Nevin Manimala

JBI Evid Synth. 2021 Jul 6. doi: 10.11124/JBIES-20-00257. Online ahead of print.

ABSTRACT

OBJECTIVE: The objective of this review is to investigate the association between the use of cardiovascular medicines and the risk of mild cognitive function impairment and dementia in people with cardiovascular disease.

INTRODUCTION: Cardiovascular disease is one of the most important modifiable factors for mild cognitive function impairment and dementia. The current evidence about the effectiveness of cardiovascular disease medicine on the risk of dementia is inconclusive; hence, it is imperative to conduct a comprehensive investigation on the effect of cardiovascular disease medicine on the risk of mild cognitive function impairment and dementia.

INCLUSION CRITERIA: This review will include studies involving participants (age ≥18 years) who were using cardiovascular medicine for hypertension, myocardial infarction, atrial fibrillation, stroke, or heart failure. The eligible studies will include observational studies and randomized controlled trials.

METHODS: MEDLINE (Ovid), Embase (Ovid), and PsycINFO (Ovid) will be searched from 2000 to the present. We will only include studies published in English. Title, abstracts, and full texts will be screened by authors independently. The methodological quality of included studies will be assessed using the JBI critical appraisal checklist for observational studies and randomized controlled trials. The data to be extracted will include the basic study characteristics, populations, drug groups, clinical indicators, and outcomes. Studies will be pooled using statistical meta-analysis, where possible. Alternatively, the findings will be presented in narrative form where statistical pooling is not possible.

SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020175386.

PMID:34230444 | DOI:10.11124/JBIES-20-00257

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S358. doi: 10.14701/ahbps.EP-159.

ABSTRACT

INTRODUCTION: The systemic inflammation response index (SIRI, neutrophil x monocyte/lymphocyte) is emerged in predicting oncological prognosis in various type of cancer. We investigated to examine whether SIRI is significant as a prognostic factor even in neo-adjuvant settings, and whether changes in SIRI values after neo-adjuvant chemotherapy are related to prognosis.

METHODS: Medical records were investigated retrospectively about patients underwent pancreatic surgery following neo-adjuvant chemotherapy for pancreatic cancer, from 2006 to 2019. All 160 patients were investigated. In order to find the meaningful SIRI values and their changes, values of division and as well SIRI pre-neoadjuvant and SIRI post-neoadjuvant were calculated. Among calculated SIRI values, statistically significant SIRI values were found using statistical techniques to determine the effect on the survival rate.

RESULTS: The value of SIRI post-neoadjuvant < 0.8710 affected the prognosis of patients in the univariate* and multivariate analysis** (p-value* = 0.0317, p-value** = 0.0066). The value of ΔSIRI < 0.9516 affected the prognosis of patients in the univariate* and multivariate analysis** (p-value* = 0.0380, p-value** = 0.00462). In Kaplan-Meier curve, the disease free survival was significantly different between the group of SIRI post-neoadjuvant < 0.8710 and SIRI post-neoadjuvant ≥ 0.8710 (p = 0.0303). The overall survival was significantly different between the group of SIRI post-neoadjuvant/pre-neoadjuvant < 0.9516 and SIRI post-neoadjuvant/pre-neoadjuvant ≥ 0.9516 (p = 0.0368).

CONCLUSIONS: An SIRI can be used to predict the survival of patients with pancreatic cancer after pancreatic resection following neo-adjuvant chemotherapy.

PMID:34230422 | DOI:10.14701/ahbps.EP-159

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S354. doi: 10.14701/ahbps.EP-156.

ABSTRACT

INTRODUCTION: Postoperative pancreatic fistula (POPF) is one of the most critical complications following pancreatic surgery. The aim of this study was to evaluate selective use of prophylactic octreotide for patients stratified by their individual risks of POPF.

METHODS: From June 2019 to July 2020, a total of 243 patients underwent pancreatoduodenectomy with pancreatojejunostomy in Samsung Medical Center. Individual POPF risk scores were calculated with previously developed nomogram and clinicopathological data of the patients were retrospectively reviewed.

