ObjectiveTo summarise the application research progress of clinical prediction models in postoperative complications of gastric cancer, in order to reduce the risk of complications after gastric cancer surgery. MethodThe literature on the study of postoperative complications of gastric cancer at home and abroad was read and reviewed. ResultsAt present, the main way of treating gastric cancer was still radical resection, and the occurrence of complications after surgical treatment seriously affected the recovery and survival quality of patients. With the deepening of research, the prediction models of postoperative complications in gastric cancer were constantly constructed, and these models provided strong evidence for the early judgement of postoperative complications in gastric cancer, and provided a scientific basis for the improvement of patients’ life quality. ConclusionClinical predictive models are expected to become risk screening tools for predicting the risk of postoperative complications of gastric cancer with clinical utility.
ObjectiveTo compare the effects of transthoracic device closure and traditional surgical repair on atrial septal defect systemically.MethodsA systematic literature search was conducted using the PubMed, EMbase, The Cochrane Library, VIP, CNKI, CBM, Wanfang Database up to July 31, 2018 to identify trials according to the inclusion and exclusion criteria. Quality was assessed and data of included articles were extracted. The meta-analysis was conducted by RevMan 5.3 and Stata 12.0 software.ResultsThirty studies were identified, including 3 randomized controlled trials (RCTs) and 27 cohort studies involving 3 321 patients. For success rate, the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.34, 95%CI 0.16 to 0.69, P=0.003). There was no statistical difference in mortality between the two groups (CCT, OR=0.43, 95%CI 0.12 to 1.52, P=0.19). Postoperative complication occurred less frequently in the transthoracic closure group than that in the surgical repair group (RCT, OR=0.30, 95%CI 0.12 to 0.77, P=0.01; CCT, OR=0.27, 95%CI 0.17 to 0.42, P<0.000 01). The risk of postoperative arrhythmia in the transthoracic closure group was lower than that in the surgical repair group (CCT, OR=0.56, 95%CI 0.34 to 0.90, P=0.02). There was no statistical difference in the incidence of postoperative residual shunt in postoperative one month (CCT, OR=4.52, 95%CI 0.45 to 45.82, P=0.20) and in postoperative one year (CCT, OR=1.03, 95%CI 0.29 to 3.68, P=0.97) between the two groups. Although the duration of operation (RCT MD=–55.90, 95%CI –58.69 to –53.11, P<0.000 01; CCT MD=–71.68, 95%CI –79.70 to –63.66, P<0.000 01), hospital stay (CCT, MD=–3.31, 95%CI –4.16, –2.46, P<0.000 01) and ICU stay(CCT, MD=–10.15, 95%CI –14.38 to –5.91, P<0.000 01), mechanical ventilation (CCT, MD=–228.68, 95%CI –247.60 to –209.77, P<0.000 01) in the transthoracic closure group were lower than those in the traditional surgical repair group, the transthoracic closure costed more than traditional surgical repair during being in the hospital (CCT, MD=1 221.42, 95%CI 1 124.70 to 1 318.14, P<0.000 01).ConclusionCompared with traditional surgical repair, the transthoracic closure reduces the hospital stay, shortens the length of ICU stay and the duration of ventilator assisted ventilation, while has less postoperative complications. It is safe and reliable for patients with ASD within the scope of indication.
ObjectiveTo analyze the risks and complications after operation of colorectal cancer in the current version of Database from Colorectal Cancer (DACCA).MethodsThe DACCA version selected for this data analysis was the updated version on July 28th, 2020. The data items included surgery reaction, body temperature, flatus, pain and mental status; preoperative complication, postoperative complication, short-term and long-term complication. The selected data items were statistically analyzed.ResultsThe total number of medical records (data rows) that met the criteria was 6 422, including 4 185 (65.2%) valid data on surgery reaction, 3 833 (59.7%) valid data on body temperature, 3 835 (59.7%) valid data on flatus, 3 597 (56.0%) valid data on pain, 3 551 (55.3%) valid data on mental status, 6 422 (100%) valid data on preoperative complications, postoperative complications, short-term complications and long-term complications. In the surgical response, 1 517 (36.2%) lines of data showed “normal” structure were the most. Among the days with elevated body temperature, the number of 0-day data lines with the structure of “body temperature >37.5 ℃” was the highest, with 1 980 (51.7%). In postoperative flatus, there were 1 675 (43.7%) data lines with the structure showing “3 days”. The largest number of rows (2 755, 76.6%) showed a structure that was “not obvious” in the pain scale. The mental status showed the highest number of “better” rows (2 976, 83.8%). There were 50 preoperative complications (0.8%). And 595 postoperative complications (9.3%), including anastomotic leakage (80, 13.4%), inflammatory ileus (62, 10.4%), pulmonary infection (57, 9.6%), and anastomotic bleeding (56, 9.4%), etc. There were 6 169 (96.1%) without short-term complication in structural form. There were 6 283 (97.8%) without long-term complications.ConclusionsThe changes in complications shown in the real world data from DACCA suggest that the focus of postoperative risks must be changed with the over the follow-up time. As for the complication evaluation system, it is necessary to establish a complete evaluation system combining the corresponding types and risks, to carry out valuable complication researches.
