Objective: Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this selfcontrolled study was to examine the effect of jejunostomy tube feeding(JTF) and other factors on postopera...Objective: Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this selfcontrolled study was to examine the effect of jejunostomy tube feeding(JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer.Methods: All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database(2003–2014). Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy.Results: Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range(IQR), 10–55 d]. Jejunostomy-related complications occurred in 11(17%)patients, including skin leakage(n=3) and peritoneal leakage(n=2), luxation(n=3), occlusion(n=2), infection(n=1)and torsion(n=1). In 2(3%) patients, a reoperation was needed due to jejunostomy-related complications. The mean preoperative weight of patients was 71.8 kg(100%), and remained stable during JTF(73.9 kg, 103%,P=0.331). After JTF was stopped, the mean weight of patients decreased to 64.9 kg(90%) at 12 months after surgery(P<0.001). A high preoperative body mass index(BMI)(≥25 kg/m^2) was associated with high postoperative weight loss compared to patients with a low BMI(<25 kg/m^2)(16.3% vs. 8.6%, P=0.016).Conclusions: JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.展开更多
BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depressio...BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depression and posttraumatic stress disorder(PTSD).AIM To identify studies that examined the prevalence of clinically relevant levels of depression,anxiety,comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.METHODS Four databases(PubMed,PsycInfo,PubPsych and the Cochrane Database)were searched and resulted in a total of 2387 articles to be screened.To be included,a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities.All articles were screened by two authors with a third author reviewing debated articles.RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review.The studies showed heterogeneity regarding the study characteristics,number of participants,time since diagnosis,and assessment tools.Generally,all four comorbidities show higher prevalences in cancer survivors than the general population.Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety.Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities.Regarding comorbidities,a wide range in prevalence existed across the tumor types.Within one cancer site,the prevalence also varied considerably among the studies.CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population,as reflected by the prevalence of depression,anxiety,comorbid anxiety-depression and PTSD across all tumor subtypes.Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.展开更多
文摘Objective: Patients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this selfcontrolled study was to examine the effect of jejunostomy tube feeding(JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer.Methods: All consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database(2003–2014). Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy.Results: Of 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range(IQR), 10–55 d]. Jejunostomy-related complications occurred in 11(17%)patients, including skin leakage(n=3) and peritoneal leakage(n=2), luxation(n=3), occlusion(n=2), infection(n=1)and torsion(n=1). In 2(3%) patients, a reoperation was needed due to jejunostomy-related complications. The mean preoperative weight of patients was 71.8 kg(100%), and remained stable during JTF(73.9 kg, 103%,P=0.331). After JTF was stopped, the mean weight of patients decreased to 64.9 kg(90%) at 12 months after surgery(P<0.001). A high preoperative body mass index(BMI)(≥25 kg/m^2) was associated with high postoperative weight loss compared to patients with a low BMI(<25 kg/m^2)(16.3% vs. 8.6%, P=0.016).Conclusions: JTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.
文摘BACKGROUND Psychiatric disorders are common but underdiagnosed in cancer survivors.Research suggests that tumor type has an effect on the prevalence of clinically relevant depression,anxiety,comorbid anxiety-depression and posttraumatic stress disorder(PTSD).AIM To identify studies that examined the prevalence of clinically relevant levels of depression,anxiety,comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes.METHODS Four databases(PubMed,PsycInfo,PubPsych and the Cochrane Database)were searched and resulted in a total of 2387 articles to be screened.To be included,a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities.All articles were screened by two authors with a third author reviewing debated articles.RESULTS Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review.The studies showed heterogeneity regarding the study characteristics,number of participants,time since diagnosis,and assessment tools.Generally,all four comorbidities show higher prevalences in cancer survivors than the general population.Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety.Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities.Regarding comorbidities,a wide range in prevalence existed across the tumor types.Within one cancer site,the prevalence also varied considerably among the studies.CONCLUSION Psychiatric comorbidities are more frequent in cancer survivors than in the general population,as reflected by the prevalence of depression,anxiety,comorbid anxiety-depression and PTSD across all tumor subtypes.Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.
