Abstract:
BACKGROUND:The technique of total mesorectal excision (TME) increases the risk of anastomotic leakage. The impact of postoperative morbidity of TME on longterm survival has never been described. We retrospectively analyzed factors that might influence survival after TME for rectal cancer, including postoperative morbidity. STUDY DESIGN:From 1994 to 2001, 300 patients (192 men and 108 women; mean age, 64 years) had TME for rectal cancer. Preoperative radiotherapy was given in 202 patients. Age, gender, tumor height, size and circular invasion of the tumor, pathologic tumor and nodal status, distal and circumferential margins, number of lymph nodes analyzed, type of surgery, postoperative pelvic sepsis, preoperative radiotherapy, and adjuvant chemotherapy were examined; their association with overall and disease-free survival was evaluated by the log-rank test in univariate analysis and by multivariable Cox proportional hazards analysis. RESULTS:Postoperative morbidity was 38% (113 of 300 patients) and included 18% (54 of 300 patients) pelvic sepsis. The local recurrence rate was 6% (18 of 300 patients), and the distant metastasis rate was 24% (73 of 300 patients). Recurrence was three times more frequent distally than locally, including patients with pelvic sepsis The 5-year overall and disease-free survival rates were 72% and 60%, respectively. Independent predictors of overall survival were age older than 64 years (odds ration [OR]=2.19, 95% CI 1.32 to 4.17), pelvic sepsis (OR=2.06, 95% CI 1.10 to 3.87), circumferential surgical margin (OR=3.19, 95% CI 1.67 to 6.09), pathologic tumor (OR=2.69, 95% CI1.23 to 5.88), and nodal status (OR=3.18, 95% CI 1.79 to 5.64). Independent predictors of disease-free survival were pelvic sepsis (OR=2.17, 95% CI 1.31 to 3.58), circumferential surgical margin (OR=2.61, 95 CI 1.52 to 4.49), pathologic tumor (OR=1.82, 95% CI 1.04 to 3.20), and nodal status (OR=2.67, 95% CI 1.68 to 4.23). Patients with pelvic sepsis had a 5-year disease-free survival of 39% compared with 65% without pelvic sepsis (p<0.001). CONCLUSIONS:After TME for rectal cancer, pelvic sepsis is a common complication that is associated with increased risk of distant recurrence and decreased longterm survival. Efforts are necessary to decrease postoperative morbidity in surgical treatment of rectal cancer.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Laurent C,Nobili S,Rullier A,Vendrely V,Saric J,Rullier Edoi
10.1016/j.jamcollsurg.2006.07.021subject
Has Abstractpub_date
2006-11-01 00:00:00pages
684-91issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(06)01160-4journal_volume
203pub_type
杂志文章abstract:BACKGROUND:Rests of thyroid tissue within the thyrothymic area are relatively common and might be of clinical importance. The purpose of this study is to define the incidence and anatomy of thyroid tissue located in the line of the thyrothymic ligament, referred to here as "rests." STUDY DESIGN:Prospective descriptive...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01319-4
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND:Surgeons in academic medical centers have traditionally taken a siloed approach to reducing postoperative complications. We initiated a project focusing on transparency and sharing of data to engage surgeons in collaborative quality improvement. Its key features were the development of a comprehensive depart...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.12.013
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:To better understand how the COVID-19 pandemic has affected surgical trainees' and early-career surgeons' professional and personal experiences, a survey of the membership of the American College of Surgeons (ACS) Resident and Associate Society (RAS) and Young Fellows Association (YFA) was performed. STUDY ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2020.09.026
更新日期:2021-02-01 00:00:00
abstract:BACKGROUND:Disconnected pancreatic duct syndrome (DPDS) typically complicates acute necrotizing pancreatitis (ANP) and presents as a pseudocyst months after the initial episode of pancreatitis. However, our experience suggests that the presentation of DPDS may be quite varied and might require significant evaluation an...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.03.055
更新日期:2014-10-01 00:00:00
abstract:BACKGROUND:There is great interest in efficiently evaluating health care quality, but there is controversy over the use of administrative versus clinical data methods. We sought to compare actual mortality with risk-adjusted expected mortality in a sample population calculated by two different methods; one based on pre...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.08.013
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Abdominal wall reconstruction for complex ventral and incisional hernias is associated with significant complications. Commonly, the peritoneal cavity is opened and adhesiolysis is performed with the potential for enterotomy. A totally extraperitoneal (TE) approach to abdominal wall reconstruction is feasibl...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.11.012
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:The role of imaging studies before parathyroidectomy has been extensively debated and recent advances in unilateral parathyroidectomy intensify this controversy. The purpose of this study was to review the parathyroidectomy experience of a single surgeon, looking at the role of sestamibi scans and a standard...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(00)00258-1
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:There are few studies that report on stenosis of the intrahepatic bile ducts associated with choledochal cysts. We investigated the presence and clinical significance of stenosis of the intrahepatic bile ducts associated with choledochal cysts. STUDY DESIGN:We examined intrahepatic bile ducts in patients wi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-11-01 00:00:00
abstract:BACKGROUND:The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically. STUDY DESIGN:Between May 1982 and December 1993, 249 patients with necrotiz...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-10-01 00:00:00
abstract:BACKGROUND:Reoperation in the neck can be challenging and is associated with increased complication rates and operative times. Here we analyze our methylene blue dye injection method to localize reoperative neck pathology in patients with thyroid cancer and lymph node metastases. STUDY DESIGN:We retrospectively review...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.06.006
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2012.12.024
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Obese patients are more prone to post-injury multiple organ failure (MOF). Obesity pathophysiology includes an adipose-tissue-derived, renin-angiotensin-aldosterone system affecting inflammatory responses via leukocyte angiotensin receptors. We hypothesized that obese patients receiving pre-injury angiotensi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.03.051
