Palliative Gastrointestinal Surgery in Patients With Advanced Peritoneal Carcinomatosis: Clinical Experience and Development of a Predictive Model for Surgical Outcomes

BackgroundPalliative gastrointestinal (GI) surgery potentially relieves distressing symptoms arising from intestinal obstruction (IO) in patients with advanced peritoneal carcinomatosis (PC). As surgery is associated with significant morbidity risks in advanced cancer patients, it is important for surgeons to select patients who can benefit the most from this approach. Hence, we aim to determine predictors of morbidity and mortality after palliative surgery in patients with PC. In addition, we evaluate the utility of the UC Davis Cancer Care nomogram (UCDCCn) and develop a simplified model to predict short-term surgical mortality in these patients.MethodsA retrospective review of patients with IO secondary to PC undergoing palliative GI surgery was performed. Logistic regression was used to determine independent predictors of 30-day morbidity and mortality after surgery. UCDCCn was evaluated using the area under the curve (AUC) for discriminatory power and the Hosmer-Lemeshow test for calibration. Our simplified model was developed using logistic regression and evaluated using cross-validation.ResultsA total of 254 palliative GI surgeries were performed over a 10-year duration. The 30-day morbidity and mortality were 43% (n = 110) and 21% (n = 53), respectively. Preoperative albumin, age, and emergency nature of surgery were significant independent predictors for 30-day morbidity. A simplified model using preoperative Eastern Cooperative Oncology Group (ECOG) status and albumin (AUC = 0.71) achieved better predictive power than UCDCCn (AUC = 0.66) for 30-day mortality.ConclusionGood ECOG status and high preoperative albumin levels were independently associated with good short-term outcomes after palliative GI surgery. Our simplified model may be used to conveniently and efficiently select patients who stand to benefit the most from surgery.

Association between postoperative hypoalbuminemia and postoperative pulmonary imaging abnormalities patients undergoing craniotomy for brain tumors: a retrospective cohort study

Hypoalbuminemia is associated with poor outcome in patients undergoing surgery intervention. The main aim for this study was to investigate the incidence and the risk factors of postoperative hypoalbuminemia and assessed the impact of postoperative hypoalbuminemia on complications in patients undergoing brain tumor surgery. This retrospective study included 372 consecutive patients who underwent brain tumors surgery from January 2017 to December 2019. The patients were divided into hypoalbuminemia (< 35 g/L) and non-hypoalbuminemia group (≥ 35 g/L) based on postoperative albumin levels. Logistic regression analyses were used to determine risk factors. Of the total 372 patients, 333 (89.5%) developed hypoalbuminemia after surgery. Hypoalbuminemia was associated with operation time (OR 1.011, P < 0.001), preoperative albumin (OR 0.864, P = 0.015) and peroperative globulin (OR 1.192, P = 0.004). Postoperative pulmonary imaging abnormalities had a higher incidence in patients with than without hypoalbuminemia (41.1% vs 23.1%, P = 0.029). The independent predictors of postoperative pulmonary imaging abnormalities were age (OR 1.053, P < 0.001), operation time (OR 1.003, P = 0.013) and lower postoperative albumin (OR 0.946, P = 0.018). Pulmonary imaging abnormalities [OR 19.862 (95% CI 2.546–154.936, P = 0.004)] was a novel independent predictors of postoperative pneumonia. Postoperative hypoalbuminemia has a higher incidence with the increase of operation time, and may be associated with postoperative complications in patients undergoing brain tumor surgery.

Using Nomograms to Predict the PPCs of Patients With Diffuse Peritonitis Undergoing Emergency Gastrointestinal Surgery

