-hospital mortality was 6%. Multivariate analysis of the primary endpoint disclosed soft pancreatic texture (odds ratio: 2.1, P = 0.016) as the only independent risk factor. Compared with PJ, PG was associated with an increased rate of grade A/B bleeding events, perioperative stroke, less enzyme supplementation at 6 months, and improved results in some quality of life parameters.Conclusions:The rate of grade B/C fistula after PG versus PJ was not different. There were more postoperative bleeding events with PG. Perioperative morbidity and mortality of pancreatoduodenectomy seem to be underestimated, even in the high-volume center setting.
250 citations
TL;DR: Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary retroperitoneal sarcoma and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials.
Abstract: OBJECTIVE To determine the prognostic significance of histologic type/subtype in a large series of patients with primary resected retroperitoneal sarcoma. BACKGROUND The histologic diversity and rarity of retroperitoneal sarcoma has hampered the ability to predict patient outcome. METHODS From a single-institution, prospective database, 675 patients treated surgically for primary, nonmetastatic retroperitoneal sarcoma during 1982 to 2010 were identified and histologic type/subtype was reviewed. Clinicopathologic variables were analyzed for association with disease-specific death (DSD), local recurrence (LR), and distant recurrence (DR). RESULTS Median follow-up for survivors was 7.5 years. The predominant histologies were well-differentiated liposarcoma, dedifferentiated liposarcoma, and leiomyosarcoma. Five-year cumulative incidence of DSD was 31%, and factors independently associated with DSD were R2 resection, resection of 3 or more contiguous organs, and histologic type. Five-year cumulative incidence for LR was 39% and for DR was 24%. R1 resection, age, tumor size, and histologic type were independently associated with LR; size, resection of 3 or more organs, and histologic type were independently associated with DR. Liposarcoma and leiomyosarcoma were associated with late recurrence and DSD (as long as 15 years from diagnosis). For solitary fibrous tumor, LR was uncommon (<10%), but early distant recurrence was common (36% at 5 years). Nomograms were developed to predict DSD, LR, and DR. CONCLUSIONS Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary retroperitoneal sarcoma. Histology predicts the pattern and incidence of LR and DR and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials.
235 citations
TL;DR: A longer waiting interval from the end of neoadjuvant chemoradiotherapy increases the rate of pCR by 6% in rectal cancer, with similar outcomes and complication rates.
Abstract: Objective:The aim of this meta-analysis was to demonstrate whether a longer interval between the end of neoadjuvant chemoradiotherapy (CRT) and surgery is associated with a better rate of pathological complete response (pCR) in rectal cancer.Background:The standard of care in locally advanced rectal
TL;DR: The study validated MRI low rectal plane assessment, reducing pCRM involvement and avoiding overtreatment through selective preoperative therapy and rationalized use of permanent colostomy.
Abstract: Objective:This study aimed to validate a magnetic resonance imaging (MRI) staging classification that preoperatively assessed the relationship between tumor and the low rectal cancer surgical resection plane (mrLRP).Background:Low rectal cancer oncological outcomes remain a global challenge, evidenc
TL;DR: PSH did not increase recurrence in the liver remnant but more importantly improved 5-year survival in case of recurrence (salvageability).
Abstract: Objective:To investigate prognostic impact of parenchymal-sparing hepatectomy (PSH) for solitary small colorectal liver metastasis (CLM).Background:It is unclear whether PSH confers an oncologic benefit through increased salvageability or is a detriment through increasing recurrence rate.Methods:Dat
TL;DR: The magnitude of quality improvement increases with time in the program, and participation in ACS NSQIP is associated with reductions in adverse events after surgery.
Abstract: Background:The American College of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) surgical quality feedback models are recalibrated every 6 months, and each hospital is given risk-adjusted, hierarchical model, odds ratios that permit comparison to an estimated average NSQIP hosp
TL;DR: The management of HCC has witnessed significant strides with advances in existing options and introduction of several new treatment modalities of various combinations.
Abstract: Objective:To review the current management, outline recent advances and address controversies in the management of hepatocellular carcinoma (HCC).Summary of Background data:The treatment of HCC is multidisciplinary involving hepatologists, surgeons, medical oncologists, radiation oncologists, radiol
TL;DR: The analysis of perioperative surgical outcomes indicated that robotic Gastrectomy is not superior to laparoscopic gastrectomy, and the use of robotic systems is assumed to provide a technically superior operative environment for minimally invasive surgery.
Abstract: Objective:To compare short-term surgical outcomes including financial cost of robotic and laparoscopic gastrectomy.Background:Despite a lack of supporting evidence, robotic surgery has been increasingly adopted as a minimally invasive modality for the treatment of gastric cancer because of its assum
TL;DR: This meta-analysis included studies from different countries with disparate health care systems and provided strong evidence for an inverse association between higher hospital volume and lower mortality after PD.
