Conversion to thoracotomy during minimally invasive esophagectomy: Retrospective analysis in a single center / 中国胸心血管外科临床杂志

@#Objective     To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods     The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results     In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion     In MIE, advanced-stage tumor, anesthesia-related factors,extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.

Mortalidad perioperatoria / Perioperative mortality

Introducción: La tasa de mortalidad perioperatoria representa un indicador global del acceso seguro a la atención quirúrgica y anestesiológica. Objetivo: Caracterizar los pacientes fallecidos durante el perioperatorio en intervenciones quirúrgicas. Métodos: Se realizó un estudio descriptivo transversal en el servicio de Anestesiología del Hospital Clínico Quirúrgico Arnaldo Milián Castro, provincia Villa Clara, en el periodo período de enero de 2015 a diciembre de 2018. La población estuvo constituida por los pacientes intervenidos quirúrgicamente en dicho hospital (N: 133 724). La muestra fueron los pacientes fallecidos durante el período intraoperatorio y primeras 24 h tras la intervención quirúrgica (n: 77). Resultados: La tasa de mortalidad perioperatoria general fue de 5,76/10 000. Incidencia de mortalidad mayor en hombres (59,7 por ciento), ancianos (75,3 por ciento), con varias comorbilidades asociadas (51,9 por ciento), clase 4 de la ASA (41,5 por ciento), riesgo quirúrgico grupo II (62,3 por ciento), cirugía abdominal (63,6 por ciento), intervenciones de urgencia (88,3 por ciento), bajo una técnica anestésica general (84,4 por ciento) y en el período postoperatorio 24 h (68,8 por ciento). El shock séptico constituyó la principal causa de mortalidad (48,1 por ciento). Conclusiones: Predominaron las defunciones en ancianos con comorbilidades asociadas, alto riesgo anestésico y quirúrgico, intervenidos de urgencia bajo anestesia general, con el shock séptico como principal causa de muerte. La tasa de mortalidad perioperatoria fue similar a naciones de desarrollo socioeconómico equivalente(AU)

Introduction: Perioperative mortality rate represents a global indicator for safe access to surgical and anesthesiological care. Objective: To characterize patients who deceased during the perioperative period in surgical interventions. Methods: A cross-sectional and descriptive study was carried out in the anesthesiology service of Arnaldo Milián Castro Clinical-Surgical Hospital, in Villa Clara Province, in the period from January 2015 to December 2018. The study population consisted of patients who received surgery within that hospital (N: 133 724). The sample consisted of patients who died during the intraoperative period and within the first 24 hours after surgery (n: 77). Results: The general perioperative mortality rate was 5.76/10 000. There was incidence of higher mortality among men (59.7 percent), elderlies (75.3 percent), patients with several associated comorbidities (51.9 percent), those classified as ASA-IV (41.5 percent), those belonging to group II for surgical risk (62.3 percent), cases of abdominal surgery (63.6 percent), emergency interventions (88.3 percent), patients under general anesthetic technique (84.4 percent), and at 24 hours after the postoperative period (68.8 percent). Septic shock was the main cause of mortality (48.1 percent). Conclusions: There was a predominance of deaths among elderlies with associated comorbidities, high anesthetic, as well as surgical risk, who received emergency surgery under general anesthesia, being septic shock the main cause of death. The perioperative mortality rate was similar to that in nations of equivalent socioeconomic development(AU)

55 cases of perioperative mortality in oral maxillofacial head and neck cancer patients: a retrospective analysis / 口腔疾病防治