Objective: To develop and validate a nomogram model for predicting postoperative pulmonary complications (PPCs) in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery.Methods: We used the least absolute shrinkage and selection operator (LASSO) regression model to analyze the independent risk factors for PPCs in patients with diffuse peritonitis who underwent emergency gastrointestinal surgery. Using R, we developed and validated a nomogram model for predicting PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery.Results: The LASSO regression analysis showed that AGE, American Society of Anesthesiologists physical status classification (ASA), DIAGNOSIS, platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN were independent risk factors for PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery. The area under the curve (AUC) value of the nomogram model in the training group was 0.8240; its accuracy was 0.7000, and its sensitivity was 0.8658. This demonstrates that the nomogram has a high prediction value. Also in the test group, the AUC value of the model established by the variables AGE, ASA, and platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN was 0.8240; its accuracy was 0.8000; and its specificity was 0.8986. In the validation group, the same results were obtained. The results of the clinical decision curve show that the benefit rate was also high.Conclusion: Based on the risk factors AGE, ASA, DIAGNOSIS, platelets (on the 3rd day after surgery), cholesterol (on the 3rd day after surgery), ALBUMIN (on the first day after surgery), and preoperative ALBUMIN, the nomogram model established in this study for predicting PPCs in patients with diffuse peritonitis undergoing emergency gastrointestinal surgery has high accuracy and discrimination.

Application of Clavien–Dindo Classification System for Complications of Minimally Invasive Percutaneous Nephrolithotomy

Objective. To investigate the clinical applications of the Clavien–Dindo classification system (CDCS) in the assessment of perioperative complications in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods. Totally, 390 patients with renal stones in our hospital from March 2015 to March 2020 were included for this study and then were divided into observation group (complication group, 78 cases) and control group (noncomplication group, 312 cases) according to the incidence of perioperative complications in CDCS. Single factor analysis and multivariate logistic regression analysis were used to analyze the risk factors of the perioperative complications of MPCNL. Results. The total incidence of complication in the 390 cases with MPCNL was 20.00% (78 cases) according to CDCS, among which the incidence of complications at grades I, II, III, IV, and V was 6.92% (27 cases), 8.21% (32 cases), 2.82% (11 cases), 1.79% (7 cases), and 0.26% (1 case), respectively. The proportion of patients, that aged >60 years, complicated with comorbidities, sophisticated calculi, the preoperative albumin level (<35 g/L), the operation time (>180 minutes), intraoperative bleeding volume (>300 mL), and hospitalization time (>7 days) in the observation group was significantly higher than that in the control group ((75.64% vs. 61.86%, 38.46% vs. 24.36%, 83.33% vs. 69.55%, 83.33% vs. 69.55%, 70.51% vs. 30.76%, 53.85% vs. 36.54%, and 60.26% vs. 43.27%), all P < 0.05). Multivariate logistic regression analysis showed that gender, associated comorbidities, preoperative albumin level, calculus complexity, operation time, and intraoperative bleeding volume (>300 mL) were correlated with the occurrence of complications ( P ≤ 0.001, 0.001, 0.001, 0.001, 0.003, and 0.001 respectively). Conclusion. The CDCS can give standard and more comparative criteria for the assessment of perioperative complications, which will provide reference data for reducing complications and ensuring safety profiles in these high-risk patients.

Relationship between the Preoperative Albumin Levels and Postoperative Complications in Carcinoma Stomach Patients

Background: Malnutrition in gastrointestinal cancer patients adversely affects the surgical outcomes. low serum albumin and postoperative complications were associated with one another. Objectives: To find out the relationship between preoperative albumin levels and postoperative complications among carcinoma stomach patients. Materials and Methods: The present study was a single institution retrospective study carried out in the department of general surgery, Saveetha medical college and hospital between February 2021 to July 2021. Fifty patients diagnosed with carcinoma stomach and electively posted for surgery during the study period were included into the study. The data was collected using structured proforma. Preoperative albumin and haemoglobin levels were estimated using blood samples. All the data collected were analysed using SPSS version 23. Results: The preoperative albumin levels among those who had reported complication was 3.04±0.19 g/dl while those who had no complication in the postoperative period had preoperative albumin level of 3.82±0.31g/dl. The preoperative mean haemoglobin level among those who developed complications in the post operative period was 9.68±0.95 mg/dl and the mean haemoglobin level among those with no complication was 11.46±1.89 mg/dl. Albumin and haemoglobin values were found to be negatively correlated with duration of stay in hospital. Conclusion: Malnutrition in the preoperative period would increase the probability of occurrence of postoperative complications and increased duration of stay in hospital. Attending to malnutrition of the admitted patients in the preoperative period would help in decreasing the postoperative complications and duration of stay.

Clinicopathological Progress of Colorectal Resection in Gynecological Malignancy Patients : Does the risk of anastomotic leakage increase after surgery?

