• Journal of Gastric Cancer
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• 제18권3호
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• pp.230-241
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• 2018

Purpose: Enhanced recovery after surgery (ERAS) protocols for gastric cancer patients have shown improved outcomes in Asia. However, data on gastric cancer ERAS (GCERAS) programs in the United States are sparse. The purpose of this study was to compare perioperative outcomes before and after implementation of an GC-ERAS protocol at a National Comprehensive Cancer Center in the United States. Materials and Methods: We reviewed medical records of patients surgically treated for gastric cancer with curative intent from January 2012 to October 2016 and compared the GC-ERAS group (November 1, 2015-October 1, 2016) with the historical control (HC) group (January 1, 2012-October 31, 2015). Propensity score matching was used to adjust for age, sex, number of comorbidities, body mass index, stage of disease, and distal versus total gastrectomy. Results: Of a total of 95 identified patients, matching analysis resulted in 20 and 40 patients in the GC-ERAS and HC groups, respectively. Lower rates of nasogastric tube (35% vs. 100%, P<0.001) and intraabdominal drain placement (25% vs. 85%, P<0.001), faster advancement of diet (P<0.001), and shorter length of hospital stay (5.5 vs. 7.8 days, P=0.01) were observed in the GC-ERAS group than in the HC group. The GC-ERAS group showed a trend toward increased use of minimally invasive surgery (P=0.06). There were similar complication and 30-day readmission rates between the two groups (P=0.57 and P=0.66, respectively). Conclusions: The implementation of a GC-ERAS protocol significantly improved perioperative outcomes in a western cancer center. This finding warrants further prospective investigation.

• Journal of Gastric Cancer
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• 제8권2호
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• pp.57-64
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• 2008

현재 국소 위암에서 유일한 완치적 치료법은 수술적 절제이나 적절한 수술적 치료에도 불구하고 상당 수의 환자들이 재발을 경험한다. 이에 다학제적 병용 치료 전략에 대해 많은 관심이 있어왔고 특히 최근에는 암의 병기 감소, 근치적 절제률의 증가, 미세 원격전이의 조기 치료 등의 가능성을 가지는 수술 전 선행항암화학요법에 대한 관심이 증대되고 있다. 최근의 3상 임상 연구인 MAGIC trial은 수술 전후 항암화학요법이, 수술 단독에 비해, 병리학적 병기를 감소시키며 국소 재발과 원격 전이를 감소시켜 생존율을 향상시킴을 보고하였고 또 다른 3상 연구인 FNLCC 94012/FFCD 9703 trial 역시, 수술 전후 항암화학요법이 근치적 절제율과 생존율을 향상시킴을 보고하였다. 두 연구는 수술 전후 항암화학요법에 대한 것이지만 수술 후 보조항암화학요법의 불량한 치료 순응도에 비추어 볼 때 치료성적의 향상은 주로 수술 전 선행항암화학요법에 기인하는 것으로 생각된다. 상기 연구들이 이루어진 서양과 달리 광범위(D2) 림프절 절제술을 표준적 치료로 시행하고 있는 한국의 현실에서 이들 연구결과를 그대로 적용하기에는 어려움이 있으나 한국에서 이루어진, 국소 진행성 위암 환자를 대상으로 한 몇 가지 임상 연구 역시 선행항암화학요법을 통한 근치적 절제률의 증가 및 병기 감소 효과를 시사하였다. 이러한 고무적인 치료 성적에 근거하여 향후 수술 전 또는 수술 전후 항암화학요법이 국소 위암에서 표준적인 치료 전략으로 자리잡을 수 있을 지 결론을 짓기 위해서는 대규모 임상 연구가 시행되어야 할 것이다.

• 생명과학회지
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• 제20권9호
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• pp.1299-1305
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• 2010

심혈관질환 진단을 위해 여러 가지 표지자들이 이용되고 있으며 그와 같은 표지자로 cardiac troponin-I (cTNI), creatine kinase-MB (CK-MB), C-reative protein (CRP)이 있다. 최근, 심장기능부전의 표지자로서 brain natriuretic peptide (BNP)에 대한 관심이 집중되고 있다. 이 연구는 심폐바이패스(cardiopulmonary bypass) 비적용 관상동맥우회수술을 시행한 74명의 성인환자를 대상으로 수술 전 BNP 농도와 다른 심장 표지자들 농도, 그리고 수술 전후 표지자들 간의 상관관계를 규명하기 위해 시행하였다. 수술 전 시기의 BNP, cTNI, CK-MB, CRP 각각의 농도는 수술 전 심초음파 변수와 양 또는 음의 상관성을 보였다. 수술 전 BNP 농도와 수술 전 cTNI, CK-MB, CRP 농도 각각과 높은 양의 상관관계가 있었다. 수술 전 BNP, cTNI, CK-MB, CRP 농도 각각은 수술 후 기계호흡보조시간, 중환자실치료기간과 유의한 양의 상관관계를 보였다. 이 연구의 결과들은 수술 전 BNP, cTNI, CK-MB, CR과 같은 심장 표지자들의 측정 및 병용은 심혈관질환자들의 진단, 환자들의 등급화, 수술 후 예후평가에 매우 유용한 방법임을 시사하고 있다.

