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  1. Article ; Online: Multicentre observational cohort study of implementation and outcomes of laparoscopic distal pancreatectomy.

    Lof, S / Moekotte, A L / Al-Sarireh, B / Ammori, B / Aroori, S / Durkin, D / Fusai, G K / French, J J / Gomez, D / Marangoni, G / Marudanayagam, R / Soonawalla, Z / Sutcliffe, R / White, S A / Abu Hilal, M

    The British journal of surgery

    2019  Volume 106, Issue 12, Page(s) 1657–1665

    Abstract: Background: Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to ... ...

    Abstract Background: Laparoscopic distal pancreatectomy (LDP) is increasingly being performed as an alternative to open surgery. Whether the implementation and corresponding learning curve of LDP have an impact on patient outcome is unknown. The aim was to investigate the temporal trends in practice across UK centres.
    Methods: This was a retrospective multicentre observational cohort study of LDP in 11 tertiary referral centres in the UK between 2006 and 2016. The learning curve was analysed by pooling data for the first 15 consecutive patients who had LDP and examining trends in surgical outcomes in subsequent patients.
    Results: In total, 570 patients underwent LDP, whereas 888 underwent open resection. For LDP the median duration of operation was 240 min, with 200 ml blood loss. The conversion rate was 12·1 per cent. Neuroendocrine tumours (26·7 per cent) and mucinous cystic neoplasms (19·7 per cent) were commonest indications. The proportion of LDPs increased from 24·4 per cent in 2006-2009 (P1) to 46·0 per cent in 2014-2016 (P3) (P < 0·001). LDP was increasingly performed for patients aged 70 years or more (16 per cent in P1 versus 34·4 per cent in P3; P = 0·002), pancreatic ductal adenocarcinoma (6 versus 19·1 per cent; P = 0·005) and advanced malignant tumours (27 versus 52 per cent; P = 0·016). With increasing experience, there was a trend for a decrease in blood transfusion rate (14·1 per cent for procedures 1-15 to 3·5 per cent for procedures 46-75; P = 0·008), ICU admissions (32·7 to 19·2 per cent; P = 0·021) and median duration of hospital stay (7 (i.q.r. 5-9) to 6 (4-7) days; P = 0·002). After 30 procedures, a decrease was noted in rates of both overall morbidity (57·7 versus 42·2 per cent for procedures 16-30 versus 46-75 respectively; P = 0·009) and severe morbidity (18·8 versus 9·7 per cent; P = 0·031).
    Conclusion: LDP has increased as a treatment option for lesions of the distal pancreas as indications for the procedure have expanded. Perioperative outcomes improved with the number of procedures performed.
    MeSH term(s) Blood Loss, Surgical ; Blood Transfusion ; Conversion to Open Surgery ; Critical Care ; Female ; Humans ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Learning Curve ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Pancreatectomy/adverse effects ; Pancreatectomy/methods ; Pancreatic Neoplasms/surgery ; Retrospective Studies ; United Kingdom
    Language English
    Publishing date 2019-08-27
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11292
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Gemcitabine-based adjuvant chemotherapy in subtypes of ampullary adenocarcinoma: international propensity score-matched cohort study.

    Moekotte, A L / Malleo, G / van Roessel, S / Bonds, M / Halimi, A / Zarantonello, L / Napoli, N / Dreyer, S B / Wellner, U F / Bolm, L / Mavroeidis, V K / Robinson, S / Khalil, K / Ferraro, D / Mortimer, M C / Harris, S / Al-Sarireh, B / Fusai, G K / Roberts, K J /
    Fontana, M / White, S A / Soonawalla, Z / Jamieson, N B / Boggi, U / Alseidi, A / Shablak, A / Wilmink, J W / Primrose, J N / Salvia, R / Bassi, C / Besselink, M G / Abu Hilal, M

    The British journal of surgery

    2020  Volume 107, Issue 9, Page(s) 1171–1182

    Abstract: Background: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy ...

