Is Central Pancreatectomy Truly Recommendable? A 9-Year Single-Center Experience

2017 ◽  
Vol 35 (6) ◽  
pp. 532-538 ◽  
Author(s):  
Ang Lv ◽  
Hong-Gang Qian ◽  
Hui Qiu ◽  
Jian-Hui Wu ◽  
Chun-Yi Hao
Keyword(s):  
Endocrine Function ◽  
Low Grade ◽  
Central Pancreatectomy ◽  
Long Term Outcomes ◽  
Exocrine Insufficiency ◽  
Severe Diarrhea ◽  
Single Center Experience ◽  
Short And Long Term

Aims: To compare the short- and long-term outcomes in patients with pancreatic benign or borderline neoplasm who underwent central pancreatectomy (CP) and distal pancreatectomy (DP). Methods: The inclusion criteria were as follows: (1) single benign or low-grade malignant tumor; (2) tumor confined to the pancreatic neck or proximal body; and (3) tumor amenable to either CP or DP. Short and long-term outcomes, including complications, pancreatic exocrine and endocrine function, and quality of life (QoL) were analyzed retrospectively. Results: Sixteen patients who underwent CP and 26 patients who underwent DP were included. The median follow-up period was 53 months (range 21–117 months). Patients undergoing CP were significantly more likely to experience complications (68.7 vs. 23%, p = 0.003) especially grade B/C postoperative pancreatic fistula (62.5 vs. 23%, p = 0.011) than those undergoing DP. During the long-term follow-up, 2 patients in the DP group developed new-onset diabetes mellitus, but no patient in CP group developed this condition (8 vs. 0%, p = 0.382). Evidence of exocrine insufficiency, including severe diarrhea or steatorrhea, was not observed in either group. Both groups were equally satisfied with the overall health status and overall QoL. Conclusion: CP is associated with excellent pancreatic function but a significantly increased postoperative morbidity and risk compared to DP. Therefore, the indication of CP should be chosen strictly.

Infective endocarditis in patients who use IV drugs: a single centre cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Alraddadi ◽  
A Alsagheir ◽  
S Gao ◽  
K An ◽  
H Hronyecz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Long Term Outcomes ◽  
Replacement Surgery ◽  
Short Term Mortality ◽  
History Of ◽  
Short And Long Term ◽  
Baseline Characteristics

Abstract Background Managing endocarditis in intravenous drug use (IVDU) patients is challenging: unless patients successfully quit IVDU, the risk of re-infection is high. Clinicians often raise concerns with ethical and resource allocation principles when considering valve replacement surgery in this patient population. To help inform practice, we sought to determine the long-term outcomes of IVDU patients with endocarditis who underwent valve surgery in our center. Method After research ethics board approval, infective endocarditis cases managed surgically at our General Hospital between 2009 and 2018 were identified through the Cardiac Care Network. We reviewed patients' charts and included those with a history of IVDU in this study. We abstracted data on baseline characteristics, peri-operative course, short- and long-term outcomes. We report results using descriptive statistics. Results We identified 124 IVDU patients with surgically managed endocarditis. Mean age was 37 years (SD 11), 61% were females and 8% had redo surgery. During admission, 45% (n=56) of the patients had an embolic event: 63% pulmonary, 30% cerebral, 18% peripheral and 11% mesenteric. Causative organisms included Methicillin-Sensitive Staphylococcus Aureus (51%, n=63), Methicillin-Resistant Staphylococcus Aureus (15%, n=19), Streptococcus Viridans (2%, n=2), and others (31%, n=38). Emergency cardiac surgery was performed for 42% of patients (n=52). Most patients (84%) had single valve intervention: 53% tricuspid, 18% aortic and 13% mitral. Double valve interventions occurred in 15% (n=18). Overall, bioprosthetic replacement was most commonly chosen (79%, n=98). In-hospital mortality was 7% (n=8). Median length of stay in hospital was 13 days (IQR 8,21) and ICU 2 days (IQR 1,6). Mortality at longest available follow-up was 24% (n=30), with a median follow-up of 129 days (IQR 15,416). Valve reintervention rate was 11% (n=13) and readmission rate was 14% (n=17) at a median of 275 days (IQR 54,502). Conclusion Despite their critical condition, IVDU patients with endocarditis have good intra-hospital outcomes. Challenges occur after hospital discharge with loss of follow-up and high short-term mortality. IVDU relapse likely accounts for some of these issues. In-hospital and community comprehensive addiction management may improve these patients' outcomes beyond the surgical procedure. Annual rate 2009–2018 Funding Acknowledgement Type of funding source: None

