Critique of CSPH impact on HCC surgical outcomes.

Diagnosis and management of ovarian cancer remain complex due to the overlap of symptoms with other malignancies and the variability in preoperative diagnostic approaches. While histological confirmation is crucial, the role of preoperative colonoscopy in improving surgical planning and patient outcomes remains unclear. This study aims to evaluate the impact of preoperative colonoscopy on surgical outcomes, peri-operative complications and interdisciplinary coordination in ovarian cancer patients. A retrospective, single-center study was conducted at the University Medical Center Freiburg, including 306 patients diagnosed with malignant ovarian tumors between 2016 and 2023. Patients were stratified into two groups: those who underwent preoperative colonoscopy (n=104) and those who did not (n=202). Tumor characteristics, diagnostic findings, and surgical outcomes were compared. Primary endpoints included the detection of abnormal colonoscopic findings and their correlation with intraoperative interventions. Secondary endpoints assessed the impact of colonoscopy on macroscopic complete resection rates and peri-operative complications. Patients undergoing preoperative colonoscopy exhibited higher rates of advanced tumor stages (FIGO III/IV: 84.5% vs. 47.5%). Abnormal colonoscopic findings were observed in 38.8% of cases, yet colorectal resections were performed in only 53% of these patients. Despite a higher frequency of neoadjuvant chemotherapy in the colonoscopy group (57.3 vs. 33.7%), macroscopic complete resection rates were lower (67.0 vs. 79.2%). Sensitivity and specificity analyses indicated moderate predictive accuracy of colonoscopy for colorectal involvement (67 and 74%, respectively). In advanced ovarian cancer, preoperative colonoscopy influenced colorectal surgery decisions, with higher resection rates but minimal impact on neoadjuvant chemotherapy rates, despite moderate sensitivity and specificity. While preoperative colonoscopy identified colorectal involvement in a subset of ovarian cancer patients, particularly in advanced tumor stages, its impact on surgical decision-making, oncological outcomes, and physicians' choice for neoadjuvant chemotherapy was limited. The findings suggest that intraoperative assessments remain the primary determinant for colorectal interventions. Future prospective studies are warranted to clarify the clinical utility of colonoscopy in preoperative evaluation and its potential influence on interdisciplinary surgical strategies. 24-1364-S1-retro.

Gastric cancer is the fifth most prevalent malignancy globally and the fourth major contributor to cancer-related mortality. The comparative effectiveness of robotic gastrectomy (RG) versus laparoscopic gastrectomy (LG) at different stages of gastric cancer is unclear regarding surgical and survival outcomes. We compared surgical and survival outcomes between RG and LG in early-stage (cStage I) and advanced (cStage II/III) gastric cancers to elucidate the difference in the efficacy of RG across various stages of gastric cancer. We identified 299 patients (LG, 170; RG, 129) with cStage II/III disease and 569 (LG, 455; RG, 114) with cStage I disease who underwent either LG or RG. Following propensity score matching for RG and LG, 118 pairs were selected for cStage II/II and 113 pairs for cStage I. Surgical and survival outcomes of LG and RG were separately compared for cStage II/III and cStage I. In cStage II/III, RG showed significantly fewer intra-abdominal complications of Clavien-Dindo (C.D.) Grade ≥ III in the RG group than in the LG group (LG = 8.5 vs. RG = 1.7%, P = 0.033). Multivariate analysis identified LG as an independent risk factor for intra-abdominal complications of C.D. Grade ≥ III (OR 5.69, 95% CI 1.17-27.70, P = 0.031). However, in cStage I, no difference in surgical outcomes between LG and RG was observed. No differences were observed in survival outcomes between LG and RG in both cStage I or cStage II/III. The real benefit of RG was demonstrated in surgical outcomes, especially for advanced-stage gastric cancer.

Impact of visceral obesity and sarcobesity on surgical outcomes and recovery after laparoscopic resection for colorectal cancer.

