The Comprehensive Complication Index

Introduction Benign duodenal and periampullary tumors are uncommon lesions requiring careful attention to their complex anatomic relationships with the major and minor papillae as well as the gastric outlet during surgical intervention. While endoscopy is less morbid than open resection, many lesions are not amenable to endoscopic removal. Robotic surgery offers technical advantages above traditional laparoscopy, and we demonstrate the safety and feasibility of this approach for a variety of duodenal lesions. Methods We performed a retrospective review of all robotic duodenal resections between April 2010 and December 2013 from two institutions. Demographic, clinicopathologic, and operative details were recorded with special attention to the post-operative course. Results Twenty-six patients underwent robotic duodenal resection for a variety of diagnoses. The majority (88 %) were symptomatic at presentation. Nine patients underwent transduodenal ampullectomy, seven patients underwent duodenal resection, six patients underwent transduodenal resection of a mass, and four patients underwent segmental duodenal resection. Median operative time was 4 h with a median estimated blood loss of 50 cm3 and no conversions to an open operation. The rate of major Clavien-Dindo grades 3–4 complications was 15 % at post-operative days 30 and 90 without mortality. Final pathology demonstrated a median tumor size of 2.9 cm with a final histologic diagnoses of adenoma (n=13), neuroendocrine tumor (n=6), gastrointestinal stromal tumor (GIST) (n=2), lipoma (n=2), Brunner’s gland hamartoma (n=1), leiomyoma (n=1), and gangliocytic paraganglioma (n=1). Conclusion Robotic duodenal resection is safe and feasible for benign and premalignant duodenal tumors not amenable to endoscopic resection.

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“…40 Recently, Clavien has revised his scoring system to allow a more granular view of complications. 41 …”

Section: Discussionmentioning

confidence: 99%

Robotic Surgery for Benign Duodenal Tumors

Downs-Canner

Vliet

Thoolen

et al. 2015

Journal of Gastrointestinal Surgery

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“…Table 1). Postoperative morbidity was defined as Clavien-Dindo Grade 3 and above, that is, complications requiring surgical, endoscopic or radiological intervention (Grade 3), life-threatening complications requiring management in an Intensive Care Unit (Grade 4) and death (Grade 5) [17]. …”

Section: Methodsmentioning

confidence: 99%

Lung Carcinoids: Long-Term Surgical Results and the Lack of Prognostic Value of Somatostatin Receptors and Other Novel Immunohistochemical Markers

Daskalakis¹,

Kaltsas²,

Öberg³

et al. 2018

Neuroendocrinology

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Background/Aims: Lung carcinoids (LCs) are often diagnosed at an early stage and surgical intervention becomes the next phase of treatment. To date, there is lack of long-term follow-up data after surgery and prognostication based on WHO classification criteria and evolving prognostic markers, particularly the expression of somatostatin receptors (SSR). Methods: We included 102 consecutive patients (72 women; age at baseline 51 ± 16 years [mean ± SD]) with LCs, who underwent thoracic surgery (n = 99) and/or laser treatment (n = 8). Hospital charts were reviewed for clinico-pathological parameters. Immunohistochemical (IHC) expression of SSR1–5 and other novel markers were studied with regard to their prognostic value. Results: Five- and 10-year overall survival (OS) was 96 and 83% respectively; relative survival (RS) was 101 and 93% respectively; and event-free survival (EFS) was 80 and 67% respectively. Independent prognostic factors for OS, RS and/or EFS were age at diagnosis, histopathological type and the presence of ipsilateral mediastinal subcarinal lymph node metastases. Macro-radicality of resective surgery and its extent were associated with increased OS and EFS. The IHC expression of SSR1–5 and other novel markers was not associated with OS or EFS. Conclusion: The long-term outcome of surgically treated patients with LCs is favourable. Age, histopathological type and ipsilateral mediastinal subcarinal lymph node status at baseline were independent prognostic factors for survival and disease recurrence or progression. The extent of surgery and operative macro-radicality also had an impact on prognosis. None of the IHC markers tested appeared to be associated with disease prognosis.

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“…The CCI ® was developed to overcome an underestimation of the true overall postoperative morbidity 19, 20. In this study, the CCI ® was used to evaluate postoperative morbidity, and low values were obtained throughout our study period.…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative morbidity and mortality were defined as any complication or death within 90 days, respectively. Complications were graded according to the Clavien‐Dindo classification system and were scored by the comprehensive complication index (CCI ® ) 19, 20. CCI ® was calculated online by http://www.assessurgery.com.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy

Hasegawa

Nitta

Takahara

et al. 2018

Annals of Gastroent Surgery

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AimAs a procedure, major laparoscopic liver resection (LLR) remains in the exploration phase. Previous studies have assessed major LLR en bloc, including hepatectomies of varying complexities; however, the number of segments alone does not convey the complexity of a resection. This study aimed to assess operative outcomes of LLR procedures with more than one sectionectomy, and to identify the best procedure as a first step when learning to carry out major LLR in order to make LLR a safer, more widely used procedure.MethodsWe carried out a retrospective review of the operative outcomes of 120 consecutive patients who underwent pure LLR with more than one sectionectomy. Operative outcomes were compared according to the complexity classification recently published, and the learning curve for each LLR procedure was assessed and compared.ResultsOperative outcomes, including operative time, blood loss, and the comprehensive complication index, were significantly stratified according to complexity. There were significant differences in operative outcomes among the medium complexity procedures. The operative time for left hemihepatectomy was the shortest, and the amount of blood loss was the lowest among the medium complexity LLR. Operative times for left hemihepatectomy shortened significantly with time and experience (r = −0.639), and the slope of the learning curve was steeper than for right hemihepatectomy and right posterior sectionectomy.ConclusionLeft hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy and, given its safety and rapid learning curve for surgeons, it could become the gold standard procedure.

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The Comprehensive Complication Index

Cited by 1,174 publications

References 32 publications

Robotic Surgery for Benign Duodenal Tumors

Robotic Surgery for Benign Duodenal Tumors

Lung Carcinoids: Long-Term Surgical Results and the Lack of Prognostic Value of Somatostatin Receptors and Other Novel Immunohistochemical Markers

Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy

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