Abstract:
Importance:Surgery represents the mainstay treatment of colorectal liver metastases. Indications for the laparoscopic approach in this setting have been widened and there is a need to confirm the benefits of minimally invasive liver surgery (MILS) in patients with complex disease states. Objective:To compare outcomes of laparoscopic surgery with those of open surgery for liver metastases from colorectal cancer, focusing on the characteristics of modern MILS and therefore overcoming possible selection bias related to different policies for patients' eligibility for MILS over time. Design, Setting, and Participants:A cohort study of 885 resections performed for liver metastases from colorectal cancer between January 1, 2004, and June 30, 2017, at the Hepatobiliary Surgery Unit of San Raffaele Hospital, Milano, Italy, comprising 187 laparoscopic and 698 open resections. Procedures performed using the MILS approach with a ratio of MILS to total resections per year of more than 30% were considered and were matched by propensity scores (ratio of 1:4) to procedures performed using the open approach with a ratio of MILS to total resections per year of less than 30%. Main Outcomes and Measures:The primary end point was short-term outcomes, including morbidity, mortality, functional recovery, and interval between surgery and adjuvant treatments; the secondary end point was long-term outcomes. Results:Among this cohort (104 patients in the MILS group; 46 women and 58 men; median age, 62 years [range, 35-81 years]; and 412 patients in the open group; 181 women and 231 men; median age, 60 years [range, 37-80 years]), primary end-point data showed a significantly higher incidence of postoperative morbidity in patients who underwent open resections compared with those who underwent MILS (94 [22.8%] vs 21 [20.2%]; P = .04). Patients in the MILS group had fewer major complications (Dindo-Clavien grades III-V) compared with patients in the open group (Dindo-Clavien grades III-V; 7 [6.7%] vs 35 [8.5%]; P = .03) as well as shorter lengths of stay (median [range] duration, 3 [2-35] vs 5 [4-37] days; P = .02). Oncologic results were not compromised by the laparoscopic approach. Conclusions and Relevance:In this study, the results of the propensity score matching analysis between modern laparoscopic surgery and previous open surgery appear to confer more comparable cohorts for complexity, further supporting the advantages of laparoscopy in the surgical treatment of liver metastases from colorectal cancer. The increase in use that laparoscopy has experienced appears to be based on increased feasibility, widening of eligibility criteria for patients, enhanced clinical effectiveness, and oncologic outcomes. All these elements together suggest that up to 70% of patients appear to be candidates for this minimally invasive surgical approach in high-volume centers.
journal_name
JAMA Surgjournal_title
JAMA surgeryauthors
Ratti F,Fiorentini G,Cipriani F,Catena M,Paganelli M,Aldrighetti Ldoi
10.1001/jamasurg.2018.2107subject
Has Abstractpub_date
2018-11-01 00:00:00pages
1028-1035issue
11eissn
2168-6254issn
2168-6262pii
2688236journal_volume
153pub_type
杂志文章相关文献
JAMA Surgery文献大全abstract:Importance:Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. Objective:To evaluate the association between the Danish nationwide introduction ...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2018.5840
更新日期:2019-06-01 00:00:00
abstract:Importance:Liposomal bupivacaine is a novel extended-duration anesthetic that has recently been used for local infiltration in total knee arthroplasty (TKA). Athough liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. Objective:To evaluate ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.3474
更新日期:2017-01-01 00:00:00
abstract:IMPORTANCE:Nonsteroidal anti-inflammatory drugs (NSAIDs) have many physiologic effects and are being used more commonly to treat postoperative pain, but recent small studies have suggested that NSAIDs may impair anastomotic healing in the gastrointestinal tract. OBJECTIVE:To evaluate the relationship between postopera...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.2239
更新日期:2015-03-01 00:00:00
abstract:Importance:There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective:To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain manageme...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2017.2872
更新日期:2017-10-18 00:00:00
abstract:IMPORTANCE:Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE:To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complicated appendicitis. DE...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2015.4236
更新日期:2016-04-01 00:00:00
abstract:Importance:Hospitals are rapidly consolidating into regional delivery networks. To our knowledge, whether these multihospital networks leverage their combined assets to improve quality and provide a uniform standard of care has not been explored. Objective:To evaluate the extent to which surgical outcomes varied acros...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2019.0090
更新日期:2019-06-01 00:00:00
