Negative Impact Of Postoperative Complications Research Articles

The influence of delayed gastric emptying on quality of life after partial duodenopancreatectomy.

Quality of life (QoL) is temporarily compromised after pancreatic surgery, but no evidence for a negative impact of postoperative complications on QoL has been provided thus far. Delayed gastric emptying (DGE) is one of the most common complications after pancreatic surgery and is associated with a high level of distress. Therefore, the aim of this study was to analyse the influence of DGE on QoL. This single-centre retrospective study analysed QoL after partial duodenopancreatectomy (PD) via the European Organization for Research and Treatment of Cancer core questionnaire (QLQ-C30). The QoL of patients with and without postoperative DGE was compared. Between 2010 and 2022, 251 patients were included, 85 of whom developed DGE (34%). Within the first postoperative year, compared to patients without DGE, those with DGE had a significantly reduced QoL, by 9.0 points (95% CI: -13.0 to -5.1, p < 0.001). Specifically, physical and psychosocial functioning (p = 0.020) decreased significantly, and patients with DGE suffered significantly more from fatigue (p = 0.010) and appetite loss (p = 0.017) than patients without DGE. After the first postoperative year, there were no significant differences in QoL or symptom scores between patients with DGE and those without DGE. Patients who developed DGE reported a significantly reduced QoL and reduced physical and psychosocial functioning within the first year after partial pancreatoduodenectomy compared to patients without DGE.

Old age and intense chemotherapy exacerbate negative prognostic impact of postoperative complication on survival in patients with esophageal cancer who received neoadjuvant therapy: a nationwide study from 85 Japanese esophageal centers.

The prognostic impact of docetaxel, cisplatin, and 5-FU (DCF) reported in JCOG1109 was successfully validated using real-world data in patients < 75years old. However, DCF was not reported to be beneficial in elderly patients with a relatively higher postoperative complication incidence. This study aimed to clarify the impact of postoperative complications on the prognosis of ESCC and the difference in the magnitude of the impact by age and regimen. Patients with esophageal squamous cell carcinoma (ESCC) who underwent subtotal esophagectomy at 85 authorized institutes were retrospectively reviewed from 2010 to 2015. The prognostic impact of postoperative anastomotic leakage (AL) and pneumonia on survival was evaluated. The prognostic value of the postoperative complications was assessed by stratifying patients according to age and neoadjuvant chemotherapy regimen. Patients with AL, pneumonia, and infectious complications (ICs: a combination of pneumonia and AL) showed significantly worse overall survival (OS). IC served as a negative prognostic factor of OS and recurrence-free survival, and its negative prognostic impact was more evident in patients aged > 75years. When the patients were further stratified by chemotherapeutic regimens, using the CF/IC(-) group as a reference, the DCF/IC (+) group showed significantly shorter OS in patients aged > 75years with a hazard ratio (HR) of 2.551. The HR of the CF/IC (+) group was 1.503. The negative impact of postoperative complications on survival was confirmed in this nationwide study. Furthermore, its magnitude was higher in elderly patients who received triplet chemotherapy.

Impact of postoperative complications on survival outcomes in patients with gastric cancer: exploratory analysis of a randomized controlled JCOG1001 trial.

Recent studies have found a negative impact of postoperative complications on long-term survival outcomes, but it has not been confirmed by data obtained from a prospective study with a large sample size. This study investigated the impact of postoperative complications on long-term survival outcomes, and considered the optimal definition of complication, using data from JCOG1001, which compared bursectomy and non-bursectomy for patients with cT3/4a locally advanced gastric cancer. This study included 1191 of 1204 patients enrolled in the JCOG1001 trial. Complications were graded by Clavien-Dindo (C-D) classification. Impact of the grade (≥ C-D grade II or ≥ grade III) or type (any or intra-abdominal infectious) of complication on survival outcome was evaluated by univariate and multivariable analyses using the Cox proportional hazard model. The incidence of any ≥ C-D grade II and ≥ grade III complication was 23.0% and 9.7%, respectively, and that of ≥ grade II and ≥ grade III intra-abdominal infectious complication was 13.4% and 6.9%, respectively. Multivariable analysis showed all four definitions of complications were independent prognostic factors for overall survival. Conversely, only any≥ C-D grade III complication was found to be an independent prognostic factor for relapse-free survival (hazard ratio, 1.445; 95% confidence interval, 1.026-2.036; P = 0.035). Postoperative complications adversely affect the long-term survival outcomes of patients with cT3/4a gastric cancer. Any ≥ C-D grade III complication seems to be the most suitable definition of complication for predicting negative long-term survival outcomes.

