RESUMO
Lung cancer is the most common cancer in males and the second most common among females both in Europe and worldwide. Moreover, lung cancer is the leading cause of death due to cancer in males. The European region accounts for 23% of total cancer cases and 20% of cancer-related deaths. Relationships have been described between a number of infectious agents and cancers, but our knowledge of the role of viruses, both respiratory and systemic, in the pathogenesis of lung cancer is still rudimentary and has been poorly disseminated. In this chapter, we review the available evidence on the involvement of HPV, Epstein-Barr virus, HIV, cytomegalovirus and measles virus in the epidemiology and pathogenesis of lung cancer.Copyright © ERS 2021.
RESUMO
Background: coronaviral pandemic (COVID-19) induced by severe acute coronaviral syndrome 2 has imminent consequences for COVID-19 patients. To determine the effect of this pandemic on oncological treatment, Netherlands cancer patients performed a national study . Method(s): From 11 April 2020 to 11 Jan 2021, the oncological care perspective was discussed by an online study. The survey included 20 questions on four topics: patient characteristics, hospital engagement, COVID-19 and COVID-19 problems. Result(s): A total of 2418 (64.53%) patients were female and the remainder (57.5%) were <50 years of age. The most prevalent cancer diagnosis were haematological malignancies (26.1%), breast cancer (22.8%) and other cancers (19.2%). Depending on their illness environment, 34.7% of patients had incurable conditions while 21.6% and 31.8% had curable or healed diseases. The (expected) result of their illness was 'unknown' for 11.9% of patients. According to outpatient environment, 1691 (45.1%) patients have been oncologically examined and have taken follow-up, contrasted with 529 (14.1%) and 1527 (40.8%) patients presently or pending for therapy. Conclusion(s): This is the first research exploring cancer patients' experiences after the COVID-19 pandemic in Iraq. The research indicates the major effect of COVID-19 on oncological treatment, showing the need for psycho-oncological assistance during this pandemic.Copyright © 2020 Ubiquity Press. All rights reserved.
RESUMO
Introduction: Incidental elevations in Carbohydrate Antigen 19-9 (CA19-9) can trigger extensive medical evaluations for malignancy. Though classically associated with pancreatic cancer, CA19-9 is a nonspecific manifestation of multiple benign and malignant disease processes. Case Description/Methods: An asymptomatic, healthy 50-year-old female presented to primary care for an elevated CA19-9 level obtained for pancreatic cancer screening in Asia in 2019. Her evaluation in 2019 included abdominopelvic CT and magnetic retrograde cholangiopancreatography, which were normal. She was offered endoscopic ultrasonography to further evaluate pancreaticobiliary etiologies but was lost to follow-up amid the COVID-19 pandemic. She returned to the US in 2021, and basic laboratory testing and routine cervical cancer screening were performed. She was referred to Gastroenterology (GI) for further evaluation. Cervical cytology revealed atypical endometrial cells, and endometrial biopsy by gynecology was concerning for gastric-type endocervical adenocarcinoma. Transvaginal ultrasound revealed a thickened endometrial stripe, and pan CT revealed duodenal thickening, for which GI performed bidirectional endoscopy without significant abnormalities and no pancreatic or metastatic disease. Repeat CA19- 9 increased. She was referred to gynecologic oncology, where cervical biopsy and pelvic MRI confirmed an endocervical mass. She was diagnosed with Stage IIB gastric-type endocervical adenocarcinoma and underwent hysterectomy and left salpingectomy with adjuvant chemoradiation. Discussion(s): CA19-9 is synthesized in multiple organ systems. Elevations in asymptomatic patients are rarely predictive of pancreatic cancer but may expose patients to unnecessary testing and inadvertent harms without identifying malignancy. Thus, CA19-9 is not recommended for pancreatic cancer screening. Incidental elevations do warrant repeat testing. Benign processes will yield stable or decreasing levels, while rising levels suggest progressive or malignant processes. If concern for pancreatic malignancy is low, a reasonable investigation includes chest X-ray or CT, metabolic studies, hemoglobin A1c, liver and thyroid function panels, abdominopelvic CT or gynecologic cancer evaluation, and any other age-indicated cancer screening. In this case, prior imaging studies suggested low concern for pancreatic cancer. Her subsequent evaluation aligned with this suggested work-up and revealed gynecologic cancer as the ultimate etiology for her elevated CA19-9.
