ABSTRACT
Log odds of positive nodes (LODDS), defined as the log of the ratio between the number of positive nodes and the number of negative nodes, has been recently introduced as a tool in predicting prognosis. This study aims to establish the effective and prognostic value of LODDS in predicting the survival outcome of CRC patients undergoing surgical resection. The study population is represented by 323 consecutive patients with primary colon or rectal adenocarcinoma thatunderwent curative resection. LODDS values were calculated by empirical logistic formula, log(pnod + 0.5)/(tnod - pnod + 0.5). It was defined as the log of the ratio between the number of positive nodes and the number of negative nodes. The patients were divided into three groups: LODDS0 (≤ - 1.36), LODDS1 (> - 1.36 ≤ - 0.53) and LODDS2 (> - 0.53). Kaplan-Meier curve analyses showed 3-year OS rates of the patients staged by LODDS classification. These values were 88.3, 74.8 and 61.8% for LODDS0, LODDS1 and LODDS2, respectively (P ≤ 0.001). In a multivariate analysis, LODDS is an independent prognostic factor of 3-year OS. This is in contrast to pN stage and lymph node ratio, which shows no statistical significance. ROC analyses showed that LODDS predicted OS better than lymph node ratio. LODDS classification has a better prognostic effect than pN stage and lymph node ratio. LODDS offers a finer stratification and accurately predicts survival of CRC patients.
Subject(s)
Adenocarcinoma/pathology , Colonic Neoplasms/pathology , Lymph Nodes/pathology , Rectal Neoplasms/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/mortality , Adenocarcinoma/surgery , Adult , Aged , Aged, 80 and over , Colonic Neoplasms/diagnosis , Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Female , Follow-Up Studies , Humans , Logistic Models , Lymph Node Excision , Lymphatic Metastasis , Male , Middle Aged , Neoplasm Staging , Prognosis , Rectal Neoplasms/diagnosis , Rectal Neoplasms/mortality , Rectal Neoplasms/surgery , Retrospective Studies , Survival AnalysisABSTRACT
Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence of disease and mortality. In these patients, oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein patients. Thus, normalization of portal vein pressure may be a favorable determinant factor to reduce complications. We report a case of a patient with hepatitis C virus-related hepatic cirrhosis, esophageal varices, portal hypertension and gastric cancer. We demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more safely. We retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases.
Subject(s)
Gastrectomy , Hypertension, Portal/surgery , Liver Cirrhosis/complications , Portasystemic Shunt, Transjugular Intrahepatic , Stomach Neoplasms/surgery , Aged, 80 and over , Blood Loss, Surgical/prevention & control , Esophageal and Gastric Varices/etiology , Esophageal and Gastric Varices/virology , Female , Humans , Hypertension, Portal/diagnosis , Hypertension, Portal/physiopathology , Hypertension, Portal/virology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/virology , Portal Pressure , Portography , Stomach Neoplasms/complications , Stomach Neoplasms/diagnosis , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, ColorABSTRACT
The optimal timing and best method for removal of common bile duct stones (CBDS) associated with gallbladder stones (GBS) is still controversial. The aim of this study is to investigate the outcomes of a single-step procedure combining laparoscopic cholecystectomy (LC), intraoperative cholangiography (IOC), and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2003 and January 2012, 1972 patients underwent cholecystectomy at our hospital. Of those, 162 patients (8.2%; male/female 72/90) presented with GBS and suspected CBDS. We treated 54 cases (Group 1) with ERCP and LC within 48 to 72 hours. In 108 patients (Group 2) we performed LC with IOC and, if positive, was associated with IO-ERCP and sphincterotomy. In Group 1, a preoperative ERCP and LC were completed in 50 patients (30%). In four cases (2%), an ERCP and endobiliary stents were performed without cholecystectomy and then patients were discharged because of the severity of clinical conditions and advanced American Society of Anesthesiologists score (III to IV). Two months later a preoperative ERCP and removal of biliary stents were performed followed by LC 48 to 72 hours later. In Group 2, the IOC was performed in all cases and CBDS were extracted in 94 patients (87%). In two cases, the laparoscopic choledochotomy was necessary to remove large stones. In another two cases, an open choledochotomy was performed to remove safely the stones with T-tube drainage. In three cases, conversion was necessary to safely complete the procedure. The mean operative time was 95 minutes (range, 45 to 150 minutes) in Group 1 and 130 minutes (range, 50 to 300 minutes) in Group 2. The mean hospital stay was 6.5 days (range, 4 to 21 days) in Group 1 and 4.7 days (range, 3 to 14 days) in Group 2. Five cases (two in Group 2 and three in Group 1) presented with CBDS at 12 to 18 months after surgery. They were treated successfully with a second ERCP. There was no perioperative mortality. Our experience suggests that when clinically and technically feasible, a single-stage approach combining LC, IOC, and ERCP to the patients diagnosed with chole-choledocholithiasis is indicated. The IO-ERCP with CBDS extraction is a safe and effective method with low risk of postoperative pancreatitis. One-step treatment is more comfortable for the patient and also reduces the mean hospital stay.
Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Cholecystolithiasis/complications , Cholecystolithiasis/surgery , Choledocholithiasis/complications , Choledocholithiasis/surgery , Adult , Cholecystolithiasis/diagnosis , Choledocholithiasis/diagnosis , Female , Humans , Length of Stay , Male , Patient Selection , Retrospective Studies , Sphincterotomy, Endoscopic , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND AND AIMS: Progress in laparoscopic experience has increased the number of laparoscopic procedures performed, even in emergency cases. Herewith, results in a prospective series of 300 patients laparoscopically treated for nontraumatic abdominal emergencies are presented with the intent to prove the safety and feasibility of laparoscopic approach in the treatment of acute abdomen. MATERIALS AND METHODS: From a prospective multicenter study performed between June 2008 and December 2009, the authors collected data on 300 patients with a provisional diagnosis of acute abdomen, laparoscopically treated or who underwent explorative laparoscopy. RESULTS: A correct diagnosis was made by means of laparoscopy in all 300 (100%) patients, and therapeutic laparoscopy was successfully performed in 270 (90%) patients. With laparoscopy, it was possible to modify the preoperative diagnosis and the treatment in 17 cases (5.6%). Upon statistical analysis, the conversion rate was correlated to the age of the patients (P<.0001) and to the operative time (P<.0001). The overall postoperative morbidity rate was 8%. Statistical analysis revealed that morbidity is correlated to the age of patients (P<.0001) and to the operative time (P<.0001). The mean hospital stay was 5.4 days. CONCLUSIONS: Laparoscopy has been shown to play a crucial role in the management of almost every abdominal emergency, offering, compared with the open approach, an initial diagnostic or explorative tool and a valid alternative in the treatment of the cause of acute abdomen with low morbidity and mortality rates.