Objective: This study was conducted to investigate the clinicopathological outcomes of colorectal resection in patients with advanced gynecological malignancies.Methods: We reviewed the medical records of 104 patients of gynecological cancer with co-operation for colorectal resection from December 2008 to August 2020 by retrospective cohort study in a single center (PNUYH). Variables for risk factors and postoperative complications were compared by descriptive statistics. We excluded the cases with malignancies from other than female genital organs, gynecological benign diseases, primary creation of stoma, and any other bowel surgeries except colorectal resection.Results: Of 104 patients in total, the mean age was 62.0 years. The most common gynecological malignancy was ovarian cancer(85 patients, 81.7%) and the most commonly performed operation was low anterior resection(80 patients, 76.9%). 61 patients(58.7%) had postoperative complications, while only 3 patients(2.9%) with anastomotic leakage. Only preoperative albumin was statistically significant(p=0.019) among the risk factors.Conclusion: Our experience suggests that colorectal resection can be safely and efficaciously performed in patients with advanced gynecological malignancy.

Preoperative Albumin-to-Globulin Ratio Predicts Prognosis in Hepatocellular Carcinoma: A Cohort Study Including Non-Hepatitis Virus-Infected Patients

<b><i>Introduction:</i></b> We evaluated the prognostic significance of the preoperative albumin-to-globulin ratio (AGR) in patients with hepatocellular carcinoma (HCC) with various liver etiologies. <b><i>Methods:</i></b> We retrospectively analyzed 157 patients with HCC between July 2010 and February 2021. The relationship between clinicopathological variables was investigated using univariate and multivariate analyses. Statistical significance was set at <i>p</i> &#x3c; 0.05. <b><i>Results:</i></b> The mean overall survival (OS) was 24.5 months. The 1-, 3-, and 5-year OS rates were 90.4%, 81.2%, and 68.7%, respectively. Patients were classified into 2 groups: AGR &#x3c;1.16 (low-AGR group; <i>n</i> = 43) and AGR ≥1.16 (high-AGR group; <i>n</i> = 114). In univariate analysis, OS was significantly reduced in patients with a low AGR (AGR &#x3c;1.16), an alpha-fetoprotein level ≥25 ng/mL, a tumor size ≥3.5 cm, microvascular invasion, and poor tumor differentiation. In multivariate analysis, a low AGR (hazard ratio [95% confidence interval]) (2.394 [1.092–5.213]; <i>p</i> = 0.030) and microvascular invasion (2.268 [1.019–5.169]; <i>p</i> = 0.045) were independent predictors of OS. <b><i>Discussion/Conclusion:</i></b> A low AGR was significantly associated with poor OS in patients with HCC, regardless of liver etiology. This may assist in treatment stratification and better management of patients with HCC.

Developing Machine Learning Algorithms to Predict Pulmonary Complications After Emergency Gastrointestinal Surgery

Objective: Investigate whether machine learning can predict pulmonary complications (PPCs) after emergency gastrointestinal surgery in patients with acute diffuse peritonitis.Methods: This is a secondary data analysis study. We use five machine learning algorithms (Logistic regression, DecisionTree, GradientBoosting, Xgbc, and gbm) to predict postoperative pulmonary complications.Results: Nine hundred and twenty-six cases were included in this study; 187 cases (20.19%) had PPCs. The five most important variables for the postoperative weight were preoperative albumin, cholesterol on the 3rd day after surgery, albumin on the day of surgery, platelet count on the 1st day after surgery and cholesterol count on the 1st day after surgery for pulmonary complications. In the test group: the logistic regression model shows AUC = 0.808, accuracy = 0.824 and precision = 0.621; Decision tree shows AUC = 0.702, accuracy = 0.795 and precision = 0.486; The GradientBoosting model shows AUC = 0.788, accuracy = 0.827 and precision = 1.000; The Xgbc model shows AUC = 0.784, accuracy = 0.806 and precision = 0.583. The Gbm model shows AUC = 0.814, accuracy = 0.806 and precision = 0.750.Conclusion: Machine learning algorithms can predict patients' PPCs with acute diffuse peritonitis. Moreover, the results of the importance matrix for the Gbdt algorithm model show that albumin, cholesterol, age, and platelets are the main variables that account for the highest pulmonary complication weights.