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1.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(11): 837-842, 2019 Nov 07.
Artigo em Chinês | MEDLINE | ID: mdl-31795545

RESUMO

Objective: To investigate the potential risk factors for the death of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy during perioperative periods. Methods: A total of 71 patients, including 64 males and 7 females, aged from 35 to 72 years old, with hypopharyngeal or cervical esophageal carcinoma, who underwent gastric pull-up reconstruction after pharyngoesophagectomy between October 2008 and October 2017, were reviewed retrospectively. Seventeen factors which may have potential influence on the mortality of patients during perioperative periods were evaluated by single factor Logistic regression analysis, and then those factors with obvious difference in statistics were further analyzed by multi-factor Logistic regression. Results: The rate of perioperative mortality was 9.9% (7/71). Single factor Logistic regression analysis indicated that the age of patients, abnormal electrocardiogram, TNM stages, alanine aminotransferase and D-Dimer changes, postoperative bleeding were risk factors for the death of patients(P values were 0.023, 0.004, 0.026, 0.021, 0.015 and 0.002, respectively). Multi-factor Logistic regression showed that postoperative bleeding and D-Dimer changes were 2 independent risk factors for perioperative death(P=0.021 and 0.047, respectively). Conclusions: Many potential factors may affect the perioperative mortality of patients underwent gastric pull-up reconstruction following total pharyngoesophagectomy. Postoperative bleeding and significantly elevated D-Dimer level were independent risk factors for the death of patients, indicating poor prognosis.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/mortalidade , Esôfago/cirurgia , Faringectomia/mortalidade , Faringe/cirurgia , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Neoplasias Esofágicas/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/sangue , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Fatores de Risco
2.
Rev Med Chil ; 147(6): 718-726, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859824

RESUMO

BACKGROUND: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. AIM: To describe the five-year evolution of a cohort of patients operated on with this technique. MATERIAL AND METHODS: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. RESULTS: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. CONCLUSIONS: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.


Assuntos
Anastomose de Artéria Torácica Interna-Coronária/métodos , Artéria Torácica Interna/cirurgia , Idoso , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Feminino , Seguimentos , Humanos , Anastomose de Artéria Torácica Interna-Coronária/mortalidade , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Reprodutibilidade dos Testes , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
3.
J Laparoendosc Adv Surg Tech A ; 29(6): 759-769, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30835156

RESUMO

Background: Short-term outcomes after laparoscopic pancreaticoduodenectomy (LPD) seem promising, but long-term outcomes of LPD for pancreatic cancer (PC) warrant further investigation. Methods: A systematic research of various databases was performed to identify studies analyzing long-term outcomes in LPD versus open pancreaticoduodenectomy (OPD) for PC. Survival parameters of overall survival (OS) and disease-free survival (DFS) were extracted. The search was last conducted before May 23, 2018. Results: A total of 10 studies involving 11,180 patients (1437 in LPD and 9743 in OPD) met the final inclusion criteria. Pooled analyses showed that LPD was associated with longer DFS compared with OPD (hazard ratio [HR]: 0.77, 95% confidence interval [CI]: 0.61 to 0.98, P = .033). No significant difference in OS was found between LPD and OPD (HR: 0.98, 95% CI: 0.90 to 1.07, P = .672). In addition, patients of LPD had much shorter time to receive postoperative adjuvant chemotherapy compared with OPD (weighted mean difference: -10.17, 95% CI: -17.90 to -2.45, P = .010). Discussion: With regard to long-term survival, LPD is comparable with OPD for PC. Furthermore, LPD is associated with longer DFS compared with OPD. Future well-designed, randomized controlled trials with longer follow-up are still essential to further demonstrate the advantages of LPD for PC.


Assuntos
Laparoscopia/mortalidade , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/mortalidade , Quimioterapia Adjuvante , Terapia Combinada , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Resultado do Tratamento
4.
J Plast Reconstr Aesthet Surg ; 72(4): 642-648, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30799122

RESUMO

BACKGROUND: Sentinel lymph node biopsy (SLNB) is an indispensable surgical procedure in staging and management of intermediate-to-thick melanomas. Although recent studies have demonstrated that complete lymph node dissection (CLND) does not improve 3-year specific survival, its utility in increasing the disease-free period and the control of local disease remains confirmed. The most frequent complication related to CLND is lymphedema, which may affect up to 20% of patients undergoing CLND. The preventive use of lymphatic-venous micro-anastomoses could avoid this complication. MATERIALS AND METHODS: We performed a single-institution retrospective case-control study. CLND was proposed to all subjects with positive-SLNB; a preventive procedure involving multiple lymphaticovenular anastomoses (PMA) was performed in a cohort of subjects undergoing CLND. Frequency of lymphedema was compared among subjects undergoing and not-undergoing PMA during CLND. RESULTS: We selected patients affected by melanoma of the trunk and with a minimum follow-up of 3 years, identifying 23 patients who underwent PMA during CLND (PMA group) and 120 subjects who underwent CLND without PMA (control group). The frequency of lymphedema was significantly lower in the PMA group than in the control group (4.3% vs. 24.2%, p = 0.03). Patients of the PMA group and the control group showed similar 3-year recurrence-free period (65.2% vs. 62.5%, log-rank test p = 0.88) and 3-year overall survival (73.9% vs. 72.5%, log-rank test p = 0.97) and frequency of nonsentinel-node metastases (26.7% vs. 30.4%, p = 0.71). CONCLUSION: PMA appear to represent a useful and safe procedure in reducing the risk of lymphedema in patients with melanoma undergoing CLND.