abstract:IMPORTANCE:Older adults are at increased risk for adverse events after surgical procedures. Loss of independence (LOI), defined as a decline in function or mobility, increased care needs at home, or discharge to a nonhome destination, is an important patient-centered outcome measure. OBJECTIVE:To evaluate LOI among ol...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.1689
更新日期:2016-09-21 00:00:00
abstract:Importance:Primary hyperparathyroidism (pHPT) is a common clinical entity, with approximately 100 000 new cases diagnosed each year in the United States. Most patients with pHPT have a relatively mild form of the disease and present with few if any overt signs or symptoms. This has led to a dilemma regarding which pati...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2017.1721
更新日期:2017-09-01 00:00:00
abstract:Importance:Incisional hernia is a frequent complication after open abdominal surgery. Prophylactic mesh implantation in the onlay or sublay position requires dissection of the abdominal wall, potentially leading to wound-associated complications. Objective:To compare the incidence of incisional hernia among patients a...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2018.4221
更新日期:2019-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided s...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.739
更新日期:2013-03-01 00:00:00
abstract:Importance:In general surgery, women earn less money and hold fewer leadership positions compared with their male counterparts. Objective:To assess whether differences exist between the perspectives of male and female general surgery residents on future career goals, salary expectations, and salary negotiation that ma...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.2879
更新日期:2019-11-01 00:00:00
abstract:IMPORTANCE:To reduce the amount of skin surface bacteria for patients undergoing elective surgery, selective health care facilities have instituted a preadmission antiseptic skin cleansing protocol using chlorhexidine gluconate. A Cochrane Collaborative review suggests that existing data do not justify preoperative ski...
journal_title:JAMA surgery
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamasurg.2015.2210
更新日期:2015-11-01 00:00:00
abstract:Importance:Surgical patient outcomes are related to surgeon skills. Objective:To measure resident surgeon technical and nontechnical skills for trauma core competencies before and after training and up to 18 months later and to compare resident performance with the performance of expert traumatologists. Design, Setti...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2017.0092
更新日期:2017-06-01 00:00:00
abstract:IMPORTANCE:Surgical site infection remains a major challenge in surgery. Delayed primary closure of dirty wounds is widely practiced in war surgery; we present a meta-analysis of evidence to help guide application of the technique in wider context. OBJECTIVE:To determine using meta-analysis whether delayed primary ski...
journal_title:JAMA surgery
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamasurg.2013.2336
更新日期:2013-08-01 00:00:00
abstract:Importance:Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts. Objective:To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. Design, Setting, and Participants:I...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.2484
更新日期:2020-08-05 00:00:00
abstract:IMPORTANCE:Endovascular technology has become ubiquitous in the modern care of abdominal aortic aneurysm (AAA), yet broad estimates of its efficacy among variable hospital and regional settings is not known. OBJECTIVE:To perform a preliminary analysis of hospital effects on mortality following open AAA repair (OAR) an...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2014.3871
更新日期:2015-07-01 00:00:00
abstract:Importance:Although the Afghanistan and Iraq conflicts have the lowest US case-fatality rates in history, no comprehensive assessment of combat casualty care statistics, major interventions, or risk factors has been reported to date after 16 years of conflict. Objectives:To analyze trends in overall combat casualty st...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2019.0151
更新日期:2019-07-01 00:00:00
abstract:Importance:Expansion of donor acceptance criteria for liver transplant increased the risk for early allograft failure (EAF), and although EAF prediction is pivotal to optimize transplant outcomes, there is no consensus on specific EAF indicators or timing to evaluate EAF. Recently, the Liver Graft Assessment Following ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.4095
更新日期:2020-12-01 00:00:00
abstract:IMPORTANCE:Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates that individual patient characteristics do not affect existing criteria for intraoperative parathyroid h...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.104
更新日期:2013-07-01 00:00:00
abstract:Importance:Acute cholangitis (AC), particularly severe AC, has historically required urgent endoscopic decompression, although the timing of decompression is controversial. We previously identified 2 admission risk factors for adverse outcomes in AC: total bilirubin level greater than 10 mg/dL and white blood cell coun...
