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Combined and intraoperative risk modelling for oesophagectomy:A systematic review

World Journal of Gastrointestinal Surgery 2023年第7期15卷 1485-1500页

作者： James Paul Grantham Amanda Hii Jonathan Shenfine Department of General Surgery Modbury HospitalModbury 5092South AustraliaAustralia Department of General Surgical Unit Jersey General HospitalSaint Helier JE13QSJerseyUnited Kingdom

BACKGROUND Oesophageal cancer is the eighth most common malignancy worldwide and is associated with a poor prognosis.Oesophagectomy remains the best prospect for a cure if diagnosed in the early disease stages.However,the procedure is associated with significant morbidity and mortality and is undertaken only after careful consideration.Appropriate patient selection,counselling and resource allocation is essential.Numerous risk models have been devised to guide surgeons in making these decisions.AIM To evaluate which multivariate risk models,using intraoperative information with or without preoperative information,best predict perioperative oesophagectomy outcomes.METHODS A systematic review of the MEDLINE,EMBASE and Cochrane databases was undertaken from 2000-2020.The search terms used were[(Oesophagectomy)AND(Model OR Predict OR Risk OR score)AND(Mortality OR morbidity OR complications OR outcomes OR anastomotic leak OR length of stay)].Articles were included if they assessed multivariate based tools incorporating preoperative and intraoperative variables to forecast patient outcomes after oesophagectomy.Articles were excluded if they only required preoperative or any post-operative data.Studies appraising univariate risk predictors such as preoperative sarcopenia,cardiopulmonary fitness and American Society of Anesthesiologists score were also excluded.The review was conducted following the preferred reporting items for systematic reviews and meta-analyses model.All captured risk models were appraised for clinical credibility,methodological quality,performance,validation and clinical effectiveness.RESULTS Twenty published studies were identified which examined eleven multivariate risk models.Eight of these combined preoperative and intraoperative data and the remaining three used only intraoperative values.Only two risk models were identified as promising in predicting mortality,namely the Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity(POSSUM)and POSSUM scor

关键词： Oesophagectomy Risk model Oesophageal cancer Preoperative Intraoperative morbidity Mortality

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Short and long-term outcomes between laparoscopic and open total gastrectomy for advanced gastric cancer after neoadjuvant chemotherapy

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World Journal of Gastrointestinal Surgery 2022年第5期14卷 452-469页

作者： Hao Cui Ke-Cheng Zhang Bo Cao Huan Deng Gui-Bin Liu Li-Qiang Song Rui-Yang Zhao Yi Liu Lin Chen Bo Wei School of Medicine Nankai UniversityTianjin 300071China Department of General Surgery and Institute of General Surgery the First Medical CenterChinese PLA General HospitalBeijing 100853China Medical School Chinese PLA General HospitalBeijing 100853China

BACKGROUND Neoadjuvant chemotherapy(NACT)combined with surgery is regarded as an effective treatment for advanced gastric cancer(AGC).Laparoscopic surgery represents the mainstream of minimally invasive surgery.Currently,surgeons focus more on surgical safety and oncological outcomes of laparoscopic gastrectomy after NACT.Thus,we sought to evaluate short-and long-term outcomes between laparoscopic total gastrectomy(LTG)and open total gastrectomy(OTG)after NACT.AIM To compare the short and long-term outcomes between LTG and OTG for AGC after NACT.METHODS We retrospectively collected the clinicopathological data of 136 patients who accepted gastrectomy after NACT from June 2012 to June 2019,including 61 patients who underwent LTG and 75 who underwent OTG.Clinicopathological characteristics between the LTG and OTG groups showed no significant difference.SPSS 26.0,R software,and GraphPad PRISM 8.0 were used to perform statistical analyses.RESULTS Of the 136 patients included,eight acquired pathological complete response,and the objective response rate was 47.8%(65/136).The LTG group had longer operation time(P=0.015),less blood loss(P=0.003),shorter days to first flatus(P<0.001),and shorter postoperative hospitalization days(P<0.001).LTG spent more surgical cost than OTG(P<0.001),while total hospitalized cost of LTG was less than OTG(P<0.001).21(28.0%)patients in the OTG group and 14(23.0%)in the LTG group had 30-d postoperative complications,but there was no significant difference between the two groups(P=0.503).The 3-year overall survival(OS)rate was 60.6%and 64.6%in the LTG and OTG groups,respectively[hazard ratio(HR)=0.859,95%confidence interval(CI):0.522-1.412,P=0.546],while the 3-year disease-free survival(DFS)rate was 54.5%and 51.8%in the LTG and OTG group,respectively(HR=0.947,95%CI:0.582-1.539,P=0.823).Multivariate cox analysis showed that body mass index and pTNM stage were independent risk factors for OS while vascular invasion and pTNM stage were independent risk factors for DFS(P<0.05).CONCLUSION After N

