OBJECTIVE:Patients with lung cancer are often elderly, frail, and smokers with poor functional reserve, making them excellent candidates for multimodal prehabilitation to improve postoperative outcomes. Patients referred to the prehabilitation clinic are at an even higher surgical risk. This retrospective observational study aimed to compare the postoperative 30-day outcomes in lung cancer surgery among the propensity score-matched patients. METHODS:Patients who underwent lung cancer surgery between August 2018 and January 2024 were accessed for eligibility. After exclusion, a 1:1 propensity score-matching analysis was performed based on the following baseline characteristics: respiratory disease, predicted length of stay based on American College of Surgeons National Surgical Quality Improvement Program, Duke Activity Status Index less than 34, tumor stage, and neoadjuvant therapy. Baseline characteristics, preoperative and intraoperative data, and postoperative outcomes were compared between the matched patients. RESULTS:Among 1242 patients, 555 were selected for propensity score matching, resulting in 147 matched pairs in each group. The control group exhibited significantly higher rates of overall (65.3% vs 46.3%, P = .001) and major complications (27.9% vs 13.6%, P = .003). Patients who underwent multimodal prehabilitation had a significantly lower Comprehensive Complication Index (12.2 [0-26.2] vs 0 [0-20.9], P < .0001), reduced intensive care unit admission rates (8.2% vs 2.7%, P = .040), and lower readmission rates (14.3% vs 6.1%, P = .021). CONCLUSIONS:Multimodal prehabilitation significantly reduced overall and major postoperative 30-day complications in lung cancer surgery. It also contributed to reducing the severity of complications. These findings suggest that multimodal prehabilitation may improve postoperative outcomes for patients with lung cancer.

Pancreatic metastasis from cervical cancer is extremely rare. We report a case of metastatic adenocarcinoma of the pancreas from uterine cervical cancer. A 70-year-old woman was referred because of a pancreatic mass detected by CT. She had been diagnosed with uterine cervical adenocarcinoma 20 months previously. After concurrent chemoradiotherapy, CT showed no evidence of the cervical mass, and follow-up showed no evidence of recurrence. Endoscopic ultrasound-guided fine needle aspiration biopsy of the pancreatic mass resulted in a diagnosis of metastatic adenocarcinoma from uterine cervix.

Background: Lung cancer is the most common cause of cancer-related mortality worldwide. We previously reported the identification of a new genetic marker, cellular retinoic acid binding protein 2 (CRABP2), in lung cancer tissues. The aim of this study was to assess plasma levels of CRABP2 from patients with non-small cell lung cancer (NSCLC). Methods: Blood samples that were collected from 122 patients with NSCLC between September 2009 and September 2013 were selected for the analysis, along with samples from age(± 5 years), sex-, and cigarette smoking history (± 10 pack-years [PY])-matched controls from the Korea Biobank Network. The control specimens were from patients who were without malignancies or pulmonary diseases. We measured plasma levels of CRABP2 using commercially available enzyme-linked immunosorbent assay kits. Results: The mean age of the NSCLC patients was 71.8 ± 8.9 years, and the median cigarette smoking history was 32 PY (range, 0–150 PY). Plasma CRABP2 levels were significantly higher in patients with NSCLC than in the matched controls (37.63 ± 28.71 ng/mL vs. 24.09 ± 21.09 ng/mL, P < 0.001). Higher plasma CRABP2 levels were also correlated with lower survival rates in NSCLC patients (P = 0.014). Conclusion: Plasma CRABP2 levels might be a novel diagnostic and prognostic marker in NSCLC.