RESULTS: There were 81 patients in low-risk group and 182 patients in high-risk group. No statistically significant differences were found in clinically relevant POPF (CR-POPF) rates between the control group and the octreotide group in both low- (3.0% vs. 7.1%, p = 0.439) and high- (23.6% vs. 16.1%, p = 0.206) risk groups. In risk factor analyses, postoperative use of octreotide was not an independent risk factor for CR-POPF in all (p = 0.897) patients, low- (p = 0.436), and high- (p = 0.614) risk group. Drain fluid amylase on the first postoperative day was significantly correlated with CR-POPF, regardless of individual risks.

CONCLUSIONS: Selective use of octreotide, even in high risk patients, showed no protective effect against POPF. Routine use of postoperative octreotide would not be recommended.

PMID:34230419 | DOI:10.14701/ahbps.EP-156

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S350. doi: 10.14701/ahbps.EP-152.

ABSTRACT

INTRODUCTION: Pancreatic cancer has an extremely poor prognosis. Adjuvant chemotherapy is recommended for patients with resected pancreatic cancer. However, optimal adjuvant therapy for resected pancreatic cancer remains controversial. This study aimed to evaluate the efficacy of adjuvant chemotherapy according to the cancer status.

METHODS: We assessed a 253 patients with pancreatic ductal adenocarcinoma who underwent surgery in between January, 2011 and August, 2019 at Kyungpook National University Chilgok Hospital. Among 253 patients, 132 patients with R0 resection and no prior radiation or chemothrapy were retrospectively analyzed.

RESULTS: Of the 132 patients analyzed, 67 (50.8%) were men and 65 (49.2%) were women and the median age was 67 (42-85). Overall median survival was 21.8 months. Fifty-seven patients (43.2%) received adjuvant chemotherapy, whereas 75 (56.8%) did not receive adjuvant cheomtherapy after surgery. Although not statistically significant, patients who received chemotherapy seemed to be improved median OS compared with surgery alone (25.6 versus 17.4 months, p = 0.077). Strtified by different lymph node status, the benefit of adjuvant chemotherapy was only seen among the patients with nodal metastasis (HR = 1.78, 95% CI, 1.11-2.87; p = 0.018).

CONCLUSIONS: This study suggests adjuvant chemotherapy for resected pancreatic cancer is associated with improved survival in selected patients. Adjuvant chemotherapy seems to favorably impact on overall survival for resected pancreatic cancer with nodal metastasis.

PMID:34230415 | DOI:10.14701/ahbps.EP-152

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S349. doi: 10.14701/ahbps.EP-151.

ABSTRACT

INTRODUCTION: Apart from bacterial infections Procalcitonin (PCT) also increases in burns, trauma, and surgery.

METHODS: In a prospective study 45 cases (30 male and 15 female) of hepatobiliary and gastrointestinal cancer were taken, which were undergone surgery. It included the cases without (34) and with (11) prior radiotherapy. TPO and PCT were measured (ELISA) on day-1 preoperatively and day-3 (D3) & 5 (D5) postoperatively.

RESULTS: At base level prior to surgery lower value of TPO was noted in the group not given RT (174.8 ± 98.2 pg/mL) than the group who were given (220.3 ± 120.7 pg/mL), although statistically insignificant (p-value 0.2). On D3, TPO value in the cases without RT was 287.2 ± 177.3 pg/mL and in the cases with RT, it was 472.6 ± 265.2 pg/mL, was statistically significant (p-value 0.01). On D5, TPO in patients without RT was 409.57 ± 318.34 pg/mL (further increased) & in cases with RT 585.00 ± 469.61 pg/mL (further increased), p-value 0.2, was statistically insignificant. The corresponding PCT preoperatively was 171.6 ± 563.7 pg/mL & 100.0 ± 42.08 pg/mL in the cases without RT & with RT respectively (p-value 0.2, statistically insignificant). On D3, PCT value was 668.56 ± 1,114.09 pg/mL and 400.63 ± 660.64 pg/mL in the cases without & with RT respectively; p-value 0.4, statistically insignificant. On D5, PCT was 265.54 ± 513.77 & 648.27 ± 1,771.99 pg/mL in cases without & with RT respectively; p-value 0.3, statistically insignificant.

CONCLUSIONS: – Higher TPO level after surgery or radiotherapy is indicator of better response. – TPO level may be indicator therapeutic response after radiotherapy or cancer surgery.

PMID:34230414 | DOI:10.14701/ahbps.EP-151

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S339. doi: 10.14701/ahbps.EP-141.

