Incidence and Risk Factors for Symptomatic Myocardial Ischemia After Posterior Decompressive Surgery for Degenerative Lumbar Disorders

Background: This study aimed to determine the incidence of symptomatic myocardial ischemia (PSMI) after posterior decompressive surgery for degenerative lumbar disorders and identify its risk factors. Methods: 256 patients who underwent the posterior decompressive surgery and were discharged from the hospital between January 2011 and December 2016 were enrolled in this study, according to the inclusion and exclusion criteria. Subjects were divided into two groups by the occurrence of PSMI: the PSMI group and the N-PSMI group. Three sets of factors were analyzed to investigate potential risk factors for PSMI. Patient characteristics included age, gender, body mass index, smoking, drinking, venous thrombosis of lower extremities, comorbidities, visual analog scale, hemoglobin, electrolytes. Preoperative cardiac functional variables included electrocardiogram, ventricular ejection fraction, history of ischemic attack, previous cardiac surgery. Perioperative variables included surgical strategy, surgery time, blood loss, intraoperative aortic injury, intraoperative maximum heart rate, arterial blood pressure, postoperative temperature, daily liquid intake and output volume, electrolytes glucose, drug allergy, and postoperative visual analog scale. Univariate analyses followed by the multivariate logistic regression model were employed to identify the risk factors for PSMI. Results: PSMI was developed in 23 of 256 patients (8.9%) before discharge. Univariate analyses revealed that patients with onset of PSMI were older, more likely to have undergone cardiac surgery, with less daily liquid intake volume, and less intravenous infusion (p < 0.05). Logistic regression analysis revealed that age > 52 years, heart rate > 81 Bpm, daily liquid intake < 2140 mL, and cardiac surgery history were independently associated with PSMI after posterior decompressive surgery for degenerative lumbar disorders.Conclusions: The incidence of PSMI after posterior decompressive surgery for degenerative lumbar disorders was 8.9%; senior, fast heart rate, insufficient daily liquid intake, and cardiac surgery history are potential risk factors and should be carefully evaluated before an operation.

Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.