RESUMO
Background: This study analyzed the causes of death in the Korean population in 2020. Method(s): Cause-of-death data for 2020 from Statistics Korea were examined based on the Korean Standard Classification of Diseases and Causes of Death, 7th revision and the International Statistical Classification of Diseases and Related Health Problems, 10th revision. Result(s): In total, 304,948 deaths occurred, reflecting an increase of 9,838 (3.3%) from 2019. The crude death rate (the number of deaths per 100,000 people) was 593.9, corresponding to an increase of 19.0 (3.3%) from 2019. The 10 leading causes of death, in descending order, were malignant neoplasms, heart diseases, pneumonia, cerebrovascular diseases, intentional self-harm, diabetes mellitus, Alzheimer disease, liver diseases, hypertensive diseases, and sepsis. Cancer accounted for 27.0% of deaths. Within the category of malignant neoplasms, the top 5 leading organs of involvement were the lung, liver, colon, stomach, and pancreas. Sepsis was included in the 10 leading causes of death for the first time. Mortality due to pneumonia decreased to 43.3 (per 100,000 people) from 45.1 in 2019. The number of deaths due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 950, of which 54.5% were in people aged 80 or older. Conclusion(s): These changes reflect the continuing increase in deaths due to diseases of old age, including sepsis. The decrease in deaths due to pneumonia may have been due to protective measures against SARS-CoV-2. With the concomitant decrease in fertility, 2020 became the first year in which Korea's natural total population decreased.Copyright © Korean Medical Association.
RESUMO
Aims: To describe combined neural and muscular interventions in post covid exacerbations of cancer pain with disabilities.To present a new perspective of neuromyopathy to explain Intractable CA pancreas pain. Introduction: Additional challenges in cancer pain management are due to cancer treatment complications (chemotherapy, radiotherapy). CA Pancreas pains routinely addressed with oral neuromodulators, opioids neurolytic coeliac plexus block (NCPB) or splanchnic nerve radiofrequency ablation (SRF). 75 years male, CA pancreas with spine, pelvic bone metastasis, post chemotherapy radiotherapy. 6 months bedridden with post covid exacerbations in pain (vas 10/10) received prior painkillers. Started oral pregabalin 75mg od, ultracet bd, myospaz bd. Result(s): With 15 days medications vas 6/10, patient could sit on wheelchair. Given sciatico-femoral block, pain reduced vas 2/10 but recurred in 7 day vas 5/10. Started USGDN of tight back and lower limb muscles with 32G solid needles.post3 sessions vas 2/10, able to walk with support after 4 weeks. Discussion(s): Viscerosomatic convergence at the dorsal horn neurons produces visceral pain referred to back and abdominal muscles led to muscle spasm with generation of myofascial trigger points(MTrPs)and pain. USGDN addresses MTrPs. Needle insertion produces local twitch reflex (LTR) followed by muscle relaxation with pain relief. Neural interventions addresses only visceral nociceptive afferents from celiac plexus which forms 10% of total spinal cord afferent input which sensitizes peripheral and central motor nociceptive pathway processing neuromyopathy. Conclusion(s): Viscerosomatic convergence with muscles involvement (neuromyopathy) proved to be effectively managed by using combined approaches, neuromoduation and USGDN in Ca pancreas pain with disabilities.Copyright © 2023
RESUMO
