Leukocyte alkaline phosphatase (LAP) as a marker for colon cancer patients: the sensitivity and specificity of LAP compared with CEA and CA 19-9

This study was undertaken to test the hypothesis of a possible correlation of LAP activity with biological behavior of the colon cancer. Lap score were measured in the blood of 70 patients operated for colon cancer during 1995-1997 in the 1st Surgical Department of Athens University Medical School in Hippocration Hospital and 30 healthy controls. Measurements of the score were conducted preoperatively and every 3 months until 1 year postoperatively using an histochemical method. The method includes procedures for preparing fixative, buffer, and counter stains; for staining blood smears; scoring criteria for determining LAP activity. The sensitivity of LAP compared with CEA and CA19-9. The results of the study revealed that:❖ Cancer patients have increased LAP score preoperatively compared with healthy controls.❖ LAP score levels are gradually elevated with direct relationship to the stage of the tumor. Low values indicate early stage of the tumor, while high values indicate a more aggressive tumor❖ There was no significant correlation between LAP score levels and patient's age or sex.❖ Patients are found to have lower LAP score levels for the firsts three months after operation. The next months the score levels hang on the presentation of métastasés or disease recurrence❖ CAI9-9 has very low sensitivity for colon cancer.❖ CEA and LAP score have the same sensitivity.The study concludes that the activity of Leukocyte Alkaline Phosphatase could be used as a new marker for colon cancer patients.Η μελέτη αυτή έχει σα σκοπό να διερευνήσει αν υπάρχει σχέση μεταξύ της δράσης της Αλκαλικής Φωσφατάσης των Λευκοκυττάρων (LAP score) και της βιολογικής συμπεριφοράς του αδενοκαρκινώματος του παχέος εντέρου. Ο προσδιορισμός της δράσης της LAP έγινε σε 70 ασθενείς, οι οποίοι έπασχαν από αδενοκαρκίνωμα παχέος εντέρου και υπεβλήθησαν σε χειρουργική επέμβαση κατά τα έτη 1995-1997 στην Α' Προπαιδευτική Χειρουργική Κλινική του Πανεπιστημίου Αθηνών, και σε 40 υγιείς μάρτυρες. Οι μετρήσεις πραγματοποιήθηκαν προεγχειρητικά όσο και σε τακτά χρονικά διαστήματα (κάθε 3 μήνες) μέχρι την ολοκλήρωση 1 έτους μετεγχειρητικά. Για το προσδιορισμό της δράσης του ενζύμου χρησιμοποιήσαμε μια κυτταροχυμική μέθοδο και το Kaplow score. Συγκρίναμε την ευαισθησία του LAP score με αυτή των νεοπλασματικών δεικτών CEA και CAI9-9 Τα αποτελέσματα της παρούσης μελέτης αποδεικνύουν ότι:❖ Προεγχειρητικά το LAP score των ασθενών έχει σε υψηλό ποσοστό παθολογικές τιμές σε σχέση με αυτές των μαρτύρων.❖ Οι διακυμάνσεις των τιμών του LAP score συμβαδίζουν με τα στάδια της νόσου. Οσο πιο προχωρημένο είναι το στάδιο της νόσου τόσο πιο υψηλές είναι οι τιμές του score.❖ Οι τιμές του LAP score δεν επηρεάζονται από το φύλο και την ηλικία των ασθενών.❖ Στους πρώτους μετεγχειρητικούς μήνες έχουμε μείωση των τιμών του LAP score. Οι διακυμάνσεις του στους επόμενους μετεγχειρητικούς μήνες εξαρτώνται από την ύπαρξη μεταστάσεων ή την υποτροπή της νόσου.❖ Το CAI9-9 έχει πολύ μικρή ευαισθησία για το καρκίνο του παχέος εντέρου.❖ To LAP score έχει την ίδια αξιοπιστία με το CEA.Συμπερασματικά μπορούμε να πούμε ότι η μέτρηση της δράσης της Αλκαλικής Φωσφατάσης των Λευκοκυττάρων στους ασθενείς με αδενοκαρκίνωμα του παχέος εντέρου μπορεί να προστεθεί με αξιοπιστία στο σύγχρονο φάσμα των καρκινικών δεικτών

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine