Results of upfront surgery in a mixed stage population of patients with esophageal carcinoma: early outcome and long term survival.

PURPOSE: To evaluate early outcome and long term survival in a mixed stage population of patients undergoing upfront esophagectomy for esophageal cancer. METHODS: Retrospective analysis of the data of 92 patients who underwent esophagectomy (thoracoabdominal: 76, Ivor-lewis: 16) between 1998 and 2017. Tumors were located in gastro-esophageal junction (52), lower third (31) and middle third (9) of the esophagus. Histology was: 73 adenocarcinomas and 19 squamous cell carcinomas. The stomach was used for reconstruction in 90 patients. A neck anastomosis was performed in 7 patients. End points of the study included: mortality, morbidity and long term survival. Kaplan-Meier and Cox regression analyses were used to identify prognostic factors for survival. RESULTS: The mortality was 10.9% and 29 patients presented 49 complications. Anastomotic dehiscence occurred in 17.4% of the patients and represented the most common cause of death with mortality of 37.5%. Reoperation was necessary in 14 patients. Median survival reached 25 months with 3 and 5 year survival of 30.5% and 21% respectively. Early stage tumors, absence of nodal disease, well differentiated carcinomas and lymph node ratio ≤ 0.2 were associated with 5 year survival of 82.6%, 81.6%, 83.3% and 40.4% respectively. In multivariate analysis early stage disease (OR: 15.746, 95%CI: 4.332-58.579, p < 0.001) and lymph node ratio (OR: 1.700 95%CI: 1.051-2.752, p = 0.031) were statistically associated with long term survival. CONCLUSIONS: Our results support the role of upfront surgery as the treatment of choice in early stage esophageal carcinomas without or with low nodal involvement.

Nursing activities and use of time in the postanesthesia care unit.

Specialty areas, such as the PACU, are currently characterized by a shortage of qualified nursing personnel along with the pressure for a most cost-conscious function of services. These, in combination with both the increasing acuity of patients and the advances of science and technology, have rendered necessary the investigation of how existing personnel can be better used. The work sampling approach has been widely used in different clinical settings to offer data about the amount of time nurses devote to specific activities. The aim of the current study was to categorize and quantify the activities of nurses employed in the PACU of the General University Hospital of Patras, Greece, and to identify differences with regard to shifts, varying nurse-patient ratios, and nurses' experiences. In the first phase, a classification form, which included all nursing activities, was constructed. This was based on literature review, researchers' experience, and semistructured personnel interviews. In the second phase, the researchers observed all PACU nurses, and activities were recorded on an hourly check sheet. A total of 4,320 observations were collected from 9/1/2004 to 9/30/2004. Nurses spent 35.2% of their time on direct clinical care, 11.6% on patient assessment, 7.0% on communication with patients, 7.2% on communication with other persons, 8.6% on clerical nursing duties, 9.3% on documentation, 2.3% on non-nursing duties, and 18.8% on personal activities. Variations in the use of time were found between shifts, different nurse-patient ratios, and PACU experience. Methods of decreasing time when the nurse-patient ratio is inappropriate and increasing time allocated to direct care activities are proposed.