Introduction Edoxaban is a non-vitamin K dependent oral anticoagulant (NOAC) licensed for venous thromboembolism (VTE) treatment or stroke prevention in atrial fibrillation (SPAF). Major surgical procedures are not uncommon in anticoagulated patients but data on perioperative edoxaban management are scarce. Method Using data from the prospective DRESDEN NOAC REGISTRY we extracted data on major surgical procedures in patients who took edoxaban within the preceding 7 days. Periinterventional edoxaban management patterns and rates of outcome events were evaluated until day 30 after procedure. Results Between 2011 and 2021, 3448 procedures were identified in edoxaban patients, including 287 (8.3 %) major procedures. Overall, patient characteristics were comparable for major and non-major procedures, but significant differences existed with regard to gender, concomitant antiplatelet therapies and the proportion of patients with a CHA2DS2-VASc score >= 2 (Table 1). Major procedures consisted of orthopaedic/trauma surgery (44.3 %);open pelvic, abdominal or thoracic surgery (30.4 %), central nervous system surgery and procedures (13.9 %), vascular surgery (9.1 %) and extensive wound revision surgery (2.4 %). A scheduled interruption of edoxaban was observed in 284/287 major procedures (99 %) with a total median edoxaban interruption time of 11.0 days (25- 75th percentile 5.0-18.0 days). Heparin bridging was documented in 183 procedures (46 prophylactic dosages, 111 intermediate and 26 therapeutic dosages). Overall, 7 (2.4 %;95 %-CI 1.2 %-4.9 %) major cardiovascular events (5 VTE, 2 arterial thromboembolic events) occurred and 63 bleeding events were observed in 287 major procedures (22.0 %;95 %-CI 17.6 %-2.71 %), comprising of 38 ISTH major bleeding events (13.2 %;95 %-CI 9.8 %-17.7 %) and 25 ISTH CRNM bleedings (8.7 %;95 %-CI 6.0 %-12.5 %). Rates of major cardiovascular events with or without heparin bridging were comparable (6/183;3.3 %;95 %-CI 1.5 %-7.0 % vs. 1/36;2.8 %;95 %-CI 0.5 %-14.2 %;p = 0.7173). ISTH major bleeding occurred numerically more frequent in patients receiving heparin bridging (30/183;16.4 %;95 %-CI 11.7 %-22.4 %) versus procedures without heparin bridging (2/36;5.6 %;95 %-CI 1.5 %-18.1 %;p = 0.1542) (Fig. 1). Within 30 days of follow up, 6 patients died (2.1 %;95 %-CI 1.0 %-4.5 %) with causes of death being a ruptured truncus coeliacus following palliative angioplasty for an infiltrating pancreas cancer (ruled as fatal bleeding), septic organ failure, pneumocystis jirovecii pneumonia, COVID-19-pneumonia, septic complications following clipping of a ruptured cerebrovascular aneurism or terminal malignant disease. No fatal cardiovascular event occurred. Conclusion Within the limitations of our study design, periprocedural edoxaban management seems effective and safe in routine care. Use of heparin bridging seems to have limited effects on reducing vascular events but may increase bleeding risk. (Table Presented).
RESUMO
Purpose: We examined the effect of COVID-19 on diseases treated with hepato- biliary- pancreatic surgery from the experience of nosocomial infection at our hospital. Method(s): We examined the treatment of 106 patients admitted by the Division of Hepato- Biliary- Pancreatic Surgery to The Jikei University Hospital for elective surgery from January through May 2020. Result(s): Of the 106 operations, 90 (85%) were performed as scheduled and did not include COVID-19-positive patients. Operations for 16 patients (15%) were postponed, but 5 (31%) of these operations were urgent or quasiurgent and were performed during the study period. Of 95 patients who underwent surgery, 50 (53%) had a malignant tumor, 3 (3%) had a borderline malignant tumor, and 42 (44%) had a benign lesion, of which 41 were gallstones or gallbladder polyps and 1 was an intraductal papillary mucinous neoplasm that caused pancreatitis. Surgery for the latter tumor was postponed while conservative treatment improved conditions, but pancreatitis recurred 2 weeks after discharge, leading to a quasiurgent surgery. Conclusion(s): Owing to COVID-19, 15% of the scheduled elective hepato- biliary- pancreatic operations were postponed. Even lesions considered benign or not requiring emergency surgery should be treated promptly. Thus, the timing of treatment should be determined so that the risks of exacerbation and COVID-19 can be balanced.Copyright © 2022 Jikei University School of Medicine. All rights reserved.