    Abstract Background: Whether patients who undergo resection of ampullary adenocarcinoma have a survival benefit from adjuvant chemotherapy is currently unknown. The aim of this study was to compare survival between patients with and without adjuvant chemotherapy after resection of ampullary adenocarcinoma in a propensity score-matched analysis.
    Methods: An international multicentre cohort study was conducted, including patients who underwent pancreatoduodenectomy for ampullary adenocarcinoma between 2006 and 2017, in 13 centres in six countries. Propensity scores were used to match patients who received adjuvant chemotherapy with those who did not, in the entire cohort and in two subgroups (pancreatobiliary/mixed and intestinal subtypes). Survival was assessed using the Kaplan-Meier method and Cox regression analyses.
    Results: Overall, 1163 patients underwent pancreatoduodenectomy for ampullary adenocarcinoma. After excluding 187 patients, median survival in the remaining 976 patients was 67 (95 per cent c.i. 56 to 78) months. A total of 520 patients (53·3 per cent) received adjuvant chemotherapy. In a propensity score-matched cohort (194 patients in each group), survival was better among patients who received adjuvant chemotherapy than in those who did not (median survival not reached versus 60 months respectively; P = 0·051). A survival benefit was seen in patients with the pancreatobiliary/mixed subtype; median survival was not reached in patients receiving adjuvant chemotherapy and 32 months in the group without chemotherapy (P = 0·020). Patients with the intestinal subtype did not show any survival benefit from adjuvant chemotherapy.
    Conclusion: Patients with resected ampullary adenocarcinoma may benefit from gemcitabine-based adjuvant chemotherapy, but this effect may be reserved for those with the pancreatobiliary and/or mixed subtype.
    MeSH term(s) Adenocarcinoma/drug therapy ; Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Aged ; Ampulla of Vater/pathology ; Ampulla of Vater/surgery ; Antimetabolites, Antineoplastic/therapeutic use ; Chemotherapy, Adjuvant/methods ; Chemotherapy, Adjuvant/mortality ; Common Bile Duct Neoplasms/drug therapy ; Common Bile Duct Neoplasms/pathology ; Common Bile Duct Neoplasms/surgery ; Deoxycytidine/analogs & derivatives ; Deoxycytidine/therapeutic use ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis
    Chemical Substances Antimetabolites, Antineoplastic ; Deoxycytidine (0W860991D6) ; gemcitabine (B76N6SBZ8R)
    Language English
    Publishing date 2020-04-07
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1002/bjs.11555
    Database MEDical Literature Analysis and Retrieval System OnLINE

    Full text online

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.66: Show issues Location:
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  3. Article ; Online: Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection

