BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the a...BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.展开更多
BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperat...BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.展开更多
BACKGROUND Textbook outcome(TO),an emerging composite metric for surgical quality assessment,has recently gained recognition for evaluating perioperative results.Laparoscopic transcystic common bile duct exploration(L...BACKGROUND Textbook outcome(TO),an emerging composite metric for surgical quality assessment,has recently gained recognition for evaluating perioperative results.Laparoscopic transcystic common bile duct exploration(LTCBDE)has become a widely adopted minimally invasive technique for treating cholecystolithiasis with choledocholithiasis.Despite its growing clinical application,TO has not yet been formally defined for LTCBDE,nor have its failure-associated risk factors been systematically examined.AIM To define TO for LTCBDE,establish standardized criteria,and identify risk factors for TO failure via logistic regression.METHODS A retrospective cohort of 388 patients who underwent LTCBDE in combination with laparoscopic cholecystectomy at the Department of Biliopancreatic Surgery,Tongji Hospital,from January 2018 to October 2024,was analyzed.The study delineated TO criteria for LTCBDE,calculated the rate of TO achievement,and employed logistic regression to determine independent predictors of TO failure.RESULTS TO was defined as the absence of the following seven criteria:Conversion to open surgery,postoperative complications(Clavien-Dindo grade≥2),biliary leakage(International Study Group of Pancreatic Surgery/International Study Group of Liver Surgery grade B/C),delayed removal of drainage tube(>4 days),postoperative interventions,prolonged length of stay(>7 days),and 30-day readmission or mortality.Among 388 patients,276(71.1%)achieved TO.The primary causes of TO failure included delayed removal of drainage tube(94 cases,83.9%),prolonged length of stay(50 cases,44.6%).Multivariate analysis revealed four independent risk factors for TO failure:Preoperative endoscopic retrograde cholangiopancreatography(P=0.022),advanced age(P=0.010),prolonged anesthesia time(P<0.001),and elevated preoperative alkaline phosphatase levels(P=0.048).These findings suggest that applying the concept of TO to LTCBDE enhances surgical quality evaluation and supports early identification of high-risk patients,facilitating personalized clinical decisions and optimizing individual management.展开更多
Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the&...Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the"Textbook Outcome"(TO),to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma(G-NEC)patients.Methods:Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed.TO included receiving a curative resection,≥15 lymph nodes examined,no severe postoperative complications,hospital stay≤21 d,and no hospital readmission≤30 d after discharge.Hospital variation in TO was analyzed using a case mix-adjusted funnel plot.Prognostic factors of survival and risk factors for non-Textbook Outcome(non-TO)were analyzed using Cox and logistic models,respectively.Results:TO was achieved in 56.6%of 860 G-NEC patients.TO patients had better overall survival(OS),disease-free survival(DFS),and recurrence-free survival(RFS)than non-TO patients(P<0.05).Moreover,TO patients accounted for 60.3%of patients without recurrence.Multivariate Cox analysis revealed non-TO as an independent risk factor for OS,DFS,and RFS of G-NEC patients(P<0.05).Increasing TO rates were associated with improved OS for G-NEC patients,but not hospital volume.Multivariate logistic regression revealed that nonlower tumors,open surgery,and>200 mL blood loss were independent risk factors for non-TO patients(P<0.05).Conclusions:TO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients.Factors predicting non-TO are identified,which may help guide strategies to optimize G-NEC outcomes.展开更多
BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and furt...BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy(PD).METHODS Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified.A TO was defined by R0 resection,examination of≥12 Lymph nodes,no prolonged hospitalization,no intensive care unit treatment,no postoperative complications,and no 30-day readmission or mortality.Cox regression analysis was used to identify the prognostic value of a TO for overall survival(OS)and recurrence-free survival(RFS).Logistic regression was used to identify predictors of a TO.The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.RESULTS Ultimately,only 24.3%of 272 AC patients achieved a TO.A TO was independently associated with improved OS[hazard ratio(HR):0.443,95%confidence interval(95%CI):0.276-0.711,P=0.001]and RFS(HR:0.379,95%CI:0.228-0.629,P<0.001)in the Cox regression analysis.Factors independently associated with a TO included a year of surgery between 2010 and 2020(OR:4.549,95%CI:2.064-10.028,P<0.001)and N1 stage disease(OR:2.251,95%CI:1.023-4.954,P=0.044).In addition,the TO rate was significantly higher in patients who underwent surgery after 2010(P<0.001)than in those who underwent surgery before 2010.CONCLUSION Only approximately a quarter(24.3%)of AC patients achieved a TO following PD.A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery.Further multicentre research is warranted to better elucidate its impact.展开更多