ABSTRACT

INTRODUCTION: Statins are widely prescribed both for primary and secondary prevention of cardiovascular diseases. Preclinical studies indicate that statins have anticancer properties. Epidemiological studies have shown that statin use is associated with decreased risks of various cancer and cancer related mortality. We performed a meta-analysis of all existing studies investigating the association between statin use and the risk of developing cholangiocarcinoma (CCA), which to the best of our knowledge is the first meta-analysis on this issue.

METHODS: A comprehensive literature search for articles and abstracts published up to June 2020 was carried out. For inclusion, studies had to report odds ratio (OR), relative risk, or hazard ratio, with 95% confidence interval (CI). Pooled adjusted ORs with corresponding 95% CIs were calculated using random effects model. Publication bias was assessed through Egger’s test and Begg test. Heterogeneity was accessed by means of the I2 value.

RESULTS: Five observational studies were included in our analysis, with 8,450 CCA subjects and 978,008 healthy controls. Administration of statins significantly reduced the incidence of CCA (OR = 0.79, 95% CI: 0.73-0.86, p = 0.0001). No heterogeneity was found in the study (I² = 46%, p = 0.12). No evidence of publication bias was observed in this meta-analysis.

CONCLUSIONS: Our study shows statistically significant association between the use of statins and 0.79-fold decreased risk of CCA.

PMID:34230404 | DOI:10.14701/ahbps.EP-141

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S338. doi: 10.14701/ahbps.EP-140.

ABSTRACT

INTRODUCTION: Acute cholecystitis is a major complication of biliary lithiasis. Cholecystectomy is the gold standard treatment for gallbladder disease. According to the 2015 Statistics Office in Korea, 4.51% of the population is aged 80 to 89 years and 0.3% is aged 90 to 99 years. The safety and feasibility of cholecystectomy in octogenarians have been proven in many studies. In this study, we aimed to assess the outcomes of cholecystectomy in octogenarians and nonagenarians with acute cholecystitis.

METHODS: A total of 393 patientsaged 80 to 89 years (352 octogenarians) and 90 to 99 years (41 nonagenarians) diagnosed with acute cholecystitis underwent cholecystectomy between March 2012 and June 2020. All patients were classified according to the Tokyo guidelines. The evaluated parameters included demographic data, surgical outcomes, American Society of Anesthesiologists score (ASA), and Tokyo guidelines. All data were analyzed with SPSS ver. 1.0.0.1406.

RESULTS: All 393 patients were analyzed and divided into two groups according to age: octogenarians (83.57 ± 2.64 years) and nonagenarians (92.98 ± 3.15 years). The survival rate was 97.7% for octogenarians and 97.6% for nonagenarians. Laparoscopic surgery was performed more in both groups (96.8% in octogenarians and 92.7% in nonagenarians) than open surgery (3.2% in octogenarians and 7.3% in nonagenarians). The incidences of postoperative complications in the octogenarian and nonagenarian groups were as follows: pneumonia, 5.7% and 7.3%; bleeding, 1.7% and 2.4%; gastrointestinal symptoms, 6.0% and 2.4%.

CONCLUSIONS: Cholecystectomy is a safe and efficient procedure for the treatment of acute cholecystitis in both octogenarians and nonagenarians.

PMID:34230403 | DOI:10.14701/ahbps.EP-140

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S331. doi: 10.14701/ahbps.EP-133.

ABSTRACT

INTRODUCTION: Single-incision-robotic cholecystectomy (SIRC) using the da Vinci Xi system (Xi) (Intuitive, Sunnyvale, CA, USA) is a safe and effective operation. Recently, the da Vinci SP system (SP) (Intuitive) which is a new platform specialized for single-port surgery has been released. The study aimed to compare perioperative outcomes of Xi and SP in regards to SIRC.

METHODS: In this multicenter retrospective cohort study, patients who underwent SIRC with benign gallbladder disease between 2019 and 2020 were enrolled. In Seoul National University Hospital, Xi was used with 3 separate arms of instruments inserted through the single incision made in umbilical area. In Ewha Womans University Seoul Hospital, SP was used with single multi-channel port through the umbilical incision. Patient’s demographics, intraoperative factors, postoperative complications, and postoperative pain were investigated.

