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Shahin Hajibandeh,Shahab Hajibandeh,Daisy Evans,Tejinderjit S. Athwal 한국간담췌외과학회 2024 한국간담췌외과학회지 Vol.28 No.3
The role of surgical resection in patients with recurrent pancreatic cancer is unclear. We aimed to evaluate the survival outcomes of pancreatic re-resection for locally recurrent pancreatic cancer following index pancreatectomy. A literature search was carried out in CENTRAL, EMBASE, MEDLINE, CINAHL, and Web of Science. Proportion meta-analysis model was constructed to quantify 1 to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data. Fifteen retrospective studies were included, reporting a total of 250 patients who underwent pancreatic re-resection for locally recurrent pancreatic cancer following their index pancreatectomy. Pancreatic re-resection was associated with 1-year survival 70.6% (95% confidence interval [CI], 65.0−76.2), 2-year survival 38.8% (95% CI, 28.6−49.0), 3-year survival 20.2% (95% CI, 13.8−26.7), and 5-year survival 9.2% (95% CI, 5.5−12.8). The between-study heterogeneity was insignificant in all outcome syntheses. Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favorable tumor size and location. Our findings may encourage more robust studies to be conducted in this context to provide stronger evidence.
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Mon Ohn,Kathleen J Maddison,Julie Nguyen,Daisy Evans,Natasha Bear,R. Nazim Khan,Peter R Eastwood,Britta S. von Ungern-Sternberg,Andrew C Wilson,Jennifer H Walsh 대한수면연구학회 2023 Journal of sleep medicine Vol.20 No.2
Objectives: Obstructive sleep apnea (OSA) increases the risk of perioperative adverse events in children. While polysomnography (PSG) remains the reference standard for OSA diagnosis, oximetry is a valuable screening tool. The traditional practice is the manual analysis of desaturation clusters derived from a tabletop device using the McGill oximetry score. However, automated analysis of wearable oximetry data can be an alternative. This study investigated the accuracy of wrist-worn oximetry with automated analysis as a preoperative OSA screening tool. Methods: Healthy children scheduled for adenotonsillectomy underwent concurrent overnight PSG and wrist-worn oximetry. PSG determined the obstructive apnea-hypopnea index (OAHI). Oximetry data were auto-analyzed to determine 3% oxygen desaturation index (ODI3) and visually scored as per McGill criteria. The logistic regression model assessed the predictive performance of ODI3 for detecting the presence and severity of OSA after adjusting for covariates. Results: Seventy-six children (34 females), aged (mean±standard deviation) 5.7±1.6 years were classified, based on PSG-derived OAHI, as no OSA (n=31), mild (n=31), and moderate-severe OSA (n=14). Oximetric ODI3 was identified as the sole predictor of moderate-severe OSA (OAHI≥5 events/h) (odds ratio 1.38, 95% confidence interval 1.15, 1.65, <i>p</i>=0.001). The best diagnostic performance was at ODI3=5 events/h (78.6% sensitivity, 75.8% specificity [receiver operating characteristic-area under the curve {ROC-AUC}=0.857]). ODI3 was also more sensitive than the McGill oximetry score in diagnosing moderate-severe OSA (78.6% by ODI3 vs. 33.0% by McGill). The performance was suboptimal for any level of OSA (OAHI≥1 event/h) (75.6% sensitivity, 61.3% specificity [ROC-AUC=0.709]). Conclusions: Wrist-worn oximetry-derived automated ODI3 can reliably identify moderate-severe OSA in children undergoing adenotonsillectomy, making it a potentially useful preoperative OSA screening tool.
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