Impact of Postoperative Complications on Survival and Recurrence After Resection of Colorectal Liver Metastases: Systematic Review and Meta-analysis.

To study the effect of postoperative complications (POC) on overall survival (OS) and disease-free survival (DFS) after surgical resection of colorectal liver metastases (CRLM). Morbidity rates after liver resection can reach 45%. The negative impact of POC on oncologic outcomes has been reported in various types of cancer, especially colorectal. However, data on the consequences of POC after CRLM resection on long-term survival are scarce. Eligible studies examining the association between POC after CRLM resection and OS/DFS were sought using the PubMed and Web of Science databases. A random-effects model was used to calculate pooled effect estimate for OS and DFS hazard ratios (HR), estimating between-study variance with restricted maximum likelihood estimator with Hartung-Knapp adjustment. Subgroup analysis was used to control the effect of POC on OS and DFS for: 1) Method used to define postoperative complications, 2) Exclusion of early postoperative death from survival analysis, 3) Method of data extraction used, and 4) Tumor and treatment characteristics. Forty-one studies were deemed eligible, including 12,817 patients. POC patients had a significant risk of reduced OS compared with no POC group (HR 1.43 [95% CI: 1.3, 1.57], P < 0.0001). POC had also a negative impact on DFS. The HR for reduced DFS was 1.38 [95% CI 1.27, 1.49], P < 0.0001. The negative impact of POC on survival and recurrence was confirmed in subgroup analysis. Our findings evidence the negative impact of POC on survival and recurrence after CRLM resection.

ASO Author Reflections: The Negative Impact of Postoperative Complications on Long-Term Outcomes After Esophagectomy: The Influence of Neoadjuvant Therapy and Future Perspectives

ASO Author Reflections: The Negative Impact of Postoperative Complications on Long-Term Outcomes After Esophagectomy: The Influence of Neoadjuvant Therapy and Future Perspectives

The impact of postoperative complications on survival outcomes in patients with cT3/4a gastric cancer.

4067 Background: Recently, the negative impact of postoperative complications on long-term survival outcomes has been reported in patients with gastric cancer. However, most are single center, retrospective studies with different definitions of postoperative complications. The objective of this study was to evaluate the impact of postoperative complications on long-term outcomes using the data of a multicenter randomized controlled trial (JCOG1001). Methods: This study included 1191 out of all 1204 patients enrolled in JCOG1001 which was aimed to confirm the superiority of bursectomy for patients with cT3/4a locally advanced gastric cancer. Complications were graded by Clavien-Dindo classification. The relationships between the grade (≥grade II or ≥grade III) or type (all or intraabdominal infectious (pancreatic fistula, anastomotic leakage, and intra-abdominal abscess.)) of complications and survival outcomes were evaluated. Results: The incidences of ≥grade II and ≥grade III all complications were 23.0% and 9.7%, and those of ≥grade II and ≥grade III intraabdominal infectious complications were 13.4% and 6.9%, respectively. The hazard ratios for overall survival (OS) of patients with ≥grade II and ≥grade III all complications and those of patients with ≥grade II and ≥grade III intraabdominal infectious complications were shown in Table. With whichever definition we adopted, postoperative complications were significantly associated with OS in both univariable and multivariable analysis. Conclusions: Postoperative complication was identified as an independent prognostic factor in patients with cT3/4a gastric cancer. Hazard ratios for overall survival by univariable and multivariable Cox proportional hazard model. Clinical trial information: UMIN000003688. [Table: see text]

The preventive effect of neoadjuvant therapy on poor long-term outcomes of postoperative complications in patients with esophageal squamous cell carcinoma: A retrospective cohort study.