Abstract: Objective:The aim of the study was to evaluate the relationship between hospital volume and outcome after pancreaticoduodenectomy (PD).Summary Background Data:Previous reviews for the hospital volume-outcome relationship after pancreatic resection were limited owing to clinical or methodological het
Emory University1, Harvard University2, Memorial Sloan Kettering Cancer Center3, University of Verona4, Johns Hopkins University5, University of Bonn6, Utrecht University7, Erasmus University Rotterdam8, Technische Universität München9, Showa University10, Tokai University11, Sungkyunkwan University12, Pontifical Catholic University of Chile13, Seoul National University14
TL;DR: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.
Abstract: Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤0.5, >0.5-≤1, >1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intrabiliary/cholecystic). Conclusions: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.
TL;DR: Postlearning curve RPD can be performed with similar perioperative outcomes achieved with open PD, and operative approach was not a significant independent predictor of margin status or suboptimal lymphadenectomy (<12 lymph nodes harvested).
Abstract: Objectives:Limited data exist comparing robotic and open approaches to pancreaticoduodenectomy (PD). We performed a multicenter comparison of perioperative outcomes of robotic PD (RPD) and open PD (OPD).Methods:Perioperative data for patients who underwent postlearning curve PD at 8 centers (8/2011–
TL;DR: Perioperative mortality in Germany is higher than anticipated from previous studies, and the absence of a significant reduction in overall mortality challenges current health policies that aim to improve the outcomes of high-risk surgical procedures in Germany.
Abstract: Objective: We aimed to determine the unbiased mortality rates for pancreatic surgery procedures at the national level through a comprehensive analysis of every inpatient case in Germany.
Summary of background data: Several studies have proclaimed a general improvement of perioperative outcomes following pancreatic surgery. These results are challenged by recent analyses of large US databases that found strong volume-outcome relationships, with high mortality in low-volume facilities.
Methods: All inpatient cases with a pancreatic surgery procedure code in Germany from 2009 to 2013 were identified from nationwide administrative hospital data. We determined the absolute number of patients and the in-hospital death rate for crucial subcategories such as medical indications and types of surgical procedure.
Results: A total of 58,003 inpatient episodes of pancreatic surgery were identified between 2009 and 2013. Annual case numbers increased significantly, which was primarily attributed to patients aged 70 years and older. The overall in-hospital mortality rate (10.1%) did not significantly change during the study period. Major pancreatic resections were associated with mortality ranging from 7.3% (distal pancreatectomy) to 22.9% (total pancreatectomy). Postoperative interventions indicative of severe complications were documented frequently (eg, more than 6 blood transfusions in 20% of all patients and relaparotomy in 16%). Their occurrence was associated with a dramatic increase in mortality.
Conclusion: At the national level in Germany, perioperative mortality is higher than anticipated from previous studies. The absence of a significant reduction in overall mortality challenges current health policies that aim to improve the outcomes of high-risk surgical procedures in Germany.
TL;DR: GDFT may not be of benefit to all elective patients undergoing major abdominal surgery, particularly those managed in an ERAS setting, particularly if managed in a traditional care setting.
Abstract: Intraoperative hypovolemia caused by loss of as little as 10% to 15% of blood volume can result in an appreciable fall in splanchnic perfusion, which often outlasts the period of hypovolemia.1 This results in an intramucosal acidosis of the gut,2 leading to a cascade of events that impair postoperative gastrointestinal function and cause complications.3 Postoperative gastrointestinal morbidity in the form of an inability to tolerate oral or enteral tube feeding, nausea, vomiting, and abdominal distension can be responsible for over half of delayed discharges.4 This concept led to the use of intraoperative goal-directed fluid therapy (GDFT) in which relatively small-volume (200–250 mL) boluses of fluid (usually a colloid) over background crystalloid infusions have been used to increase stroke volume and cardiac output, improve gut perfusion,1 and decrease gut mucosal acidosis.
