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- 저자 : Joshua G. Cohen (검색결과 2 건)
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Lymphopenia following pancreaticoduodenectomy is associated with pancreatic fistula formation
Joshua T. Cohen,Kevin P. Charpentier,Thomas J. Miner,William G. Cioffi,Rachel E. Beard 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2
Backgrounds/Aims: Post-operative pancreatic fistulas (POPF) are a major source of morbidity following pancreaticoduodenectomy (PD). This study aims to investigate if persistent lymphopenia, a known marker of sepsis, can act as an additional marker of POPF with clinical implications that could help direct drain management. Methods: A retrospective chart review of all patients who underwent PD in a single hospital network from 2008 to 2018. Persistent lymphopenia was defined as lymphopenia beyond post-operative day #3. Results: Of the 201 patients who underwent PD during the study period 161 patients had relevant laboratory data, 81 of whom had persistent lymphopenia. 17 patients with persistent lymphopenia went on to develop a POPF, compared to 7 patients without. Persistent lymphopenia had a negative predictive value of 91.3%. Multivariate analysis revealed only persistent lymphopenia as being independently associated with POPF (HR 2.57, 95% CI 1.07-6.643, p=0.039). Patients with persistent lymphopenia were more likely to have a complication requiring intervention (56.8% vs 35.0%, p<0.001). Conclusions: Persistent lymphopenia is a readily available early marker of POPF that holds the potential to identify clinically relevant POPF in patients where no surgical drain is present, and to act as an adjunct of drain amylase helping to guide drain management.
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Teresa K.L. Boitano,Haller J. Smith,Joshua G. Cohen,Emma C. Rossi,Kenneth H. Kim 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objective: To evaluate the utility of a society-based robotic surgery training program forfellows in gynecologic oncology. Methods: All participants underwent a 2-day robotic surgery training course between2015–2017. The course included interactive didactic sessions with video, dry labs, androbotic cadaver labs. The labs encompassed a wide range of subject matter includingtroubleshooting, instrument variation, radical hysterectomies, and lymph node dissections. Participants completed a pre- and post-course survey using a 5-point Likert scale rangingfrom “not confident” to “extremely confident” on various measures. Statistical analysis wasperformed using SPSS Statistics v. 24. Results: The response rate was high with 86% of the 70 participants completing the survey. Sixteen (26.7%) of these individuals were attending physicians and 44 (73.3%) were fellows. In general, there was a significant increase in confidence in more complex proceduresand concepts such as radical hysterectomy (p=0.01), lymph node dissection (p=0.01),troubleshooting (p=0.001), and managing complications (p=0.004). Faculty comfort andpractice patterns were cited as the primary reason (58.9%) for limitations during roboticprocedures followed secondarily by surgical resources (34.0%). Conclusion: In both gynecologic oncology fellows and attendings, this educational theory based curriculum significantly improved confidence in the majority of procedures andconcepts taught, emphasizing the value of hands-on skill labs.
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