Abstract:
OBJECTIVE:To identify factors that have contributed to reduced rates of death and complications after esophageal resection in a 17-year period at a tertiary referral center. SUMMARY BACKGROUND DATA:There has been an evolving refinement in surgical technique and perioperative management of patients undergoing esophageal resection at Queen Mary Hospital during the past two decades. As of the end of 1998, there had been no hospital deaths among the last 105 consecutive resections performed for esophageal squamous cancer. METHODS:The results of esophageal resection for squamous cell carcinoma were analyzed using a prospective esophageal database. A longitudinal study was performed to compare and analyze rates of death and complications for three consecutive time periods. RESULTS:The study group comprised 710 patients who underwent one-stage esophageal resection between 1982 and 1998. A transthoracic esophagectomy was the preferred approach in 590 patients (83%). The overall hospital death rate was 11%. The leading causes of hospital death were pulmonary complications (45.5%) and progression of malignant disease (21.5%); anastomotic leakage accounted for 9% of deaths. During the study period, the hospital death rate decreased from 16% to 3.2%, and the incidence of postoperative respiratory failure decreased from 15.5% to 6.5%. Perioperative factors that correlated with the decreased death rate over time were the increased postoperative use of epidural analgesia and bronchoscopy (for clearance of pulmonary secretions), a decrease in history of smoking, and a decrease in surgical blood loss of more than 1,000 mL. CONCLUSIONS:In this series of predominantly transthoracic esophagectomies, there has been a decline in the hospital death rate to less than 5%. These results are largely attributable to factors aimed at reducing postoperative pulmonary complications.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Whooley BP,Law S,Murthy SC,Alexandrou A,Wong Jdoi
10.1097/00000658-200103000-00006subject
Has Abstractpub_date
2001-03-01 00:00:00pages
338-44issue
3eissn
0003-4932issn
1528-1140journal_volume
233pub_type
杂志文章abstract:OBJECTIVE:To identify and prioritize hazards in surgical wards and recommend interventions. BACKGROUND:Retrospective and prospective studies report the frequency and severity of surgical adverse events, but not in sufficient detail to allow interventions to be recommended in surgical wards. METHODS:Seventy hours of o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824f5f36
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND:The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182360118
更新日期:2011-11-01 00:00:00
abstract::Ambulatory venous pressure (AVP) and ascending and retro-grade phlebography have been used to elucidate the precise pathogenetic factors in cases of venous stasis. On the bases of this information, procedures aimed at the correction of the particular pathophysiological alterations were carried out. Fifty-two lower ext...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198201001-00004
更新日期:1982-01-01 00:00:00
abstract::Cyclosporine has been used as primary immunosuppression in renal allograft recipients in our unit for the past decade. The overall clinical experience and long-term effects of the agent are reviewed. There were 461 consecutive recipients of kidney grafts; 379 received grafts from cadaver donors (CAD) and 82 from livin...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199107000-00007
更新日期:1991-07-01 00:00:00
abstract:OBJECTIVE:To identify independent predictors of 30-day venous thromboembolism (VTE) events requiring treatment after outpatient surgery. BACKGROUND:An increasing proportion of surgical procedures are performed in the outpatient setting. The incidence of VTE requiring treatment after outpatient surgery is unknown. MET...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182519ccf
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVE:To determine the survival curves for laparoscopic resection (LR) of colorectal cancer. SUMMARY BACKGROUND DATA:Laparoscopic resection for cure of colorectal cancer is controversial, and survival curves have not been determined. METHODS:A prospective database of 177 consecutive LRs of colorectal cancers perf...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199904000-00006
更新日期:1999-04-01 00:00:00
abstract::Spectral analysis was used to examine 257 carotid arteries in 227 patients who had undergone carotid endarterectomy at 1, 3, 6, and 12 months after surgery and annually thereafter. Routine intraoperative completion angiography ensured that the operations were technically satisfactory. Postoperative restenoses were ide...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198407000-00013
更新日期:1984-07-01 00:00:00
abstract:OBJECTIVE:To determine the incidence of Wnt pathway activation in patients with stage I NSCLC and its influence on lung cancer recurrence. BACKGROUND:Despite resection, the 5-year recurrence with localized stage I nonsmall cell lung cancer (NSCLC) is 18.4%-24%. Aberrant Wnt signaling activation plays an important role...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31826d81fd
更新日期:2013-03-01 00:00:00
abstract::Early aggressive therapy with maintenance infusions of methylprednisolone sodium succinate and gentamicin sulfate significantly increases the probability for survival of baboons given LD100 Escherichia coli. The present study was designed to determine if baboons would recover when initiation of treatment was delayed u...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198107000-00009
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVE:To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND:The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocorticoids may reduce postopera...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000895
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:To specifically target tumor angiogenesis by linking transgene expression of engineered mesenchymal stem cells to angiopoietin-1-induced differentiation. BACKGROUND:Mesenchymal stem cells (MSCs) have been used to deliver therapeutic genes into solid tumors. These strategies rely on their homing mechanisms on...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181fcb5d8
更新日期:2011-03-01 00:00:00
abstract::Thromboxane (Tx) synthase but not cyclo-oxygenase inhibitors prevent acute tubular necrosis (ATN) after renal ischemia, a phenomenon believed to be due to stimulation of the endogenous production of vasodilating prostaglandins (PG). This study directly tests that vasodilating PG protect against the consequences of ren...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198702000-00015
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVE:The current study investigates activation of the nutritional anti-inflammatory pathway by lipid-rich nutrition. BACKGROUND:Enteral nutrition activates humoral and neural pathways to regulate food intake and sustain energy balance. Recently, we demonstrated that enteral nutrition and in particular lipid-rich ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181dae411
更新日期:2010-08-01 00:00:00