Abstract 19771: Persistent Thrombocytopenia after Myocardial Infarction is Associated with Increased Short- and Long-Term Mortality

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Salim Virani ◽  
Scott Bassett ◽  
Mahboob Alam ◽  
Ravi Hira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Complications ◽  
Group Differences ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Short And Long Term ◽  
The Impact ◽  
Long Term Mortality

Background: Thrombocytopenia (TCP) occurs commonly in patients hospitalized with acute myocardial infarction (AMI). It is unclear whether persistent TCP after discharge among AMI survivors is associated with worse outcomes. Methods: We examined the impact of persistent post-discharge TCP on outcomes in a registry of consecutive AMI patients hospitalized between January 2004 and December 2007. In-hospital (IH) TCP was defined by a nadir platelet count < 150 x 109/L. Resolved TCP was defined as IH TCP which resolved within 3 months after discharge while persistent TCP was defined as IH TCP which did not resolve within 3 months. Results: Of 842 patients hospitalized for a first AMI, we examined data on 617 hospital survivors who had follow-up within 3 months of discharge and documented long-term outcomes. Of those, 474 (76.8%) patients did not experience IH TCP while 42 (6.8%) and 101 (16.4%) had persistent and resolved TCP, respectively (Table). Patients with persistent TCP were older, had worse comorbidities, and were more likely to have TCP at baseline and discharge. There were no inter-group differences in infarct size, major bleeding complications, revascularization, or ejection fraction at discharge. Mortality following discharge was higher at all time-points among AMI patients with persistent TCP compared to patients with resolved or without IH TCP (Figure). Patients with resolved TCP had comparable mortality to those without IH TCP. Conclusion: Persistent TCP within 3 months after hospital discharge for AMI is associated with significantly increased short- and long-term mortality compared to patients with recovered TCP or without IH TCP.

scholarly journals Liver Transplantation from Voluntary Organ Donor System in China: A Comparison between DBD and DCD Liver Transplants

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Wei Chen ◽  
Dipesh Kumar Yadav ◽  
Xueli Bai ◽  
Jianying Lou ◽  
Risheng Que ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Organ Donation ◽  
Survival Rates ◽  
Organ Donor ◽  
Long Term Outcomes ◽  
Significant Difference ◽  
Short And Long Term ◽  
Donor System

Background. In China, the cases of liver transplantation (LT) from donation after citizens’ death have rose year by year since the citizen-based voluntary organ donor system was initiated in 2010. The objective of our research was to investigate the early postoperative and late long-term outcomes of LT from donation after brain death (DBD) and donation after circulatory death (DCD) according to the current organ donation system in China. Methods. Sixty-two consecutive cases of LT from donation after citizens’ death performed in our hospital between February 2012 and June 2017 were examined retrospectively for short- and long-term outcomes. These included 35 DCD LT and 27 DBD LT. Result. Subsequent median follow-up time of 19 months and 1- and 3-year graft survival rates were comparative between the DBD group and the DCD group (81.5% and 66.7% versus 67.1% and 59.7%; P=0.550), as were patient survival rates (85.2% and 68.7% versus 72.2% and 63.9%; P=0.358). The duration of ICU stay of recipients was significantly shorter in the DBD group, in comparison with that of the DCD group (1 versus 3 days, P=0.001). Severe complication incidence (≥grade III) after transplantation was identical among the DBD and DCD groups (48.1% versus 60%, P=0.352). There was no significant difference in postoperative mortality between the DBD and DCD groups (3 of 27 cases versus 5 of 35 cases). Twenty-one grafts (33.8%) were lost and 18 recipients (29.0%) were dead till the time of follow-up. Malignancy recurrence was the most prevalent reason for patient death (38.8%). There was no significant difference in incidence of biliary stenosis between the DBD and DCD groups (5 of 27 cases versus 6 of 35 cases, P=0.846). Conclusion. Although the sample size was small to some extent, this single-center study first reported that LT from DCD donors showed similar short- and long-term outcomes with DBD donors and justified the widespread implementation of voluntary citizen-based deceased organ donation in China. However, the results should be verified with a multicenter larger study.