关键词： Neoadjuvant chemotherapy Gastric cancer Laparoscope Total gastrectomy morbidity Survival

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Preoperative risk modelling for oesophagectomy: A systematic review

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World Journal of Gastrointestinal Surgery 2023年第3期15卷 450-470页

作者： James Paul Grantham Amanda Hii Jonathan Shenfine Department of General Surgery Modbury HospitalAdelaide 5092South AustraliaAustralia General Surgical Unit Jersey General HospitalSaint Helier JE13QSJerseyUnited Kingdom

BACKGROUND Oesophageal cancer is a frequently observed and lethal malignancy worldwide.Surgical resection remains a realistic option for curative intent in the early stages of the disease.However,the decision to undertake oesophagectomy is significant as it exposes the patient to a substantial risk of morbidity and mortality.Therefore,appropriate patient selection,counselling and resource allocation is important.Many tools have been developed to aid surgeons in appropriate decision-making.AIM To examine all multivariate risk models that use preoperative and intraoperative information and establish which have the most clinical utility.METHODS A systematic review of the MEDLINE,EMBASE and Cochrane databases was conducted from 2000-2020.The search terms applied were((Oesophagectomy)AND(Risk OR predict OR model OR score)AND(Outcomes OR complications OR morbidity OR mortality OR length of stay OR anastomotic leak)).The applied inclusion criteria were articles assessing multivariate based tools using exclusively preoperatively available data to predict perioperative patient outcomes following oesophagectomy.The exclusion criteria were publications that described models requiring intra-operative or post-operative data and articles appraising only univariate predictors such as American Society of Anesthesiologists score,cardiopulmonary fitness or pre-operative sarcopenia.Articles that exclusively assessed distant outcomes such as long-term survival were excluded as were publications using cohorts mixed with other surgical procedures.The articles generated from each search were collated,processed and then reported in accordance with PRISMA guidelines.All risk models were appraised for clinical credibility,methodological quality,performance,validation,and clinical effectiveness.RESULTS The initial search of composite databases yielded 8715 articles which reduced to 5827 following the deduplication process.After title and abstract screening,197 potentially relevant texts were retrieved for detailed review.Twenty-seven publi

关键词： Oesophagectomy Risk model Oesophageal cancer Preoperative morbidity Mortality

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Central pancreatectomy for benign or low-grade malignant pancreatic tumors in the neck and body of the pancreas

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World Journal of Gastrointestinal Surgery 2022年第9期14卷 896-903页

作者： Yi-Wen Chen Jian Xu Xiang Li Wei Chen Shun-Liang Gao Yan Shen Min Zhang Jian Wu Ri-Sheng Que Jun Yu Ting-Bo Liang Xue-Li Bai Department of Hepatobiliary and Pancreatic Surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310000Zhejiang ProvinceChina Department of Pancreatic Disease Zhejiang Provincial Key LaboratoryHangzhou 310000Zhejiang ProvinceChina The Study of Pancreatic Disease Zhejiang Provincial Innovation CenterHangzhou 310000Zhejiang ProvinceChina The Study of Hepatobiliary&Pancreatic Diseases Zhejiang Provincial Clinical Research CenterHangzhou 310003Zhejiang ProvinceChina Cancer Center Zhejiang UniversityHangzhou 310058Zhejiang ProvinceChina

