Outcomes of nutritional jejunostomy in the curative treatment of esophageal cancer

2018 ◽  
Vol 32 (7) ◽  
Author(s):  
F Klevebro ◽  
A Johar ◽  
J Lagergren ◽  
P Lagergren
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Hospital Stay ◽  
Cox Regression ◽  
Gastroesophageal Junction ◽  
Length Of Hospital Stay ◽  
Cancer Surgery ◽  
Early Enteral Nutrition ◽  
Esophageal Cancer Surgery ◽  
Increased Risk

SUMMARY Substantial weight loss and eating problems are common before and after esophagectomy for cancer. The use of jejunostomy might prevent postoperative weight loss, but studies evaluating other outcomes are scarce. This study aims to assess the influence of jejunostomy on postoperative health-related quality of life (HRQOL), complications, reoperation, hospital stay, and survival. This prospective and population-based cohort study included all patients operated on for esophageal or gastroesophageal junction cancer in Sweden in 2001–2005 with follow-up until 31st December 2016. Data regarding patient and tumor characteristics and treatment were prospectively collected. Multivariable logistic regression provided odds ratios (OR) with 95% confidence intervals (CI), whereas Cox regression provided hazard ratios with 95% CI. All risk estimates were adjusted for age, sex, tumor histology, stage, comorbidity, surgical approach, neoadjuvant therapy, and body mass index and weight loss at baseline. Among 397 patients, 181 (46%) received a jejunostomy during surgery. The use of jejunostomy did not influence the HRQOL at 6 months or 3 years after treatment. Jejunostomy users had no statistically significantly increased risk of postoperative complications (OR 1.27; 95% CI 0.86–1.87) or reoperation (OR 1.70; 95% CI 0.88–3.28). Intensive unit care and length of hospital stay was the same independent of the use of jejunostomy. The all-cause mortality was not increased in the jejunostomy group (HR 0.89, 95% CI: 0.74–1.07). This study indicates that jejunostomy does not influence postoperative HRQOL, complications, or survival after esophageal cancer surgery, it can be considered a safe method for early enteral nutrition after esophageal cancer surgery but benefits for the patients need further investigations.

scholarly journals Impact of De-escalation on Prognosis of Patients With Bacteremia due to Enterobacteriaceae: A Post Hoc Analysis From a Multicenter Prospective Cohort

2018 ◽  
Vol 69 (6) ◽  
pp. 956-962 ◽  
Author(s):  
Zaira R Palacios-Baena ◽  
Mercedes Delgado-Valverde ◽  
Adoración Valiente Méndez ◽  
Benito Almirante ◽  
Silvia Gómez-Zorrilla ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Cox Regression ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Lower Probability ◽  
Post Hoc Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Post Hoc ◽  
The Impact

Abstract Background More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). Methods A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. Results Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30–.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14–.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25–1.31); model with PS, 0.69 (.29–1.65); and PS-based matched pairs, 0.98 (.76–1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. Conclusions De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.

Esophageal cancer surgery in Greece during the era of the financial crisis

2020 ◽  
Author(s):  
Dimitrios Schizas ◽  
Konstantinos S Mylonas ◽  
Natasha Hasemaki ◽  
Efstratia Mpaili ◽  
Vasileia Ntomi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Financial Crisis ◽  
Gastroesophageal Junction ◽  
Disease Free Survival ◽  
Circular Stapler ◽  
Cancer Surgery ◽  
International Standards ◽  
R0 Resection ◽  
Time Of Surgery ◽  
Esophageal Cancer Surgery