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Palliative surgery for advanced cancer patients involves complex decision making. Surgeons with a cancer-focused practice were surveyed to determine the extent to which palliative surgery was currently practiced, to identify ethical dilemmas and barriers they faced in performing palliative surgery, and to ev...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01306-6
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Colonic Crohn's disease can be treated surgically by total colonic resection or by segmental colonic resection. The aim of this study was to analyze the outcomes of patients treated by segmental colectomy for colonic Crohn's disease. STUDY DESIGN:Among 413 patients undergoing operations for Crohn's disease,...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01122-5
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND:In the present study we evaluated gastrointestinal motility after gastrectomy of a new pylorus-preserving technique that is becoming a popular operation for early stage carcinoma of the stomach. STUDY DESIGN:Using strain-gauge force transducers we studied gastrointestinal motility in control dogs, dogs afte...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:After the successful evolution of hepatic transplantation during the last decade, small bowel and multivisceral transplantation remains the sole elusive achievement for the next era of transplant surgeons. Until recently, and for the last thirty years, the results of the sporadic attempts of intestinal trans...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract:BACKGROUND:Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly trauma patients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly trauma patients. METHODS:We conducted a single-center cohort study of adul...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.12.011
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Hemorrhage can modify the leukocyte-endothelial cell response leading to tissue injury. The selectin family of adhesion molecules and chemokines mediate the leukocyte-endothelial cell interaction, resulting in neutrophil sequestration and activation. This work studies whether a small molecule inhibitor of se...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00213-6
更新日期:1999-12-01 00:00:00
abstract::One hundred and seventy consecutive patients undergoing parathyroid gland exploration and bilateral thyroidectomy received, postoperatively, routine oral calcium supplementation, close monitoring of total serum calcium, and addition of vitamin D for specific criteria, all to accomplish a postoperative course free of s...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease. STUDY DESIGN:Retrospective review. RESULTS:During the 5-year period from June 1988 to October 199...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:The surgical management of esophageal perforation (EP) often results in mortality and significant morbidity. Recent less invasive approaches to EP management include endoscopic luminal stenting and minimally invasive surgical therapies. We wished to establish therapeutic efficacy of minimally invasive therap...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.12.033
更新日期:2014-04-01 00:00:00
abstract:BACKGROUND:Many patients seek greater accessibility to health care. Meanwhile, surgeons face increasing time constraints due to workforce shortages and elevated performance demands. Online postoperative care may improve patient access while increasing surgeon efficiency. We aimed to evaluate patient and surgeon accepta...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.08.429
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:Thyroglossal duct remnants are the most common midline neck masses in childhood but can be found in adults and the elderly. Sistrunk's procedure, with dissection of the tract and removal of the hyoid bone, is accepted as the main operation of choice. STUDY DESIGN:Fifty-five patients were treated from Januar...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)01171-1
更新日期:2002-03-01 00:00:00
abstract:BACKGROUND:Retained surgical items (RSI) continue to occur. Large RSI studies are few due to low RSI frequency in single institutions and the medicolegal implications. Consequently, RSI risks are not fully defined, with discrepancies persisting among published studies. The goals of this study were to better define risk...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2012.08.026
更新日期:2013-01-01 00:00:00
abstract:BACKGROUND:Delayed gastric emptying (DGE) is a common serious problem after pancreaticoduodenectomy (PD). Flange gastrojejunostomy (FL-GE) is a previously described technique that creates an internal flange in a hand-sewn gastroenterostomy. Results of FL-GE on incidence and severity of DGE after PD are presented. STUD...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.06.006
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Laparoscopic surgery (LS) is contemplated during long duration space flight, but it typically necessitates intraabdominal hypertension (IAH) from insufflation to create a surgical domain. Because there are spontaneous changes in abdominal wall behavior in weightlessness (0g) that have been previously suggest...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.03.026
更新日期:2009-08-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. STUD...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2007.07.015
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Cecal leak or disruption after appendectomy for complicated appendicitis is a consequence of severity of disease and is related to residual abscess cavity, inflammation, phlegmon, and nonviable intestine. In an attempt to improve results, we have begun to resect the cecum and other localized infected tissue ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-08-01 00:00:00
abstract:BACKGROUND:The National Veterans Affairs Surgical Risk Study was designed to collect reliable, valid data on patient risk and outcomes for major surgery in the Veterans Health Administration and to report comparative risk-adjusted postoperative mortality rates for surgical services in Veterans Health Administration. S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:
更新日期:1997-10-01 00:00:00
abstract:BACKGROUND:Coughing, bending, and lifting raise the pressure inside the abdomen, repetitively increasing stresses on the abdominal wall and the associated scaffold. The purpose of this study was to evaluate the effect of repetitive loading on biological scaffolds. It was hypothesized that exposure to repetitive loading...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.03.006
更新日期:2012-08-01 00:00:00