Background: There are few studies on intensive care unit (ICU) patients in the Republic of Korea. We analyzed the characteristics and mortality changes of all ICU patients over the last 8 years. Methods: This study used the cohort of the National Health Insurance Corporation, which provides medical care to all residents of the Republic of Korea. The cohort consists of patients aged 20 years or older between 2003 and 2010 with a history of ICU admission. We analyzed changes in sex, age, household income, number of hospital beds, emergency admissions, and reasons for admission using the Cochran-Armitage trend test. The adjusted hazard ratios (HRs) of mortality according to these variables and year of admission were calculated by Cox proportional hazards regression. Results: The proportion of patients aged >= 70 years increased over that period, as did their average age (by 3.6 years). During the 8-year study period, the 3-year mortality rate was 32.91%-35.83%. The overall mortality was higher in males and older patients, in those with a lower household income and higher Charlson Comorbidity Index (CCI) score, those admitted to a hospital with a smaller number of beds, and those admitted via the emergency room. There was no significant change in crude mortality rate over the 8-year study period; however, the adjusted HR showed a decreasing trend. Conclusions: Patients admitted to the ICU were older and had higher CCI score. Nevertheless, there was a temporal trend toward a decrease in the HR of long-term mortality.

위암의 ì „ì´ëŠ” 주로 혈행성 ì „íŒŒ, ë¦¼í”„ì ˆì„ 통한 ì „ì´, 주위 장기를 통한 ì§ì ‘ 침윤과 복강내 íŒŒì¢ ì„ 통해 이루어지며 장기로는 주로 간, 폐, 뼈로 ì „ì´ê°€ ëœë‹¤ê³ ì•Œë ¤ì ¸ 있다. 위암의 담낭 ì „ì´ëŠ” 흔하지 ì•Šê³ ì˜ˆí›„ê°€ 좋지 않으며 담낭염으로 발현한 경우 더 예후가 ë‚˜ì˜ë‹¤ê³ ì•Œë ¤ì ¸ 있다. 본 ì €ìžë“¤ì€ 위암의 담낭으로의 ì „ì´ì™€ 담낭염이 동반된 증례를 경험하여 ë³´ê³ í•˜ëŠ” 바이다. Keywords: 위암, 담낭, 담낭염

Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.

Patients undergoing colorectal cancer resections are at risk for delayed recovery. Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery. The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone. They propose an expanded trimodal prehabilitation program that adds nutritional counseling, protein supplementation, and anxiety reduction to a moderate exercise program. This study aimed to estimate the impact of this trimodal program on the recovery of functional capacity compared with standard surgical care.

Introduction: Abdominal surgery represents a physiologic stress and is associated with a period of recovery during which functional capacity is often diminished. “Prehabilitation” is a program to increase functional capacity in anticipation of an upcoming stressor. We recently reported the results of a randomized trial comparing two prehabilitation programs prior to colorectal surgery (stationary cycling plus weight training vs. a recommendation to increase walking coupled with breathing exercises), however adherence to the programs was low. The objectives of this study are (1) to estimate the extent to which physical function could be improved with either prehabilitation regime and identify variables associated with improvement; and (2) to estimate the impact of change in preoperative function on post-operative recovery. Methods: A reanalysis of data arising from a randomized trial. The primary outcome measure was functional walking capacity measured by the Six Minute Walk Test (6MWT); secondary outcomes were anxiety, depression, health-related quality of life (HRQL) and complications (Clavien). Multiple linear regression was used to estimate the extent to which key explanatory variables predicted change in functional walking capacity over the prehabilitation and follow-up phases. Results: 95 people completed the prehabilitation phase (median 38 days, IQR 22-60 days), and 75 were also evaluated postoperatively (mean 9 weeks). During prehabilitation, 33% improved their physical function, 38% stayed the same, and 40% deteriorated. In people who improved, mental health, vitality, self-perceived health (EQ-VAS), and V02peak also increased significantly. Women and people older than 75 were less likely to improve during prehabilitation; low baseline 6MWT, high anxiety and belief that fitness aids recovery were associated with improvements during prehabilitation. In the postoperative phase, those patients who improved during prehabilitation were also more likely to have recovered to baseline walking capacity than those with no change or deterioration (77% vs. 54% and 32%; p=0.002). Significant predictors of poorer recovery included deterioration during prehabilitaion, age>75, high anxiety, ≥grade 2 complication and timing of follow-up assessment. Conclusions: These data support that prehabilitation in a group of patients undergoing scheduled colorectal surgery is feasible and meaningful changes in functional capacity can be achieved in some patients during a period of several weeks. Response to prehabilitation has a positive impact on HRQL preoperatively and on postoperative surgical recovery.