120 Background: Postoperative complications have a negative impact on overall survival after esophagectomy because systemic inflammation may induce residual cancer cell growth. A solution that could suppress micrometastasis is neoadjuvant therapy; however, to date, no study has shown that neoadjuvant therapy suppresses the proliferation of cancer cells due to postoperative complications after esophagectomy. To investigate the preventive effect of neoadjuvant therapy on poor long-term outcomes of postoperative complications in patients with esophageal squamous cell carcinoma. Methods: In total, 509 patients who underwent esophagectomy for primary esophageal squamous cell carcinoma were included in this retrospective cohort study. We investigated the relationship between complications, such as pneumonia, and long-term oncologic outcomes with and without neoadjuvant therapy. Results: Among all the patients, the 3-year overall survival (OS) rate was 68.4% and the disease-free survival (DFS) rate was 58.1%. The patients were categorized into two groups: the neoadjuvant therapy (+) group (n = 227) and the neoadjuvant therapy (−) group (n = 282). Among patients not undergoing neoadjuvant therapy, the patients with pneumonia, atrial fibrillation, pyothorax, or chylothorax had significantly poorer OS and DFS than patients without these complications. However, among patients undergoing neoadjuvant therapy, there were no significant differences in long-term outcomes, regardless of the presence of complications. In multivariate analyses, pneumonia (p = 0.014) and chylothorax (p = 0.006) were identified as predictors of death in the neoadjuvant therapy (−) group. Conclusions: In patients with esophageal squamous cell carcinoma, the negative impact of postoperative complications can be reduced by performing neoadjuvant therapy.

Modern conceptions of the physical rehabilitation of athletes of team sports with damaged Achilles tendon

The modern methods of rehabilitation treatment of patients with an Achilles tendon injury are considered. The analysis of the statistics of injuries of the musculoskeletal system which was determined on the basis of relevance of the subject has been conducted. It was found that the development of minimally invasive endoscopic therapies allows to minimize the negative impact of postoperative complications as well as to maintain the structure and function of the damaged tendon and to reduce recovery times. Need to develop a rehabilitation measures allowing to recover specific motor qualities and skills of athlete in the shortest possible time is accentuated.

The impact of postoperative complications on the recovery of elderly surgical patients.

While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients. Elderly patients (70years and older) undergoing elective abdominal surgery, with a planned length of stay >1day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1week, 1, 3, and 6months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index-CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach. Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7±4.9years, mean BMI was 27.2±5.5kg/m(2), and the median CCI was 3 (IQR 2-6). The mean preoperative SPPB score was 9.62±2.33. A total of 52 patients (34.9%) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7±23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94-0.98, p value=0.0004) and hence increase the time to recovery. Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.

The effect of postoperative morbidity on survival after resection for gastric adenocarcinoma: Results from the U.S. Gastric Cancer Collaborative.

5 Background: The negative impact of postoperative complications (POCs) on survival is well documented for many cancer types, but has not been well described in gastric cancer. Here, we evaluated the effect of POCs on survival after surgery for gastric cancer in a cohort of patients from a multi-institutional database. Methods: Patients who underwent surgery with curative intent for gastric adenocarcinoma between 2000-2012 from participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. Patients who died within 30 days of surgery were excluded. Ninety-day postoperative complication data were collected. Survival probabilities were estimated by Kaplan-Meier analysis and compared using the log-rank test. Results: A total of 853 patients from seven institutions met inclusion criteria. Median follow-up was 32 months. The overall complication rate was 40% (n=344). The most frequent complications were: infectious (25%, including surgical site infection [8%]), and anastomotic leak (6%). 7% of patients underwent reoperation during the same hospitalization. Five-year overall survival (OS) for patients without perioperative complications was 54%, compared with 39% for patients with POCs (p=0.001). Disease free survival (DFS) at five years was 61% for patients without POCs compared to 49% in patients with POCs (p=0.002). Patients without POCs were significantly more likely to receive adjuvant therapy (55% vs 42%; p&lt;0.001). Conclusions: In a large, multi-institutional cohort, POCs were associated with decreased survival in patients undergoing surgery for gastric adenocarcinoma. This may be due, in part, to the negative impact of complications on the receipt of adjuvant therapy. Efforts aimed at reducing perioperative morbidity are important not only for short-term surgical outcomes, but also for enhancing long-term oncologic outcomes in patients with gastric cancer. [Table: see text]

