BACKGROUND:Surgical outcome results after repair for parastomal hernia are sparsely reported and based on small-scale studies.
OBJECTIVE:This study aims to analyze surgical risk factors for 30-day ...reoperation and mortality, and, secondarily, to report the risk of reoperation for recurrence.
DESIGN:This is a retrospective analysis of nationwide perioperative surgical variables. The primary outcome was reoperation for surgical complications and/or mortality within 30 days after parastomal hernia repair. Follow-up was obtained from the Danish National Patient Register. Detailed patient-related data were based on hospital files. Multivariate analysis was based on a compound parameter30-day reoperation or death.
SETTING AND PATIENTS:All patients with a parastomal hernia repair registered in the Danish Hernia Database from January 1, 2007 to December 31, 2010 were included.
MAIN OUTCOME MEASURES:Univariate and logistic regression was used to identify risk factors for 30-day reoperation or death.
RESULTS:The study included 174 patients with a parastomal hernia repair (142 elective and 32 emergency repairs; 56 open and 118 laparoscopic repairs). Median follow-up was 20 months (range, 0–47). A total of 13.2% were reoperated because of postoperative complications, and 6.3% of patients died within the first 30 postoperative days. Emergency repair was the strongest risk factor for reoperation or death in multivariate analyses (OR, 7.6; 95% CI, 2.7–21.5). No difference was found in preoperative risk of poor outcome between elective and emergency repairs (Charlson score 4 (range, 0–12) vs 5 (0–11), p = 0.07). After 3 years, the cumulated reoperation rate for recurrence was 10.8% (open 17.2% and laparoscopic 3.8%).
LIMITATIONS:Patients’ comorbidity was based on retrospective data, and the study had a relatively short follow-up.
CONCLUSION:In the present nationwide study, repair for a parastomal hernia was associated with high rates of morbidity, mortality, and repair for recurrence. Emergency repair was the only important risk factor to predict poor 30-day postoperative outcome.
Scarce data exist on the true incidence of postoperative atrial fibrillation (POAF) after acute abdominal surgery and associated outcomes. The current study aimed to identify the frequencies of ...clinically recognized POAF and associated complications, along with their risk factors.
This study was a prospective, single-center cohort study of unselected adult patients referred for acute abdominal surgery during a 3-month period. Through careful review, demographics, comorbidity, and surgical characteristics were prospectively drawn from medical charts. The primary outcome was clinically recognized POAF occurring in-hospital. Logistic regression was used to determine the risk factors of POAF and associated complications. A subgroup was enrolled in a feasibility study of peri- and postoperative continuous cardiac rhythm monitoring.
In total, 450 patients were enrolled. Clinically recognized in-hospital POAF was observed in 22 patients (4.9%). All cases were observed in patients aged ≥60 years, corresponding to 22 of 164 patients (13.4%). Multiple risk factors were observed, such as age, prior atrial fibrillation, heart failure, hypertension, diabetes mellitus, chronic renal disease, and major (vs. minor) surgery. POAF was associated with severe in-hospital complications (POAF group 45.5% vs. non-POAF group 8.6%, p < .001) and in-hospital mortality (POAF group 13.6% vs. non-POAF group 3.0%, p = .043). In total, 295 patients were monitored by continuous cardiac rhythm monitoring for 12,148 h, yielding five patients with asymptomatic AF.
In conclusion, this prospective study of POAF in patients undergoing acute abdominal surgery showed that one in 20 patients developed clinically recognized in-hospital POAF. Multiple risk factors of POAF were identified. POAF was associated with severe complications up to 30 days after surgery.
Background
Previous meta-analyses on the clinical outcome after laparo-endoscopic single-site surgery (LESS) versus conventional laparoscopic surgery (CLS) have not revealed any major differences in ...postoperative pain between the two procedures. This meta-analysis aims to evaluate the difference in postoperative pain between the two procedures, focusing on whether LESS was conducted with a non-expanding port (LESSnonex) or a port expanding (LESSex) within the incision.
Method
EMBASE, Medline, PubMed, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) on LESS versus CLS for general abdominal procedures. Weighted mean difference (WMD) and Odds ratios (OR) were calculated with 95% confidence intervals (CI).
Results
A total of 29 RCTs with 2999 procedures were included. Pain (VAS 0–10) 6 h after surgery was significantly lower in the group where LESS was conducted with LESSnonex compared to CLS, WMD=−0.72 (− 1.10 to − 0.33). Pain 18–24 h was significantly higher in the group where LESS was conducted with LESSex compared to CLS, WMD = 0.38 (0.01–0.75). Wound-related complications were significantly more frequent in LESSex procedures compared to CLS, OR = 1.94 (1.03–3.63).