    Nepogodiev D. / Bhangu A. / Glasbey J.C. / Li E. / Omar O.M. / Simoes J.F. / Abbott T.E. / Alser O. / Arnaud A.P. / Bankhead-Kendall B.K. / Breen K.A. / Cunha M.F. / Davidson G.H. / Di Saverio S. / Gallo G. / Griffiths E.A. / Gujjuri R.R. / Hutchinson P.J. / Kaafarani H.M. /
    Lederhuber H. / Loffler M.W. / Mashbari H.N. / Minaya-Bravo A. / Morton D.G. / Moszkowicz D. / Pata F. / Tsoulfas G. / Venn M.L. / Cox D. / Roslani A.C. / Alakaloko F. / de Vries J.-P.P. / Aaraj M.A. / Abbott S.J. / Abdalla M.O. / Abdelaal A.S. / Ademuyiwa A.O. / Aherne T.M. / Ali O.M. / Alkadeeki G.Z. / Almeida A.C. / Alrahawy M.M. / Ambler G.K. / Alameer E. / Andreani S.M. / De Andres-Asenjo B. / Antonanzas L.L. / Aoun S.G. / Ashoush F.M. / Augestad K.M. / Avellana R.B. / Ayeni F.A. / Ayorinde J.O. / Babu B.H. / Baig M.M. / Bajomo O.M. / Baker O.J. / Baker M.P. / Baldwin A.J. / Ban V.S. / Baron R.D. / Barranquero A.G. / Barry C.P. / DI Bartolomeo A. / Bass G.A. / Bath M.F. / Batjer H.H. / Beamish A.J. / Belgaumkar A.P. / Bence M.N. / Benson R.A. / Bernal-Sprekelsen J.C. / Bhama A.R. / Bhavaraju A.V. / Biffl W.L. / Blundell C.M. / Boddy A.P. / Borgstein A.B. / Bosanquet D.C. / Bosch K.D. / Bouhuwaish A.E. / Bozkurt M.A. / Brathwaite C.E. / Brown B.C. / Brown O.D. / Brown A.K. / Buarque I.L. / Bueno-Canones A.D. / Bulugma M.R. / Burke J.R. / Byrne M.H. / Cagigal-Ortega E.P. / Callcut R.A. / DI Candido F. / Canova M.E. / Carlos W.J. / Caruana E.J. / Cato L.D. / Catton A.B. / Ceretti A.P. / Chase T.J. / Chiara F.D. / Chowdhury A.H. / Chung E.A. / Cicerchia P.M. / Clough E.C. / Coleman N.L. / Collins C.G. / Collins M.L. / Colonna E.T. / Comini L.V. / Coughlin P.A. / Cruzado L.F.-G. / Davidson B.R. / Davies R.J. / Davies E.J. / Davis N.F. / Dawson B.E. / Dean B.J. / Delgado M.G.-C. / Diaz J.J. / Dickson K.E. / Diez-Alonso M.M. / Dixon J.R. / Doe M.J. / Drake T.D. / Drake F.T. / Duffy J.P. / Dunne D.F. / Dunne N.J. / Duran-Munoz-Cruzado V.M. / Durst A.Z. / Eardley N.J. / Edwards J.G. / Elfallal A.H. / Elfiky M.M. / Elliott J.A. / Emile S.H. / Emslie K.M. / Endorf F.W. / Engel J.L. / Enjuto D.T. / Etchill E.W. / Evans J.P. / Fahey B.A. / Faria C.S. / Feo C.V. / Ferguson H.J. / Fernandez B.D. / Fernandez A.G. / Fernandez A.J. / Fernandez-Pacheco B.C. / Fitzgerald J.E. / Fonsi G.B. / Font R.F. / Fowler A.L. / Fretwell K.R. / Fructuoso L.S. / Fusai G.K. / Garcia M.H. / Garcia-Urena M.A. / Gill C.K. / Gisbertz S.S. / Del Giudice R. / Giuffrida M.C. / Di Giuseppe M. / Gomez M.F. / Guariglia C.A. / Hainsworth A.J. / Hall B.J. / Hall J.R. / Hammond J.S. / Haqqani M.H. / Harrison E.M. / Hazelton J.P. / van Heinsbergen M. / Hill A.D. / Hing C.B. / Hirji S.A. / Ho M.W. / Holbrook C.M. / Holme T.J. / Hopkins J.C. / Hopkinson D.N. / Hossain F.S. / Hudson V.E. / Hughes J.L. / Hwang E.S. / Ibrahim M.A. / Isolani S.M. / Jenkinson M.D. / Jenny H.E. / Jeyaretna D.S. / Jones R.P. / Jones A.P. / Jonker P.K. / Jonsson M.L. / Joyce D.P. / Kalkwarf K.J. / Kamarajah S.K. / El Kassas M. / Kavanagh D.O. / Keatley J.M. / Khalefa M.A. / Khan J.S. / Kirmani B.H. / Kisiel A.P. / Kouris S.M. / Kowal M.R. / Labib P.L. / Larkin J.O. / Lauscher J.C. / Leclercq W.K. / Ledesma F.S. / Leite-Moreira A.M. / Leung E.Y. / Lewis S.E. / Lima M.J. / Lin D.J. / Liu H.H. / Lowery A.J. / Lozano S.M. / Luney C.R. / Maia M.M. / Mariani N.M. / Marino M.V. / Marra A.A. / Marsh C.L. / Martin R.C. / McCluney S.J. / McIntyre R.C. / Mckay S.C. / McKevitt K.L. / Meagher A.D. / Mehdi M.Q. / Mehigan B.J. / Gonzalez-De Miguel M. / De Miguel-Ardevines M.