Does Postoperative Complication Have a Negative Impact on Long-Term Outcomes Following Hepatic Resection for Colorectal Liver Metastasis?: A Meta-Analysis

The negative impact of postoperative complications (POCs) on long-term outcomes is well documented for several cancer surgeries, but conclusive evidence has yet to be provided on the influence of POCs on long-term oncological outcomes after hepatic resection for colorectal liver metastasis (CRLM). Studies published through February 2012 evaluating the oncological impact of POCs after hepatectomy for CRLM were identified by an electronic literature search. Finally, 4 studies were identified and included in the meta-analysis. The main outcome measures were 5-year disease-free survival (DFS) and overall survival (OS). A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute odds ratio (OR) along with 95 % confidence intervals (95% CI). The outcomes of 2,280 patients were studied. Meta-analysis of 5-year DFS data extracted from three studies demonstrated a significant reduction in 5-year DFS after POCs, with an OR of 1.98 (95% CI=1.33-2.96; P=.0008). Meta-analysis of 5-year OS data extracted from four studies demonstrated a significant reduction in 5-year OS after POCs, with an OR of 1.68 (95% CI=1.25-2.27; P=.0006). No differences between study heterogeneity were observed in either the DFS or the OS analyses. This study provides persuasive evidence that POCs following hepatic resection for CRLM have significant adverse oncological outcomes. These findings emphasize the need for meticulous surgical technique and careful perioperative management to minimize POCs.

Prognostic significance of postoperative complications after hepatectomy for hepatocellular carcinoma

Hepatectomy is one of the best curative therapies for hepatocellular carcinoma (HCC). The negative impact of postoperative complications on long-term survival has been investigated in patients with several kinds of cancers. To clarify the impact of postoperative complications on long-term survival in patients who undergo hepatectomy for HCC, we conducted a comparative analysis of 376 patients using the modified Clavien classification and identified the predictors of postoperative complications. Patients were assigned into two groups: those with (N = 177) and those without complications (N = 199). The clinical data, surgical outcome, and long-term survival of patients were analyzed retrospectively. The cumulative overall survival rates of the patients with complications were significantly less than those of the patients without complications (P < 0.01). Multivariate logistic regression analysis revealed that intraoperative blood transfusion (P = 0.04), longer operation time (P = 0.02), use of Pringle's maneuver (P < 0.01), and use of the thoraco-abdominal approach (P = 0.01) were independent risk factors for postoperative complications. Postoperative complications (major or minor) are one of prognostic indicators in hepatectomy for HCC. The present study suggests that high quality surgical technique to minimize complications will improve the prognosis of HCC.

Complications and outcomes after spinal cord tumor resection in the United States from 1993 to 2002

Retrospective cohort study. Data on patient outcomes after surgery for spinal cord tumors have been derived from single-institution series. The objective of this study is to report inpatient complications, mortality and outcomes on a national level. United States, national inpatient care database. The National Inpatient Sample (NIS) was used to identify 19,017 admissions for resection of a spinal cord tumor in the United States from 1993 to 2002. The effects of patient and hospital characteristics on inpatient outcomes were analyzed using logistic regression. The in-hospital mortality rate and the complication rate were 0.55 and 17.5%, respectively. Urinary and renal complications (3.7%), postoperative hemorrhages or hematomas (2.5%) and pulmonary complications (2.4%) were the most common complications reported. A single postoperative complication increased the length of stay by 4 days, increased the mortality rate by sixfold and added over $10,000 to hospital charges. Multivariate analysis showed that complications were more likely in African Americans and patients with multiple comorbidities. The odds of an adverse outcome increased significantly with age greater than 64, multiple comorbidities and postoperative complications. A national perspective on inpatient outcomes after resection of spinal cord tumors has been provided. The significant negative impact of postoperative complications on mortality and resource utilization has been demonstrated. We have identified advanced age and multiple comorbidities as risk factors that predict adverse outcome. Furthermore, this study highlights the importance of avoidance, recognition and prompt management of nonneurologic complications.