Abstract:
BACKGROUND:We aimed to assess patient and demographic factors, treatment trends, and survival outcomes of patients with colorectal cancer with metastasis to the liver, lung, or both sites. Differences remain among national guidelines about the optimal management strategy. METHODS:Adults from the National Cancer Database (2010 to 2015) with a primary diagnosis of colorectal liver, lung, or liver and lung metastases were included and stratified by metastasis site. The primary end point was 5-year overall survival, analyzed using Kaplan-Meier survival curves, log-rank test, and the Cox proportional hazards model. RESULTS:Among 82,609 included patients, 70.42% had liver, 8.74% had lung, and 20.85% had simultaneous liver and lung metastases. Treatment with chemotherapy alone was used the most (21.11%), followed by chemotherapy with colorectal radical resection (CRRR) (19.4%), no treatment (14.35%), CRRR alone (9.03%), and chemotherapy with CRRR and liver/lung resection (8.22%). Patients with lung metastasis had significantly better 5-year overall survival rates than the other 2 metastatic groups (15.99%, 16.70%, and 5.51%; p < 0.001), even after stratifying by treatment type and adjusting for other factors. Chemotherapy with CRRR and liver/lung resection was associated with the greatest reduction in mortality risk for all sites in both unadjusted (35.15%, 44.52%, and 20.10%; p < 0.001) and adjusted analyses (hazard ratio 0.42; 95% CI, 0.38 to 0.47; p < 0.001; hazard ratio 0.31; 95% CI, 0.18 to 0.53; p < 0.001; and hazard ratio 0.79; 95% CI, 0.62 to 1.01; p = 0.064 for trend), and forgoing treatment or CRRR alone offered the worst overall survival. CONCLUSIONS:Patients with metastasis to lung had increased overall survival compared with other sites of metastases, regardless of treatment modality. Combined resection of primary tumor, metastasectomy, and chemotherapy appears to offer the greatest chance of survival.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Zhang GQ,Taylor JP,Stem M,Almaazmi H,Efron JE,Atallah C,Safar Bdoi
10.1016/j.jamcollsurg.2019.12.024subject
Has Abstractpub_date
2020-04-01 00:00:00pages
689-698issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(20)30109-5journal_volume
230pub_type
杂志文章abstract:BACKGROUND:Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.03.021
更新日期:2018-06-01 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:Many surgeons believe that primary fascial closure with mesh reinforcement should be the goal of abdominal wall reconstruction (AWR), yet others have reported acceptable outcomes when mesh is used to bridge the fascial edges. It has not been clearly shown how the outcomes for these techniques differ. We hypo...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.08.015
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:The optimal method for classifying lymph node (LN) status in breast cancer patients is unknown. We sought to determine if LN ratio (LNR) improves axillary staging. STUDY DESIGN:Kentucky Cancer Registry data (1996 to 2007) were used to compare LN categorization schemas. Overall survival (OS) was evaluated us...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.04.024
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:The Affordable Care Act (ACA)'s Medicaid expansion has increased access to surgical care overall. Whether it was associated with reduced disparities in use of regionalized surgery at high-volume hospitals (HVH) remains unknown. Quasi-experimental evaluations of this expansion were performed to examine the us...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2018.08.693
更新日期:2018-11-01 00:00:00
abstract:BACKGROUND:We sought to identify variables associated with American Board of Medical Specialties (ABMS)-member board certification and lack thereof among US medical graduates who planned at medical school graduation to become certified in surgery and entered graduate medical education in general surgery. STUDY DESIGN:...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.01.049
更新日期:2012-05-01 00:00:00
abstract:BACKGROUND:Neoadjuvant chemotherapy has been shown to increase the rate of breast conservation in clinical trials and small institutional series, but it has never been studied on a national level. STUDY DESIGN:We performed a retrospective review of the National Cancer Database (NCDB). The NCDB is a joint project of th...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.02.011
更新日期:2015-06-01 00:00:00
abstract:BACKGROUND:This study was undertaken to investigate the effect of growth hormone (GH) and insulin-like growth factor I (IGF-I), two well-known growth factors, on bacterial translocation, endotoxemia, enterocyte apoptosis, and intestinal and liver histology in a model of experimental obstructive jaundice in rats. STUDY...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00285-9
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:A clinical risk score for pancreatic fistula (CRS-PF) was recently reported to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). An independent external validation has not been performed. Our hypothesis was that CRS-PF predicts POPF after both laparoscopic and open PD. STUDY ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.05.011
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Blunt-clamp dissection allows for visualization of intrahepatic vessels and individual ligation of major blood or bile vessels. Recently, many instruments have been developed for "precoagulation" of liver parenchyma before sharp transection, but suffer from the possibility of injuring major blood and biliary...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.09.035
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Outcome improvement is a major goal of pancreatic surgery. Such efforts include decreasing perioperative narcotic use to optimize care and reduce potential contributions to the opioid crisis. Ketorolac, a frequent component of opioid-minimizing recovery pathways, has not been universally adopted over concern...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.02.024
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Uninsured patients have poor access to screening colonoscopy and subsequently present with advanced stages of colorectal cancer (CRC) that beget worse outcomes and higher total costs. Providing pro bono colonoscopies to uninsured patients at high risk for CRC can detect early stage disease and be cost-effect...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章