RESUMO
Background: COVID-19 is associated with higher mortality rates in patients with cancer. In this study, we aimed to evaluate the clinical outcomes, and laboratory and imaging data of patients with solid tumor infected with COVID-19 infection. Method(s): This is a cross-sectional retrospective study performed in 2020-2022 on 85 patients with a previous diagnosis of solid tumors infected with COVID-19. We included all patients with tumors of solid organs that were diagnosed with COVID-19 infection and required hospitalization those patients previously hospitalized for treatments and were infected with COVID-19 during hospitalization. Demographic data of patients were collected using a checklist. We collected data regarding clinical outcome (discharge, hospitalization or death), duration of hospitalization, requiring ICU admission, duration of hospitalization divided by received drugs and type of tumor and mean survival time. Furthermore, we collected laboratory data from all patients. The radiologic characteristics of patients were also extracted from their data. Result(s): Breast cancer was the most common solid tumor (34.9%), followed by lung cancer (19.3%). The mortality rate was 24.1% (20 patients). The highest mortality rate in this study was for metastatic intestinal cancer to the lung (100%, one patient), followed by metastatic prostatic cancer to lung (50%, three patients). The highest hospitalization duration was for patients with glioblastoma multiform (GBM) (30 days). The mean survival time among patients with mortality was 19.15+/-1.80 days. The mean CT severity score of all patients was 27.53+/-22.90. Patient's most common radiologic sign was air space consolidation (89.1%). The highest CT severity score was found in patients with stomach cancer (46.67+/-5.77). Conclusion(s): The mortality rate in this study was 24.1%. Based on the results of our study and previous research, special care should be provided to patients with solid tumors during the COVID-19 pandemic and in infected cases.Copyright © 2022, E-Century Publishing Corporation. All rights reserved.
RESUMO
Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022
RESUMO
Background: Care in hospitals is generally focused on prolonging life and may not adequately address the needs of dying patients. The incidence of oncologic diseases is rising, and efforts should be made to guarantee a better quality of death and dying. Aim: to evaluate the end-of-life care in patients with cancer under gastroenterologist care. Methods: Cross-sectional study including all in-patients with cancer who deceased in a Gastroenterology department in Portugal between 2012-2021. Demographic characteristics, clinical attitudes, therapeutic interventions and symptom control up to 6 months prior to the patient’s death were assessed. Results: We included 120 patients, 73% male, mean age 71±12.5 years. The most common cancers were hepatocellular carcinoma (35%), gastric cancer (16%), pancreatic cancer (15%) and cholangiocarcinoma (14%). One third of the patients had ECOG of 0-1 at admission and 77% (n=92) had advanced disease (stage IV or Barcelona Clinic Liver Cancer C/D). The median number of emergency consultations and hospitalizations in the 6 months before death was 2 (IQR 1-4). In their last month of life, the median time of hospitalization was 21.5 (IQR 12-25) days. It was documented the presence of an available caregiver in 56%(n=68) and spiritual support in only 2% (n=2) of the cases. One quarter of the patients experienced not adequately controlled pain and 72% received opioids. Palliative care consultation occurred in 60% (n=72) with a median time between that and death of 12 (IQR 3-18) days. Invasive procedures (diagnostic and therapeutic endoscopy, ERCP and EUS) were performed in half of the patients, achieving technical and clinical success in 62% (n=38) and 32% (n=19) of the cases, respectively. The mean time between those interventions and death was 12±10 days. The prognosis was discussed with the patient and family in 35% and 68% of the cases, respectively. At least 73% of the patients had visits at the end of life, which was negatively affected by the COVID-19 pandemic (p=0.022). Conclusions: In our cohort, we found a high hospitalization length of stay in the last month of life and high percentage of invasive treatments until shortly before dying. Thus, it is urgent to define and implement metrics of quality of death to prevent futile/potentially inappropriate treatment. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