Background:Textbook outcome(TO)can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement.We explored the factors associated with achieving a TO...Background:Textbook outcome(TO)can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement.We explored the factors associated with achieving a TO for gallbladder carcinoma(GBC)after curative-intent resection and analyzed the effect of adjuvant chemotherapy(ACT)on TO and non-TO patients.Methods:A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed.Multivariable logistic regression was used to investigate the factors associated with TO.Results:Among 540 patients with GBC who underwent curative-intent resection,223 patients(41.3%)achieved a TO.The incidence of TO ranged from 19.0%to 51.0%across the study period,with a slightly increasing trend over the study period.The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection(P=0.003).Age≤60 years(P=0.016),total bilirubin(TBIL)level≤34.1 mmol/L(P<0.001),well-differentiated tumor(P=0.008),no liver involvement(P<0.001),and T1-2 stage disease(P=0.006)were independently associated with achieving a TO for GBC after resection.Before and after propensity score matching(PSM),the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant;ACT improved the prognosis of patients in the non-TO group(P<0.05).Conclusion:Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection,and ACT can improve the prognosis of those with non-TO.展开更多
Background and aim:The textbook outcome(TO)is a comprehensive measure that is superior to individual measures for analysis of surgical quality of care.Anatomical hepatectomy(AH)is beneficial in terms of short-term out...Background and aim:The textbook outcome(TO)is a comprehensive measure that is superior to individual measures for analysis of surgical quality of care.Anatomical hepatectomy(AH)is beneficial in terms of short-term outcomes in patients undergoing resection.This study was performed to investigate the association between AH and achieving the TO for patients with perihilar cholangiocarcinoma(pCCA)treated with curative-intent resection.Methods:This study involved patients who underwent curative-intent resection for newly diagnosed pCCA from January 2013 to January 2018 at three hospitals in China.All patients were divided into two groups according to the type of hepatectomy:the AH group and non-AH group.The incidence and distribution of achieving the TO were compared between the two groups.Univariable and multivariable logistic regression analyses were used to identify independently predictive factors associated with achieving the TO in patients with pCCA.Results:In total,333 patients were enrolled[AH group,225(67.6%);non-AH group,108(32.4%)].The incidence of achieving the TO in all patients was 24.3%,and the incidence was significantly higher in the AH than non-AH group(30.7%vs.11.1%,respectively).Multivariable analysis revealed that AH,total bilirubin concentration of<34μmol/L,maximum tumor size of<3 cm,no macrovascular invasion,and no lymph node metastasis were independently associated with a higher incidence of achieving the TO.Conclusions:The TO was achieved in approximately one-fourth of patients with pCCA who underwent curative-intent resection.The use of AH was more conducive to achieving the TO in patients with pCCA.展开更多
The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preop...The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.展开更多
Aim:To test the hypothesis that intraoperative warming(IOW)can improve surgical outcomes after pancreaticoduodenectomy with portal vein reconstruction(PD-PVR).Methods:Patients diagnosed with pancreatic head ductal ade...Aim:To test the hypothesis that intraoperative warming(IOW)can improve surgical outcomes after pancreaticoduodenectomy with portal vein reconstruction(PD-PVR).Methods:Patients diagnosed with pancreatic head ductal adenocarcinoma who underwent PD-PVR at Huashan Hospital between January 1,2017,and January 1,2022,were retrospectively divided into 2 groups according to whether IOW was implemented.The primary outcome was the incidence of textbook outcome(TO)after pancreatectomy.The secondary outcomes were intraoperative hypothermia and adjuvant chemotherapy(AC)completion rate.Results:Among the 196 included patients,122 underwent IOW while 74 did not.Both average(35.2℃ vs 36.2℃,P<.001)and minimum(34.0℃ vs 35.6℃,P<.001)intraoperative body temperature were significantly higher in the IOW group compared with the non-IOW one.Satisfactory surgical outcomes were observed in the IOW group,due to a higher incidence of TOs(51.4%vs 68.9%,P=.021),lower incidence of post-pancreatectomy hemorrhage(13.5%vs 3.3%,P=.010),earlier AC initiation(48 vs 40 days,P<.001),and AC completion rate(59.5%vs 76.2%,P=.020).IOW was the independent influential factor for TOs,intraoperative hypothermia,and AC completion.In survival analysis,the median overall survival was longer with AC completion(month,8.6 vs 27.5,P<.001)or TO(month,16.2 vs 20.0,P=.002).Intraoperative hypothermia(hazard ratio,1.53;95% confidence interval:1.03–2.25,P=.033)was the independent risk factor of overall survival.Conclusions:Intraoperative hypothermia occurred frequently in patients with PD-PVR.IOW had a positive impact on surgical outcomes of PD-PVR,resulting in higher rates of TOs and postoperative AC completion.展开更多