doi:10.1016/j.jamcollsurg.2016.04.035
更新日期:2016-07-01 00:00:00
abstract:BACKGROUND:Advances in esophageal manometry have facilitated identification of variants of achalasia, suggesting they are more common than previously thought. This study assesses the frequency and clinical characteristics of patients with motility abnormalities similar to, but not meeting criteria for, classic achalasi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.02.008
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Preprocedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement, and evaluate a preoperative briefing for cardiovascular surgery. STUDY DESIGN:The briefing was developed by using a combined questionnaire and semi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.01.037
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:The link between inflammation and cancer is well-established, but the link between Hashimoto thyroiditis (HT) and thyroid cancer remains controversial. The purpose of our study was to determine the incidence of patients with thyroid cancer and associated HT at our institution, to correlate our patient popula...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.12.037
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Transversus abdominis plane (TAP) block has been used as a component of multimodal analgesia after abdominal operation. We introduced a new laparoscope-assisted TAP (LTAP) block technique using intraperitoneal injection and compared its analgesic effect with that of an ultrasound-guided TAP (UTAP) block in t...
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.2017.05.017
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:Comparison of quality outcomes generated from administrative and clinical datasets have shown inconsistencies. Understanding this is important because data designed to drive performance improvement are used for public reporting of performance. We examined administrative and clinical data and 2 clinical data ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.12.037
更新日期:2012-05-01 00:00:00
abstract::Limited resection can be a therapeutic approach in patients with cirrhosis with very low remnant hepatic function after resection. In this study, two hilar vascular clamping methods (hilar selective clamping [n = 13] and hilar lobar clamping method [n = 8]), which were used for resection of hepatocellular carcinoma in...
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:With the general acceptance of lumpectomy, axillary staging, and radiotherapy as local treatment for infiltrating breast cancer, an appreciation is evolving for the spectrum of vascular lesions that occur in the mammary skin after this treatment. Most of these lesions develop within the prior radiation field...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00863-8
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not be...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(01)00895-x
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.04.034
更新日期:2007-09-01 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:Among surgically treated patients with colon cancer, lower long-term mortality has been demonstrated in those with 12 or more lymph nodes evaluated. We examined whether patients receiving adequate lymph node evaluation were also more likely to receive comprehensive postsurgical care, leading to lower mortali...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.05.014
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Interleukin-6 (IL-6) plays a central role in the acute phase of inflammation after surgical injury. The serum concentration of IL-6 increases during an operation. The mechanisms of this increase in the serum IL-6 level, however, has not yet been fully clarified. STUDY DESIGN:To determine the possibility of ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-09-01 00:00:00
abstract::The management of PABC is very difficult. The incidence of PABC is low, but may be increasing because of the number of women who are becoming pregnant at a later age. More investigation is needed to understand whether the biology of PABC is different from that of breast cancer in nonpregnant women. One exciting area o...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,评审
doi:10.1016/s1072-7515(01)01105-x
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:Academic medical centers are faced with increasing volumes, higher acuity, and, as a consequence, capacity issues. These affect operating room (OR) use and patient throughput, with negative impact on finances and patient and physician satisfaction. We evaluated our experiences in dealing with OR efficiency a...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.01.052
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:There are few reproducible models of blast injury, so it is difficult to evaluate new or existing therapies. We developed a clinically relevant polytrauma model to test the hypothesis that cerebrovascular resuscitation is optimized when intravenous fluid is restricted. STUDY DESIGN:Anesthetized swine (42+/-...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.11.014
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Trauma services are increasingly providing emergency surgery care by creating "acute care surgery" teams. We compared two periods at a Level I trauma center to determine if trauma service coverage would negatively impact timely management of acute appendicitis. STUDY DESIGN:All patients admitted through the...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.01.016
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:In the past, type 2 (C-peptide positive) diabetes mellitus (DM) was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). STUDY DESIGN:We retrospectively analyzed outcomes in SPKT recipients according to pretransplantation C-peptide levels ≥ 2.0 ng/mL or < 2.0 ng/mL. RESULTS:From Nove...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.12.020
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Surgery remains the most effective intervention for obesity and its comorbidities. However, the long-term efficacy of bariatric procedures is rarely reported. This study addresses operative trends, efficiency, and long-term outcomes from a large bariatric program. STUDY DESIGN:Data were prospectively collec...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.01.056
更新日期:2014-06-01 00:00:00