RESUMO
Background: In a national survey 40.9% of 4,975 adults reported delaying or avoiding care due to concerns over COVID-19. Avoidance of medical care with lockdown and a decrease in access to services carries the possibility of increased morbidity and mortality from metastatic disease due to delays in diagnosis. We examine the trends in cancer diagnosis in admitted adult patients, comparing the incidences of diagnoses before lockdowns, after lockdowns, and as restrictions were lifted. Increase in diagnoses linked with metastatic disease in the late pandemic compared to early when lockdowns occurred would show delays in care due to decreased access from the pandemic, and likely increase in morbidity and mortality. Methods: Data was retrospectively analyzed patients admitted to HCA hospitals March 2020 to December 2021, separated to three periods: pre (Mar 2019-Feb 2020), early (Mar 2020-November 2020) and late pandemic (Dec 2020-December 2021). 66,022 patients with ICD-10 codes matching malignancies of lung, small intestine, colorectal, pancreas, breast, or cervix were included and patients that additionally had ICD-10 codes for metastatic disease were identified. Patients with unlinked metastatic disease codes were removed. Population demographics including sex, race, ethnicity, insurance were also included. Results: There was a decrease in lung cancer diagnoses in the pre-pandemic period from 6,546 to early at 3,248, and an increase in the late period to 4,763. Diagnoses of metastatic disease with lung cancer decreased from 4,143 in pre-pandemic to 3,357 in late pandemic. Colorectal cancer (CRC) patients without metastatic disease pre-pandemic numbered at 5,836;3,717 early pandemic;and 5,672, late pandemic. Diagnoses with metastatic disease decreased from 2,980 to 2,511 in the late period. Pancreatic cancer diagnoses decreased from 1,623 pre-pandemic to 1,508 late pandemic. Associated metastatic disease decreased from 1,181 pre-pandemic to 1,061 late pandemic. Breast cancer diagnoses decreased from 2,241 pre-pandemic to 1,915 late pandemic, and diagnoses with metastatic disease decreased from 2,334 to 1,711. Cervical cancer diagnoses increased from 385 pre-pandemic to 444 late pandemic and diagnoses with metastatic disease decreased from 252 to 187 in the late pandemic. Conclusions: Delays in access to care due to the pandemic are reflected in decreases of diagnoses seen. There was a decrease in lung, colorectal, pancreatic, breast, and cervical cancer diagnoses in the early pandemic period likely due to lockdown and diversion of medical effort. In the late pandemic period, diagnoses of these cancers rose, reflecting loosened restrictions. Our study is not able to determine the impact of delayed diagnosis, but likely results in increased morbidity and mortality. These effects could be mitigated in the future with uninterrupted access to telehealth and cancer screening.
RESUMO
The proceedings contain 374 papers. The topics discussed include: optical biopsy with linked color imaging accurately predicts inflammation in ulcerative colitis;predicting use of opiates in patients with inoperable pancreatic cancer: a retrospective cohort study;unbiased clustering of breath signature in NAFLD identifies disease progression high-risk patient phenotype - 5 year study;prevalence of malnutrition screening;the association between IBD and mental ill health: a retrospective primary care cohort study;the interleukin 22//neutrophil axis is associated with treatment resistance in ulcerative colitis;neuromuscular dysfunction in patients with nausea and vomiting syndrome defined by body surface gastric mapping;two-tiered liver fibrosis assessment in primary care annual diabetic screening 3 year follow up;can an algorithm help in the difficult dilemma of upper gastrointestinal bleed and anticoagulant COVID-19 pandemic and alcohol-specific hospital admissions;and upper gastrointestinal hemorrhages and COVID-19: a nationwide cohort study of the pandemic's impact on hospitalizations.