Assuntos
Anastomose Cirúrgica/métodos , Excisão de Linfonodo , Vasos Linfáticos/cirurgia , Linfedema/prevenção & controle , Melanoma/cirurgia , Veias/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Estudos de Casos e Controles , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/etiologia , Masculino , Melanoma/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Análise de Sobrevida , Adulto Jovem
5.
Obes Surg ; 29(2): 401-405, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30411224

RESUMO

BACKGROUND: Laparoscopic staplers are integral to bariatric surgery. Their pricing significantly impacts the overall cost of procedures. An independent device company has designed a stapler handle and single-use reloads for cross-compatibility and equivalency with existing manufacturers, at a lower cost. OBJECTIVES: We aim to demonstrate non-inferior function and cross-compatibility of a newly introduced stapler handle and reloads compared to our institution's current stapling system in a large animal survival study. SETTING: University-affiliated animal research facility, USA. METHODS: Matched small bowel anastomoses were created in four pigs, one with each stapler (a total of two per animal). After 14 days, investigators blinded to stapler type evaluated the anastomoses grossly and microscopically. Each anastomosis was scored on multiple measures of healing. Individual parameters were added for a global "healing score." RESULTS: Clinical stapler function and gross quality of anastomoses were similar between stapler groups. Individual scores for anastomotic ulceration, reepithelialization, granulation tissue, mural healing, eosinophilic infiltration, serosal inflammation, and microscopic adherences were also statistically similar. The mean "healing scores" were equal. While this study was underpowered for subtle differences, safe and reliable performance in large animals still supports the feasibility of introducing new devices into human use. CONCLUSIONS: The new stapler system delivers a similar technical performance and is cross-compatible with currently marketed stapling devices. An equivalent quality device at a lower price point should enable case cost reduction, helping to maintain hospital case margin and procedure value in the face of potentially declining reimbursement. This device may provide a safe and functional alternative to currently used laparoscopic surgical staplers.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Grampeadores Cirúrgicos/economia , Grampeamento Cirúrgico/economia , Grampeamento Cirúrgico/instrumentação , Anastomose Cirúrgica/economia , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Animais , Cirurgia Bariátrica/economia , Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/mortalidade , Custos e Análise de Custo , Modelos Animais de Doenças , Estudos de Viabilidade , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Laparoscopia/economia , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/mortalidade , Obesidade Mórbida/economia , Obesidade Mórbida/mortalidade , Obesidade Mórbida/patologia , Grampeamento Cirúrgico/métodos , Grampeamento Cirúrgico/mortalidade , Suínos
6.
J Surg Res ; 231: 24-29, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30278935

RESUMO

BACKGROUND: Magnetic compression technique (MCT) is useful for construction of digestive tract anastomoses in pigs and dogs. This study determined the efficacy of MCT for performing colonic anastomosis in rats. METHODS: Twenty male Sprague-Dawley rats (230-280 g) were randomly apportioned to a study group that underwent colonic anastomosis with MCT or a control group subjected to hand-sewn colonic anastomosis. The groups were compared for time to construct the anastomosis, survival rate, and postoperative complications. Animals were euthanized at 1 mo postsurgery to study the burst pressure and histology of the anastomoses. RESULTS: The study group required significantly less time to construct the anastomosis (6.50 ± 1.58 min) than did the control (15.6 ± 2.22 min). The survival rate of the study group (100%) was significantly higher than that of the control group (60%). In the control group, three rats developed anastomotic leakage and one rat developed anastomotic obstruction. No anastomotic leakage or obstruction was observed in the study group. The burst pressures of the two groups were similar. Histology showed that the study group had better alignment of the tissue layers and less inflammation compared with the control group. CONCLUSIONS: MCT is a safe and feasible technique for colonic anastomosis in rats, with better postoperative outcomes compared with hand-sewn anastomosis.