scholarly journals Short- and Long-term Outcomes Following Side-to-side Strictureplasty and its Modification Over the Ileocaecal Valve for Extensive Crohn’s Ileitis

2020 ◽  
Vol 14 (10) ◽  
pp. 1378-1384 ◽  
Author(s):  
G Bislenghi ◽  
M Ferrante ◽  
J Sabino ◽  
B Verstockt ◽  
B Martin-Perez ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Long Term Outcomes ◽  
Comprehensive Complication Index ◽  
Clinical Recurrence ◽  
Ileocaecal Valve ◽  
Surgical Recurrence ◽  
Endoscopic Remission ◽  
Short And Long Term

Abstract Background and Aims Postoperative recurrence remains a challenging problem in patients with Crohn’s disease [CD]. To avoid development of short bowel syndrome, strictureplasty techniques have therefore been proposed. We evaluated short- and long-term outcomes of atypical strictureplasties in CD patients with extensive bowel involvement. Methods Side-to-side isoperistaltic strictureplasty [SSIS] was performed according to the Michelassi technique or modification of this over the ileocaecal valve [mSSIS]. Ninety-day postoperative morbidity was assessed using the comprehensive complication index [CCI]. Clinical recurrence was defined as symptomatic, endoscopically or radiologically confirmed, stricture/inflammatory lesion requiring medical treatment or surgery. Surgical recurrence was defined as the need for any surgical intervention. Endoscopic remission was defined as ≤i1, according to the modified Rutgeerts score. Deep remission was defined as the combination of endoscopic remission and absence of clinical symptoms. Perioperative factors related to clinical recurrence were evaluated. Results A total of 52 CD patients [SSIS n = 12; mSSIS n = 40] were included. No mortality occurred. Mean CCI was 10.3 [range 0–33.7]. Median follow-up was 5.9 years [range 0.8–9.9]. Clinical recurrence [19 patients] was 29.7% and 39.6% after 3 and 5 years, respectively. Surgical recurrence [seven patients] was 2% and 14.1% after 3 and 5 years, respectively. At the end of the follow-up, 92% of patients kept the original strictureplasty and deep remission was observed in 25.7% of the mSSIS patients. None of the perioperative variables considered showed a significant association with clinical recurrence. Conclusions SSIS is safe, effective, and provides durable disease control in patients with extensive CD ileitis.

Short- and long-term outcomes of laparoscopic organ-sparing resection in pancreatic neuroendocrine tumors: a single-center experience

2017 ◽  
Vol 31 (10) ◽  
pp. 3847-3857 ◽  
Author(s):  
Javier A. Cienfuegos ◽  
Joseba Salguero ◽  
Jorge M. Núñez-Córdoba ◽  
Miguel Ruiz-Canela ◽  
Alberto Benito ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Pancreatic Neuroendocrine Tumors ◽  
Single Center ◽  
Long Term Outcomes ◽  
Single Center Experience ◽  
Short And Long Term ◽  
Organ Sparing

scholarly journals Short- and long-term outcomes of laparoscopic organ-sparing resection for pancreatic neuroendocrine neoplasms