RESUMO
Introduction The COVID pandemic proves that a sustainable of healthcare system is dependent both on resources and a consensus about which values should guide the decision makers to appropriately set priorities for resource allocation. There is not clear how exactly the decision makers choose the priorities for spending, but there were differences between and within countries. For example, in Sweden, where healthcare system has a pronounced public character and a declared emphasis on equity and solidarity, there was a high variation between and within regions with respect to how resources were used for treatment, prevention, and vaccination. This article is an explorative analysis of the respondents' wellbeing and their preferences regarding priority- setting in healthcare in Sweden during December 2021, when the extremely high infection risk of the Omicron sparked significant concern among global experts and politicians. Methods Our web-survey was answered by1000 respondents from the web panel Userneeds. The sample is representative with respect age, gender, and geographical region for the adult population of Sweden. The respondents are invited to imagine that they are decision-makers in the health care system and decide for six hypothetical choice situations, where the resources are allocated to save the life of patients at risk of dying due to suicide, pancreatic cancer, breast cancer and acute heart attack. In addition to the choices, the survey also includes questions about the individual's demographic and socio-economic characteristics, their well-being, their risk for and experience (their own and/or someone near them) with suicide, pancreatic cancer, breast cancer and acute heart attack. Results Our preliminary results show that regardless of their age, people with a high value of life-satisfaction and with no experience related to suicide, pancreatic cancer, breast cancer and acute heart attack tend to allocate resources for relatively young patients suffering do to suicide and breast cancer.
RESUMO
Purpose During the first peak of the COVID-19 pandemic in spring 2020, the American College of Surgeons released triage recommendations for cancer care to assist with resource allocation during a global healthcare crisis.1 Our study investigates the relationship between pandemic restrictions and pancreatic cancer diagnosis and care at a single institution. Methods Our paper reports a retrospective single-center analysis of newly diagnosed pancreatic cancer from 2016-2020. Patient data was collected from our institutional cancer registry. Data was stratified into pre-pandemic years (2016-2019) and the pandemic year (2020) with further separation into fiscal quarters (Q1-Q4). Comparison of case numbers, staging, type of treatment and time to treatment was performed. Time-to-treatment was defined as the time from the date of initial diagnosis to date of treatment, for both any treatment overall and for each specific treatment type. Statistical analysis was performed using Chi-square and independent t-tests Results No changes were seen in the number of patients diagnosed with pancreatic cancer from 2016-2019 (mean=117.5 cases/year) versus 2020 (104 cases, p=0.475). There was no change in clinical overall staging comparing pre-pandemic (stage 1, n=81;stage 2, n=45;stage 3, n=55, stage4, n=184) to pandemic years (stage 1, n=28;stage 2;n=10;stage 3, n=11;stage 4, n=43;p=0.145). There were 220 patients treated by surgery, 306 by chemotherapy, 67 by radiation and 3 by immunotherapy. There were 46 patients (18.78%) who received chemotherapy during Q3 in the pre-pandemic years compared to 19 patients (31.14%) in Q3 of 2020 (p<0.001, Table 1). No difference was seen between pre-pandemic and pandemic years for both neoadjuvant (p=0.347) or adjuvant chemotherapy (p=0.217). There was no difference between pre-pandemic versus pandemic years for the other treatment modalities, including neoadjuvant or adjuvant radiation. The average time-to-first-treatment in pre-pandemic years was 36.71 days compared to 41.46 days in 2020 (p=0.31). Conclusion The number of patients receiving chemotherapy treatment increased immediately after the peak pandemic months without any change in neoadjuvant or adjuvant treatment. No change was seen in case numbers, disease stage, time-to-treatment overall and all specific modalities during peak of the pandemic. This lack of change shows the diligence of both healthcare workers and the patients involved in treating pancreatic cancer. References 1. Kato H, Asano Y, Arakawa S, et al. Surgery for pancreatic tumors in the midst of COVID-19 pandemic. World J Clin Cases. 2021;9(18):4460-4466. doi:10.12998/wjcc.v9.i18.4460 (Table Presented)
RESUMO