Background:Pancreaticoduodenectomy(PD)is the only potentially curative treatment for distal cholangiocarcinoma(DCC).This multicenter propensity score matching(PSM)study aimed to compare the perioperative and oncologic...Background:Pancreaticoduodenectomy(PD)is the only potentially curative treatment for distal cholangiocarcinoma(DCC).This multicenter propensity score matching(PSM)study aimed to compare the perioperative and oncological outcomes of laparoscopic PD(LPD)and robotic PD(RPD)after the learning curve of surgeons.Methods:Consecutive patients with DCC who underwent curative LPD or RPD at eight Chinese centers between January 2016 and December 2022 were included.PSM was performed to minimize selection bias.Univariate and multivariate logistic regression analyses were used to identify independent prognostic factors for textbook outcome(TO)in these patients.Results:Overall,529 patients who underwent PD for DCC were included,of which 251 underwent LPD and 278 underwent RPD.After PSM,227 patients were enrolled into each group.There were no significant differences in estimated blood loss(EBL),lymph node harvest,intraoperative transfusion,vascular resection,R0 resection,severe complications,readmission,30-day mortality,or long-term survival between the two groups.However,after the learning curve,RPD had a perioperative advantage over LPD,especially in terms of operation time(270 vs.300 min,P<0.001).Similar conclusions were drawn in the subgroup analysis.Multivariable analysis showed that comorbidities(P=0.001),main pancreatic duct(MPD)>3 mm(P=0.001),and operative time>360 min(P=0.006)were significantly associated with TO.Conclusions:After the surgeon’s learning curve,the feasibility and safety of LPD and RPD for DCC patients are comparable.Randomized controlled trials(RCTs)should be performed to confirm these findings.展开更多
Background:Para-aortic lymph node(PALN)metastasis affects approximately 20%of patients with pancreatic ductal adenocarcinoma(PDAC).However,the prognostic significance of PALN metastases and dissection remains unclear....Background:Para-aortic lymph node(PALN)metastasis affects approximately 20%of patients with pancreatic ductal adenocarcinoma(PDAC).However,the prognostic significance of PALN metastases and dissection remains unclear.Methods:This retrospective cohort study included patients with PDAC of the pancreatic head who had undergone pancreaticoduodenectomy(PD)at our center between January 2017 and December 2020.Results:A total of 234 patients were included in the study.PALN dissection improved the median overall survival(OS)without statistical significance(24.1 vs 18.1 months,P=.156).The median recurrence-free survival was significantly longer in the PALN-dissection group than the group without PALN dissection(18.2 vs 11.6 months,P=.040).Conversely,there were no significant differences in the long-term prognosis between the PALN-positive and PALN-negative subgroups in the PALN-dissection group.Multivariate analysis showed that PALN metastasis was not an independent risk factor for OS(hazard ratio:0.831,95%confidence interval:0.538–1.285,P=.406).Conclusions:For patients with pancreatic head ductal adenocarcinoma,PD with PALN dissection may achieve survival prolongation and bridge the survival gap between patients with and without PALN metastasis without significantly increasing the perioperative risks.展开更多
文摘BACKGROUND Laparoscopic distal pancreatectomy(LDP)has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail.Nevertheless,a notable deficiency persists in the absence of a standardized,procedure-specific metric for evaluating and comparing surgical quality.A composite measure termed“textbook outcome(TO)”,which encompasses key short-term endpoints,has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts.The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.AIM To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.METHODS Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed.TO was defined as the absence of clinically relevant postoperative pancreatic fistula(grade B/C),post-pancreatectomy hemorrhage(grade B/C),severe complications(Clavien-Dindo≥III),readmission within 30 days,and in-hospital or 30-day mortality.Multivariable logistic regression was employed to identify independent predictors of TO failure,and a nomogram was constructed and internally validated.RESULTS Among 405 eligible patients,286(70.6%)attained TO.Multivariable analysis revealed that female sex[odds ratio(OR)=0.62,95%confidence interval(CI):0.39-0.99]conferred a protective effect,while preoperative endoscopic ultrasound-guided fine-needle aspiration(OR=2.66,95%CI:1.05-6.73),pancreatic portal hypertension(OR=2.81,95%CI:1.06-7.45),and cystic-solid(OR=2.51,95%CI:1.34-4.69)or solid lesions(OR=1.91,95%CI:1.06-3.44)were independently associated with TO failure(all P<0.05).The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.CONCLUSION The proposed LDP-specific definition of TO is feasible and discriminative,and the developed nomogram provides an objective tool for individualized risk assessment.