Assuntos
Anastomose Cirúrgica/métodos , Imãs , Anastomose Cirúrgica/mortalidade , Animais , Masculino , Complicações Pós-Operatórias , Distribuição Aleatória , Ratos Sprague-Dawley
7.
J Gastrointest Surg ; 22(12): 2142-2149, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30066066

RESUMO

BACKGROUND: This study aimed to define the incidence and risk factors of postoperative morbidity and mortality after pouch excision (PE). METHODS: ACS-NSQIP database was queried for patients who underwent PE between 2005 and 2015. Main outcome measures were 30-day mortality, major morbidity, overall surgical site infections (SSI), reoperation, and length of stay (LOS). Risk factors associated with these outcomes were assessed using multivariate logistic or quantile regression. RESULTS: Three hundred eighty-one patients underwent PE (mean age 47.7(±15.3) years; 51.7% female). Mean body mass index (BMI) was 24.6(±5.7) kg/m2, 55.4% were ASA class 1-2 and 18.4% were immunosuppressed. Mean operative time was 252(±112.7) min, 98% were elective cases, and median LOS was 7(5-11) days. Twenty-eight percent experienced major morbidity, including SSIs (21.5% overall, 9.2% superficial, 3.7% deep, 10.3% organ space), sepsis (9.5%), urinary tract infection (5.8%), and postoperative pneumonia (2.4%). The observed venous thromboembolism rate was low, with 0.5 and 0.8% of patients suffering pulmonary embolism and deep vein thrombosis, respectively; 5.5% required reoperation. Postoperative mortality was 0.8%. On multivariate logistic regression, smoking (OR 3.03 [95% CI 1.56, 5.88]) and operative time (OR 1.003 [95% CI 1.0003, 1.0005) were associated with increased odds of major morbidity. Smoking (OR 3.29 [95% CI 1.65, 6.54]) and operative time (OR 1.002 [95% CI 1.000, 1.004]) were independent risk factors for overall SSI. LOS was significantly increased in patients with major morbidity (3.29 days [95% CI 1.60, 4.99]) and increased operative time (0.013 days [95% CI 0.007, 0.018]). CONCLUSIONS: PE is an operation with significant risk of morbidity. However, mortality was low in the present cohort of patients. Patients who were smokers and had longer operative time had increased risk of overall infectious complications and major morbidity. Furthermore, major morbidity and operative time were associated with increased hospital length of stay following PE.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Bolsas Cólicas , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Bolsas Cólicas/efeitos adversos , Bases de Dados Factuais/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Morbidade , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia
8.
Dis Esophagus ; 31(12)2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29873693

RESUMO

This study aims to report the technical details and preliminary outcomes of robot-assisted Ivor-Lewis esophagectomy (RAILE) using two different types of intrathoracic anastomosis from a single institution in China. From May 2015 to October 2017, 61 patients diagnosed with mid-lower esophageal cancer were treated with RAILE. The RAILE procedure was performed in two stages. The first 35 patients underwent circular end-to-end stapled intrathoracic anastomosis (stapled group), and the remaining 26 patients had a double-layered, completely hand-sewn intrathoracic anastomosis (hand-sewn group). Patient characteristics, surgical techniques, postoperative complications, and pathology outcomes were analyzed. The mean operating time and mean blood loss were 315.6 ± 59.4 minutes and 189.3 ± 95.8 mL, respectively. There was one patient who underwent conversion to thoracotomy. The 30-day and in-hospital mortality rates were 0%. Overall complications were observed in 22 patients (36.1%) according to the Clavien-Dindo (CD) and the Esophagectomy Complications Consensus Group (ECCG) classifications, of whom 6 patients (9.8%) had anastomotic leakage (ECCG, Type II). The median length of hospitalization (LOH) was 10 days (IQR, 5 days). Complete (R0) resection was achieved in all cases. The mean tumor size was 3.2 ± 1.5 cm, and the mean number of totally dissected lymph nodes was 19.3 ± 9.2. Regarding the operative outcomes between stapled and hand-sewn groups, there were no significant differences in the operative time (325.4 ± 66.6 vs. 302.3 ± 45.9 min, P = 0.114), blood loss (172.9 ± 74.1 vs. 211.5 ± 117.0 mL, P = 0.147), conversion rate (2.9 vs. 0%, P = 1.000), overall complication rate (37.1 vs. 34.6%, P = 0.839) or LOH (10 vs. 9.5 days, P = 0.415). RAILE using both stapled and hand-sewn intrathoracic anastomosis is safe and technically feasible with satisfactory perioperative outcomes for the treatment of mid-lower thoracic esophageal cancer.


Assuntos
Abdome/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Esôfago/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Idoso , Anastomose Cirúrgica/mortalidade , Fístula Anastomótica/etiologia , China , Neoplasias Esofágicas/mortalidade , Esofagectomia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/mortalidade , Procedimentos Cirúrgicos Torácicos/mortalidade , Resultado do Tratamento
9.
Colorectal Dis ; 20(11): 986-995, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29920911

RESUMO

AIM: Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. METHOD: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. RESULTS: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). CONCLUSION: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.