BACKGROUND For tumors in the neck and body of the pancreas,distal pancreatectomy(DP)has been the standard surgical procedure for the last few decades and central pancreatectomy(CP)is an alternative surgical option.Whether CP better preserves remnant pancreatic endocrine and exocrine functions after surgery remains a subject of debate.AIM To evaluate the safety and efficacy of CP compared with DP for benign or lowgrade malignant pancreatic tumors in the neck and body of the pancreas.METHODS This retrospective study enrolled 296 patients who underwent CP or DP for benign and low-malignant neoplasms at the same hospital between January 2016 and March 2020.Perioperative outcomes and long-term morbidity of endocrine/exocrine function were prospectively evaluated.RESULTS No significant difference was observed in overall morbidity or clinically relevant postoperative pancreatic fistula between the two groups(P=0.055).Delayed gastric emptying occurred more frequently in the CP group than in the DP group(29.4%vs 15.3%;P<0.005).None of the patients in the CP group had new-onset or aggravated distal metastasis,whereas 40 patients in the DP group had endocrine function deficiency after surgery(P<0.05).There was no significant difference in the incidence of diarrhea immediately after surgery,but at postoperative 12 mo,a significantly higher number of patients had diarrhea in the DP group than in the CP group(0%vs 9.5%;P<0.05).CONCLUSION CP is a generally safe procedure and is better than DP in preserving long-term pancreatic endocrine and exocrine functions.Therefore,CP might be a better option for treating benign or low-grade malignant neoplasms in suitable patients.

关键词： Central pancreatectomy Distal pancreatectomy Endocrine function Exocrine function morbidity

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Temperature change between neighboring days and hospital admissions in China

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Advances in Climate Change Research 2023年第6期14卷 847-855页

作者： Yu-Shu HUANG He-Jia SONG Yi-Bin CHENG Shilu TONG Rui ZHANG Xiao-Yuan YAO Yong-Hong LI China CDC Key Laboratory of Environment and Population Health National Institute of Environmental HealthChinese Center for Disease Control and PreventionBeijing 100021China Deparment of Big Data in Health Science School of Public Health and Centerof Clinical Big Data and Analytics of the Second Affiliated HospialZhejiang University School of MedicineHangzhou 310058China Jiaxing Center for Disease Control and Prevention Jiaxing 314050China Instinurte of Environmenr and Population Health School of Public HealrhAnhui Medical UniversityHefei 230032China School of Public Health and Social Work Queensland University of TechnologyBrisbane 4006Australia Information Center Chinese Center for Disease Control and PreventionBeiing 102206China

The short-term temperature fluctuation caused by global climate change is one of the risk factors affecting public health.Exploring the association between temperature fluctuation and diseases,which has received relatively limited research attention,can contribute to enhancing awareness of health risks and taking timely measures for health risk alert and management.Therefore,this study aims to investigate the relationship between temperature change between neighboring days(TCN)and hospitalizations,identify diseases sensitive to extreme TCN,and evaluate the related disease burden.We collected meteorological and hospitalization data from 2014 to 2019 in 23 sites of China to explore the impact of TCN on hospitalizations.We first quantified site-specific associations between TCN and hospitalizations and then conducted meta-analysis to pool the results,to assess the relative risk of extreme TCN for susceptible diseases,and to estimate the related disease burden attributed to TCN.Stratified analyses were undertaken by age,sex,and disease type.Results showed that all-cause hospital admission was significantly linked to TCN.A negative TCN(below-1.9℃)in the cool season and a positive TCN(above 1.0℃)in the warm season increased the risk of hospitalization.People aged 15-64 years,men,and patients with musculoskeletal system or connective tissue diseases were more sensitive to extremely negative TCN during the cool season.People aged over 65 years,men,and patients with respiratory diseases were more sensitive to extremely positive TCN during the warm season.The attributable fraction to all-cause hospitalization from negative TCN in the cool season was 2.05%(95%CI:-0.90%,4.53%)and from positive TCN in the warm season was 5.79%(95%CI:2.98%,8.31%).Circulatory diseases in the cool season and respiratory diseases in the warm season had the highest disease burden.Our findings indicate that awareness of TCN and its health risks should be promoted and evidence-informed policies are needed to reduce the risk of TCN.

关键词： Temperature change between neighboring days morbidity Hospital admissions Sensitive diseases Vulnerable populations Disease burden

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Is There Comparable morbidity in Pylorus-preserving and Pylorus-resecting Pancreaticoduodenectomy? A Meta-analysis

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2015年第6期35卷 793-800页

作者：陈琦军何志强杨艳张宇舜陈星霖杨洪吉朱世凯钟平勇杨冲吴河水 Pancreatic Disease Institute Union Hospital Tongji Medical College Huazhong University of Science and Technology Community Health Service Center the 9th Hospital of Wuhan Key Laboratory of Geriatrics of Health Ministry Department of Geriatrics Union Hospital Tongji Medical College Huazhong University of Science and Technology Organ Transplantation Center Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People’s Hospital