Conclusion
The present meta-analysis indirectly indicates that the type of access device that is used for an abdominal LESS procedure may contribute to the development of early postoperative pain as the use of a non-expanding model was associated with a more advantageous outcome. Direct randomized comparison of LESSnonex and LESSex is warranted to confirm if the use of expanding access devices generates more pain and wound complications.
Background
This study aimed to estimate the prevalence of indeterminate pulmonary nodules and specific radiological and clinical characteristics that predict malignancy of these at initial staging ...chest computed tomography (CT) in patients with colorectal cancer. A considerable number of indeterminate pulmonary nodules, which cannot readily be classified as either benign or malignant, are detected at initial staging chest CT in colorectal cancer patients.
Methods
A systematic review based on a search in EMBASE, Medline, the Cochrane library and science citation index, PubMed databases, Google scholar, and relevant conference proceedings was performed in cooperation with the Cochrane Colorectal Cancer Group.
Results
A total of 2,799 studies were identified, of which 12 studies met the inclusion criteria. The studies primarily consisted of case series and included a total of 5,873 patients. Of these patients, 9 % (95 % confidence interval 95 % CI 8.9–9.2 %) had indeterminate pulmonary nodules at chest CT, of which 10.8 % (95 % CI 10.3–11.2 %) turned out to be colorectal cancer metastases at follow-up. Generally, regional lymph node metastasis, and multiple numbers of indeterminate pulmonary nodules were reported to predict malignancy, whereas calcification of the nodules indicated benign lesions.
Conclusion
It was found that 1 in 100 colorectal cancer patients subjected to preoperative staging chest CT will have an indeterminate pulmonary nodule that proves to be metastatic disease. Such a low risk suggests that indeterminate pulmonary nodules should not cause further preoperative diagnostic workup or follow-up besides routine regimens.
Type XI collagen has been associated with tumor fibrosis and aggressiveness in patients with pancreatic ductal adenocarcinoma (PDAC). The propeptide on Type XI collagen is released into the ...circulation after proteolytic processing at either amino acid 253 or 511. This allows for a noninvasive biomarker approach to quantify Type XI collagen production. We developed two ELISA‐based biomarkers, targeting the two enzymatic cleavage sites (PRO‐C11‐253 and PRO‐C11‐511). In a discovery cohort including serum from patients with PDAC (n = 39, Stages 1‐4), chronic pancreatitis (CP, n = 12) and healthy controls (n = 20), PRO‐C11‐511, but not PRO‐C11‐253, was significantly upregulated in patients with PDAC and CP compared to healthy controls. Furthermore, PRO‐C11‐511 levels >75th percentile were associated with poor overall survival (OS) (HR, 95% CI: 3.40, 1.48‐7.83). The PRO‐C11‐511 biomarker potential was validated in serum from 686 patients with PDAC. Again, high levels of PRO‐C11‐511 (>75th percentile) were associated with poor OS (HR, 95% CI: 1.68, 1.40‐2.02). Furthermore, PRO‐C11‐511 remained significant after adjusting for clinical risk factors (HR, 95% CI: 1.50, 1.22‐1.86). In conclusion, quantifying serum levels of Type XI collagen with PRO‐C11‐511 predicts poor OS in patients with PDAC. This supports that Type XI collagen is important for PDAC biology and that PRO‐C11‐511 has prognostic noninvasive biomarker potential for patients with PDAC.
What's new?
Desmoplasia, characterized by increased collagen turnover, plays an important role in pancreatic ductal adenocarcinoma (PDAC), potentially influencing cancer progression and limiting drug uptake. Poor therapeutic response in particular appears to be associated with type XI collagen, which enters the circulation following proteolytic processing. Here, assays were developed to detect either of two type XI collagen proteolytic products, PRO‐C11‐253 or PRO‐C11‐511, in PDAC patient serum. The assays show that PRO‐C11‐511 type XI collagen is significantly upregulated in PDAC patients and is associated with poor overall survival. The findings identify a potential role for collagen products as predictive markers in PDAC.