Assuntos
Fístula Anastomótica/mortalidade , Colectomia/mortalidade , Colo/cirurgia , Neoplasias do Colo/cirurgia , Grampeamento Cirúrgico/mortalidade , Idoso , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Fístula Anastomótica/etiologia , Colectomia/métodos , Neoplasias do Colo/mortalidade , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
10.
Obes Surg ; 28(7): 2122-2125, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29693220

RESUMO

Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) is a simplified biliopancreatic diversion. The objective of this study was to develop a reproducible animal model for SADI-S. We used three techniques for duodenal exclusion and duodenoileal anastomosis: (a) surgical clip and side-to-side anastomosis, (b) ligation and side-to-side anastomosis and (c) sectioning the duodenum, closing the duodenal stump and end-to-side anastomosis. We recorded the surgical technique and complications for each method. Twenty-five of 31 rats survived to the end of the study period. One death occurred from accidental anaesthesia overdose and the others from anastomosis leak. Four duodenal exclusions had repermeabilised at necropsy. Our murine model of SADI-S can be consistently reproduced. Sectioning the duodenum is preferable to avoid repermeabilisation of the duodenum.


Assuntos
Anastomose Cirúrgica/métodos , Desvio Biliopancreático/métodos , Gastrectomia/métodos , Modelos Animais , Anastomose Cirúrgica/mortalidade , Fístula Anastomótica/cirurgia , Animais , Desvio Biliopancreático/mortalidade , Duodeno/cirurgia , Gastrectomia/mortalidade , Humanos , Masculino , Camundongos , Obesidade Mórbida/patologia , Obesidade Mórbida/cirurgia , Ratos , Ratos Wistar
11.
Eur J Cardiothorac Surg ; 54(3): 475-482, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-29506024

RESUMO

OBJECTIVES: The purpose of this study was to evaluate mid-term patency and clinical outcomes according to the proximal anastomosis site after off-pump coronary artery bypass using the radial artery (RA). METHODS: From January 2001 to December 2015, 1124 patients who underwent isolated off-pump coronary artery bypass using the RA were reviewed and divided into 2 groups: the composite Y-graft (n = 1014, Y group) and aortocoronary graft (n = 110, Aorta group). Graft patency was assessed by computed tomography or coronary angiography. RESULTS: Patients receiving Y-grafts had a greater number of RA anastomoses (1.79 ± 0.68 per patient vs 1.40 ± 0.51 per patient, P < 0.001), more sequential grafts (55.6% vs 37.3%, P < 0.001) and a higher incidence of total arterial revascularization (77.9% vs 54.5%, P < 0.001). Postoperative graft patency at a mean of 3.1 ± 3.5 years was assessed in 1944 distal RA anastomoses (Y group: 1811, Aorta group: 133). No significant differences were observed in RA graft patency rate (P = 0.705), overall survival (P = 0.987) and major cardiac event-free survival (P = 0.830) between groups. Multivariable analysis demonstrated that the independent predictors of graft occlusion were age [hazard ratio (HR) 1.025, confidence interval (CI) 1.007-1.044; P = 0.007], female gender (HR 1.391, CI 1.007-1.924; P = 0.047), target of the right coronary artery territory (HR 2.135, CI 1.347-3.382; P = 0.001) and target vessel stenosis ≥90% (HR 0.478, CI 0.291-0.785; P = 0.004). The proximal anastomosis site was not significantly associated with graft occlusion (P = 0.705). CONCLUSIONS: When target vessel territory and stenosis are appropriately considered, the RA as a secondary conduit can be effectively used for myocardial revascularization, regardless of the proximal anastomosis site.


Assuntos
Anastomose Cirúrgica , Ponte de Artéria Coronária sem Circulação Extracorpórea , Artéria Radial , Grau de Desobstrução Vascular/fisiologia , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Anastomose Cirúrgica/estatística & dados numéricos , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Ponte de Artéria Coronária sem Circulação Extracorpórea/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Oclusão de Enxerto Vascular , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Complicações Pós-Operatórias , Artéria Radial/cirurgia , Artéria Radial/transplante , Estudos Retrospectivos
12.
Ann Transplant ; 23: 61-65, 2018 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-29348397