基金Supported by National Key Research and Development Program,No.2022YFC2407304Major Research Project for Middle-Aged and Young Scientists of Fujian Provincial Health Commission,No.2021ZQNZD013+2 种基金The National Natural Science Foundation of China,No.62275050Fujian Province Science and Technology Innovation Joint Fund Project,No.2019Y9108Major Science and Technology Projects of Fujian Province,No.2021YZ036017.
文摘BACKGROUND To investigate the preoperative factors influencing textbook outcomes(TO)in Intrahepatic cholangiocarcinoma(ICC)patients and evaluate the feasibility of an interpretable machine learning model for preoperative prediction of TO,we developed a machine learning model for preoperative prediction of TO and used the SHapley Additive exPlanations(SHAP)technique to illustrate the prediction process.AIM To analyze the factors influencing textbook outcomes before surgery and to establish interpretable machine learning models for preoperative prediction.METHODS A total of 376 patients diagnosed with ICC were retrospectively collected from four major medical institutions in China,covering the period from 2011 to 2017.Logistic regression analysis was conducted to identify preoperative variables associated with achieving TO.Based on these variables,an EXtreme Gradient Boosting(XGBoost)machine learning prediction model was constructed using the XGBoost package.The SHAP(package:Shapviz)algorithm was employed to visualize each variable's contribution to the model's predictions.Kaplan-Meier survival analysis was performed to compare the prognostic differences between the TO-achieving and non-TO-achieving groups.RESULTS Among 376 patients,287 were included in the training group and 89 in the validation group.Logistic regression identified the following preoperative variables influencing TO:Child-Pugh classification,Eastern Cooperative Oncology Group(ECOG)score,hepatitis B,and tumor size.The XGBoost prediction model demonstrated high accuracy in internal validation(AUC=0.8825)and external validation(AUC=0.8346).Survival analysis revealed that the disease-free survival rates for patients achieving TO at 1,2,and 3 years were 64.2%,56.8%,and 43.4%,respectively.CONCLUSION Child-Pugh classification,ECOG score,hepatitis B,and tumor size are preoperative predictors of TO.In both the training group and the validation group,the machine learning model had certain effectiveness in predicting TO before surgery.The SHAP algorithm provided intuitive visualization of the machine learning prediction process,enhancing its interpretability.
文摘BACKGROUND Textbook outcome(TO),an emerging composite metric for surgical quality assessment,has recently gained recognition for evaluating perioperative results.Laparoscopic transcystic common bile duct exploration(LTCBDE)has become a widely adopted minimally invasive technique for treating cholecystolithiasis with choledocholithiasis.Despite its growing clinical application,TO has not yet been formally defined for LTCBDE,nor have its failure-associated risk factors been systematically examined.AIM To define TO for LTCBDE,establish standardized criteria,and identify risk factors for TO failure via logistic regression.METHODS A retrospective cohort of 388 patients who underwent LTCBDE in combination with laparoscopic cholecystectomy at the Department of Biliopancreatic Surgery,Tongji Hospital,from January 2018 to October 2024,was analyzed.The study delineated TO criteria for LTCBDE,calculated the rate of TO achievement,and employed logistic regression to determine independent predictors of TO failure.RESULTS TO was defined as the absence of the following seven criteria:Conversion to open surgery,postoperative complications(Clavien-Dindo grade≥2),biliary leakage(International Study Group of Pancreatic Surgery/International Study Group of Liver Surgery grade B/C),delayed removal of drainage tube(>4 days),postoperative interventions,prolonged length of stay(>7 days),and 30-day readmission or mortality.Among 388 patients,276(71.1%)achieved TO.The primary causes of TO failure included delayed removal of drainage tube(94 cases,83.9%),prolonged length of stay(50 cases,44.6%).Multivariate analysis revealed four independent risk factors for TO failure:Preoperative endoscopic retrograde cholangiopancreatography(P=0.022),advanced age(P=0.010),prolonged anesthesia time(P<0.001),and elevated preoperative alkaline phosphatase levels(P=0.048).These findings suggest that applying the concept of TO to LTCBDE enhances surgical quality evaluation and supports early identification of high-risk patients,facilitating personalized clinical decisions and optimizing individual management.