• Journal of Chest Surgery
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• 제57권2호
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• pp.160-168
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• 2024

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

• 대한간호학회지
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• 제42권5호
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• pp.719-729
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• 2012

Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

• Journal of Chest Surgery
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• 제51권3호
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• pp.180-186
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• 2018

Background: Endovascular aortic repair (EVAR) is widely performed to treat infrarenal abdominal aortic aneurysms (AAAs), and related techniques and devices continue to be developed. Although continuous attempts have been made to perform EVAR in patients with unfavorable aortic anatomy, the outcomes are still controversial. This study examined the short-term outcomes of EVAR for the treatment of infrarenal AAAs in patients with a 'hostile' neck and unfavorable iliac anatomy. Methods: Thirty-eight patients who underwent EVAR from January 2012 to December 2017 were enrolled in this study. A hostile neck was defined based on neck length, angulation, the presence of an associated thrombus, or a conical shape. Unfavorable iliac anatomy was considered to be present in patients with a short common iliac artery (<15 mm) or the presence of aneurysmal changes. Results: No perioperative mortality was recorded. No significant differences were found depending on the presence of a hostile neck, but aneurysmal sac shrinkage was significantly less common in the group with unfavorable iliac anatomy (p=0.04). A multivariate analysis performed to analyze the risk factors for aneurysmal progression revealed only unfavorable iliac anatomy to be a risk factor (p=0.02). Conclusion: Patients with unfavorable aortic anatomy showed relatively satisfactory short-term outcomes after EVAR. No difference in the surgical outcomes was observed in patients with a hostile neck. However, unfavorable iliac anatomy was found to inhibit the shrinkage of the aneurysmal sac.

• Archives of Plastic Surgery
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• 제46권6호
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• pp.511-517
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• 2019

Background Cleft treatment is frequently performed in Indonesia, mostly in charity missions, but without a postoperative protocol it is difficult to establish the risks and complications of cleft treatment. The present study was designed to give an overview of current cleft lip and palate treatment strategies in Indonesia and to assess the complication rates during and after surgery. Methods This prospective study evaluated anesthetic, intraoperative surgical, and short-term postoperative complications in patients undergoing primary, secondary, or corrective surgery for cleft lip and palate deformities. The population consisted of 98 non-syndromic cleft patients. The main anesthetic complication that occurred during general anesthesia was high blood pressure, whereas the main intraoperative surgical complication was excessive bleeding and the main early postoperative complication was extremely poor wound hygiene. Results In this study, there were no cases of perioperative or postoperative mortality. However, in 23 (23.4%) of the 98 operations performed, at least one perioperative complication related to anesthesia occurred. The intraoperative and early postoperative complications following cleft lip and/or palate were assessed. There was a significant difference in the complication rate between procedure types (χ²=0.02; P<0.05). However, no relationship was found between perioperative complications related to anesthesia and the occurrence of postoperative complications (χ²=1.00; P>0.05). Nonetheless, a significant difference was found between procedure types regarding perioperative complications and the occurrence of postoperative complications (χ²=0.031; P<0.05). Conclusions Further evaluation of these outcomes would help direct patient management toward decreasing the complication rate.

• Journal of Korean Neurosurgical Society
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• 제65권4호
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• pp.539-548
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• 2022