RESULTS: 258 patients underwent SIRC with Xi, and 72 patients with SP. There were significant differences between Xi and SP groups in operation time at console (23.1 vs. 20.3 min, p = 0.018), numbers of postoperative analgesic injection (4.0 vs. 3.2, p < 0.001), NRS at day of operation (5.7 vs. 4.9, p < 0.001), but no difference in total operation time (43.4 vs. 45.9, p = 0.155) and postoperative complication (0.8% vs. 0.0%, p > 0.999). SP group showed more estimated blood loss (14.3 vs. 19.2 mL, p = 0.031).

CONCLUSIONS: Although operation time at console was shorter and pain was less in SP group statistically, clinical benefit appears to be minimal. Both Xi and SP can be a safe and feasible platform to perform SIRC, but further investigation is needed as prospective study.

PMID:34230396 | DOI:10.14701/ahbps.EP-133

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S324. doi: 10.14701/ahbps.EP-126.

ABSTRACT

INTRODUCTION: Gallbladder cancer (GBC) is the most common biliary tract malignancy. There is conflicting evidence in literature regarding curative surgery in presence of retroperitoneal lymph nodal (interaorto-caval and para-aortic) metastasis. This is a study of patients, in whom a curative resection was abandoned due to the presence of retroperitoneal lymph node metastasis (RLNM) or distant metastasis (DM), to see the effect of RLNM on survival of the GBC patients.

METHODS: A retrospective analysis of the patients with GBC found to have RLNM or DM on frozen section biopsy at surgery, between January 2013 and December 2018. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 22.0). Survival in these two groups (RLNM and DM) was compared with log rank test. p-value of < 0.05 was considered significant.

RESULTS: 235 patients with ostensibly resectable GBC underwent surgical exploration. The planned curative resection was abandoned in 91 (39%) patients because of RLNM (n = 20, 9%) or DM (n = 71, 30%) on frozen section biopsy. Demographic profile and blood parameters were similar in the two groups. The median survival for RLNM and DM groups were 5 (range 2-26; interquartile range [IQR] 3-11) and 6 (range 2-24; IQR 4-10) months, respectively. No significant difference was documented on log rank test (p = 0.64). There was no 3-year in either group.

CONCLUSIONS: RLNM should be considered as DM and every effort should be made to target suspicious RLNM pre-operatively. At surgery retroperitoneal lymph nodes should be sampled as a routine for frozen section histological examination to avert a futile exercise.

PMID:34230389 | DOI:10.14701/ahbps.EP-126

Ann Hepatobiliary Pancreat Surg. 2021 Jun 30;25(Suppl 1):S322. doi: 10.14701/ahbps.EP-124.

ABSTRACT

INTRODUCTION: Hepaticojejunostomy (HJ), a standard method of bilioenteric anastomosis, is done with interrupted sutures by most surgeons. This audit of a prospective database compares the safety, economics, short term and long term outcome of continuous suture HJ (CSHJ) and interrupted suture HJ (ISHJ).

METHODS: An audit of a prospecrive database of all HJ performed between January 2014 and December 2018 after IEB approval. Patients with type IV or higher biliary strictures, duct diameter < 8 mm and/or associated vascular injury and liver transplant recipients were excluded. Patient demographics, diagnosis, pre-operative parameters, intra-operative findings, type and number of sutures, suturing time, and postoperative morbidity (Clavien Dindo) were recorded, and patients followed up to 60 months. McDonald’s grade A and B were considered as good outcome. Cost of suture (polydioxanone) 3-0/5-0 mean cost – ₹686/length, polyglactin 3-0, 4-0 mean cost – ₹486/length), operating room time (₹5,000/hour) were considered for comparison of economics of both techniques. Statistical analysis done on SPSS 22 software.

RESULTS: 556 eligible patients – 468 with ISHJ and 88 with CSHJ analyzed. 258 (54%) had benign and 300 (46%) had malignant pathology. The groups were similar. PDS sutures dominated in CSHJ. Number of sutures, cost, time, and postoperative bile leak was significantly more in ISHJ group. Fifty four patients had bile leak (6 CSHJ and 48 ISHJ). There were 16 mortalities (3 CSHJ, 13 ISHJ) due to septic shock. Morbidity was comparable according to Clavien Dindo grading. Anastomotic stricture rate was comparable.

CONCLUSIONS: CSHJ is safe, economic and worthy of routine practice.

PMID:34230387 | DOI:10.14701/ahbps.EP-124