基金supported by scientific and technological innovation joint capital projects of Fujian province(No.2018Y9041)National Natural Science Foundation of China(No.82002462)+2 种基金China Scholarship Council(No.201908350095)Provincial Natural Science Foundation Project(No.2020J011001)Fujian Medical University Outstanding Young Cultivation Project(No.2020PYY002)。
文摘Objective:Quality assurance is crucial for oncological surgical treatment assessment.For rare diseases,singlequality indicators are not enough.We aim to develop a comprehensive and reproducible measurement,called the"Textbook Outcome"(TO),to assess the quality of surgical treatment and prognosis of gastric neuroendocrine carcinoma(G-NEC)patients.Methods:Data from patients with primary diagnosed G-NEC included in 24 high-volume Chinese hospitals from October 2005 to September 2018 were analyzed.TO included receiving a curative resection,≥15 lymph nodes examined,no severe postoperative complications,hospital stay≤21 d,and no hospital readmission≤30 d after discharge.Hospital variation in TO was analyzed using a case mix-adjusted funnel plot.Prognostic factors of survival and risk factors for non-Textbook Outcome(non-TO)were analyzed using Cox and logistic models,respectively.Results:TO was achieved in 56.6%of 860 G-NEC patients.TO patients had better overall survival(OS),disease-free survival(DFS),and recurrence-free survival(RFS)than non-TO patients(P<0.05).Moreover,TO patients accounted for 60.3%of patients without recurrence.Multivariate Cox analysis revealed non-TO as an independent risk factor for OS,DFS,and RFS of G-NEC patients(P<0.05).Increasing TO rates were associated with improved OS for G-NEC patients,but not hospital volume.Multivariate logistic regression revealed that nonlower tumors,open surgery,and>200 mL blood loss were independent risk factors for non-TO patients(P<0.05).Conclusions:TO is strongly associated with multicenter surgical quality and prognosis for G-NEC patients.Factors predicting non-TO are identified,which may help guide strategies to optimize G-NEC outcomes.
文摘BACKGROUND Textbook outcomes(TOs)have been used to assess the quality of surgical treatment for many digestive tumours but not ampullary carcinoma(AC).AIM To discuss the factors associated with achieving a TO and further explore the prognostic value of a TO for AC patients undergoing curative pancreaticoduodenectomy(PD).METHODS Patients who underwent PD at the China National Cancer Center between 1998 and 2020 were identified.A TO was defined by R0 resection,examination of≥12 Lymph nodes,no prolonged hospitalization,no intensive care unit treatment,no postoperative complications,and no 30-day readmission or mortality.Cox regression analysis was used to identify the prognostic value of a TO for overall survival(OS)and recurrence-free survival(RFS).Logistic regression was used to identify predictors of a TO.The rate of a TO and of each indicator were compared in patients who underwent surgery before and after 2010.RESULTS Ultimately,only 24.3%of 272 AC patients achieved a TO.A TO was independently associated with improved OS[hazard ratio(HR):0.443,95%confidence interval(95%CI):0.276-0.711,P=0.001]and RFS(HR:0.379,95%CI:0.228-0.629,P<0.001)in the Cox regression analysis.Factors independently associated with a TO included a year of surgery between 2010 and 2020(OR:4.549,95%CI:2.064-10.028,P<0.001)and N1 stage disease(OR:2.251,95%CI:1.023-4.954,P=0.044).In addition,the TO rate was significantly higher in patients who underwent surgery after 2010(P<0.001)than in those who underwent surgery before 2010.CONCLUSION Only approximately a quarter(24.3%)of AC patients achieved a TO following PD.A TO was independently related to favourable oncological outcomes in AC and should be considered as an outcome measure for the quality of surgery.Further multicentre research is warranted to better elucidate its impact.