Objective : Although full-endoscopic lumbar interbody fusion (Endo-LIF) has been tried as the latest alternative technique to minimally invasive transforaminal lumbar interobody fusion (MIS-TLIF) since mid-2010, the evidence is still lacking. We compared the clinical outcome and safety of Endo-LIF to MIS-TLIF for lumbar degenerative disease. Methods : We systematically searched electronic databases, including PubMed, EMBASE, and Cochrane Library to find literature comparing Endo-LIF to MIS-TLIF. The results retrieved were last updated on December 11, 2020. The perioperative outcome included the operation time, blood loss, complication, and hospital stay. The clinical outcomes included Visual analog scale (VAS) of low back pain and leg pain and Oswestry disability index (ODI), and the radiological outcome included pseudoarthosis rate with 12-month minimum follow-up. Results : Four retrospective observational studies and one prospective observational study comprising 423 patients (183 Endo-LIF and 241 MIS-TLIF) were included, and the pooled data analysis revealed low heterogeneity between studies in our review. Baseline characteristics including age and sex were not different between the two groups. Operation time was significantly longer in Endo-LIF (mean difference [MD], 23.220 minutes; 95% confidence interval [CI], 10.669-35.771; p=0.001). However, Endo-LIF resulted in less perioperative blood loss (MD, -144.710 mL; 95% CI, 247.941-41.478; p=0.023). Although VAS back pain at final (MD, -0.120; p=0.586), leg pain within 2 weeks (MD, 0.005; p=0.293), VAS leg pain at final (MD, 0.099; p=0.099), ODI at final (MD, 0.141; p=0.093) were not different, VAS back pain within 2 weeks was more favorable in the Endo-LIF (MD, -1.538; 95% CI, -2.044 to -1.032; p<0.001). On the other hand, no statistically significant group difference in complication rate (relative risk [RR], 0.709; p=0.774), hospital stay (MD, -2.399; p=0.151), and pseudoarthrosis rate (RR, 1.284; p=0.736) were found. Conclusion : Relative to MIS-TLIF, immediate outcomes were favorable in Endo-LIF in terms of blood loss and immediate VAS back pain, although complication rate, mid-term clinical outcomes, and fusion rate were not different. However, the challenges for Endo-LIF include longer operation time which means a difficult learning curve and limited surgical indication which means patient selection bias. Larger-scale, well-designed study with long-term follow-up and randomized controlled trials are needed to confirm and update the results of this systematic review.

• Journal of Yeungnam Medical Science
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• 제37권4호
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• pp.308-313
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• 2020

Background: Hysterectomy is one of the major gynecologic surgeries. Historically, several surgical procedures have been used for hysterectomy. The present study aims to evaluate the surgical trends and clinical outcomes of hysterectomy performed for benign diseases at the Yeungnam University Hospital. Methods: We retrospectively reviewed patients who underwent a hysterectomy for benign diseases from 2013 to 2018. Data included the patients' demographic characteristics, surgical indications, hysterectomy procedures, postoperative pathologies, and perioperative outcomes. Results: A total of 809 patients were included. The three major indications for hysterectomy were uterine leiomyoma, pelvic organ prolapse, and adenomyosis. The most common procedure was total laparoscopic hysterectomy (TLH, 45.2%), followed by open hysterectomy (32.6%). During the study period, the rate of open hysterectomy was nearly constant (29.4%-38.1%). The mean operative time was the shortest in the single-port laparoscopic assisted vaginal hysterectomy (LAVH, 89.5 minutes), followed by vaginal hysterectomy (VH, 96.8 minutes) and TLH (105 minutes). The mean decrease in postoperative hemoglobin level was minimum in single-port LAVH (1.8 g/dL) and VH (1.8 g/dL). Conversion to open surgery or multi-port surgery occurred in five cases (0.6%). Surgical complications including wound dehiscence, organ injuries, and conditions requiring reoperation were observed in 52 cases (6.4%). Conclusion: Minimally invasive approach was used for most hysterectomies for benign diseases, but the rate of open hysterectomy has mostly remained constant. Single-port LAVH and VH showed the most tolerable outcomes in terms of operative time and postoperative drop in hemoglobin level in selected cases.

• Journal of Gastric Cancer
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• 제19권2호
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• pp.165-172
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• 2019

Purpose: The robotic system for surgery was introduced to gastric cancer surgery in the early 2000s to overcome the shortcomings of laparoscopic surgery. The more recently introduced da Vinci $Xi^{(R)}$ system offers benefits allowing four-quadrant access, greater range of motion, and easier docking through an overhead boom rotation with laser targeting. We aimed to identify whether the $Xi^{(R)}$ system provides actual advantages over the $Si^{(R)}$ system in gastrectomy for gastric cancer by comparing the operative outcomes. Materials and Methods: We retrospectively reviewed all patients who underwent robotic gastrectomy as treatment for gastric cancer from March 2016 to March 2017. Patients' demographic data, perioperative information, and operative and pathological outcomes were collected and analyzed. Results: A total of 109 patients were included in the $Xi^{(R)}$ group and 179 in the $Si^{(R)}$ group. Demographic characteristics were similar in both groups. The mean operative time was 229.9 minutes in the $Xi^{(R)}$ group and 223.7 minutes in the $Si^{(R)}$ group. The mean estimated blood loss was 72.7 mL in the $Xi^{(R)}$ group and 62.1 mL in the $Si^{(R)}$ group. No patient in the $Xi^{(R)}$ group was converted to open or laparoscopy, while 3 patients in the $Si^{(R)}$ group were converted, 2 to open surgery and 1 to laparoscopy, this difference was not statistically significant. Bowel function was resumed 3 days after surgery, while soft diet was initiated 4 days after surgery. Conclusions: We found no difference in surgical outcomes after robotic gastrectomy for gastric cancer between the da Vinci $Xi^{(R)}$ and da Vinci $Si^{(R)}$ procedures.