Objective@#To analyze the characteristics of perioperative mortality (POM) in oral maxillofacial head and neck cancer patients.@*Methods@#A retrospective study was adapted for head and neck cancer patients who were treated and had POM in the department of oral maxillofacial & head and neck oncology in Shanghai Ninth People′s Hospital from Jan 1999 to Dec 2019. Demographic information, disease characteristic and clinical records were collected. The factors of POM were classified into surgical complication, medical complication, mixed complication (surgical and medical) and personal complication. SPSS 17.0 software was used to analyze the cause composition for POM under different condition.@*Results @# 55 patients were included: 39 were male, and 16 were female. A total of 12 patients had a smoking history. Furthermore, 28 patients had general comorbidities. 20 underwent preoperative radiotherapy and 9 received preoperative chemotherapy. Squamous cell carcinoma was the most frequent pathological diagnosis in 37 patients. A total of 9 patients had tumors in the maxilla and skull base. In addtition, 4 patients had POM preoperatively, 1 patient had POM within the operation, and 50 patients had POM postoperatively. The leading causes of death were as follows: rupture of the carotid artery was the most frequent (8), and the surgical complication of pulmonary infection was the main medical complication (6). Pulmonary infection and hemorrhage were regarded as the main mixed complication (4). Two patients had POM due to personal complications. The higher the American Society of Anesthesiologists (ASA) score, the higher the proportion of medical factors in POM (P=0.039).@*Conclusion@#The composition of POM in oral maxillofacial- head and neck cancer (OMHNC) patients was complicated. Carotid artery rupture was the most common and fatal surgical complication, especially for those who underwent preoperative radiotherapy. Pulmonary infection was the most frequent medical complication, and those who had a higher ASA grade tended to have more complication.

Morbidity and Mortality Analysis after Noncardiac Surgery in Patients with Prior Myocardial Infarction / 대한마취과학회지

BACKGROUND: Patients with a prior myocardial infarction who undergo noncardiac surgery have a higher risk of perioperative morbidity and mortality. Therefore, this study was designed to assess the outcomes after non-cardiac surgery in patients who had a previous myocardial infarction. METHODS: Ninety three patients who had a prior myocardial infarction and underwent noncardiac surgery were included in this study. The patients were divided as follows: the Complication group versus the Non-Complication group. A retrospective analysis was performed to determine if age, gender, ejection fraction, prior coronary revascularization, ASA physical status, operation time and type, perioperative vital signs, cardiac risk factor, preoperative medications and coronary multivessel disease influence the perioperative morbidity and mortality. RESULTS: Fourteen of the 93 patients (15.1%) had perioperative complications, of which 3 (3.2%) were fatal. All fatal patients had undergone noncardiac surgery within 3 months after the previous coronary revascularization. The incidence of intraoperative tachycardia and oliguria, operation time and the ASA physical status were longer and greater in the Complication group (P<0.05). Otherwise there were no significant differences between the two groups. CONCLUSIONS: The incidence of intraoperative tachycardia and oliguria, the operation time and ASA physical status influence the outcomes after noncardiac surgery of patients with a prior myocardial infarction. In addition, the interval between the coronary revascularization procedure and the noncardiac surgery has a major impact on postoperative mortality. However, prospective multi-center studies will be needed to determine the effects of several variables.

Long-term Clinical Study of Total Anomalous Pulmonary Venous Return

PURPOSE: Total anomalous pulmonary venous return is a rare congenital heart disease, which is fatal if untreated, especially, if the obstruction in pulmonary venous return is obstructed. With the technical development of echocardiogram, we are now able to do an early diagnosis if TAPVR and perform surgery. Accordingly, this report was aimed to evaluate patients with TAPVR as well as evaluate the problematic factors in order to contribute to future treatment. METHODS: From Sept. 1st, 1985 to June 30, 1999, we retrospectively evaluated 107 patients who were diagnosed TAPVR by echocardiogram and catheterization and angiogram. TAPVR in complex heart diseases were excluded. RESULTS: The patients were composed of 64 boys and 43 girls with the mean age of 206 days. The subtype of TAPVR is as follows : supracardiac type 45%, cardiac type 33%, infracardiac type 9% and mixed type was 13%. In 39 patients(36%), pulmonary venous obstruction was detected by echocardiogram and all the patients with infracardiac type TAPVR, except one patient, revealed obstructive pulmonary venous return. Surgery was performed in 96 patients and the mean age at operation was 270 days old. The operative mortality was not different statistically among subtypes(P=0.212) and also was not different between obstructive type and nonobstructive type(P=0.370). The mean age at operation from 1994 to 1999 was younger than that of up to 1994. Pulmonary vein stenoses after operation were detected in 14 patients(14.6%) and only in 3 patients developed, pulmonary vein stenoses at the same site of previous ones. Thus, pulmonary vein stenoses after operation could be mainly considered as secondary due to operation. CONCLUSION: The results from our study reveal that operative results for TAPVR were much improved with early diagnosis and operation and those results were not dependent on the subtypes of TAPVR. Postoperative pulmonary vein stenosis was a poor prognostic factor and for early detection, catheterization and angiogram could be recommended if there is suspicion.