Summary： Pancreaticoduodenectomy （PD） is the most effective treatment for patients with pancreatic head or periampullary lesions. Two major strategies exist： pylorus-preserving pancreaticoduodenectomy （PPPD） and pylorus-resecting pancreaticoduodenectomy （PRPD）. However, it is yet unclear regarding the morbidity after PPPD and PRPD. This study analyzed the morbidity after PPPD and PRPD to de- termine the optimal surgical treatment of masses in the pancreatic head or periampullary region. A sys- tematic search of databases identifying randomized controlled trials （RCTs） from the Cochrane Library, PubMed, EMBASE and Web of Science was performed. Outcome was compared by postoperative mor- bidity including overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, biliary leakage, ascites and delayed gastric emptying （DGE） rate between PPPD and PRPD. The DGE rate in the PRPD subgroups （conventional PD [CPD] and subtotal stomach-preserving PD [SSPPD], respec- tively） was also analyzed. The results showed that 9 RCTs including 722 participants were included for meta-analysis. Among these RCTs, 7 manuscripts described PRPD as CPD, and 2 manuscripts described PRPD as SSPPD. There were no significant differences in the overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding, or biliary leakage between PPPD and PRPD. There was a lower rate of DGE with PRPD than that with PPPD （RR=2.15, P=0.03, 95% CI, 1.09-4.23）. Further subgroup analysis indicated a comparable DGE rate for the CPD but a lower DGE rate for the SSPPD group than the PPPD group. However, the result did not indicate any difference between CPD and SSPPD regarding the DGE rate （P=-0.92）. It is suggested that PPPD is comparable to PRPD in overall morbidity, pancreatic fistulas, wound infections, postoperative bleeding and biliary leakage. The current data are not sufficient to draw a conclusion regarding which surgical procedure is associated with a lower postoperative DGE rate. Our conclusions were limited by the av

关键词： pancreaticoduodenectomy pylorus morbidity meta-analysis

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Protocol for the FACE study:frailty and comorbidity in elderly patients—a multicenter,Chinese observational cohort study

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Journal of Geriatric Cardiology 2023年第1期20卷 83-90页

作者： Wen ZHENG Xin HUANG Min SUO Xiao WANG Xue-Dong ZHAO Wei GONG Yan YAN Xiao-Na WANG Li SHENG Shao-Ping NIE Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijingChina Department of Cardiology Beijing Shijitan HospitalCapital Medical UniversityBeijingChina Department of Geriatric Cardiology National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina

The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].

关键词： patients morbidity prescription

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Road traffic injury mortality and morbidity by country development status, 2011- 2017

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Chinese Journal of Traumatology 2021年第2期24卷 88-93页

作者： Jie-Yi He Wang-Xin Xiao David CSchwebel Mo-Tao Zhu Pei-Shan Ning Li Li Xun-Jie Cheng Jun-Jie Hua Guo-Qing Hu Department of Epidemiology and Health Statistics Xiangya School of Public HealthCentral South UniversityChangsha410078China Department of Psychology University of Alabama at BirminghamBirminghamAL35294USA Center for Injury Research and Policy Abigail Wexner Research Institute at Nationwide Children’s HospitalDepartment of PediatricsThe Ohio State UniversityColumbusOH43205USA Division of Epidemiology College of Public HealthThe Ohio State UniversityColumbusOH43210USA

Purpose:This research examined road traffic injury mortality and morbidity disparities across of country development status,and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 e to halve the number of global deaths and injuries from road traffic accidents by 2020.Methods:Data for road traffic mortality,morbidity,and socio-demographic index(SDI)were extracted by country from the estimates of the Global Burden of Disease study,and the implementation of the three types of national actions(legislation,prioritized vehicle safety standards,and trauma-related post-crash care service)were extracted from the Global Status Report on Road Safety byWorld Health Organization.We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.Results:Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017(by 7.52%e16.08%).Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period,while age-adjusted morbidity generally increased as SDI increased.Subgroup analysis by road user yielded similar results,but with two major differences during the study period of 2011 to 2017:(1)pedestrians in the high SDI countries experienced the lowest mortality(1.68e1.90 per 100,000 population)and morbidity(110.45e112.72 per 100,000 population for incidence and 487.48e491.24 per 100,000 population for prevalence),and(2)motor vehicle occupants in the high SDI countries had the lowest mortality(4.07e4.50 per 100,000 population)but the highest morbidity(428.74e467.78 per 100,000 population for incidence and 1025.70e1116.60 per 100,000 population for prevalence).Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries.Lower income nations comprise the he