Objective: Pancreatectomies are technically challenging procedures frequently associated with morbidity and mortality. Nonetheless, pancreatectomies are the only potentially curative treatment for pancreatic cancer. The aim of this study is to compare the clinical and cost outcomes of patients undergoing pancreatectomy for treatment of pancreatic cancer at our institution against national benchmarks of large, specialized complex care medical centers (LSCMCs) and safety-net hospitals (America's Essential Hospitals, AEHs). Methods: The Vizient Clinical Data Base was queried for all participating institutions performing any type of pancreatectomy for pancreatic cancer for adults over the age of 18 from 2018-2020. Institution-level clinical and cost outcomes were compared across our institution, LSCMCs, and AEHs. Clinical outcomes included hospital length of stay (LOS) index, 30-day mortality index, case mix index (CMI), and percentage of 30-day readmissions. Cost outcomes comprised the direct cost index. LOS, mortality, and direct cost indices were defined as the ratio of observed values to expected values, derived from the Vizient comparison hospitals. Indices with a value greater than one indicated the observed value was greater than the expected comparison value for that measure. Continuous variables were summarized as weighted means and standard deviation. Continuous measures were analyzed by the twosample t-test or Mann-Whitney U test, as appropriate. P-values with α<0.05 defined statistical significance. Results: A total of 78 LSCMCs and 52 AEHs performed 6,795 pancreatectomies from 2018-2020. Our institution performed a total of 90 pancreatectomies during this period. LOS index was below national benchmarks at our institution (1.08-0.82), LSCMCs (0.91-0.85), and AEHs (0.94-0.93), with an increasing CMI at our institution (3.33-4.20) from 2018-2020. The mortality index declined at our institution (5.07-0.00) below national benchmarks compared to LSCMCs (1.23-1.29) and AEHs (1.19-1.45). 30-day readmissions were lower at our institution (6.25-10.26%) compared to LSCMCs (17.62-16.83%) and AEHs (18.93-15.51%). Direct cost index at our institution declined (1.00 to 0.67) below the benchmark compared to LSCMCs (0.90-0.93) and AEHs (1.02-1.04). Conclusion: From 2018-2020, clinical and cost outcomes after pancreatectomies for pancreatic cancer at our safety-net hospital are comparable to peer LSCMCs and AEHs. These outcomes have improved, exceeding national benchmarks despite an increasing CMI over this 3-year period. These findings are of particular importance given the growing reimbursement constraints coupled with the strain of the COVID-19 pandemic on the health care system. This study highlights the role of LSCMCs and safety-net hospitals in providing high-quality care to a medically underserved population requiring complex surgery. (Figure Presented)
RESUMO
Introduction. The coronavirus disease 2019 (COVID-19) pandemic has constrained healthcare units to reorganize hospital departments, substantially reducing their capacity to perform oncology-related surgeries. Despite the efforts to reduce the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization, COVID-19 has complicated the recovery of many surgical patients. Our objective was to assess the impact of SARS-CoV-2 infection on the postoperative evolution of patients with pancreatic surgery. Cases presentation. We present four patients with pancreaticoduodenectomy for malignant disease, operated in our hepato-biliary-pancreatic surgery department, who presented COVID-19 in the postoperative period, despite initial negative screening. 10% of patients who had pancreaticoduodenectomies were subsequently detected with minimal, moderate to severe forms of COVID-19 in the postoperative period, which led to an extension of the hospitalization period, in some cases, by up to five weeks. Conclusions. The side effects of COVID-19 pandemic are yet to have reached their limits. Pancreaticoduodenectomy is a complex surgery with high morbidity rates, but during the COVID-19 pandemics it has become more challenging.
RESUMO
Background: Fever of unknown origin (FUO) is a challenging clinical problem in medicine that needs collaboration of various diagnostic techniques to establish the accurate diagnosis. We evaluated the diagnostic performance of 18F-FDG PET/CT in patients who presented themselves with FUO. Our study included 40 patients with FUO who underwent PET/CT examination and their results were compared to the results of laboratory, histopathological, microbiological investigations and/or response to therapy. Results: The final diagnosis included malignancy in 20 patients (50%), infectious causes in 7 patients (17.5%) and non-infectious inflammatory causes in 6 patients (15%). Fever resolved without diagnosis in 4 patients (10%), while no definite diagnosis was reached in 3 patients (7%). PET/CT successfully contributed to diagnosis of 35 out of 40 patients with diagnostic accuracy of 87.5%. The sensitivity, specificity, positive predictive value and negative predictive value of PET/CT in our study were 93.5%, 66.7%, 90.6% and 75%, respectively. Conclusion: PET/CT is a useful tool to investigate and diagnose the cause of FUO. It provides information that can guide the treatment strategy of the patients.