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Mark K Ferguson

Publications and source records attributed to Mark K Ferguson.

9 recordsLinked to original sources
PubMed2006

Bowel necrosis associated with early jejunal tube feeding: A complication of postoperative enteral nutrition.

HYPOTHESIS: Postoperative enteral nutrition may sometimes be responsible for severe complications such as mesenteri ischemia. DATA SOURCES: Studies in the English literature were identified by a computer-assisted search of the MEDLINE database using the key words "enteral feeding OR jejunostomy" AND "complications OR mesenteric ischemia." Cited references of each retrieved paper were checked for relevance. STUDY SELECTION: All reports of mesenteric ischemia in the setting of postoperative enteral feeding were included. In cases of multiple articles from the same institution with overlapping patients, the most exhaustive article was included. DATA EXTRACTION: All reports were abstracted for number of patients, presence of preoperative comorbidities, development of perioperative hypotension or mesenteric occlusion, and outcome. DATA SYNTHESIS: Nine studies were retrieved in which enteral feedings were responsible for bowel ischemia; we report an additional case. The common clinical picture is that of a patient without significant risk factors for mesenteric ischemia, which during the early postoperative course develops nonspecific abdominal symptoms and then rapidly progresses to septic shock and eventually to multisystem organ failure and death. Mesenteric ischemia may present in up to 3.5% of enterally fed surgical patients; the associated mortality approaches 100%. The lack of specific symptoms requires a high index of suspicion for diagnosis; prompt abdominal exploration and bowel resection are the only chance for survival. CONCLUSIONS: The benefits of enteral nutrition outweigh the likelihood of severe complications; when mesenteric ischemia develops, early diagnosis is challenging and the prognosis is poor.

Enteral Nutrition↗
PubMed2006

Strangulation of the reconstructive gastric tube by the azygos arch.

Graft necrosis after esophageal reconstruction is a rare but disastrous complication associated with a high mortality rate. Azygos arch strangulation of the graft is an unusual cause of graft necrosis. We report two cases of postesophagectomy gastric tube reconstruction complicated by azygos arch strangulation and graft ischemia. In one patient, graft necrosis resulted and a reconstruction was performed later with a colon interposition. In the other patient, the azygos arch was divided and the graft was preserved. We recommend dividing the azygos arch routinely during transthoracic or thoracoscopic esophagectomy if the reconstruction graft is to be brought up through the posterior mediastinal route to help avoid this problem.

Aged↗
PubMed2004

Induction therapy does not increase surgical morbidity after esophagectomy for cancer.

BACKGROUND: A complete pathological response after induction therapy for esophageal cancer offers survival benefits, but induction therapy may increase the risk of postoperative complications and mortality. METHODS: We performed a retrospective review of consecutive patients who underwent esophagectomy for esophageal cancer to identify preoperative predictors of complications and assess the possible influence of induction therapy on surgical outcomes. RESULTS: Between 1988 and 2003, 170 esophagectomies were performed on our service; 95 (55.9%) underwent surgery alone and 75 (44.1%) received preoperative chemotherapy, 35 of whom also had preoperative radiation therapy. Based on multivariable regression analyses, independent covariates for complication categories included performance status (pulmonary, cardiovascular, total complications, and death), age (cardiovascular and other complications), and FEV(1)% (pulmonary complications). Whether patients received induction therapy was unrelated to the incidence of postoperative complications. CONCLUSIONS: We found no evidence that induction therapy adversely influences the incidence of postoperative morbidity or mortality after esophagectomy for cancer.

Adenocarcinoma↗
PubMed2003

Optimal management when unsuspected N2 nodal disease is identified during thoracotomy for lung cancer: cost-effectiveness analysis.

OBJECTIVES: Whether to proceed with lung resection when N2 nodal disease is identified at the time of thoracotomy for lung cancer is controversial. A decision analysis model was developed to address this question. METHODS: A meta-analysis was performed on data from reports published between 1990 and 2002 evaluating survival for (1) patients who were treated by initial resection for clinically unsuspected N2 nodal disease (initial resection) and (2) survival for patients undergoing resection after neoadjuvant therapy for N2 nodal disease (no initial resection). Hospital cost data for surgery were derived from our institution, and cost data for chemotherapy and radiation therapy were obtained from current literature. A decision model was developed to compare initial resection to no initial resection from the perspective of the medical center using survival, quality-adjusted life years survival, and cost-effectiveness as outcomes. RESULTS: The no initial resection option provided better median survival (2.1 versus 1.7 years), quality-adjusted life years (1.8 versus 1.3), and cost-effectiveness, with an incremental cost-effectiveness ratio of 17,119 dollars/quality-adjusted life year. Outcomes were influenced by survival estimates for each treatment option. CONCLUSIONS: When N2 nodal disease is discovered during thoracotomy, the approach of delaying resection until after neoadjuvant therapy provides the best survival and is more cost-effective. This is likely due to the beneficial effects of neoadjuvant therapy and the exclusion of patients with more aggressive disease from the surgical candidate pool.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

Sleeve lobectomy or pneumonectomy: optimal management strategy using decision analysis techniques.

BACKGROUND: The choice between sleeve lobectomy and pneumonectomy is controversial for patients with early-stage lung cancer and who have acceptable lung function. METHODS: We performed a meta-analysis of results of sleeve lobectomy and pneumonectomy published in English from 1990 to 2003. A decision model was developed with 5-year survival, quality-adjusted life years (QALY), and cost effectiveness as the outcomes, and sensitivity analyses were performed. RESULTS: The model favored sleeve lobectomy (3.5 percentage point survival advantage) when the reward was 5-year survival; the results were influenced primarily by the 5-year survival rates for patients who did not develop recurrent cancer. Sleeve lobectomy was strongly favored when the reward was QALY (1.53 QALY advantage). Sleeve lobectomy was more cost effective than pneumonectomy, and had an incremental cost effectiveness ratio of $1,300/QALY. CONCLUSIONS: In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better long-term survival and quality of life than does pneumonectomy and is more cost effective.

