Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection.

Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06−2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14−2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40−1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88−2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64−4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence.

Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery.

INTRODUCTION: Gastric cancer patients are often transfused with red blood cells, with negative impact on postoperative course. This multicenter prospective interventional cohort study aimed to determine whether implementation of a Patient Blood Management (PBM) program, was associated with a decrease in transfusion rate and improvements in clinical outcomes in gastric cancer surgery. METHODS: We compared transfusion practices and clinical outcomes in patients undergoing elective gastric cancer resection before and after implementing a PBM program, including strategies to detect and treat anemia and restrictive transfusion practice (2014-2018). Primary outcome was transfusion rate (TR). Secondary outcomes were complications, reoperations, length of stay, readmissions, 90-day mortality and failure-to-rescue. Differences were adjusted by confounding factors. RESULTS: Some 789 patients were included (496 pre- and 293 post-PBM). TR decreased from 39.1% to 27.0% (adjusted difference -9.1, 95% CI -15.2 to -2.9), being reduction particularly significant in patients with anemia, ASA score 3-4, locally advanced tumors, undergoing open surgery and total gastrectomy. Infectious complications diminished from 25% to 16.4% (-6.1, 95%CI -11.5 to -0.7), reoperations from 8.1% to 6.1% (-2.2, 95%CI -5.1 to +0.6), median length of stay from 11 [IQR 8-18] to 8 [7-12] days (p < 0.001), hospital readmission from 14.1% to 8.9% (-5.4, 95%CI -9.6 to -1.1), mortality from 7.9% to 4.8% (-2.4, 95%CI -4.7 to -0.01), and failure-to rescue from 62.7% to 32.7% (-23.1, 95%CI -37.7 to -8.5). CONCLUSION: Implementation of a PBM program was associated with a reduction in transfusion rate and improvement in postoperative outcomes in gastric cancer patients undergoing curative resection.

Evaluación objetiva del grado de comorbilidad en pacientes geriátricos con neoplasia de colon: relación con los resultados quirúrgicos y la supervivencia / Objective assessment ofthe level of comorbidity in geriatric patients with bowel cancer: relationship between the surgical results and survival

Objetivos La neoplasia de colon es cada vez más prevalente en la edad geriátrica (mayores de 65 años). La influencia de las comorbilidades en los resultados postquirúrgicos de la neoplasia de colon es poco conocida. Nuestro objetivo fue valorar las comorbilidades a través del índice de Charlson en una población geriátrica intervenida por neoplasia de colon, y estudiar su influencia en los resultados postoperatorios y la mortalidad. Material y métodos Se incluyó a 115 pacientes intervenidos de neoplasia de colon en el Hospital General de Vic entre los años 2003 y 2005 con más de 65 años y 5 años de control evolutivo. Mediante el índice de comorbilidad de Charlson se establecieron 3 grupos de comorbilidad: ausencia (0 puntos), baja (1-2 puntos) y alta (≥ 3 puntos). Para cada uno de los grupos se determinaron complicaciones postoperatorias médicas, quirúrgicas y mortalidad. Resultados El riesgo relativo de complicación médica ajustado por edad y estadio fue 2,7 (IC 1,07-7) y 4,3 (IC 1,3-14) veces superior en los grupos de baja y alta comorbilidad respectivamente. Las complicaciones quirúrgicas postoperatorias no fueron diferentes entre los grupos de comorbilidad. El tiempo de estancia hospitalaria fue mayor en el grupo de alta comorbilidad respecto al de nula comorbilidad (17 días respecto a 26, p = 0,02). El riesgo relativo de mortalidad ajustado por edad y estadio fue de 1.7 (IC 1,04-3) y 2,5 (IC 1,3-4,6) en los grupos de baja y alta comorbilidad respectivamente. Conclusión La presencia de algún grado de comorbilidad medida por el índice de Charlson es un factor predictor independiente de complicaciones médicas y de aumento de mortalidad global en pacientes geriátricos intervenidos por neoplasia de colon (AU)

