| 5 | Impact of frailty on approach to colonic resection: Laparoscopy vs open surgery显示文摘AIM To understand the influence of frailty on postoperative outcomes for laparoscopic and open colectomy. METHODS Data were obtained from the National Surgical Quality Improvement Program(2005-2012) for patients undergoing colon resection [open colectomy(OC) and laparoscopic colectomy(LC)]. Patients were classified as non-frail(0 points), low frailty(1 point), moderate frailty(2 points), and severe frailty(≥ 3) using the Modified Frailty Index. 30-d mortality and complications were used as the primary end point and analyzed for the overall population. Complications were grouped into major and minor. Subset analysis was performed for patients undergoing colectomy(total colectomy, partial colectomy and sigmoid colectomy) and separately for patients undergoing rectal surgery(abdominoperineal resection, low anterior resection, and proctocolectomy). We analyzed the data using SAS Platform JMP Pro version 10.0.0(SAS Institute Inc., Cary, NC, United States). RESULTS A total of 94811 patients were identified; the majority underwent OC(58.7%), were white(76.9%), andnon-frail(44.8%). The median age was 61.3 years. Prolonged length of stay(LOS) occurred in 4.7%, and 30-d mortality was 2.28%. Patients undergoing OC were older(61.89 ± 15.31 vs 60.55 ± 14.93) and had a higher ASA score(48.3% ASA3 vs 57.7% ASA2 in the LC group)(P < 0.0001). Most patients were non-frail(42.5% OC vs 48% LC, P < 0.0001). Complications, prolonged LOS, and mortality were significantly more common in patients undergoing OC(P < 0.0001). OC had a higher risk of death and complications compared to LC for all frailty scores(non-frail: OR = 4.7, and OR = 4.67; mildly frail: OR = 2.51, and OR = 2.47; moderately frail: OR = 2.94, and OR = 2.02, severely frail: OR = 2.37, and OR = 2.34, P < 0.05) and an increase in absolute mortality with increasing frailty(non-frail 0.68% OC, mildly frail 1.39%, moderately frail 3.44%, and severely frail 5.83%, P < 0.0001). CONCLUSION LC is associated with improved outcomes. Although the odds of mortality are higher in non-frail, there is a progressive increase in mortality with increasing frailty. | Catalina Mosquera Konstantinos Spaniolas Timothy L Fitzgerald | 2016 | World Journal of Gastroenterology2016，22，43： | 0 |
| 6 | Reconstruction using a pedicled upper arm fillet flap after excision of a malignant peripheral nerve sheath tumor: A case report显示文摘Non-salvageable extremities have been utilized for harvesting fillet flaps as part of the 'spare parts' concept in traumatic and oncologic settings. Here we report on the use of a pedicled fillet flap of the upper arm for chest wall reconstruction after excision of a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis. Pedicled flaps as part of the 'spare parts' concept provide the advantage of reduced donor-site morbidity, immediate closure, intact vasculature, and adequate soft tissue coverage of large defects. Malignant peripheral nerve sheath tumor is a rare aggressive tumor with a poor prognosis that may result in large defects post resection. Limited data describes the use of pedicled fillet flaps of the upper extremity. We report the use of a pedicled fillet flap of the upper arm as a viable option that can be successfully used for coverage of soft tissue defects of the shoulder and chest wall post complex resections in an oncologic setting. | Parteek Singla Swapnil D Kachare Timothy L Fitzgerald Richard S Zeri Enamul Haque | 2014 | World Journal of Clinical Cases2014，2，12： | 0 |
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