ObjectiveTo investigate the clinical value of the C-reactive protein (CRP) ratio (CRP value on postoperative day 3/day 1) as an early predictor of postoperative severe complication after laparoscopic gastrectomy (LG) for gastric cancer.MethodsThis retrospective study examined the relationship between the occurrence of severe complication and the CRP ratio of 259 gastric cancer patients, who underwent LG in the Department of General Surgery of General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group from January 2015 to January 2020. According to Clavien-Dindo (CD) grading system, gastric cancer patients were divided into the severe postoperative complication group (n=41, 15.8%) and the non-severe postoperative complication group (n=218, 84.2%). The relationship between CRP ratio and clinicopathologic characteristics of patients and the predictive value of CRP ratio for severe complication were analyzed.ResultsThe optimal cutoff value of CRP ratio of 2.2 offered 63.2% sensitivity, 91.0% specificity, 70.7% positive predictive value, and 85.8% negative predictive value for severe postoperative complication. The area under the receiver operating characteristic curve was 0.766. There had distinct differences (P<0.05) on body mass index, preoperative comorbidity, type of surgery, T stage, and TNM stage between the high CRP ratio group (CRP ratio >2.2, n=60) and the low CRP ratio group (CRP ratio ≤2.2, n=199). Logistic regression showed that preoperative comorbidity [OR=3.624, 95%CI (1.191, 11.206), P=0.023], later of TNM stage [OR=9.037, 95% CI (1.729, 47.226), P=0.009], and CRP ratio >2.2 [OR=20.473, 95%CI (7.948, 52.737), P<0.001] were independent risk factors for postoperative severe complication after LG.ConclusionThere must to be paid enough attention to the CRP ratio >2.2 on the day 1 and 3 after LG, it suggests that there might be a risk of severe postoperative complications.
Objective To evaluate the clinical effectiveness and safety of different mesh fixation techniques in laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) by using network meta-analysis. Methods CNKI, WanFang Data, VIP, CBM, the Cochrane Library, PubMed, Embase, and Web of Science databases were retrieved to collect randomized controlled trials (RCTs) studies comparing different fixation methods of patches in laparoscopic TAPP. The retrieval time limit was from the establishment of the database to March 1, 2022. After two researchers independently screened the literatures, extracted the data, and evaluated the bias risk, Bayesian network meta-analysis was conducted by using R4.1.2 software. Results Twenty-nine RCTs were included, including 4 095 patients. The results of network meta-analysis showed that the risk of chronic postoperative inguinal pain was higher in staples fixation than that of no fixation [OR=0.06, 95%CI (0.01, 0.26), P＜0.001], glue fixation [OR=0.21, 95%CI (0.04, 0.53), P=0.001] and self-gripping mesh [OR=0.09, 95%CI (0.01, 0.52), P=0.009], the incidence of chronic postoperative inguinal pain with suture fixation was higher than that with no fixation [OR=0.10, 95%CI (0.01, 0.70), P= 0.020]. Postoperative visual analogue scale of staples fixation was higher than those of no fixation [MD=–0.90, 95%CI (–1.49, –0.33), P=0.002] and glue fixation [MD=–0.92, 95%CI (–1.35, –0.49), P＜0.001], the postoperative visual analogue scale with suture fixation was higher than those of no fixation [MD=–0.83, 95%CI (–1.61, –0.08), P=0.030] and glue fixation [MD=–0.85, 95%CI (–1.56, –0.13), P=0.020]. There was no significant difference in the incidence of seroma and hematoma, hospital stay and hernia recurrence among different fixation methods. Conclusions The network meta-analysis shows that medical glue and self-gripping mesh have certain advantages in reducing chronic pain after surgery, which may be the better patch fixation method in TAPP. The non fixation mesh will not increase the risk of postoperative recurrence, and can be used in clinical practice. This conclusion needs to be further verified by large sample, long-term follow-up and high-quality RCTs.