RESUMO

BACKGROUND The aim of this study was to assess the impact of placement of an aortohepatic conduit on graft and patient survival after liver transplantation (LT) in selected patients with an inadequate recipient hepatic artery (HA) for a standard arterial anastomosis. MATERIAL AND METHODS Of 331 patients who underwent deceased donor LT, 25 (7.6%) who received placement of an aortohepatic conduit at the time of transplantation were included. Clinical characteristics and outcomes, including postoperative complications, conduit patency, and graft and patient survival rates, were analyzed. RESULTS All 25 patients included in this study presented a high preoperative Model for End-stage Liver Disease score (25.4±8.6; range, 6-42) and high rates of retransplantation (n=11, 44%) or previous abdominal - pelvic surgery (n=5, 20%). The observed postoperative vascular complications were portal vein thrombosis in 3 cases (12%) and anastomosis-site bleeding of the aortohepatic conduit in 1 case (4%); there was no HA thrombosis or stenosis in our analysis. With a median follow-up of 37 months (range, 0-69 months), all aortohepatic conduits were patent, and the graft and patient survival rates were 84% and 68%, respectively. The causes of death were graft failure (n=4), pneumonia (n=3), and cerebrovascular accidents (n=1). CONCLUSIONS Our results indicate that placement of an aortohepatic conduit is a feasible alternative to a standard arterial anastomosis in selected patients whose HA and surrounding potential inflow arteries are not suitable for standard arterial anastomosis.


Assuntos
Anastomose Cirúrgica/métodos , Doença Hepática Terminal/cirurgia , Sobrevivência de Enxerto/fisiologia , Artéria Hepática/cirurgia , Transplante de Fígado/métodos , Adulto , Idoso , Anastomose Cirúrgica/mortalidade , Doença Hepática Terminal/mortalidade , Feminino , Humanos , Fígado/irrigação sanguínea , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Reoperação , Taxa de Sobrevida , Resultado do Tratamento
13.
Eur J Cardiothorac Surg ; 53(4): 732-739, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29182759

RESUMO

OBJECTIVES: An anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly, often associated with severely impaired left ventricular (LV) contractility and functional mitral valve (MV) regurgitation. Current data suggest that earlier correction of ALCAPA may result in a more complete recovery of LV function. By analysing the results of a large single-centre ALCAPA cohort, we sought to investigate whether these treatment paradigms remain valid. METHODS: A retrospective study was performed evaluating all patients undergoing repair of ALCAPA over a period of almost 40 years. All preoperative and postoperative echocardiographic reports were reviewed, focusing on the recovery of LV and MV function. RESULTS: The study cohort included 78 patients who underwent ALCAPA repair between 1977 and 2015, who were divided into 2 groups based on patient age at initial repair: Group A (n = 52, age <1 year) and Group B (n = 26, age >1 year). Following repair, systolic LV and MV function improved significantly (P < 0.01) in both groups. Patient age at the time of initial surgery had no significant influence on the improvement of LV function. Early mortality (within 30 days) was 10% (n = 8). No 30-day mortality was reported in the past 20 years. Survival at 20 years following ALCAPA repair was 86 ± 4%. CONCLUSIONS: Following ALCAPA repair, LV function significantly improved, regardless of age at the time of repair. In addition, preoperative functional MV regurgitation decreased over time. Concomitant mitral valve surgery at the time of ALCAPA repair is required in patients with structural abnormalities of the MV.


Assuntos
Anomalias dos Vasos Coronários/cirurgia , Artéria Pulmonar/anormalidades , Adolescente , Adulto , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Criança , Pré-Escolar , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/mortalidade , Ecocardiografia , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/cirurgia , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda , Adulto Jovem
14.
Asian J Surg ; 41(3): 250-256, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28286020

RESUMO

BACKGROUND/OBJECTIVE: Postoperative pancreatic fistula (POPF) remains an important cause of morbidity and mortality after pancreaticoduodenectomy. Pancreaticogastrostomy (PG) as a reconstruction method after pancreaticoduodenectomy is a safe and optional surgical technique in decreasing the risk of POPF. In this study, a retrospective analysis was carried out to evaluate a new modification of PG technique that uses a two-layer anastomoses with an internal stent. METHODS: Forty-seven patients underwent this newly modified PG technique between February 2012 and August 2016. Demographics, histopathological findings, type of surgery performed, perioperative parameters, postoperative length of stay, postoperative complications and interventional procedures, follow-up, and mortality data were collected and analyzed. Clavien-Dindo classification was used to grade the complications' severity. RESULTS: Postoperative mortality was 4.25%, unrelated to POPF, and postoperative morbidity was 44.68%. Thirteen patients had severe (>Grade IIIa) complications, according to Clavien-Dindo classification. As classified in accordance to the International Study Group of Pancreatic Fistula, 24 (51.06%) patients developed Grade A POPF, and no occurrence of Grade B/C POPF was noted. All patients recovered uneventfully with successful treatment interventions. CONCLUSION: The reported PG anastomotic technique is a safe and dependable reconstruction procedure with acceptable morbidity and mortality.