基金supported by grants from the National Natural Science Foundation of China(No.62076194)the Key Research and Development Program of Shaanxi Province(Nos.2021-SF-016,2022-SF-410,and 2022-SF-606)+1 种基金the Central University Basic Research Business Fund(No.xzy012020113)the Clinical Research Fund of the First Affiliated Hospital of Xi’an Jiaotong University(No.XJTU1AF-CRF-2018-022).
文摘Background:Textbook outcome(TO)can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement.We explored the factors associated with achieving a TO for gallbladder carcinoma(GBC)after curative-intent resection and analyzed the effect of adjuvant chemotherapy(ACT)on TO and non-TO patients.Methods:A total of 540 patients who underwent curative-intent resection for GBC at the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2011 to December 2020 were retrospectively analyzed.Multivariable logistic regression was used to investigate the factors associated with TO.Results:Among 540 patients with GBC who underwent curative-intent resection,223 patients(41.3%)achieved a TO.The incidence of TO ranged from 19.0%to 51.0%across the study period,with a slightly increasing trend over the study period.The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection(P=0.003).Age≤60 years(P=0.016),total bilirubin(TBIL)level≤34.1 mmol/L(P<0.001),well-differentiated tumor(P=0.008),no liver involvement(P<0.001),and T1-2 stage disease(P=0.006)were independently associated with achieving a TO for GBC after resection.Before and after propensity score matching(PSM),the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant;ACT improved the prognosis of patients in the non-TO group(P<0.05).Conclusion:Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection,and ACT can improve the prognosis of those with non-TO.
文摘Background and aim:The textbook outcome(TO)is a comprehensive measure that is superior to individual measures for analysis of surgical quality of care.Anatomical hepatectomy(AH)is beneficial in terms of short-term outcomes in patients undergoing resection.This study was performed to investigate the association between AH and achieving the TO for patients with perihilar cholangiocarcinoma(pCCA)treated with curative-intent resection.Methods:This study involved patients who underwent curative-intent resection for newly diagnosed pCCA from January 2013 to January 2018 at three hospitals in China.All patients were divided into two groups according to the type of hepatectomy:the AH group and non-AH group.The incidence and distribution of achieving the TO were compared between the two groups.Univariable and multivariable logistic regression analyses were used to identify independently predictive factors associated with achieving the TO in patients with pCCA.Results:In total,333 patients were enrolled[AH group,225(67.6%);non-AH group,108(32.4%)].The incidence of achieving the TO in all patients was 24.3%,and the incidence was significantly higher in the AH than non-AH group(30.7%vs.11.1%,respectively).Multivariable analysis revealed that AH,total bilirubin concentration of<34μmol/L,maximum tumor size of<3 cm,no macrovascular invasion,and no lymph node metastasis were independently associated with a higher incidence of achieving the TO.Conclusions:The TO was achieved in approximately one-fourth of patients with pCCA who underwent curative-intent resection.The use of AH was more conducive to achieving the TO in patients with pCCA.
文摘The study by Huang et al,published in the World Journal of Gastroenterology,advances intrahepatic cholangiocarcinoma(ICC)management by developing a machine-learning model to predict textbook outcomes(TO)based on preoperative factors.By analyzing data from 376 patients across four Chinese medical centers,the researchers identified key variables influencing TO,including Child-Pugh classification,Eastern Cooperative Oncology Group score,hepatitis B status,and tumor size.The model,created using logistic regression and the extreme gradient boosting algorithm,demonstrated high predictive accuracy,with area under the curve values of 0.8825 for internal validation and 0.8346 for external validation.The integration of the Shapley additive explanation technique enhances the interpretability of the model,which is crucial for clinical decision-making.This research highlights the potential of machine learning to improve surgical planning and patient outcomes in ICC,opening possibilities for personalized treatment approaches based on individual patient characteristics and risk factors.
基金approved by the Ethics Committee of Huashan Hospital,Fudan University(KY2022-668).