关键词： Road traffic injury Mortality morbidity Socioeconomic disparity Sustainable development goals

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Assessment of morbidity due to Schistosoma japonicum infection in China

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Infectious Diseases of Poverty 2014年第1期3卷 40-55页

作者： Ming-gang Chen National Institute of Parasitic Diseases Chinese Center for Disease Control and PreventionShanghaiPeople’s Republic of China WHO Collaborative Center for Malaria Schistosomiasis and FilariasisShanghaiPeople’s Republic of China

This paper presents a historical assessment of morbidity due to the Schistosoma japonicum infection in China.Due to the socio-economic situation,which did not allow for a control program to be implemented until the early 1950s,morbidity was serious and mortality was high before this.Based on a few investigations and published papers,it can be said that the disease caused millions of deaths,and destroyed numerous families and villages.Since the 1950s,there has been a national control program,intensive control and prevention work has been carried out,and consequently the disease is being controlled.At present,both the prevalence and the morbidity of the disease have been decreasing substantially.The morbidity of the three phases of the disease is outlined in this paper.Comparatively higher morbidity is seen in the acute and advanced phases of the disease.The four major forms of advanced schistosomiasis i.e.,ascites,megalosplenia,dwarfism,and colonic tumoroid proliferation,are outlined with their characteristic clinical presentations;their proportions are different during various periods of the national control program.Ectopic schistosomiasis and the relationship between the S.japonicum infection and colorectal cancer are also discussed.Post-transmission schistosomiasis is briefly discussed(which can happen even if the disease reaches the criteria of elimination,and the infection and transmission have stopped,but yet it still develops).The problem of mammalian reservoir hosts of S.japonicum makes the epidemiology and control of schistosomiasis in China even more complicated and arduous,and the control progress in animal reservoirs is briefly presented.

关键词： Schistosoma japonicum Schistosomiasis morbidity China

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Extent of morbidity associated with schistosomiasis infection in Malawi: a review paper

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Infectious Diseases of Poverty 2015年第1期4卷 185-192页

作者： Austin H N Mtethiwa Gamba Nkwengulila Jared Bakuza Daniel Sikawa Abigail Kazembe Lilongwe University of Agriculture and Natural Resources(LUANAR) Bunda CampusPO Box 219LilongweMalawi Zoology Department University of Dar es SalaamCollege of Natural and Applied SciencePO Box 35064Dar es SalaamTanzania Biological Sciences Unit Dar es Salaam University College of Education(DUCE)PO Box 2329Dar es SalaamTanzania University of Malawi Kamuzu College of NursingPrivate Bag 1LilongweMalawi

Data on the extent of the burden due to schistosomiasis is sparse in most Sub-Saharan African countries.However,this data is crucial for triggering medical attention.A review of extent of morbidity and determinants associated with schistosomiasis in Malawi was therefore conducted to quantify the infection in order to concretise the need for medical intervention.A systematic and traditional search strategy was used to find literature for the review,whilst exclusion and inclusion criteria were used to identify appropriate articles.Logistic regression curves of epidemiological model Y=(a+bxc)/(1+bxc)and the recommendation that schistosomiasis prevalence can be used to estimate morbidity were employed to quantify morbidity at various infection stages.morbidity was quantified as a direct proportion of the population and the respective national schistosomiasis prevalence.Findings showed that both S.mansoni and S.haematobium are present in Malawi with the latter highly prevalent(50%).Furthermore,out of the estimated population of 16,829 million,approximately 8.4 million have schistosomiasis,with about 4.4 million of these aged 18 years and below.The most frequent manifestation is Katayama syndrome,while ascites is the lowest,impacting about 3.0 million and 960 individuals,respectively.Localised studies on association of schistosomiasis infection to risk factors such as occupation,age and gender found odds ratio(OR)ranging from 1.29 to 5.37.morbidity due to schistosomiasis is high in Malawi.It is therefore recommended that a more detailed study on the determinants of high schistosomiasis and re-evaluation of the current control measures be conducted if the current morbidity statistics are to be remarkably reduced.

关键词： Schistosomiasis morbidity Risk factors Quantification Burden Extent

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