Assuntos
Pâncreas/cirurgia , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia , Complicações Pós-Operatórias/prevenção & controle , Stents , Estômago/cirurgia , Adulto , Idoso , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/epidemiologia , Fístula Pancreática/etiologia , Pancreaticoduodenectomia/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Rev. chil. cir ; 70(5): 432-438, 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-978010

RESUMO

Introducción: La hemicolectomía derecha con anastomosis ileocólica es una cirugía frecuentemente realizada para la que existen muchas formas de realizarla. Objetivo: Evaluar cuál es la mejor anastomosis ilecólica en términos de morbimortalidad y realizar una evaluación comparativa de la evolución clínica posoperatoria según el tipo de configuración anastomótica. Pacientes y Método: Estudio observacional analítico, con criterios de inclusión y exclusión definidos. Las variables a estudiar las dividimos en dos grupos, las relacionadas a la técnica quirúrgica y su configuración anastomótica, y las variables relacionadas con resultados de la intervención quirúrgica, creando una tabla de contingencia en que se cruzan los datos. Análisis de datos con STATA 13.0. Resultados: 216 pacientes con anastomosis ileocólica, destacando significancia estadística al cruzar: A) reoperación y tipo de sutura (p = 0,044), con un OR 3,4 (IC 95% 0,94-18,6), siendo de mayor riesgo la mecánica; B) mortalidad y urgencia (p = 0,001) con un OR 7,76 (IC 95% 1,56-49,29), siendo de mayor riesgo la cirugía de urgencia. Las anastomosis isoperistálticas possen eliminación de gases (p < 0,001), tránsito intestinal (p = 0,009) e ingesta de sólidos (p = 0,005) más precoz. Hay expulsión de gases antes en el abordaje laparoscópico, sutura manual, configuración término lateral e isoperistáltica de la anastomosis y cirugía electiva. Conclusión: Existe gran variabilidad de técnicas para realizar la anastomosis ileocólica. La anastomosis manual muestra menor probabilidad de necesitar una reintervención quirúrgica, la cirugía electiva tiene menor mortalidad que la realizada de urgencia. Sugerimos realizarla vía laparoscópica, con sutura manual, término lateral, isoperistáltica y de forma electiva, por tener una recuperación más corta.


Introduction: Right hemicolectomy with ileocolic anastomosis is a frequent surgery with many ways to perform it. Objective: To evaluate which is the best ileocolic anastomosis in terms of morbidity and mortality and to make a comparative evaluation of the postoperative clinical evolution according to the type of anastomosis. Patients and Method: Analytical observational study, with defined inclusion and exclusion criteria. The variables to be studied are divided into two groups, those related to the surgical technique and its anastomotic configuration, and the variables related to the results of the surgical intervention, creating a contingency table that crosses the data. Data analysis with STATA 13.0. Results: 216 patients with ileocolic anastomosis, highlighting statistical significance when crossing: A) reoperation and type of suture (p = 0.044), with UN or 3.4 (95% CI 0.94 to 18.6), being of greater risk the mechanics; B) mortality and urgency (p = 0.001) with an OR 7.76 (95% CI 1.56-49.29), with emergency surgery being of greater risk. Isoperistaltic anastomosis with gas elimination (p < 0.001), intestinal transit (p = 0.009) and solid intake (p = 0.005) earlier. There is earlier expulsion of gases in the laparoscopic approach, manual suture, end-to-side and isoperistaltic of the anastomosis and elective surgery. Conclusion: There is great variability of techniques to perform the ileocolic anastomosis. Manual anastomosis is less likely to require surgical reoperation, elective surgery has a lower mortality than that of emergency surgery. We suggest performing it laparoscopically, with manual suture, lateral term, isoperistaltic and electively, for having a shorter recovery.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Colectomia/métodos , Colectomia/mortalidade , Reoperação , Anastomose Cirúrgica/efeitos adversos , Estudos Retrospectivos , Colectomia/efeitos adversos , Colo/cirurgia , Fístula Anastomótica/etiologia , Fístula Anastomótica/epidemiologia , Íleo/cirurgia
16.
Clin Transplant ; 31(7)2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28489291

RESUMO

BACKGROUND: Endoscopic treatment of anastomotic biliary stricture (ABS) after liver transplantation (LT) has been proven to be effective and safe, but long-term outcomes of early compared to late onset ABS have not been studied. The aim of this study is to compare the long-term outcome of early ABS to late ABS. METHODS: Of the 806 adult LT recipients (04/2006-12/2012), 93 patients met the criteria for inclusion, and were grouped into non-ABS (no stenosis on ERCP, n=41), early ABS (stenosis <90 days after LT, 18 [19.3%]), and late ABS (stenosis ≥90 days after LT, 34 [36.5%]). A propensity matched control group for the ABS group (n=42) was obtained matched for outcome variables for age, gender, and calculated MELD score at listing. RESULTS: Mean number of ERCPs (2.33±1.3 vs 2.56±1.5, P=.69) were comparable between the groups; however, significantly better long-term resolution of the stricture was noted in the early ABS group (94.44% vs 67.65%, P=.04). Kaplan-Meier analysis revealed worst survival in the early ABS group compared to the non-ABS, late ABS, and control groups (P=.0001). CONCLUSION: LT recipients with early ABS have inferior graft survival despite better response to endoscopic intervention.