2020 ◽  
Author(s):  
Ren-Chao Zhang ◽  
Jun Ma ◽  
yiping mou ◽  
Yu-Cheng Zhou ◽  
Wei-Wei Jin ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Neuroendocrine Neoplasms ◽  
Transfusion Rate ◽  
Long Term Outcomes ◽  
Pancreatic Neuroendocrine Neoplasms ◽  
Spleen Preserving ◽  
Short And Long Term ◽  
Organ Sparing

Abstract Background：Pancreatic neuroendocrine neoplasms (PNENs) are rare neoplasms associated with a long life expectancy after resection. In this setting, patients may benefit from laparoscopic organ-sparing resection. Studies of laparoscopic organ-sparing resection for PNENs are limited. The aim of this study was to evaluate the short- and long-term outcomes of laparoscopic organ-sparing resection for PNENs.Methods： A retrospective study was performed for patients with PNENs who underwent laparoscopic organ-sparing pancreatectomy between March 2005 and May 2018. The patients’ demographic data, operative results, pathological reports, hospital courses and morbidity, mortality, and follow-up data (until August 2018) were analysed.Results：Thirty-five patients were included in the final analysis. There were 9 male and 26 female patients, with a median age of 46 years (range, 25-75 years). The mean BMI was 24.6±3.3 kg/m2. Nine patients received laparoscopic enucleation (LE), 20 received laparoscopic spleen-preserving distal pancreatectomy (LSPDP), and 6 received laparoscopic central pancreatectomy. The operative time, intraoperative blood loss, transfusion rate, and postoperative hospital stay were 186.4±60.2 min, 165±73.0 ml, 0 d, and 9 d (range, 5-23 d), respectively. The morbidity rate, grade ≥III complication rate and grade ≥B pancreatic fistula rate were 34.2%, 11.4%, and 8.7%, respectively, with no mortality. The rate of follow-up was 94.3%, and the median follow-up time was 55 months (range, 3-158 months). One patient developed recurrence 36 months after LE and was managed with surgical resection. The other patients survived without metastases or recurrence during the follow-up. One patient had diabetes after laparoscopic spleen-preserving distal pancreatectomy, and no patients had symptoms of pancreatic exocrine insufficiency. Conclusions： Laparoscopic organ-sparing resection for selected cases of PNENs is safe and feasible and has favourable short- and long-term outcomes.

Surgical Pericardiectomy for Constrictive Pericarditis: A Single Tertiary Center Experience

2018 ◽  
Vol 68 (08) ◽  
pp. 730-736 ◽  
Author(s):  
Eyal Nachum ◽  
Leonid Sternik ◽  
Yigal Kassif ◽  
Ehud Raanani ◽  
Ilan Hay ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Functional Class ◽  
Right Atrial ◽  
Long Term Outcomes ◽  
Tertiary Center ◽  
Short And Long Term

Abstract Background Although surgery is the sole therapeutic option for patients with constrictive pericarditis (CP), reports on high postoperative mortality rates have led to hesitant surgery referral. The aim of this study was to report the short- and long-term outcomes of surgical pericardiectomy (SP) from a large tertiary center. Methods Between January 2005 and January 2017, 55 consecutive patients underwent SP after comprehensive echocardiography, computed tomography, and hemodynamic studies. Detailed clinical, imaging, surgical techniques and follow-up outcomes were recorded. Results The most common etiology was idiopathic (n = 27, 49%) and 33 patients (60%) were in functional class 3/4. Sixteen patients (29%) underwent concomitant interventions during SP, and cardiopulmonary bypass (CPB) was used in these, as well as in four additional cases. Complete resection, independent of CPB, was achieved in 96%. One patient died during the index hospitalization, and four (7%) needed re-explorations due to bleeding. While 12 patients (22%) died during a mean follow-up of 52 ± 39 months, only 1 death was due to right heart failure. Functional class significantly improved (with a p-value < 0.001), diuretics were discontinued in all, and significant reductions of right atrial pressures were recorded. None of these outcomes differed as a result of concomitant interventions at the time of SP. Conclusion Short- and long-term outcomes of SP, performed either alone or concomitantly with other procedures, indicate high safety and favorable clinical and hemodynamic efficacy for the treatment of CP.

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