abstract::A new system for long-term, 24-hour, ambulatory dual gastroduodenal pH monitoring is described. Eighteen patients with active duodenal ulcers and ten healthy subjects were studied. Simultaneous gastric and duodenal bulb pH were measured during fasting, the ingestion of a solid meal, and for the remainder of the 24-hou...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198812000-00005
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:To develop and validate a preoperative frailty index (pFI) for use in population-based health administrative (HA) data. SUMMARY BACKGROUND DATA:Frailty is a robust predictor of adverse postoperative outcomes. Population-level frailty measures used in surgical studies have significant methodological limitatio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002769
更新日期:2019-07-01 00:00:00
abstract:SUMMARY BACKGROUND DATA:High rate of complications has been reported following revascularization for acute limb ischemia (ALI). No adjuvant pharmacologic treatment, apart from anticoagulation and standard perioperative care, has been shown clinically effective. OBJECTIVE:Aim of this study was to evaluate the effects o...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000217555.49001.ca
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:Sentinel lymph node (SLN) biopsy is fast becoming the standard for testing lymph node involvement in many institutions. However, questions remain as to the best method of injection. The authors hypothesized that a subareolar injection of material would drain to the same lymph node as a peritumoral injection,...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/00000658-199906000-00013
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to compare the hand-sewn and stapled methods in esophagogastric anastomosis. SUMMARY BACKGROUND DATA:After esophageal resection for cancer, the relative merits of the hand-sewn and the stapled methods of esophagogastric anastomosis, especially regarding leakage and stricture r...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-199708000-00008
更新日期:1997-08-01 00:00:00
abstract::The abilities of polymorphonuclear leukocytes (PMN) and pulmonary alveolar macrophages (PAM), to demonstrate chemotaxis, phagocytosis, and superoxide release after bile duct ligation in the rat were investigated to determine the effect of cholestasis on nonspecific cellular immune mechanisms. Chemotactic response to C...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198711000-00004
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:To determine the optimum excision margin and nodal management for patients with primary cutaneous melanomas 2.01- to 4.00-mm thick (T3 melanomas). BACKGROUND:Currently available evidence does not reliably define the minimum safe excision margin and best nodal management for patients with primary cutaneous T3...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000000792
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVE:We sought to quantitate the course of specific cytokine mRNA expression in tissues that exhibit increasing histopathological changes in time in an animal model for the multiple organ dysfunction syndrome (MODS). SUMMARY BACKGROUND DATA:The development of treatment protocols for MODS requires elucidation of t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000130725.52373.e7
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:The aim of the present trial was to ascertain whether laparoscopic cholecystectomy (LCC) can prevent recurrent attacks of idiopathic acute pancreatitis (IAP). SUMMARY:Up to 50% to 75% of IAP may be due to microlithiasis, which is undetectable by conventional imaging methods. METHODS:This randomized, prospec...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000001469
更新日期:2015-11-01 00:00:00
abstract:OBJECTIVE:This study aimed at: (1) documenting the evolution of surgical results of esophagectomy in a high-volume center, (2) identifying predictive factors of pulmonary complications and mortality, and (3) examining whether preoperative chemoradiation therapy would complicate postoperative recovery. SUMMARY BACKGROU...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000143123.24556.1c
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:To document the decreased incidence of surgical complications after pancreas transplantation in recent times. SUMMARY BACKGROUND DATA:Compared with other abdominal transplants, pancreas transplants have historically had the highest incidence of surgical complications. However, over the past few years, the au...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200002000-00017
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:To assess the association of 0.9% saline use versus a calcium-free physiologically balanced crystalloid solution with major morbidity and clinical resource use after abdominal surgery. BACKGROUND:0.9% saline, which results in a hyperchloremic acidosis after infusion, is frequently used to replace volume loss...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31825074f5
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVE:Perioperative blood transfusions may adversely affect survival in patients with colorectal malignancy, although definite proof of a causal relationship has never been reported. BACKGROUND:We report the long-term outcomes of a randomized controlled trial performed between 1986 and 1991 to compare the effects ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0b013e318271cedf
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVE:To evaluate whether intravascular volume expansion would improve renal blood flow and function during prolonged CO2 pneumoperitoneum. SUMMARY BACKGROUND DATA:Although laparoscopic living donor nephrectomies have a considerably reduced risk of complications for the donors, significant concerns exist regarding...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200002000-00007
更新日期:2000-02-01 00:00:00
abstract:OBJECTIVE:To analyze long-term weight loss, changes in comorbidities and quality of life, and late complications after laparoscopic and open gastric bypass. SUMMARY BACKGROUND DATA:Early results from our prospective randomized trial comparing the outcome of laparoscopic versus open gastric bypass demonstrated less pos...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000197381.01214.76
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of early, routine antioxidant supplementation using alpha-tocopherol and ascorbic acid in reducing the rate of pulmonary morbidity and organ dysfunction in critically ill surgical patients. SUMMARY BACKGROUND DATA:Oxidative stress has been associated with the development of the...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000658-200212000-00014
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:To investigate adverse event free admissions as a potential, patient-centered indicator aligned directly with the goal of patient safety-freedom from harm. BACKGROUND:Preventable adverse event rates in healthcare could be further reduced. These are generally measured separately, one adverse event at a time. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001792
更新日期:2017-05-01 00:00:00