Assuntos
Anastomose Cirúrgica/mortalidade , Sistema Biliar/patologia , Colestase Extra-Hepática/mortalidade , Constrição Patológica/mortalidade , Rejeição de Enxerto/mortalidade , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Adulto , Estudos de Casos e Controles , Colestase Extra-Hepática/etiologia , Colestase Extra-Hepática/terapia , Constrição Patológica/etiologia , Constrição Patológica/terapia , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/terapia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo
17.
Int J Radiat Oncol Biol Phys ; 97(4): 813-821, 2017 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-28244418

RESUMO

PURPOSE: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. METHODS AND MATERIALS: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. RESULTS: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. CONCLUSION: With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.


Assuntos
Anastomose Cirúrgica/mortalidade , Quimiorradioterapia Adjuvante/mortalidade , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/terapia , Estenose Esofágica/mortalidade , Esofagectomia/mortalidade , Lesões por Radiação/mortalidade , Comorbidade , Esofagoplastia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Intubação Gastrointestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Terapia Neoadjuvante , Países Baixos/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 20(1): 67-72, 2017 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-28105623

RESUMO

OBJECTIVE: To evaluate the clinicopathologic characteristics and prognostic difference of gastric stump cancer between non-anastomotic site and anastomotic site. METHODS: Clinicopathologic data of 149 patients with gastric stump cancer undergoing operation (radical resection and palliative resection) in our department from January 1999 to June 2015 were analyzed retrospectively. Gastric stump cancer was defined as a primary carcinoma detected in the remnant stomach more than 5 years after subtotal gastrectomy for a benign disease(87 cases) or over 10 years after radical subtotal gastrectomy for a malignant disease (62 cases). Patients were divided into the anastomotic site group (72 cases) and the non-anastomotic site group (77 cases) according to tumor sites within the remnant stomach. Clinicopathologic characteristics, operative data, lymph node metastasis and prognosis were compared between the two groups. RESULTS: Compared with non-anastomotic site group, the T stage, N stage and TNM stage were later in the anastomotic site group. Number of case of T1, T2, T3, and T4 stage in anastomotic site group was 1(1.4%), 2 (2.8%), 17(23.6%) and 52(72.2%), while such number in non-anastomotic site group was 8(10.4%), 10(13.0%), 27(35.1%) and 32(41.6%) respectively(χ2=17.665, P=0.001). Number of case of N0, N1, N2, and N3 in anastomotic site group was 28 (38.9%), 10 (13.9%), 23 (31.9%) and 11 (15.3%), while such number in non-anastomotic site group was 55 (71.4%), 10 (13.0%), 7 (9.1%) and 5 (6.5%) respectively(χ2=19.421, P=0.000). Number of case of stage I(, II(, III( and IIII( in anastomotic site group was 3(4.2%), 10(13.9%), 47(65.3%) and 12(16.7%), while such number in non-anastomotic site group was 16(20.8%), 40 (51.9%), 15(19.5%) and 6(7.8%) respectively(χ2=45.294, P=0.000). The histology and Borrmann classification were worse in anastomotic site group. Anastomotic site group had 19 cases(26.4%) of good differentiation and 53 cases(73.6%) of bad differentiation, while non-anastomotic site group had 43 cases (55.8%) of well-differentiated and 34 cases (44.2%) of poorly-differentiated tumors respectively(χ2=13.287, P=0.000). Anastomotic site group had 3 cases (4.2%) of Borrmann I(, 17 cases (23.6%) of Borrmann II(, 47 cases(65.3%) of Borrmann III( and 5 cases (6.9%) of Borrmann IIII(, while non-anastomotic site group had 18 cases (23.4%) of Borrmann I(, 16 cases (20.8%) of Borrmann II(, 34 cases (50.6%) of Borrmann III( and 4 cases (5.2%) of Borrmann IIII( respectively(χ2=11.445, P=0.010). Compared with non-anastomotic site group, anastomotic site group had a lower curative resection rate [63.9% (46/72) vs. 89.6% (69/77), χ2=13.977, P=0.000], a higher combined organ resection rate [33.3% (24/72) vs. 16.9% (13/77), χ2=5.394, P=0.020] and a more metastatic lymph nodes (4.3±4.9 vs. 1.9±3.6, t=3.478, P=0.000). The lymph node metastasis rates of No.4, No.10 and jejunal mesentery root lymph node in anastomotic site group and non-anastomotic site group were 15.3% (11/72) and 5.2% (4/77)(χ2=4.178, P=0.041), 9.7% (7/72) and 1.3% (1/77) (χ2=5.196, P=0.023), and 25.0% (18/72) and 3.9% (3/77)(χ2=13.687, P=0.000), respectively. Median followed up of all the patients was 37(2 to 154) months and the overall 5-year survival rate was 44.1%. The 5-year survival rate was 33.1% in anastomotic site group and 55.2% in non-anastomotic site group, and the difference was statistically significant between two groups (P=0.015). In the subgroup analysis according to the histology differentiation, the 5-year survival rate of patients with well-differentiation was not significantly different between two groups (43.7% vs. 56.2%, P=0.872), but the 5-year survival rate of patients with bad differentiation in anastomotic site group was significantly lower than that in non-anastomotic site group(29.8% vs. 53.8%, P=0.029). CONCLUSION: Gastric stump cancer locating in anastomotic site indicates worse differentiation histology, higher lymph node metastasis rate, lower curative resection rate and poorer prognosis.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Carcinoma/patologia , Gastrectomia/efeitos adversos , Coto Gástrico/patologia , Coto Gástrico/cirurgia , Neoplasias Gástricas/patologia , Idoso , Anastomose Cirúrgica/mortalidade , Anastomose Cirúrgica/estatística & dados numéricos , Carcinoma/mortalidade , Carcinoma/terapia , Feminino , Humanos , Linfonodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/estatística & dados numéricos , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/classificação , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/terapia , Taxa de Sobrevida , Resultado do Tratamento
19.
World J Surg ; 41(2): 525-537, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27785554