A number of methods, including transesophageal Doppler (TED), lithium dilution, arterial pulse contour analysis, thoracic electrical bioimpedance, partial non-rebreathing systems, and transpulmonary thermodilution techniques have been used to measure intraoperative stroke volume and cardiac output and, thereby, help direct fluid therapy.5 The methods used most frequently in clinical practice are the TED and lithium dilution techniques. The commonest algorithm assesses the change in stroke volume in response to a fluid bolus of 200 to 250 mL infused over 5 to 10 minutes. An increase in stroke volume of more than 10% in response to this bolus signifies hypovolemia and indicates the need for a further bolus. An increase in stroke volume of 10% or less suggests adequate filling and continuation of the background crystalloid infusion without the need for another fluid bolus. A reduction in stroke volume by more than 10% during continued monitoring necessitates a further bolus and repetition of the cycle. Variations in this methodology include monitoring of stroke volume variation and corrected flow time (FTc).6,7
Randomized controlled trials and meta-analyses8–11 published in the first decade of the twenty-first century suggested that intraoperative GDFT resulted in a statistically significant reduction in postoperative complication rates and length of stay (LOS) when compared with patients receiving conventional intraoperative fluid therapy. This led to intraoperative GDFT being recommended as a standard of care by the UK National Institute for Health and Clinical Excellence (NICE).12 However, postoperative fluid therapy regimens were not clear in most of the early studies, and perioperative care was not standardized. Avoidance of postoperative salt and water overload and maintaining patients in as near a state to zero fluid balance as possible has been shown to reduce both complication rates and length of hospital stay even in patients not receiving GDFT.13–16 In addition, the use of fast-track or Enhanced Recovery After Surgery (ERAS) protocols,17,18 which are multimodal perioperative care pathways designed to reduce the metabolic stress of surgery and accelerate postoperative recovery, have resulted in fewer complications [risk ratio 0.5, 95% confidence interval (CI) 0.4–0.7] and reduction in LOS by 2.5 (95% CI −3.5 to −1.5) days after colorectal surgery when compared with patients managed with traditional care.19 More recent trials14,17,18 in which patients have been managed within ERAS protocols with avoidance of postoperative fluid overload have suggested that, although intraoperative GDFT resulted in improvement of cardiovascular variables when compared with conventional fluid therapy, there was no significant difference in clinical outcomes.14,20,21
The aims of this meta-analysis of randomized clinical trials of intraoperative GDFT versus conventional fluid therapy in patients undergoing elective major abdominal surgery were to
compare the effects of intraoperative GDFT with conventional fluid therapy on postoperative complications, length of hospital stay, gastrointestinal function, and mortality.
determine whether there was a difference in outcome between studies that used ERAS protocols for perioperative care and those that did not.
TL;DR: Improved understanding of these mechanisms has implications for clinical study design and has led to the emergence of novel biomarkers such as Toll-like receptor expression that can be used to stratify patient care pathways to maximize the benefit from current therapies or to select the right target at the right phase of illness for future drug development.
Abstract: Objective:The aim of this study was to describe current understanding of the local and systemic immune responses to surgery and their impact on clinical outcomes, predictive biomarkers, and potential treatment strategies.Background:Patients undergoing major surgery are at risk of life-threatening in
TL;DR: In this paper, the authors evaluated short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis (Hinchey III) in a randomized controlled trial.
Abstract: Objective:To evaluate short-term outcomes of a new treatment for perforated diverticulitis with purulent peritonitis in a randomized controlled trial.Background:Perforated diverticulitis with purulent peritonitis (Hinchey III) has traditionally been treated with surgery including colon resection and
TL;DR: The results show no statistically significant difference in the combined outcome of mortality or BPD between the 2 ventilation groups in prenatally diagnosed congenital diaphragmatic hernia infants, and other outcomes, including shorter ventilation time and lesser need of extracorporeal membrane oxygenation, favored conventional ventilation.
Abstract: Objectives:To determine the optimal initial ventilation mode in congenital diaphragmatic hernia.Background:Congenital diaphragmatic hernia is a life-threatening anomaly with significant mortality and morbidity. The maldeveloped lungs have a high susceptibility for oxygen and ventilation damage resul
TL;DR: A review of current practice in US hospitals shows significant associations between high fluid volume given on the day of surgery with both increased LOS and increased total costs and fluid optimization would likely lead to decreased variability and improved outcomes.
Abstract: Objectives To study current perioperative fluid administration and associated outcomes in common surgical cohorts in the United States. Background An element of enhanced recovery care protocols, optimized perioperative fluid administration may be associated with improved outcomes; however, there is currently no consensus in the United States on fluid use or the effects on outcomes of this use. Methods The study included all inpatients receiving colon, rectal, or primary hip or knee surgery, 18 years of age or older, who were discharged from a hospital between January 1, 2008 and June, 30 2012 in the Premier Research Database. Patient outcomes and intravenous fluid utilization on the day of surgery were summarized for each surgical cohort. Regression models were developed to evaluate associations of high or low day-of-surgery fluids with the likelihood of increased hospital length of stay (LOS), total costs, or postoperative ileus. Results The study showed significant associations between high fluid volume given on the day of surgery with both increased LOS (odds ratio 1.10-1.40) and increased total costs (odds ratio 1.10-1.50). High fluid utilization was associated with increased presence of postoperative ileus for both rectal and colon surgery patients. Low fluid utilization was also associated with worse outcomes. Conclusions According to results from this review of current practice in US hospitals, fluid optimization would likely lead to decreased variability and improved outcomes.