journal_title:JAMA surgery
pub_type: 杂志文章,多中心研究
doi:10.1001/jamasurg.2016.2329
更新日期:2016-11-01 00:00:00
abstract:IMPORTANCE:Population-based studies on the prevalence of symptoms after Roux-en-Y gastric bypass (RYGB) surgery are sparse. Knowledge about possible predictors of these symptoms is important for prevention. OBJECTIVES:To examine patients' overall well-being and the prevalence and predictors of medical, nutritional, an...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.5110
更新日期:2016-06-01 00:00:00
abstract::Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minima...
journal_title:JAMA surgery
pub_type: 杂志文章,评审
doi:10.1001/jamasurg.2013.366
更新日期:2013-12-01 00:00:00
abstract:IMPORTANCE:The appropriately coached implementation of surgical safety checklists (SSCs) reduces the incidence of perioperative complications and 30-day mortality of patients undergoing surgery. The association of the introduction of SSCs with 90-day mortality remains unclear. OBJECTIVE:To assess the association betwe...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2015.5490
更新日期:2016-07-01 00:00:00
abstract:IMPORTANCE:Among patients presenting with critical lower extremity ischemia, it has been previously documented that white individuals are more likely to undergo revascularization than nonwhite individuals, with the disparity largely attributed to differences in resources and access to care. OBJECTIVE:To investigate th...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1436
更新日期:2013-07-01 00:00:00
abstract:Importance:Medically treated symptomatic severe aortic stenosis has poor outcomes, and in the past 6 decades, it has successfully been treated with surgical aortic valve replacement (SAVR). However, one-third of patients with indications for SAVR are not offered surgery because of the high risk of complications. Transc...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2019.4449
更新日期:2019-11-27 00:00:00
abstract:Importance:All events that transpire during laparoscopic cholecystectomy (LC) cannot be adequately reproduced in the operative note. Video recording is already known to add important information regarding this operation. Objective:It is hypothesized that additional audio recordings can provide an even better procedura...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2020.0741
更新日期:2020-07-01 00:00:00
abstract:Importance:Assessment of physical frailty in older trauma patients admitted to the intensive care unit is often not feasible using traditional frailty assessment instruments. The use of opportunistic computed tomography (CT) scans to assess sarcopenia and osteopenia as indicators of underlying frailty may provide compl...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2016.4604
更新日期:2017-02-15 00:00:00
abstract:IMPORTANCE:The Centers for Medicare and Medicaid Services have implemented penalties for hospitals with above-average readmission rates under the Hospital Readmissions Reductions Program. These changes will likely be extended to affect postoperative readmissions in the future. OBJECTIVES:To identify variables that pla...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.4043
更新日期:2015-06-01 00:00:00
abstract:IMPORTANCE:This study analyzes a role of laparoscopy in obese patients with ventral hernia. OBJECTIVE:To evaluate the outcomes of laparoscopic compared with open ventral hernia repair (VHR) in obese patients. DESIGN:Retrospective cohort analysis. SETTING:Nationwide hospital survey. PARTICIPANTS:Obese patients under...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2013.1395
更新日期:2013-08-01 00:00:00
abstract:IMPORTANCE:Hemorrhage is the leading cause of death in military trauma and second leading cause of death in civilian trauma. Although many well-established animal models of hemorrhage exist in the trauma and anticoagulant literature, few focus on directly quantitating blood loss. OBJECTIVE:To establish and validate a ...
journal_title:JAMA surgery
pub_type: 杂志文章
doi:10.1001/jamasurg.2014.1685
更新日期:2015-04-01 00:00:00