PURPOSE:Unlike normal weight individuals, individuals with extreme obesity do not show a decrease in arterial carbon dioxide pressure (PaCO₂) from rest to peak exercise. This indicates that breathing is compromised. The objective of this study was to determine if prior high intensity exercise lowers PaCO₂ in comparison with a first bout, normalized for the same metabolic rate.METHODS:Oxygen consumption during incremental, ramped exercise was matched to constant workload exercise (75% of peak power). Both protocols were to volitional exhaustion 39 ± 8 min apart. Eleven obese subjects (BMI = 47 ± 8 kg/m², aerobic capacity = 2.3 ± 0.6 L/min) were evaluated. Forty paired samples were obtained at the same metabolic rate between the two protocols.RESULTS:The mean absolute difference and 95% CI were large for arterial oxygen pressure (PaO₂) = 9 (6, 11) mmHg and alveolar to arterial oxygen pressure difference (AaDO2) = 7 (5, 8) mmHg. The mean absolute difference for arterial oxyhemoglobin saturation (%SaO₂) = 0.5 (0.4, 0.7) %; PaCO2 = 4 (3, 4) mmHg; physiological dead space to tidal volume ratio (VD/VT) = 0.04 (0.03, 0.05); and alveolar ventilation (VA) = 3 (2, 4) L/min. The recovery period after the first bout of exercise reduced the PaCO₂ by 3 mmHg when matched for similar metabolic rates. Constant workload exercise predicted VA, %SaO2, V(D)/V(T), and PaCO₂, but not PaO₂ or AaDO₂ during incremental exercise at similar metabolic rates.CONCLUSION:Given a sufficient chemical stimulus, obese subjects will attempt to breathe more, although this does not mean more VA, which removes CO₂.

Surgical patients often show physiological and metabolic distress, muscle weakness, and long hospital stays. Physical conditioning might help recovery. We attempted to identify the most responsive measure of aerobic fitness from a four-week pre-surgical aerobic exercise program (prehabilitation) in patients undergoing major bowel resection. Twenty-one subjects randomized two to one (exercise: control) scheduled for colorectal surgery. Fourteen subjects [Body Mass Index (BMI) = 27 +/- 6 kg/m(2); maximal oxygen uptake (VO(2max)) = 22 +/- 10 ml/kg/min] underwent 3.8 +/- 1.2 weeks (27 +/- 8 sessions) of progressive, structured pre-surgical aerobic exercise training at 40 to 65% of heart rate reserve (%HRR). Peak power output was the only maximal measure that was responsive to training [26 +/- 27%, Effects Size (ES) = 0.24; Standardized Response Mean (SRM) = 1.05; p < 0.05]. For the submaximal measures, heart rate and oxygen uptake during submaximal exercise was most responsive to training (decrease by 13% +/- 15%, ES = -0.24; SRM = -0.57; and 7% +/- 6%, ES = -0.40; SRM -0.97; p < 0.05) at an exercise intensity of 76 +/- 47 W. There was no change to maximal or submaximal measures in the control group. The distance walked over six minutes improved in both groups (by approximately 30 m), but the effect size and t-statistic were higher in the exercise group. Heart rate and oxygen uptake during submaximal exercise, and peak power output are the most responsive measures to four weeks of prehabilitation in subjects with low initial fitness.

