3 results on '"Patti M"'
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2. Barrett's esophagus: a surgical disease.
- Author
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Patti MG, Arcerito M, Feo CV, Worth S, De Pinto M, Gibbs VC, Gantert W, Tyrrell D, Ferrell LF, and Way LW
- Subjects
- Adenocarcinoma pathology, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical adverse effects, Barrett Esophagus etiology, Barrett Esophagus pathology, California, Cough therapy, Esophageal Neoplasms pathology, Esophagectomy adverse effects, Esophagoscopy, Esophagus pathology, Female, Follow-Up Studies, Fundoplication, Gastroesophageal Reflux complications, Heartburn therapy, Humans, Hydrogen-Ion Concentration, Incidence, Laparoscopy, Length of Stay, Male, Manometry, Metaplasia, Middle Aged, Monitoring, Ambulatory, Time Factors, Barrett Esophagus surgery
- Abstract
Barrett's metaplasia can develop in patients with gastroesophageal reflux disease (GERD), and metaplasia can evolve into dysplasia and adenocarcinoma. The optimal treatment for Barrett's metaplasia and dysplasia is still being debated. The study reported herein was designed to assess the following: (1) the incidence of Barrett's metaplasia among patients with GERD; (2) the ability of laparoscopic fundoplication to control symptoms in patients with Barrett's metaplasia; (3) the results of esophagectomy in patients with high-grade dysplasia; and (4) the character of endoscopic follow-up programs of patients with Barrett's disease being managed by physicians throughout a large geographic region (northern California). Five-hundred thirty-five patients evaluated between October 1989 and February 1997 at the University of California San Francisco Swallowing Center had a diagnosis of GERD established by upper gastrointestinal series, endoscopy, manometry, and pH monitoring. Thirty-eight symptomatic patients with GERD and Barrett's metaplasia underwent laparoscopic fundoplication. Eleven other consecutive patients with high-grade dysplasia underwent transhiatal esophagectomies. Barrett's metaplasia was present in 72 (13%) of the 535 patients with GERD. The following results were achieved in patients who underwent laparoscopic fundoplication (n = 38): Heartburn resolved in 95% of patients, regurgitation in 93% of patients, and cough in 100% of patients. With regard to transhiatal esophagectomy (n = 11), the average duration of the operation was 339 +/- 89 minutes. The only significant complications were two esophageal anastomotic leaks, both of which resolved without sequelae. Mean hospital stay was 14 +/- 5 days. There were no deaths. The specimens showed high-grade dysplasia in seven patients and invasive adenocarcinoma (undiagnosed preoperatively) in four (36%). These results can be summarized as follows: (1) Barrett's metaplasia was present in 13% of patients with GERD being evaluated at a busy diagnostic center; (2) laparoscopic fundoplication was highly successful in controlling symptoms of GERD in patients with Barrett's metaplasia; (3) in patients with high-grade dysplasia esophagectomy was performed safely (invasive cancer had eluded preoperative endoscopic biopsies in one third of these patients); and (4) even though periodic endoscopic examination of Barrett's disease is universally recommended, this was actually done in fewer than two thirds of patients being managed by a large number of independent physicians in this geographic area.
- Published
- 1999
- Full Text
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3. A hospital's annual rate of esophagectomy influences the operative mortality rate.
- Author
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Patti MG, Corvera CU, Glasgow RE, and Way LW
- Subjects
- Adult, Aged, Analysis of Variance, California epidemiology, Chi-Square Distribution, Comorbidity, Esophageal Neoplasms surgery, Esophagectomy adverse effects, Esophagectomy mortality, Female, Hospital Mortality, Humans, Length of Stay statistics & numerical data, Logistic Models, Male, Middle Aged, Patient Discharge statistics & numerical data, Postoperative Hemorrhage epidemiology, Retrospective Studies, Risk Factors, Surgical Wound Infection epidemiology, Treatment Outcome, Esophagectomy statistics & numerical data, Hospitals statistics & numerical data
- Abstract
The reported operative mortality rate for esophagectomy for malignancy ranges from 2% to 30%. The goal of this retrospective study was to evaluate the relationship between a hospital's annual rate of esophagectomy for esophageal cancer and the clinical outcome of the operation. Discharge abstracts of 1561 patients who had undergone esophagectomy for malignancy at acute care hospitals in California from 1990 through 1994 were obtained from the Office of Statewide Health Planning and Development. The hospitals were grouped according to the number of esophagectomies performed during the 5-year period, and a mortality rate was calculated for each group. Logistic regression analysis was used to determine the relationship between a hospital's rate of esophagectomy and the mortality rate. Esophageal resections were performed in 273 hospitals. An average of two or fewer resections were performed annually in 88% of hospitals, which accounted for 50% of all patients treated. The mortality rate in hospitals with more than 30 esophagectomies for the 5-year period was 4.8%, compared with 16% for hospitals with fewer than 30 esophagectomies. This could not be accounted for by other health variables affecting the patients' risk for surgery. There was a striking correlation between a hospital's frequency of esophagectomy and the outcome of this operation. The results support the proposition that high-risk general surgical procedures, such as esophagectomy for malignancy, should be restricted to hospitals that can exceed a yearly minimum experience.
- Published
- 1998
- Full Text
- View/download PDF
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