ObjectiveTo evaluate the predictive value of C-reactive protein/albumin ratio (CAR) for postoperative complications of pancreaticoduodenectomy (PD).MethodsThe clinical data of 134 patients with pancreaticoduodenectomy (PD) in the Department of Pancreatic Surgery of The First Affiliated Hospital of Xinjiang Medical University from 2015 to 2018 were retrospectively collected, including general conditions and postoperative complications. The predictive value of CAR was calculated.ResultsOf the 134 patients, 38 patients suffered from postoperative pancreatic fistula (POPF), 32 patients suffered from abdominal infection, 5 patients suffered from biliary fistula, 63 patients suffered from delayed gastric emptying (DGE), 13 patients suffered from post pancreatectomy hemorrhage (PPH), 8 patients suffered from wound infection, and 1 patient suffered from chyle leakage. There was no significant difference in general conditions such as gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor nature, tumor diameter, operative time, intraoperative blood loss, diabetes history, jaundice history, and drinking history (P>0.05), but the hospital stay in the complication group was longer than that of the non-complication group (P<0.05). The value of CAR in the pancreatic fistula and abdominal infection group were significantly higher than those in the non-complication group at 1 d, 3 d and 5 d (exclude 1 day after surgery on POPF), the difference was statistically significant (P<0.05). On the 3rd day after surgery, the sensitivity of CAR predicting POPF was 79.95%, the specificity was 86.46%; the sensitivity of predicting abdominal infection was 75.00%, the specificity was 81.37%, and the result was better than using procalcitonin (PCT) alone, but similar with C-reactive protein (CRP) alone or CRP+PCT.ConclusionPostoperative CAR can better predict POPF and abdominal infection after PD, and the effect is better than PCT alone.
Objective To explore, identify, and develop novel blood-based indicators using machine learning algorithms for accurate preoperative assessment and effective prediction of postoperative complication risks in patients with rheumatoid arthritis (RA) undergoing total knee arthroplasty (TKA). Methods A retrospective cohort study was conducted including RA patients who underwent unilateral TKA between January 2019 and December 2024. Inpatient and 30-day postoperative outpatient follow-up data were collected. Six machine learning algorithms, including decision tree (DT), random forest (RF), logistic regression (LR), support vector machine (SVM), extreme gradient boosting (XGBoost), and light gradient boosting machine (LightGBM), were used to construct predictive models. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), F1-score, accuracy, precision, and recall. SHAP values were employed to interpret and rank the importance of individual variables. Results According to the inclusion criteria, a total of 1 548 patients were enrolled. Ultimately, 18 preoperative indicators were identified as effective predictive features, and 8 postoperative complications were defined as prediction labels for inclusion in the study. Within 30 days after surgery, 453 patients (29.2%) developed one or more complications. Considering overall accuracy, precision, recall, and F1-score, the random forest model [AUC=0.930, 95%CI(0.910, 0.950)] and the extreme gradient boosting model [AUC=0.909, 95%CI(0.880, 0.938)] demonstrated the best predictive performance. SHAP analysis revealed that anti-cyclic citrullinated peptide antibody, C-reactive protein, rheumatoid factor, interleukin-6, body mass index, age, and smoking status made significant contributions to the overall prediction of postoperative complications. Conclusion Machine learning-based models enable accurate prediction of postoperative complication risks among RA patients undergoing TKA. Inflammatory and immune-related blood biomarkers, such as anti- cyclic citrullinated peptide antibody, C-reactive protein, and rheumatoid factor, interleukin-6, play key predictive roles, highlighting their potential value in perioperative risk stratification and individualized management.