Carcinoma, Non-Small-Cell Lung↗
PubMed2003

A comparison of three scoring systems for predicting complications after major lung resection.

OBJECTIVES: Although complications occur frequently after major lung resection, current predictive models are not entirely satisfactory. We devised a new predictive scoring system and compared it to two existing systems. METHODS: We performed an initial retrospective review of 400 patients who underwent major resection for lung cancer from 1980 to 1995. Predictive covariates (age, spirometry, diffusing capacity) associated with three or more complication groups were used to develop a scoring system. This system (EVAD) was then evaluated against the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) and Cardiopulmonary Risk Index (CPRI) systems for patients operated between 1996 and 2001. RESULTS: Major resection for lung cancer included lobectomy (188) and pneumonectomy (30). Complication categories were: pulmonary (23; 10.5%); cardiovascular (24; 11.0%); infectious (8; 3.6%); other (29; 13.2%); nonfatal (45; 20.6%); and any (53; 24.2%). Death occurred in ten patients (4.6%). Mean EVAD scores were significantly different between groups with and without complications in all categories except infectious complications and death, whereas mean CPRI scores differed only for pulmonary complications, nonfatal complications, and death, and mean POSSUM scores did not appropriately differ for any complications. EVAD predicted incremental risk in all complication categories except cardiovascular, infectious, and death, whereas CPRI predicted incremental risk only for nonfatal and possibly any complications, and POSSUM did not predict incremental risk for any complication category. Receiver operating characteristic analysis demonstrated the EVAD system to be equivalent to or better than CPRI and POSSUM for all complication categories. CONCLUSIONS: A simple scoring system (EVAD) that utilizes pulmonary function test data and patient age predicts the likelihood of complications after major lung resection. It is easier to use and at least as accurate as other scoring systems currently in use.

Adult↗
PubMed2002

Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer.

OBJECTIVES: Pulmonary complication is a frequent morbid event after esophagectomy for cancer. Its prediction may help select patients for preoperative rehabilitation. METHODS: We performed a retrospective review of 292 patients (231 men and 61 women; mean age, 60.1 years) who underwent esophagectomy for cancer between 1980 and 2000. Data were analyzed to identify factors associated with the development of pulmonary complications (reintubation for isolated respiratory failure and pneumonia). A scoring system was developed, and its ability to predict complications was assessed. RESULTS: Resection was performed for squamous cancer (n = 100), adenocarcinoma (n = 186), and other histologic types (n = 6) in patients with stages 0 or I (n = 53), II (n = 94), III (n = 114), and IV (n = 23) disease. Pulmonary complications, which developed in 78 (27%) patients, were associated with a 4.5-fold increase in operative mortality (7%-32%). Multivariable analysis identified independent predictors of pulmonary complications to be patient age (odds ratio [OR], 1.31; 95% confidence interval [CI], 0.99-1.74; P =.059), percentage forced expiratory volume in 1 second (OR, 1.21; 95% CI, 1.07-1.38; P =.003), and possibly performance status (OR, 1.48; 95% CI, 0.88-2.50; P =.14). A scoring system using these 3 covariates was developed, which predicted incremental risk of pulmonary complications (P =.013). The incremental risks of cardiovascular and overall cardiopulmonary complications were also predicted with this scoring system (P <.01 for each). CONCLUSIONS: A scoring system using patient age, spirometry, and performance status helps predict the likelihood of pulmonary and cardiovascular complications after esophagectomy and can help select patients who may benefit from preoperative cardiopulmonary rehabilitation.

Adenocarcinoma↗
PubMedDate not supplied

Long-term survival after esophagectomy for Barrett's adenocarcinoma in endoscopically surveyed and nonsurveyed patients.

There is growing controversy over the cost-effectiveness of surveillance endoscopy for patients with Barrett's esophagus. A retrospective review was performed of 80 patients who underwent resection for Barrett's adenocarcinoma to assess the influence of endoscopic surveillance on long-term survival. Twelve patients initially were diagnosed with benign Barrett's esophagus and were followed with endoscopic surveillance. The remaining 68 patients had the diagnosis of Barrett's esophagus made at the time of their cancer diagnosis or resection. Patients in surveillance programs were younger (53 vs. 64 years; P = 0.008), had better performance status (8.9 vs. 8.2; P = 0.04), had less weight loss (0.3 vs. 5.5 kg; P < 0.001), had a similar incidence of gastroesophageal reflux disease symptoms (75% vs. 60%), and were less likely to undergo preoperative chemotherapy and/or radiation therapy (8% vs. 28%). Pathologic stage was 0 or I in 9 (75%) of 12 patients in the surveillance group compared to 12 (18%) of 68 of those in the no surveillance group (P < 0.001). Median survival for patients in the surveillance group was 107 months compared to 12 months for those in the no surveillance group (P < 0.001). Stratifying for stage, surveillance (hazard ratio = 3.05; confidence interval = 1.09 to 8.57; P = 0.034) was the only predictor of survival. Surveillance endoscopy permits early diagnosis of adenocarcinoma in patients with Barrett's esophagus and contributes substantially to long-term survival.

Adenocarcinoma↗