Morbidly obese individuals may have altered pulmonary diffusion during exercise. The purpose of this study was to examine pulmonary diffusing capacity for nitric oxide (DLNO) and carbon monoxide (DLCO) during exercise in these subjects. Ten morbidly obese subjects (age = 38 ± 9 years, BMI = 47 ± 7 kg/m 2 , peak oxygen consumption or O 2peak = 2.4 ± 0.4 l/min) and nine nonobese controls (age = 41 ± 9 years, BMI = 23 ± 2 kg/m 2 , O 2peak = 2.6 ± 0.9 l/min) participated in two sessions: the first measured resting O 2 and O 2peak for determination of wattage equating to 40, 75, and 90% oxygen uptake reserve ( O 2 R). The second session measured pulmonary diffusion from single‐breath maneuvers of 5 s each, as well as heart rate (HR) and O 2 over three workloads. DLNO, DLCO, and pulmonary capillary blood volume were larger in obese compared to nonobese groups ( P ≤ 0.06) only when expressed relative to alveolar volume (VA). The slope between O 2 and all measures of pulmonary diffusion, whether or not expressed to VA, were not different between groups ( P > 0.10). The morbidly obese have increased pulmonary diffusion per unit increase in VA compared with nonobese controls which may be due to a lower rise in VA per unit increase in O 2 in the obese during exercise.

Background: Lidocaine has been shown to inhibit neural conduction and to have anti-inflammatory properties. The purpose of this study was to determine whether intraoperative lidocaine infusion reduces opioid consumption in the postanesthesia care unit (PACU). Methods: Fifty patients were enrolled in this prospective, randomized and observer-blinded study. At induction of anesthesia the control group ( n =25) received fentanyl 3 µg·kg −1 while the lidocaine group received fentanyl 1.5 µg·kg −1 and a bolus of lidocaine 1.5 mg·kg −1 followed by a continuous infusion of lidocaine 2 mg·kg −1 ·hr −1 . General anesthesia included propofol, rocuronium, and desflurane titrated to maintain blood pressure and heart rate within set parameters, and the bispectral index between 35 and 50. No supplemental opioids were given during surgery. All patients received acetaminophen, ketorolac, dexamethasone, droperidol and local anesthetics in the skin incision. Patients received fentanyl and ondansetron in the PACU. The primary outcome variable was the amount of fentanyl required in the PACU to establish and to maintain visual analogue scale pain scores<3. Results: Most patients received fentanyl for pain relief in the PACU, but the cumulative mean dose was lower in the lidocaine group compared to the control group (98±54 µg, vs 154±3 99 µg, respectively, P =0.018). Lidocaine infusion reduced by 10% the amount of desflurane required ( P =0.012). White-Song scoresτ;12 were attained by all patients in both groups within 30 min of their arrival in the PACU. Median time from arrival to the PACU to discharge home was similar in both groups, 167.5 min in the control group vs 180 min in the lidocaine group ( P =0.649). Conclusion: Intraoperative lidocaine infusion reduces opioid consumption in the PACU and intraoperative requirements of desflurane.

BACKGROUND:Morbidly obese individuals may have poor compensatory hyperventilation during exercise. The objective was to examine pulmonary gas exchange and the compensatory hyperventilatory response during exercise pre- and post-weight reduction surgery in obese subjects.METHODS:Fifteen patients (age=39+/-8 years, body mass index=47+/-6 kg/m2), with an excess weight of 69+/-17 kg, were recruited. Pulmonary function at rest was assessed and arterial-blood gases were sampled at rest and all levels of exercise pre- and 10+/-3 weeks postsurgery.RESULTS:There was a loss of excess weight 21+/-6 kg (p<0.01). Waist and hip circumference decreased by 13+/-9 and 8+/-7 cm, respectively (p<0.01). Prior to surgery, there was no compensatory hyperventilation between rest and peak exercise as arterial PCO2 (PaCO2) remained unchanged (37+/-3 mm Hg). However, postsurgery, there was compensatory hyperventilation as PaCO2 decreased to 33+/-2 mm Hg at peak exercise (p<0.01), with no change in peak oxygen consumption (VO2peak in L/min). Multiple linear regression revealed that the restored ventilatory response to exercise was most strongly associated with the reduction in overall fat mass (adjusted r2=0.25; p=0.03). Total weight loss of 21 kg induces adequate compensatory hyperventilation that begins to show at about 50% of VO2peak, resulting in improved gas exchange at moderate to peak exercise intensities.CONCLUSION:Improvement in compensatory hyperventilation is most closely related to loss in overall fat mass.