ObjectiveTo explore the application value of prognostic nutritional index (PNI) in the postoperative complications of McKeown surgery for da Vinci robotic esophageal cancer. MethodsThe clinical data of the patients who underwent da Vinci robotic McKeown surgery for esophageal cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2019 to June 2022 were retrospectively collected. According to the receiver operating characteristic (ROC) curve, the optimal cut-off value of PNI for predicting postoperative complications was explored. The patients were divided into a high PNI group and a low PNI group according to the cut-off value, and the differences in basic characteristics, surgery-related indexes and postoperative complications between the two groups were analyzed. According to the occurrence of postoperative complications, the patients were divided into a non-complication group and a complication group. Univariate and multivariate analyses were used to explore the influence of relevant indicators on the occurrence of postoperative complications in da Vinci robotic McKeown surgery for esophageal cancer. ResultsFinally 120 patients were collected, including 95 males and 25 females, with an average age of 62.82 years. The preoperative hemoglobin content, preoperative blood lymphocyte count, preoperative serum albumin and preoperative blood total cholesterol in the high PNI group were higher than those in the low PNI group (P<0.05). There were statistical differences between the two groups in the incidences of postoperative overall complications, pulmonary infection, pleural effusion and poor incision healing (P<0.05). The relevant indicators that may cause postoperative complications were included in univariate analysis, and the results showed that age, operation time, intraoperative blood loss, preoperative blood lymphocyte count, preoperative hemoglobin content, preoperative blood mononuclear cell count, preoperative blood monocyte count, serum albumin level and PNI were possible influencing factors of postoperative complications after da Vinci robotic McKeown surgery for esophageal cancer. Incorporating these influencing factors into multivariate analysis, the results showed that age, PNI, operation time and intraoperative blood loss were independent influencing factors of postoperative complications. ConclusionPNI has certain predictive value in the postoperative complications of da Vinci robotic McKeown surgery for esophageal cancer. PNI is an independent factor affecting postoperative complications. Improving the level of PNI in esophageal cancer patient before surgery may help reduce the occurrence of postoperative complications.
ObjectiveTo provide clinical reference for the perioperative management of esophageal cancer patients with different stages of chronic obstructive pulmonary disease (COPD) through investigating the impact of COPD on postoperative complications and survival in esophageal cancer patients undergoing oesophagectomy.MethodsThe clinical data of 163 patients who underwent radical resection of esophageal cancer in our department from January 2015 to January 2018 were retrospectively analyzed, including 124 males and 39 females, with a median age of 64 years (IQR: 23.8 years). They were divided into a COPD group (n=87) and a non-COPD group (n=76) according to the presence of COPD before operation. The clinical data were collected and the postoperative complications and 2-year survival between the two groups were compared and analyzed.ResultsThe incidence of major postoperative complications (pulmonary infection, respiratory failure, arrhythmia and anastomotic leakage) in the COPD group were higher than those in the non-COPD group (all P<0.05). Spearman correlation analysis showed that the severity of preoperative COPD was positively correlated with the incidence of postoperative complications in patients with esophageal cancer (r=0.437, P<0.001). The incidence of postoperative respiratory failure and mortality in patients with severe COPD were significantly higher than those in patients without COPD and those with mild or moderate COPD. The 2-year survival rate of patients with esophageal cancer in the COPD group was lower than that in the non-COPD group (56.1% vs. 78.5.%, P=0.001), and the severity of COPD was negatively correlated to the survival rate.ConclusionCOPD significantly increases the incidence of postoperative complications in patients with esophageal cancer, which is not conducive to the prognosis of patients, and the severity of COPD is correlated with postoperative complications and 2-year survival rate.
Objective To compare anastomotic fistula of modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy. Methods The clinical data of 147 patients underwent pancreaticoduodenectomy from January 2015 to June 2017 in the West China Hospital of Sichuan University were retrospectively analyzed. The modified triple-layer duct-to-mucosa pancreaticojejunostomy were used in 101 cases (MTL group) and end-to-end invagination pancreaticojejunostomy were used in 46 cases (IPJ group). The differences of intraoperative and postoperative statuses were compared between the two groups. Results The baseline data of these two groups had no significant differences (P>0.05). Except for the average time of the pancreaticoenterostomy of the MTL group was significantly longer than that of the IPJ group (P<0.05), the intraoperative blood loss, the first postoperative exhaust time, postoperative hospitalization time, reoperation rate, death rate, and rates of complications such as the pancreatic fistula, biliary fistula, anastomotic bleeding, gastric emptying disorder, and intraperitoneal infection had no significant differences between these two groups (P>0.05). Conclusions Both modified triple-layer duct-to-mucosa pancreaticojejunostomy and end-to-end invagination pancreaticojejunostomy following pancreaticoduodenectomy are safe and effective. An individualized selection should be adopted according to specific situation of patient.