Introduction: Concomitant horizontal strabismus poses significant challenges in achieving optimal surgical outcomes, with risks of undercorrection or overcorrection remaining a concern. Preoperative assessment techniques, such as the Prism Adaptation Test (PAT) and Patch Test, have been utilised to better estimate the angle of deviation and plan surgeries accordingly. The PAT is thought to refine surgical corrections by revealing the maximum angle of deviation. However, its specific impact on surgical outcomes-especially in comparison to the patch test-remains underexplored. Aim: To evaluate the impact of preoperative PAT and patch test measurements on surgical outcomes in patients with concomitant horizontal strabismus, focusing on their role in optimising surgical corrections and minimising postoperative undercorrection and overcorrection. Materials and Methods: This prospective interventional study was conducted over 15 months at Department of Ophthalmology, Employees’ State Insurance Corporation (ESIC) Postgraduate Institute of Medical Sciences and Research (PGIMSR), Basaidarapur, New Delhi, India, from October 2017 to February 2018 and included 30 subjects diagnosed with concomitant horizontal strabismus. Preoperative deviation measurements were obtained using the Prism Bar Cover Test (PBCT) at three distances: near (33 cm), intermediate (6 m), and far (12 m). These measurements were recorded both before and after a one-hour monocular occlusion (patch test). Following this, participants underwent the PAT. Based on their responses to these tests, subjects were categorised into three groups: non responders, patch test responders, and PAT responders. Surgical corrections were planned and performed using the maximum deviation identified by the PAT. Postoperative outcomes were assessed eight weeks after surgery using Hirschberg’s test and the Prism Alternate Cover Test (PACT). The study’s parameters included analysing preoperative and postoperative deviations, categorisation of test responses, and surgical outcomes. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 17.0, and a p-value of <0.05 was considered statistically significant. Results: The study included a total of 30 participants, comprising 18 males and 12 females, with a mean age of 20.83±12.03 years. Among them, 14 individuals presented with esotropia, while 16 exhibited exotropia. The study found that PAT significantly improved surgical outcomes. The actual residual deviation postsurgery ranged from 0 to 16Δ with PAT measurements, compared to an estimated range of 5 to 25Δ if surgeries were based on PBCT measurements before occlusion and 0 to 21Δ after occlusion. The mean residual deviation was lowest in PAT responders (6.8±6.07Δ) compared to patch test responders (8.5±6.09Δ) and non responders (11.5±7.09Δ) (p-value=0.02). Satisfactory alignment was observed in 90% of PAT responders, 80% of patch test responders, and 50% of non responders (p-value <0.04). Conclusion: The study concludes that the PAT significantly improves surgical precision and outcomes in patients with concomitant horizontal strabismus. By providing a more accurate assessment of deviation angles, the PAT reduces the risk of undercorrection and overcorrection compared to conventional preoperative measurements. These findings highlight the importance of incorporating PAT into preoperative evaluations to achieve optimal postoperative alignment and minimise residual deviations. The study underscores PAT’s value in enhancing surgical planning and outcomes, suggesting its routine use in clinical practice. Further research is warranted to evaluate its long-term effects on binocular vision and overall quality of life.

BackgroundIntestinal obstruction is the most common acute abdominal disorders in children requiring emergency surgical management. Although surgical management remained the best treatment modality for intestinal obstruction, significant subset of children undergoing surgical management experiences unfavorable management outcomes. Unfavorable surgical management outcomes pose substantial impacts in children, their families, and the society. However, there has been limited evidence regarding the surgical management outcomes of intestinal obstruction among children in developing countries lie Ethiopia.ObjectiveThis study aims to assess surgical management outcomes of intestinal obstruction and its associated factors among children aged less than 15 years in eastern Amhara comprehensive specialized hospitals.MethodsInstitutional-based cross-sectional study design was employed among 262 children aged less than 15 years. The study participants were selected by simple random sampling techniques after proportional allocation of the sample to the study hospitals. Data was collected using a pretested data collection checklist and it was entered to Epi Data version 4.2 and analyzed using SPSS version 25 software. Variables with p-value of < 0.25 in the bi-variable analysis were entered into multi-variable logistic regression analyses. Finally, variables with p-value < 0.05 were declared to have a significant association with the outcome variable.ResultTwo hundred and sixty-two (262) children were included with a response rate of 100%. The finding reveals that nearly one third of children undergoing surgical management for intestinal obstruction (32.1%, 95% CI 26.3, 37.8) experienced unfavorable surgical management outcomes. The study indicated that gangrenous bowel (AOR:4.47, 95%CI:1.8, 11.1), malnutrition (AOR:4.16, 95% CI:1.77, 9.81), length of hospital stays > 7 days (AOR:3.89, 95% CI:1.69, 8.95), delay of surgery > 24 h (AOR:3.27, 95% CI:1.27, 8.42), and duration of surgery > 2 h (AOR:2.61, 95%CI:1.16, 5.88) were the risk factors for unfavorable surgical management outcome of intestinal obstruction.ConclusionThe magnitude of unfavorable surgical outcome is higher than the expected rate nearly one in three children experience unfavorable surgical management outcome following surgical management of intestinal obstruction. The risk factors identified are mainly preventable which includes gangrenous bowel, malnutrition, prolonged hospital stay, delayed surgery after admission, and prolonged duration of surgery. Early identification and treatment of intestinal obstruction is recommended. In addition, implementation of standardized pre and postoperative care protocols will be needed to achieve favorable surgical management outcome.