Objectives: Bowel cancer is increasing in prevalence in geriatrics (older than 65 years). The influence of comorbidities on the post-surgical results of bowel cancer is not well known Our aim was to assess the comorbidities using the Charlson index in a geriatric population subjected to bowel cancer surgery, and analyse their influence on the postoperative results and the mortality rate. Material and methods: The study included 115 patients (over 65 years-old and with 5 years follow-up) subjected to bowel cancer surgery in the Vic General Hospital (Barcelona)between the years 2003 and 2005. Three comorbidity groups were established using the Charlson index: absent(0 points), low (1-2 points), and high ( 3 points). The postoperative medical and surgical complications, as well as mortality, were determined in each of the groups. Results: The relative risk of a medical complication adjusted for age and stage was 2.7 (95%CI; 1.07-7) and 4.3 (95% CI; 1.3-14) times higher in the low and high comorbidity groups ,respectively. There were no differences in post-surgical complications between the comorbidity groups. The length of hospital stay was higher in the in the high comorbidity group compared to the group with no comorbidity (17 days compared to 26 days, P=.02). The relative risk of mortality adjusted for age and stage was 1.7 (95% CI; 1.04-3) and 2.5 (95% CI;1.3-4.6) in the low and high comorbidity groups, respectively. Conclusion: The presence of any level of comorbidity measured by the Charlson index is an independent predictive factor of medical complications and of an increase in overall mortality in geriatric patients subjected to bowel cancer surgery (AU)

[Objective assessment of the level of comorbidity in geriatric patients with bowel cancer: relationship between the surgical results and survival]. / Evaluación objetiva del grado de comorbilidad en pacientes geriátricos con neoplasia de colon: relación con los resultados quirúrgicos y la supervivencia.

OBJECTIVES: Bowel cancer is increasing in prevalence in geriatrics (older than 65 years). The influence of comorbidities on the post-surgical results of bowel cancer is not well known. Our aim was to assess the comorbidities using the Charlson index in a geriatric population subjected to bowel cancer surgery, and analyse their influence on the postoperative results and the mortality rate. MATERIAL AND METHODS: The study included 115 patients (over 65 years-old and with 5 years follow-up) subjected to bowel cancer surgery in the Vic General Hospital (Barcelona) between the years 2003 and 2005. Three comorbidity groups were established using the Charlson index: absent (0 points), low (1-2 points), and high (≥ 3 points). The postoperative medical and surgical complications, as well as mortality, were determined in each of the groups. RESULTS: The relative risk of a medical complication adjusted for age and stage was 2.7 (95% CI; 1.07-7) and 4.3 (95% CI; 1.3-14) times higher in the low and high comorbidity groups, respectively. There were no differences in post-surgical complications between the comorbidity groups. The length of hospital stay was higher in the in the high comorbidity group compared to the group with no comorbidity (17 days compared to 26 days, P=.02). The relative risk of mortality adjusted for age and stage was 1.7 (95% CI; 1.04-3) and 2.5 (95% CI; 1.3-4.6) in the low and high comorbidity groups, respectively. CONCLUSION: The presence of any level of comorbidity measured by the Charlson index is an independent predictive factor of medical complications and of an increase in overall mortality in geriatric patients subjected to bowel cancer surgery.

A new knot technique for vessel ligatures.

A new technique for ligating vessels and similar structures that offers more security is described. The aim of the study was to test whether this hypothesis was correct. Six different types of knots, including the one described in this article were compared by a strength-testing study. The knots were tied on a silicon tube through which a constant air flow of 795.10 mmHg of pressure circulated. Tension of 2 kg was then applied to both loose ends of the suture filament (polyglyconate n degrees 1 gauge) for 25 seconds. Then, 15 seconds after the tension was released an overpressure of 2250.31 mmHg was applied to the system. Two computerized pressure sensors were applied to both ends of the tube. The newly described knot reached the highest strangulating force (997.63 mmHg) and had the highest resistance to slippage. From these results, we conclude that the new knot is far more secure for vessel and duct ligature and that it represents a new and useful tool for surgeons in both open and laparoscopic surgery.