Ulriksendrake8747
The negative prognostic impact of TDLN metastasis was evident in TDLN-Mt/Lt. The RFS and OS of patients with TDLN metastasis were almost identical to those with positive LN metastasis in extra-regional LNs.
TDLN metastasis was proven to be a strong prognostic indicator. Although the TDLN has been included in the classification of regional LN in the current staging systems, it could be independently classified from the current regional LNs. Given that neoadjuvant therapy has been a standard, we might need to introduce adjuvant therapy when TDLN metastasis is observed.
TDLN metastasis was proven to be a strong prognostic indicator. Although the TDLN has been included in the classification of regional LN in the current staging systems, it could be independently classified from the current regional LNs. Given that neoadjuvant therapy has been a standard, we might need to introduce adjuvant therapy when TDLN metastasis is observed.
Many studies have shown that patients with mental disorders are less likely than non-psychiatric patients to be diagnosed with or treated for various types of cancers because of their low awareness and understanding of the disease as well as reduced ability to cooperate with medical staff. We analyzed the clinical features of patients with colorectal cancer (CRC) and preexisting mental illness.
All patients underwent primary tumor resection for CRC. We reviewed the records of 68 patients who were diagnosed with mental disorders. The patients' clinicopathological information was compared with that of a control group of 893 CRC patients.
There was no significant difference in the overall disease stage at the time of surgery between the groups. However, disease-free survival, cancer-specific survival, and overall survival were significantly worse in the mental disorder group than in the control group (
<.01). In particular, among those with stage III CRC, overall survival was significantly worse in the patients with mental disorders than in the non-psychiatric patients (
<.001). The frequency of complications of ≥grade 2 according to the Clavien-Dindo classification was higher in the SMI group because of postoperative paralytic ileus.
Advanced CRC patients with mental disorders are less likely to receive postoperative adjuvant chemotherapy or treatment for recurrent cancer than CRC patients without mental disorders; therefore, they experience worse outcomes. Collaboration across multiple departments is necessary for managing CRC patients with mental disorders.
Advanced CRC patients with mental disorders are less likely to receive postoperative adjuvant chemotherapy or treatment for recurrent cancer than CRC patients without mental disorders; therefore, they experience worse outcomes. Collaboration across multiple departments is necessary for managing CRC patients with mental disorders.
We evaluated the association of profiles of institutional departments with operative outcomes of eight major gastroenterological procedures.
We administered a 15-item online survey to 2634 institutional departments in 2016 to investigate the association of questionnaire responses with operative mortality for the procedures. The proportions of conditions met were listed according to institutional volume and classified according to annual operative cases in 1464 departments. Group A included departments with annual performance of <40 cases of the eight procedures, B 40-79 cases, C 80-199 cases, D 200-499 cases, and E≥500 cases. JZL184 clinical trial We evaluated the number of conditions met for 10 of 15 items that could be improved by efforts of institutional departments, to assess whether the profiles of institutional departments had impacts on operative mortality. We built a multivariable logistic regression model for operative mortality with facilities categorized based on the number of conditions met and procedure-specific predicted mortality as explanatory variables using generalized estimating equation to account for facility-level clustering. We also examined how operative outcomes differed between facilities meeting nine or more conditions and those that did not.
We recognized meeting nine out of the 10 conditions as being a good indicator for having appropriate structural and process measures for gastroenterological surgery. The facilities meeting nine or more of the conditions had better operative mortality for all eight procedures.
Our findings reveal that the profiles of institutional departments can reflect the outcomes of gastroenterological surgery in Japan.
Our findings reveal that the profiles of institutional departments can reflect the outcomes of gastroenterological surgery in Japan.
In 2015, the Japanese Society of Gastroenterological Surgery (JSGS) initiated data verification in the gastroenterological section of the National Clinical Database (NCD) and reported high accuracy of data entry. Remote audits were introduced for data validation on a trial basis in 2016 and formally accepted into use in 2017-2018. The aim of this study was to audit the data quality of the NCD gastroenterological section for 2016-2018 and to confirm the high accuracy of data in remote audits.
Each year, 45-46 hospitals were selected for audit. Twenty cases were randomly selected in each hospital, and the accuracy of patient demographic and surgical outcome data (46 items) was compared with the corresponding medical records obtained by visiting the hospital (site-visit audit) or by mailing data from the hospital to the JSGS office (remote audit).
A total of 136 hospitals were included, of which 88 (64.7%) had a remote audit, and 124936 items were evaluated with an overall data accuracy of 98.1%. There was no significant difference in terms of data accuracy between site-visit audit and remote audit. Accuracy, sensitivity, and specificity of mortality were 99.7%, 89.7%, 100% for site-visit audits and 99.8%, 97.3%, 100% for remote audits, respectively. Mean time spent on data verification per case of remote audits was shorter than that of site-visit audits (10.0minutes vs 13.7minutes,
<0.001).
The audits showed that NCD data are reliable and characterized by high accuracy. Remote audits may substitute site-visit audits.
The audits showed that NCD data are reliable and characterized by high accuracy. Remote audits may substitute site-visit audits.