-C. / Mills S.J. / Mohan H.M. / Moir J.A. / Monson J.R. / Monteiro J.M. / Montella M.T. / Montesinos C.S. / Morgom M.M. / Moura F.S. / Muguerza J.M. / Murphy S.H. / De Nardi P. / Naumann D.N. / Neary P.C. / Neely D.T. / Ng-Kamstra J.S. / Ngu A.W. / Nguyen T.A. / Nita G.E. / Nunes Q.M. / Nygaard R.M. / O'Meara L.B. / O'Neill J.R. / Okafor B.U. / Olson S.A. / Oo A.Y. / Ormazabal P.C. / Osorio A.L. / Pachl M.J. / Parry J.T. / Patel P.K. / Perez-Sanchez L.E. / Pevidal A.N. / Pezzuto A.P. / Philp M.M. / Pinkney T.D. / Pollok J.M. / Povey M.G. / Poza A.A. / Rajgor A.D. / Rao J.N. / Raptis D.A. / Rice H.E. / Ridgway P.F. / Rivas A.M. / Rodriguez-Sanjuan J.C. / Rogers L.J. / Da Roit A. / Rollett R.A. / Romera J.L. / Rooney S.M. / Roxo V.I. / Le Roy B. / Rubio E.E. / Ruiz C.C. / Ruiz M.L. / Ryan E.J. / Saad A.R. / Saeed S.A. / Salama H.A. / Salamah A.A. / Sampietro G.M. / Sarma D.R. / Schaffer K.B. / Schnitzbauer A.A. / Scurrah R.J. / Serevina O.L. / Serralheiro P.A. / Sewards J.M. / Shackcloth M.J. / Shaw A.V. / Sheel A.R. / Sica G.S. / De Simone V. / Singh A.A. / Singh R.P. / Skelly B.L. / Smith H.G. / Sohail A.H. / Spalding D.R. / Springford L.R. / Ssentongo A.E. / Steinkamp P.J. / Stevens K.A. / Stewart G.D. / Stylianides N.A. / Sullivan T.B. / Taher A.S. / Tamimy M.S. / Tang A.M. / Tebala G.D. / Tejero-Pintor F.J. / Thaha M.A. / Thomas A.J. / De Toma G. / La Torre F. / Torres A.J. / Townshend D.N. / Trout I.M. / Tucker S.C. / Ubhi H.K. / Vega V.A. / Velmahos G.C. / Velopulos C.G. / Viswanath Y.K. / Vivas A.A. / Wade R.G. / Wadley M.S. / Wall J.J. / Walters A.M. / Warren O.J. / Weerasinghe C.K. / Wilkin R.J. / Williams K.J. / Winter S.C. / Wormald J.C. / Wright F.L. / Xyda S.E. / Young A.L. / Youssef M.M. / Yousuf F.B. / El Youzouri H. / Zappa M.A. / Abate E. / Abdalaziz H. / Abdelkarim M. / Abdou H. / Aboelkassem-Ibrahim A. / Abuown A. / Acebes-Garcia F. / Acharya M. / Adamina M. / Addae-Boateng E. / Aftab R. / Agarwal A. / Aguilar J. / Ahmed Y. / Aitken E. / Al-Azzawi M. / Al-Embideen S. / Al-Masri M. / Al-Najjar H. / Al-Sukaini A. / Alam R. / Alderson D. / Aliyeva Z. / Aljanadi F. / Almasri M. / Alonso-Ortuno P. / Altintoprak F. / Amira G. / Amjad R. / Anania G. / Andabaka T. / Angelou D. / Annamalai S. / Annessi V. / Anthoney J. / Anwar S. / Anwer M. / Aragon-Chamizo J. / Ardito A. / Arigoni M. / Armao T. / Arminio A. / Armstrong L. / Arnaud A. / Asaad P. / Ashcroft J. / Ashmore C. / Asqalan A. / Asti E. / Aubry E. / Aytac E. / Ayuso-Herrera E. / Baeza M. / Bailon-Cuadrado M. / Bakmaz B. / Baldi C. / Baldini E. / Baldo S. / Ballabio M. / Baloyiannis I. / Baltazar G. / Bambina F. / Bandiera A. / Barlow E. / Barmasse R. / Barmpagianni C. / Baronio G. / Barra F. / Bartsch A.-M. / Basgaran A. / 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G.S. / Mateo-Sierra O. / Martinez-Perez C. / Serrano Gonzalez J. / Hernandez Bartolome M.A. / Diaz Perez D. / Gutierrez Samaniego M. / Galindo Jara P. / Sharma N. / Smart N.J. / Keller D.S.

    an international cohort study

    2020  

    Abstract: Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and ... ...

    Abstract Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
    Keywords Adult ; Aged ; Betacoronavirus ; Coronavirus Infections ; Elective Surgical Procedures ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia ; Viral ; Postoperative Complications ; Respiratory Tract Diseases ; Retrospective Studies ; Surgical Procedures ; Operative ; Young Adult ; covid19
    Subject code 610 ; 616
    Language English
    Publishing country it
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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