Local treatment improves the outcomes for oligometastatic disease, an intermediate state between locoregional and widespread disease. However, consensus about the definition, diagnosis and treatment of oligometastatic oesophagogastric cancer is lacking. The first edition "Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe" was published on February 15, 2023 by 65 European medical specialists. In this article, the consensus will be interpreted to provide new idea for the diagnosis and treatment of oligometastatic oesophagogastric cancer for Chinese clinicians.
Objective To analyze the risk factors affecting the occurrence of arrhythmia after esophageal cancer surgery, construct a risk prediction model, and explore its clinical value. Methods A retrospective analysis was conducted on the clinical data of patients who underwent radical esophagectomy for esophageal cancer in the Department of Thoracic Surgery at Anhui Provincial Hospital from 2020 to 2023. Univariate and multivariate analyses were used to screen potential factors influencing postoperative arrhythmia. A risk prediction model for postoperative arrhythmia was constructed, and a nomogram was drawn. The predictive performance of the model was then validated. Results A total of 601 esophageal cancer patients were randomly divided into a modeling group (421 patients) and a validation group (180 patients) at a 7 : 3 ratio. In the modeling group, patients were further categorized into an arrhythmia group (188 patients, 44.7%) and a non-arrhythmia group (233 patients, 55.3%) based on whether they developed postoperative arrhythmia. Among those with postoperative arrhythmia, 43 (10.2%) patients had atrial fibrillation (AF), 12 (2.9%) patients had atrial premature beats, 15 (3.6%) patients had sinus bradycardia, and 143 (34%) patients had sinus tachycardia. Some patients exhibited multiple arrhythmias, including 14 patients with AF combined with sinus tachycardia, 7 patients with AF combined with atrial premature beats, and 3 patients with AF combined with sinus bradycardia. Univariate analysis revealed that a history of hypertension, heart disease, pulmonary infection, acute respiratory distress syndrome, postoperative hypoxia, anastomotic leakage, and delirium were risk factors for postoperative arrhythmia in esophageal cancer patients (P<0.05). Multivariate logistic regression analysis showed that a history of heart disease, pulmonary infection, and postoperative hypoxia were independent risk factors for postoperative arrhythmia after esophageal cancer surgery (P<0.05). The area under the receiver operating characteristic curve (AUC) of the constructed risk prediction model for postoperative arrhythmia was 0.710 [95% CI (0.659, 0.760)], with a sensitivity of 0.617 and a specificity of 0.768. Conclusion A history of heart disease, pulmonary infection, and postoperative hypoxia are independent risk factors for postoperative arrhythmia after esophageal cancer surgery. The risk prediction model constructed in this study can effectively identify high-risk patients for postoperative arrhythmia, providing a basis for personalized interventions.
This article reviewed other literatures in the quality management of clinical trials and summarized author’s experience in quality control of clinical trials which the author conducted as principle investigator over the past years. It provides a reference for fresh investigators before they conduct their own clinical trials.
ObjectiveTo evaluate the impact of preoperative respiratory sarcopenia (RS) on postoperative outcomes in patients with non-small cell lung cancer (NSCLC). MethodsA retrospective cohort study was conducted involving NSCLC patients who underwent surgery in the Department of Thoracic Surgery at the First Affiliated Hospital of the University of Science and Technology of China between March 2023 and February 2024. Patients were divided into an RS group or a non-RS group based on peak expiratory flow rate and pectoral muscle index. Propensity-score matching (PSM) was performed at a 1:4 ratio to adjust for age, gender, body mass index, smoking history, comorbidities, surgical approach, tumor maximum diameter, and lymph node metastasis status. Postoperative outcome measures were compared between the matched groups. Multivariate regression analysis was conducted to assess the independent impact of RS on postoperative outcomes. ResultsA total of 1074 patients were included before matching. After matching, 175 patients were enrolled, comprising 154 males (88.0%) and 21 females (12.0%), with a mean age of (62.70±9.03) years. Among them, 128 patients were in the RS group and 47 in the non-RS group. After PSM, compared with the non-RS group, the RS group demonstrated significantly shorter time to first ambulation [MD=4.000, 95%CI (3.000, 5.000), P<0.001], shorter chest tube retention time [MD=1.000, 95%CI (0.000, 1.000), P=0.006], and postoperative hospital stay [MD=1.000, 95%CI (1.000, 2.000), P<0.001], and significantly increased incidence of respiratory discomfort symptoms within 1 year postoperatively [RR=3.585, 95%CI (1.758, 7.308), P<0.001]. Multivariate regression analysis revealed that preoperative coexisting RS was an independent risk factor for prolonged time to first ambulation (P<0.001) and increased thoracic drainage volume on postoperative day 1 (P=0.005). ConclusionPreoperative RS in patients with NSCLC directly leads to delayed early postoperative ambulation and increased early thoracic drainage volume. However, no significant impact of preoperative RS on long-term postoperative outcomes was observed, indicating that respiratory muscle mass and function represent potential targets for interventions aimed at improving surgical outcomes.