TL;DR: The data presented show that implementation of PBM with a more conscious handling of transfusion practice can be achieved even in large hospitals without impairment of patient's safety.
Abstract: Objective:To determine whether the implementation of patient blood management (PBM) is effective to decrease the use of red blood cell without impairment of patient's safety.Background:The World Health Organization encouraged all member states to implement PBM programs employing multiple combined st
TL;DR: Although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals, which suggests that microsystem characteristics, such as hospital culture and safety climate, may play a larger role in improving a hospital's ability to manage postoperative complications.
Abstract: Objective:To determine the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries.Summary Background Data:Reducing failure to rescue events is a common quality target for US hospitals. Little is known about which hospital characteristics influence t
TL;DR: LSG is a safe procedure with a low morbidity rate but SLR is associated with increased leak rates and a surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.
Abstract: Questions remain regarding best surgical techniques to use for a laparoscopic sleeve gastrectomy (LSG) including the use of staple line reinforcement (SLR), bougie size (BS), and distance from the pylorus (DP) where the staple line is initiated. Our objectives were to assess the impact of these techniques on 30-day outcomes and to evaluate the impact of these techniques on weight loss and comorbidities at 1 year.
Using the MBSAQIP data registry, univariate analyses and hierarchical logistical regression models were developed to analyze outcomes for techniques of LSG at patient and surgeon-level.
A total of 189,477 LSG operations were performed by 1634 surgeons at 720 centers from 2012 to 2014. Eighty percent of surgeons used SLR, 20% did not. SLR cases were associated with higher leak rates (0.96% vs 0.65%, odds ratio [OR] 1.20 95% confidence interval [CI] 1.00–1.43) and lower bleed rates (0.75% vs 1.00%, OR 0.74 95% CI 0.63–0.86) compared to no SLR at patient level. At the surgeon level, leak rates remained significant, but bleeding events became nonsignificant. BS ≥38 was associated with significantly lower leak rates compared to BS <38 at patient and surgeon level (patient level: 0.80% vs 0.96%, OR 0.72, 95% CI 0.62–0.94; surgeon level: 0.84% vs 0.95%, OR 0.90, 95% CI 0.80–0.99). BS ≥40 was associated with increased weight loss. DP had no impact on leaks or bleeds but showed an increase in weight loss with increasing DP.
LSG is a safe procedure with a low morbidity rate. SLR is associated with increased leak rates. A surgeon should consider risks, benefits, and costs of these surgical techniques when performing a LSG and selectively utilize those that, in their hands, minimize morbidity while maximizing clinical effectiveness.
TL;DR: In this large series of complex AWR patients, it is demonstrated that posterior component separation via TAR with wide synthetic mesh sublay provides a very durable repair with low morbidity, even in comorbid patients with large defects.
Abstract: Objective:To evaluate the safety and efficacy of transversus abdominis muscle release (TAR) with retrorectus synthetic mesh reinforcement in a large series of complex hernia patients.Background:Posterior component separation via TAR during abdominal wall reconstruction (AWR) continues to gain popula
TL;DR: This study shows how the combination of TNM and mGPS effectively stratifies outcome in patients undergoing potentially curative resection of CRC, and support routine staging of both the tumor and the host in patients with CRC.
Abstract: Objective: This study aims to examine the clinical utility of the combination of TNM stage and modified Glasgow Prognostic Score (mGPS) in patients undergoing potentially curative resection of colorectal cancer (CRC).
Background: Of measures of the systemic inflammatory response, the mGPS has been most extensively validated in patients with cancer.
Methods: Data from 1000 consecutive patients undergoing potentially curative CRC resection from a single institution (January 1997–May 2013) were included. The relationship between mGPS [0–C-reactive protein (CRP) ≤ 10 mg/L, 1—CRP > 10 mg/L and albumin ≥35 g/L, 2—CRP > 10 mg/L and albumin 35 g/L], TNM stage, and cancer-specific survival (CSS) and overall survival (OS) was examined using Kaplan-Meier log-rank survival analysis and multivariate Cox regression analysis.
Results: An mGPS of 0, 1, and 2 was observed in 63%, 21%, and 16% of patients, respectively. Median follow-up was 56 months (interquartile range: 28–107 months). TNM and mGPS were independently associated with CSS and OS (all P < 0.001). In all patients, TNM and mGPS stratified 5-year CSS and OS from 97% and 87% (stage I, mGPS = 0) to 32% and 26% (stage III, mGPS = 2), respectively. In patients undergoing elective resection of colon cancer (n = 575), 5-year CSS and OS ranged from 100% and 87% (stage I, mGPS = 0) to 37% and 30% (stage III, mGPS = 2), respectively.
Conclusions: This study shows how the combination of TNM and mGPS effectively stratifies outcome in patients undergoing potentially curative resection of CRC. These data support routine staging of both the tumor and the host in patients with CRC.