CONTEXT Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on ...pulmonary complications has not been well defined. OBJECTIVE To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery. DESIGN, SETTING, AND PATIENTS The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy. INTERVENTIONS Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery. MAIN OUTCOME MEASURES Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio OR, 0.94; 95% confidence interval CI, 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13). CONCLUSION Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00364741
Background Disturbed metabolism in the extracellular matrix (ECM) contributes to formation of abdominal wall hernias. The aim of this study was to gain deeper insight into the ECM turnover in hernia ...patients by analyzing serum biomarkers specifically reflecting collagen synthesis and breakdown in the interstitial matrix (types I, III, and V collagens) and in the basement membrane (type IV collagen). Material and Methods Patients with 3 different types of hernias were included: Primary unilateral inguinal hernia ( n = 17), multiple hernias defined as ≥3 hernias ( n = 21), and incisional hernia ( n = 25). Patients without hernias scheduled to undergo elective operation for gallstones ( n = 18) served as controls. Whole venous blood was collected preoperatively. Biomarkers for synthesis of interstitial matrix (PINP, Pro-C3, P5CP) and basement membrane (P4NP) as well as corresponding degradation (C1M, C3M, C5M, and C4M) were measured in serum by validated, solid-phase competitive assays. Results In inguinal hernia patients, the turnover of the interstitial matrix collagens type III ( P < .042) and V ( P < .001) was decreased compared with controls, whereas the turnover of the basement membrane collagen type IV was increased ( P < .001). In incisional hernia patients, the turnover of type V collagen was decreased ( P = .048) and the turnover of type IV collagen was increased compared with the hernia-free controls ( P < .001). Conclusion Hernia patients demonstrated systemically altered collagen metabolism. The serologic turnover profile of type IV collagens may predict the presence of inguinal and incisional hernia. Regulation of type IV collagen turnover may be crucial for hernia development.
The role of blood-based biomarkers in surgical decision-making in patients with localised pancreatic cancer remains unclear. This review aimed to report the utility of blood-based biomarkers focusing ...on prediction of response to neoadjuvant therapy, prediction of surgical resectability and early relapse after surgery.
MEDLINE/PubMed, Embase and Web of Science were searched till October 2019. Studies published between January 2000 and September 2019 with a minimum of 20 patients with pancreatic adenocarcinoma, reporting the utility of at least one blood-based biomarker in predicting response to neoadjuvant therapy and predicting surgical resectability or early relapse after surgery were included.
A total of 2604 studies were identified, of which 24 comprising of 3367 patients and 12 blood-based biomarkers were included. All included studies were observational. Levels of carbohydrate antigen (CA)19-9 were reported in the majority of the studies. Levels of CA19-9 predicted the response to neoadjuvant therapy and early relapse in 10 studies. CA125 levels above 35 U/ml were predictive of surgical irresectability in two studies. However, marked variation in both timing of sampling and cut-off values was noted between studies.
Despite some evidence of potential benefit, the utility of currently available blood-based biomarkers in aiding surgical decision-making in patients undergoing potentially curative treatment for pancreatic cancer is limited by methodological heterogeneity. Standardisation of future studies may allow a more comprehensive analysis of the biomarkers described in this review.
•Biomarkers may aid in surgical decision-making in patients with pancreatic cancer.•Low CA19-9 and CA125 levels were predictive of surgical resectability.•Dynamic change in CA19-9 levels was predictive of response to neoadjuvant therapy.•Elevated pre- and postoperative levels of CA19-9 were prognostic of early relapse.•A heterogeneity in cut-off levels and time of sampling for biomarkers was noted.
Background Respiratory complications secondary to intermittent intra-abdominal hypertension and/or atelectasis are common after abdominal wall reconstruction for large incisional hernias. It is ...unknown if the respiratory function of this patient group is affected long term or impairs activities of daily living. We hypothesized that abdominal wall reconstruction for large incisional hernia would not lead to improved, long-term pulmonary function or respiratory quality of life. Methods Eighteen patients undergoing open abdominal wall reconstruction with mesh for a large incisional hernia (horizontal fascial defect width >10 cm) were compared with 18 patients with an intact abdominal wall who underwent colorectal resection. Patients were examined pre- and 1-year postoperatively. Examined measures included forced vital capacity, forced expiratory volume in first second, peak expiratory flow, maximal in- and expiratory mouth pressure, and 2 validated questionnaires on respiratory quality of life. In order to decrease heterogeneity, objectively examined parameters were presented relative to the predicted values, which were normality adjusted pulmonary measures. Results At 1-year follow-up, the abdominal wall reconstruction group showed significant improvement in percent predicted peak expiratory flow and maximal expiratory mouth pressure, whereas all other measurements of lung function remained unchanged. Respiratory quality of life did not change significantly. Patients who underwent abdominal wall reconstruction showed a significantly greater improvement of percent predicted peak expiratory flow compared with patients undergoing colorectal resection. Conclusion Abdominal wall reconstruction for large incisional hernia improved long-term expiratory lung function. Respiratory quality of life did not change significantly after abdominal wall reconstruction.
PDF