RESUMO

BACKGROUND: This population-based study examined surgical outcomes and hospital and post-acute care resource use after operations of cholangiocarcinoma during 2005-2012. STUDY DESIGN: Using New York State hospital claims, we identified subjects with intrahepatic tumor who underwent hepatectomy only (n = 2089), subjects with perihilar tumor who underwent hepatectomy and biliary-enteric anastomosis (BEA; n = 389) or BEA only (n = 3721), and subjects with distal cholangiocarcinoma undergoing pancreatectomy or pancreaticoduodenectomy (n = 228). We performed trend analyses for each group and calculated overall risk-adjusted mortality, complication, and 30-day readmission rates for hospitals using multivariable logistic regressions. RESULTS: Mortality rate was roughly 12 % over years for perihilar cases undergoing hepatectomy and BEA, significantly higher than the rates of other 3 groups (p = 0.000). The overall complication rate was 40 % for subjects undergoing both hepatectomy and BEA, more than doubling the rate for subjects undergoing hepatectomy or BEA alone (p = 0.000). Average LOS declined markedly for perihilar cases undergoing hepatectomy and BEA (from 21 days in 2005 to 16 days in 2012) and subjects with distal cholangiocarcinoma (from 22 days in 2005 to 16 days in 2012), but other outcomes did not change dramatically. Risk-adjusted hospital outcome rates varied substantially. CONCLUSIONS: Surgical patients with cholangiocarcinoma incur considerable mortality, postoperative complications, and resource uses, especially among those undergoing hepatectomy and BEA for perihilar tumors.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/cirurgia , Intestino Delgado/cirurgia , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/mortalidade , Anastomose Cirúrgica/tendências , Feminino , Recursos em Saúde/estatística & dados numéricos , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Hospitais/estatística & dados numéricos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , New York/epidemiologia , Pancreatectomia/efeitos adversos , Pancreatectomia/mortalidade , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/mortalidade , Readmissão do Paciente/tendências , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
20.
Surgery ; 160(5): 1279-1287, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27544541

RESUMO

BACKGROUND: Pancreaticoduodenectomy needs simple, validated risk models to better identify 30-day mortality. The goal of this study is to develop a simple risk score to predict 30-day mortality after pancreaticoduodenectomy. METHODS: We reviewed cases of pancreaticoduodenectomy from 2005-2012 in the American College of Surgeons-National Surgical Quality Improvement Program databases. Logistic regression was used to identify preoperative risk factors for morbidity and mortality from a development cohort. Scores were created using weighted beta coefficients, and predictive accuracy was assessed on the validation cohort using receiver operator characteristic curves and measuring area under the curve. RESULTS: The 30-day mortality rate was 2.7% for patients who underwent pancreaticoduodenectomy (n = 14,993). We identified 8 independent risk factors. The score created from weighted beta coefficients had an area under the curve of 0.71 (95% confidence interval, 0.66-0.77) on the validation cohort. Using the score WHipple-ABACUS (hypertension With medication + History of cardiac surgery + Age >62 + 2 × Bleeding disorder + Albumin <3.5 g/dL + 2 × disseminated Cancer + 2 × Use of steroids + 2 × Systemic inflammatory response syndrome), mortality rates increase with increasing score (P < .001). CONCLUSION: While other risk scores exist for 30-day mortality after pancreaticoduodenectomy, we present a simple, validated score developed using exclusively preoperative predictors surgeons could use to identify patients at risk for this procedure.


Assuntos
Causas de Morte , Mortalidade Hospitalar/tendências , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/mortalidade , Idoso , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia/métodos , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
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