RESUMEN
OBJECTIVE: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. BACKGROUND: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. METHODS: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only;
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Educación Médica Continua/métodos , Pancreatectomía/educación , Pancreatectomía/métodos , Procedimientos Quirúrgicos Robotizados/educación , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Femenino , Estudios de Seguimiento , Humanos , Curva de Aprendizaje , Tiempo de Internación/estadística & datos numéricos , Masculino , Massachusetts , Persona de Mediana Edad , Tempo Operativo , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Puntaje de Propensión , Estudios RetrospectivosRESUMEN
OBJECTIVE: To review the technical feasibility of resin microsphere (SIR-Spheres®) yttrium-90 radioembolization prescribed using the medical internal radiation dose (MIRD) model. METHODS: All radioembolization procedures for hepatic malignancies using resin microspheres with MIRD model between November 2015 and February 2019 were included in this IRB-approved study (n = 60). Student's T test was used to compare prescribed activity based on MIRD and BSA models. Adverse events were assessed immediately, 30 days, and 6 months post-treatment. RESULTS: Sixty radioembolizations were performed in 54 patients (age 68 ± 9 years, 48-87 years, 35% female). Mean prescribed activity calculated by the MIRD model (target absorbed dose 120-200 Gy for primary and 80-200 Gy for metastatic liver cancers) was 1.7 GBq (0.3-6.4) compared with 0.6 GBq (0.12-2.1) if BSA had been used (p < 0.0001). The prescribed activity was successfully delivered in 93% (56/60) treatments. Prophylactic embolization and anti-reflux catheters were used in 20% (12/60) and 5% (3/60) treatments, respectively. No immediate post-procedural complications occurred. Abdominal pain was the most common clinical Grade 3 CTCAE in 30 days (10%) and 6 months (12%). Radiation pneumonitis occurred in 3 (5%) patients but no radiation-induced gastric ulcer or radiation-induced liver disease occurred. CONCLUSION: MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry with resin microspheres. MIRD prescribed activity with target absorbed doses up to 200 Gy can be successfully administered without prophylactic embolization in selected patients. KEY POINTS: â¢MIRD dosimetry results in higher prescribed activity compared with BSA dosimetry for radioembolization. â¢MIRD dosimetry can be used for yttrium-90 resin microsphere radioembolization with acceptable safety profile.
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Embolización Terapéutica , Neoplasias Hepáticas , Anciano , Femenino , Humanos , Neoplasias Hepáticas/radioterapia , Masculino , Microesferas , Persona de Mediana Edad , Radioisótopos de Itrio/uso terapéuticoRESUMEN
PURPOSE: To determine the rate of and risk factors for complications in solid organ transplant (SOT) patients who have had surgery of the upper extremity. METHODS: All SOT recipients who had an upper extremity procedure performed by 1 of 6 surgeons at our institution were identified from 2006 to 2018. Demographic data, transplant date and type, upper extremity surgery procedure and date, antirejection medications, American Society of Anesthesiologists Physical Status Classification System (ASA) score, and complications were recorded. Complications were defined as any surgical complication within 1 year and any medical complication within the first 30 days after surgery. Complications were categorized according to the Clavien-Dindo classification system. RESULTS: Fifty-one upper extremity procedures in 32 SOT patients were included. Of the 51 procedures, 21 were complicated, for an overall complication rate of 41%. Surgical complications occurred equally before and after 30 days with infection being the most common. Only 1 of the procedures resulting in surgical site infection had an implant (temporary K-wire fixation). The majority of complications were grade II, and there were no grade IV or V complications. Age, ASA score, type or number of SOT, and immunosuppressive regimens were similar between complicated and noncomplicated procedures. Procedures involving male patients were more likely to be complicated than those involving female patients. CONCLUSIONS: Complications after upper extremity operations are common in SOT patients, and surgical complications often occur after 30 days. Surgeons should counsel this population that they carry a higher complication risk than the general population and may require longer-term monitoring after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.