Morbidly obese men may have poorer pulmonary gas exchange compared to morbidly obese women (see Zavorsky et al., Chest 131:362–367, 2007). The purpose was to compare pulmonary gas exchange in morbidly obese men and women at rest and throughout exercise.

Morbidly obese individuals may have impaired alveolar-membrane diffusing capacity (DmCO). The purpose of this study was to measure pulmonary diffusing capacity for NO (DLNO) as an index of DmCO pre- and postbariatric surgery in the morbidly obese.

BACKGROUND:Morbidly obese individuals (ie, body mass index [BMI], > or = 40 kg/m2) may have a pulmonary gas exchange impairment due to the large fat mass surrounding their abdomen.PURPOSES:To examine the effect of the waist-to-hip (W/H) ratio on pulmonary gas exchange in the morbidly obese.METHODS:Twenty-five morbidly obese individuals (mean [+/- SD] age, 39 +/- 10 years; mean BMI, 49 +/- 7 kg/m2; mean body fat, 50 +/- 6%; mean waist circumference, 135 +/- 15 cm; mean W/H ratio, 0.97 +/- 0.11) scheduled for bariatric surgery were recruited. Arterial blood was sampled in duplicate after 5 min of rest sitting upright.RESULTS:The mean PaO2 at rest was 88 +/- 7 mm Hg (range, 72 to 108 mm Hg), the alveolar-arterial oxygen pressure difference (P[A-a]O2) was 19 +/- 9 mm Hg (range, 1 to 37 mm Hg), and the PacO2 was 38 +/- 3 mm Hg (range, 32 to 44 mm Hg). Linear regression showed that 32% and 36%, respectively, of the variance in the P(A-a)O2 and PaO2 were explained by the W/H ratio (p < 0.004 for both). As well, 20% of the variance in PacO2 was explained by the W/H ratio (p = 0.02). Men had larger W/H ratios (p < 0.01) and poorer gas exchange (p = 0.06) compared to women (mean difference: PaO2, -7 mm Hg; P[A-a]O2, 6 mm Hg).CONCLUSION:Morbidly obese men showed a trend to have poorer pulmonary gas exchange compared to morbidly obese women, and a significant part of the blood gas status in these patients is associated with the W/H ratio.

This study was designed to compare differences in pulmonary gas exchange at rest and at peak exercise in two groups of women: (1) physically active, non-obese women and (2) women with morbid obesity. Fourteen morbidly obese women (body mass index or BMI=49+/-7 kg/m2; peak oxygen consumption or VO2 peak=14+/-2 ml/(kg min)) and 14 physically active non-obese women (BMI=22+/-2 kg/m2; VO2 peak=50+/-6 ml/(kg min)) performed an incremental, ramped exercise test to exhaustion on a cycle ergometer. Arterial blood was sampled at rest and at peak exercise. At rest, the alveolar to arterial oxygen partial pressure difference was 3x higher in the obese women (14+/-10 mmHg) compared to non-obese women (5+/-4 mmHg). Arterial carbon dioxide pressure (PaCO2) was identical in both groups at rest (37+/-4 mmHg). Only the non-obese women showed a decrease in PaCO2 rest to peak exercise (-5+/-3 mmHg). The slope between heart rate and VO2 during exercise was higher in the morbidly obese compared to non-obese women indicating that for the same absolute increase in VO2 a larger increase in heart rate is needed, demonstrating poorer cardiac efficiency in obese women. In conclusion, morbidly obese women have poorer exercise capacity, cardiac efficiency, and compensatory hyperventilation at peak exercise, and poorer gas exchange at rest compared to physically active, non-obese women.