文摘Aim:To test the hypothesis that intraoperative warming(IOW)can improve surgical outcomes after pancreaticoduodenectomy with portal vein reconstruction(PD-PVR).Methods:Patients diagnosed with pancreatic head ductal adenocarcinoma who underwent PD-PVR at Huashan Hospital between January 1,2017,and January 1,2022,were retrospectively divided into 2 groups according to whether IOW was implemented.The primary outcome was the incidence of textbook outcome(TO)after pancreatectomy.The secondary outcomes were intraoperative hypothermia and adjuvant chemotherapy(AC)completion rate.Results:Among the 196 included patients,122 underwent IOW while 74 did not.Both average(35.2℃ vs 36.2℃,P<.001)and minimum(34.0℃ vs 35.6℃,P<.001)intraoperative body temperature were significantly higher in the IOW group compared with the non-IOW one.Satisfactory surgical outcomes were observed in the IOW group,due to a higher incidence of TOs(51.4%vs 68.9%,P=.021),lower incidence of post-pancreatectomy hemorrhage(13.5%vs 3.3%,P=.010),earlier AC initiation(48 vs 40 days,P<.001),and AC completion rate(59.5%vs 76.2%,P=.020).IOW was the independent influential factor for TOs,intraoperative hypothermia,and AC completion.In survival analysis,the median overall survival was longer with AC completion(month,8.6 vs 27.5,P<.001)or TO(month,16.2 vs 20.0,P=.002).Intraoperative hypothermia(hazard ratio,1.53;95% confidence interval:1.03–2.25,P=.033)was the independent risk factor of overall survival.Conclusions:Intraoperative hypothermia occurred frequently in patients with PD-PVR.IOW had a positive impact on surgical outcomes of PD-PVR,resulting in higher rates of TOs and postoperative AC completion.
基金supported by Natural Science Foundation of Shandong Province(Nos.ZR2023QH287 and ZR2023MH094)Young Elite Scientists Sponsorship Program by CAST(No.2023QNRC001)+1 种基金Young Elite Scientists Sponsorship Program by BAST(No.BYESS2024001)National Key Research and Development Program of China(No.2022YFC2407402).
文摘Background:Pancreaticoduodenectomy(PD)is the only potentially curative treatment for distal cholangiocarcinoma(DCC).This multicenter propensity score matching(PSM)study aimed to compare the perioperative and oncological outcomes of laparoscopic PD(LPD)and robotic PD(RPD)after the learning curve of surgeons.Methods:Consecutive patients with DCC who underwent curative LPD or RPD at eight Chinese centers between January 2016 and December 2022 were included.PSM was performed to minimize selection bias.Univariate and multivariate logistic regression analyses were used to identify independent prognostic factors for textbook outcome(TO)in these patients.Results:Overall,529 patients who underwent PD for DCC were included,of which 251 underwent LPD and 278 underwent RPD.After PSM,227 patients were enrolled into each group.There were no significant differences in estimated blood loss(EBL),lymph node harvest,intraoperative transfusion,vascular resection,R0 resection,severe complications,readmission,30-day mortality,or long-term survival between the two groups.However,after the learning curve,RPD had a perioperative advantage over LPD,especially in terms of operation time(270 vs.300 min,P<0.001).Similar conclusions were drawn in the subgroup analysis.Multivariable analysis showed that comorbidities(P=0.001),main pancreatic duct(MPD)>3 mm(P=0.001),and operative time>360 min(P=0.006)were significantly associated with TO.Conclusions:After the surgeon’s learning curve,the feasibility and safety of LPD and RPD for DCC patients are comparable.Randomized controlled trials(RCTs)should be performed to confirm these findings.
文摘Background:Para-aortic lymph node(PALN)metastasis affects approximately 20%of patients with pancreatic ductal adenocarcinoma(PDAC).However,the prognostic significance of PALN metastases and dissection remains unclear.Methods:This retrospective cohort study included patients with PDAC of the pancreatic head who had undergone pancreaticoduodenectomy(PD)at our center between January 2017 and December 2020.Results:A total of 234 patients were included in the study.PALN dissection improved the median overall survival(OS)without statistical significance(24.1 vs 18.1 months,P=.156).The median recurrence-free survival was significantly longer in the PALN-dissection group than the group without PALN dissection(18.2 vs 11.6 months,P=.040).Conversely,there were no significant differences in the long-term prognosis between the PALN-positive and PALN-negative subgroups in the PALN-dissection group.Multivariate analysis showed that PALN metastasis was not an independent risk factor for OS(hazard ratio:0.831,95%confidence interval:0.538–1.285,P=.406).Conclusions:For patients with pancreatic head ductal adenocarcinoma,PD with PALN dissection may achieve survival prolongation and bridge the survival gap between patients with and without PALN metastasis without significantly increasing the perioperative risks.
