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Incidence and treatment of mediastinal leakage after esophagectomy:Insights from the multicenter study on mediastinal leaks

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World Journal of Gastroenterology 2019年第3期25卷 356-366页

作者： Uberto Fumagalli Gian Luca Baiocchi ANDrea Celotti Paolo Parise ANDrea Cossu Luigi Bonavina daniele bernardi Giovanni de Manzoni Jacopo Weindelmayer Giuseppe Verlato Stefano Santi Giovanni Pallabazzer Nazario Portolani Maurizio Degiuli Rossella Reddavid Stefano de Pascale Department of Digestive Surgery IEO European Institute of Oncology IRCCS Nazario Portolani Department of Clinical and Experimental StudiesSurgical Clinic University of Brescia General Surgery 2 ASST Spedali Civili di Brescia Department of Gastrointestinal Surgery San Raffaele HospitalVita-Salute San Raffaele University Department of Surgery IRCCS Policlinico San DonatoUniversity of Milan General and Upper GI Surgery Division University of Verona Department of Diagnostics and Public Health University of Verona Esophageal Surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease Cisanello Hospital University of Turin Department of Oncology Surgical Oncology and Digestive Surgery San Luigi University Hospital

BACKGROUND Mediastinal leakage(ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has beendifficult to establish because of the great variability in their incidence and mortality rates reported in the existing *** To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group(ECCG).METHODS Seven Italian surgical centers(five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies(n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to *** MLs were defined according to the classification recently proposed by the *** Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8%(95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy(HE), respectively, and doubled(20%) after totally minimally invasive esophagectomy(TMIE)(P = 0.016). No other predictive factors were found. The 30-and 90-d overall mortality rates were 1.4% and 3.2%,respectively; the 30-and 90-d leak-related mortality rates were 5.1% and 10.2%,respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%,respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML *** treatment had the lowest mortality rate(6.9%). Removal of the gastric tube with stoma formation was necessary in 8(13.6%) *** The incidence of ML after esophagectomy was high mainly in the TMIE ***, the general and specific(leak-related) mortality rates were low. Early treatme

关键词： Transthoracic esophagectomy Minimally invasive esophagectomy Mediastinal leak Esophagectomy complications

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Hepatitis C virus recurrence after liver transplantation:A 10-year evaluation

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World Journal of Gastroenterology 2015年第13期21卷 3912-3920页

作者： Stefano Gitto Luca Saverio Belli Ranka Vukotic Stefania Lorenzini Aldo Airoldi Arrigo Francesco Giuseppe Cicero Marcello Vangeli Lucia Brodosi Arianna Martello Panno Roberto Di Donato Matteo Cescon Gian Luca Grazi Luciano De Carlis Antonio daniele Pinna Mauro bernardi Pietro Andreone Department of Medical and Surgical Sciences University of Bologna and Azienda Ospedaliero-Universitaria di BolognaPoliclinico Sant’Orsola Malpighi40138 BolognaItaly Department of Gastroenterology Azienda Ospedaliero-Universitaria and University of Modena and Reggio Emilia41124 ModenaItaly Department of Hepatology and Gastroenterology Niguarda Hospital20162 MilanItaly Hepatobiliopancreatic and General Surgery Unit Regina Elena Institute00186 RomeItaly Department of General Surgery and Transplantation Niguarda Hospital20162 MilanItaly

AIM: To evaluate the predictors of 10-year survival of patients with hepatitis C recurrence. METHODS: Data from 358 patients transplanted between 1989 and 2010 in two Italian transplant centers and with evidence of hepatitis C recurrence were analyzed. A χ2, Fisher's exact test and Kruskal Wallis' test were used for categorical and continuous variables, respectively. Survival analysis was performed at 10 years after transplant using the Kaplan-Meier method, and a log-rank test was used to compare groups. A P level less than 0.05 was considered significant for all tests. Multivariate analysis of the predictive role of different variables on 10-year survival was performed by a stepwise Cox logistic ***: The ten-year survival of the entire population was 61.2%. Five groups of patients were identified according to the virological response or lack of a response to antiviral treatment and, among those who were not treated, according to the clinical status(mild hepatitis C recurrence, "too sick to be treated" and patients with comorbidities contraindicating the treatment). While the 10-year survival of treated and untreated patients was not different(59.1% vs 64.7%, P = 0.192), patients with a sustained virological response had a higher 10-year survival rate than both the "non-responders"(84.7% vs 39.8%, P < 0.0001) and too sick to be treated(84.7% vs 0%, P < 0.0001). Sustained virological responders had a survival rate comparable to patients untreated with mild recurrence(84.7% vs 89.3%). A sustained virological response and young donor age were independent predictors of 10-year survival. CONCLUSION: Sustained virological response significantly increased long-term survival. Awaiting the interferon-free regimen global availability, antiviral treatment might be questionable in selected subjects with mild hepatitis C recurrence.

关键词： Hepatitis C Liver transplantation Hepatitis C viru

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