Summary The aim of this study is to describe outcomes of esophageal cancer surgery in a quaternary upper gastrointestinal (GI) center in Athens during the era of the Greek financial crisis. We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the University of Athens, during the period January 2004–June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. A total of 146 patients were identified. Nearly half of the patients (49.3%) underwent surgery during the last 4 years of the financial crisis (2015–2018). Mean age at the time of surgery was 62.3 ± 10.3 years, and patients did not present at older ages during the recession (P = 0.50). Most patients were stage III at the time of surgery both prior to the recession (35%) and during the financial crisis (39.8%, P = 0.17). Ivor–Lewis was the most commonly performed procedure (67.1%) across all eras (P = 0.06). Gastric conduit was the most common form of GI reconstruction (95.9%) following all types of surgery (P < 0.001). Pre-recession anastomoses were usually performed using a circular stapler (65%). Both during (88.1%) and following the recession (100%), the vast majority of anastomoses were hand-sewn. R0 resection was achieved in 142 (97.9%) patients. Anastomosis technique did not affect postoperative leak (P = 0.3) or morbidity rates (P = 0.1). Morbidity rates were not significantly different prior to (25%), during (46.9%), and after (62.5%) the financial crisis, P = 0.16. Utilization of neoadjuvant chemotherapy (26.9%, P = 0.90) or radiation (8.4%, P = 0.44) as well as adjuvant chemotherapy (54.8%, P = 0.85) and irradiation (13.7%, P = 0.49) was the same across all eras. Disease-free survival (DFS) and all-cause mortality rates were 41.2 and 47.3%, respectively. Median DFS and observed survival (OS) were 11.3 and 22.7 months, respectively. The financial crisis did not influence relapse (P = 0.17) and survival rates (P = 0.91). The establishment of capital controls also had no impact on recurrence (P = 0.18) and survival (P = 0.94). Austerity measures during the Greek financial crisis did not influence long-term esophageal cancer outcomes. Therefore, achieving international standards in esophagectomy may be possible in resource-limited countries when centralizing care.

Hospital volume of esophageal cancer surgery in relation to outcomes from primary anti-reflux surgery

2020 ◽  
Author(s):  
Sheraz Markar ◽  
Giola Santoni ◽  
John Maret-Ouda ◽  
Jesper Lagergren
Keyword(s):  
Esophageal Cancer ◽  
Hospital Volume ◽  
Cox Regression ◽  
Population Based ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery ◽  
Hazard Ratios ◽  
Volume Group ◽  
Annual Volume

Summary No previous study has sought to identify the effect of hospital volume of esophagectomy on anti-reflux surgery outcomes. The hypothesis under investigation was hospitals performing esophagectomies, particularly those of higher annual volume, have better outcomes from primary anti-reflux surgery. This population-based cohort study included adult individuals (≥18 years) in Sweden receiving primary anti-reflux surgery for a recorded gastro-esophageal reflux disease in 1997–2010, with follow-up until 2013 The ‘exposure’ was hospital volume of esophagectomy, with hospitals conducting esophagectomies divided into 0, >0–1, >1–3 and ≥ 4 based on annual volume, and hospitals not conducting esophagectomies were the reference category. The outcomes were 30-day re-intervention and surgical re-intervention during the entire follow-up after anti-reflux surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, type of anti-reflux surgery, and year of anti-reflux surgery. Among 10,959 participants having undergone primary anti-reflux surgery, the 30-day re-intervention rate was 1.1%, and the rate of surgical re-intervention during the entire follow-up was 6.8%. Compared with hospitals not performing esophagectomy, hospitals in the highest volume group of esophagectomy showed no decreased risks of 30-day re-intervention (HR = 1.46, 95% CI 0.89–2.39) or surgical re-intervention (HR = 1.21, 95%CI 0.91–1.60) during follow-up. Similarly, the intermediate hospital volume categories of esophageal cancer surgery had no decreased risk of surgical re-interventions after anti-reflux surgery. This study provides no evidence for centralization of primary anti-reflux surgery to centers for esophageal cancer surgery.

scholarly journals Predicting the Risk of Weight Loss After Esophageal Cancer Surgery

2019 ◽  
Vol 26 (8) ◽  
pp. 2385-2391 ◽  
Author(s):  
Anna Schandl ◽  
Joonas H. Kauppila ◽  
Poorna Anandavadivelan ◽  
Asif Johar ◽  
Pernilla Lagergren
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery

Hyperglycemia 3 Days After Esophageal Cancer Surgery Is Associated with an Increased Risk of Postoperative Infection

2014 ◽  
Vol 18 (9) ◽  
pp. 1547-1556 ◽  
Author(s):  
Naoko Ito ◽  
Takeshi Iwaya ◽  
Kenichiro Ikeda ◽  
Yusuke Kimura ◽  
Yuji Akiyama ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Infection ◽  
Cancer Surgery ◽  
Esophageal Cancer Surgery ◽  
Increased Risk
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