&lt;p&gt;Compared to wealthy individuals, individuals with low socioeconomic status (SES) often receive health services of lower intensity or quality and have difficulty accessing care. This is particularly true in the area of inpatient surgery. Individuals with low socioeconomic status are often less likely than individuals associated with high socioeconomic status to receive timely surgical care, and less likely than high SES to receive evidence-based treatments for surgical care. Despite these large gaps, there is a lack of consensus whether disparities in surgical outcomes are primarily due to differences in patient characteristics such as acuity or whether they are attributable to disparities in the quality of surgical care among those with access. The overall goal of this dissertation is to illuminate the relationship between socioeconomic status and surgical outcomes. The project aims are: 1) classify trends in post-surgical quality and analyze data on the relationship between socioeconomic status and surgical outcomes; 2) to evaluate whether changes in access to care can eliminate disparities in outcomes by analyzing the impact of the Massachusetts health reform on socioeconomic disparities in inpatient surgery; and 3) to show the potential effects of SES on surgical outcomes by using the Theory of Fundamental Causes. To meet the study objectives, this study proposes to use data from the Nationwide Inpatient Sample (NIS) and the State Inpatient Database (SID). This approach uses socioeconomic information in the NIS and SID that is a quartile classification of the estimated median household income of residents in the patient’s ZIP Code. The outcomes of interest are widely used quality measures: post-surgery mortality and complications at the national level, post-surgical mortality in Massachusetts for select inpatient surgeries, and difference-in-difference estimates. The approach used to identify trends in post-surgical quality uses two analytical software products to analyze the NIS using a regression-based approach. Study findings will identify progress and gaps in the quality of inpatient surgical care over recent years and further determine whether improving access to care through policy design can eliminate or reduce disparities in surgical care outcomes. In the face of health reform, this research will offer important insight into the study of surgical disparities and potential impact following health policy changes such as the expansion of Medicaid, implementation of health insurance exchanges, and the individual mandate requiring individuals to obtain health coverage.&lt;/p&gt;

Robot-assisted laparoscopic extravesical ureteral reimplant: A critical look at surgical outcomes

Retrospective Cohort Study. To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed. Patients > 18years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively. Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, P = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .05). Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption. III.

Improvement of surgical and survival outcomes of patients with pancreatic cancer who underwent pancreaticoduodenectomy : A Chinese experience

Background: This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC).Methods: In this retrospective study, 107 patients diagnosed with clinical stage I NSCLC undergoing video-assisted thoracic surgery lobectomy (exclusion of the right middle lobe) from January 2011 to December 2018 were enrolled. The patients were assigned to the L-SND (n = 28) and SND (n = 79) groups according to the procedure performed on them. Demographics, perioperative data, and surgical and long-term oncological outcomes were collected and compared between the L-SND and SND groups. Results: The mean follow-duration was 60.6 months. The demographic data and surgical outcomes and long-term oncological outcomes were not significantly different between the two groups. The 5-year OS of the L-SND and SND groups was 82% and 84%, respectively. The 5-year DFS of the L-SND and SND groups was 70% and 65%, respectively. The 5-year CSS of the L-SND and SND groups was 80% and 86%, respectively. All the surgical and long-term outcomes were not statistically different between the two groups. Conclusion: L-SND showed comparable surgical and oncologic outcomes with SND for clinical stage I NSCLC. L-SND could be a treatment choice for stage I NSCLC.

Surgical and Reproductive Outcomes in Patients with Complete Septate Uterus and Cervical Anomalies after Metroplasty

Background: Through knee amputation (TKA) may offer benefits over above knee amputation (AKA) in patients unsuitable for below knee amputation. This retrospective analysis compared surgical and rehabilitation outcomes post TKA and AKA. Methods: All TKA and AKA procedures recorded in the Scottish Physiotherapy Amputee Research Group dataset from January 2007 to December 2017 were included for analysis. All aetiologies, re-amputations and bilateral procedures were included. Demographic information, surgical outcomes (ie, further surgery, survival, and length of stay) and rehabilitation outcomes (ie, limb fitting, early rehabilitation, and mobility scores) were compared using descriptive and inferential statistics, including Kaplan–Meier, log-rank statistics and multivariate logistic regression. Results: In total, 4,197 procedures were included for analysis (3,471 initial AKA, 146 initial TKA, 580 initial below-knee or other level). Survival (p=0.809) and length of stay (p=0.696) were similar between groups, but TKA had significantly higher rates of further surgery (p&lt;0.001). Multivariable analysis showed that patients who undergo TKA at centres which perform small numbers of TKA are significantly more likely to need further surgery (p=0.048). A significantly larger proportion of these patients had a limb fitted (25%) compared with only 12% of those from centres performing larger numbers of TKA (p=0.041). Overall, 31% (n=23) of those with TKA and 30% (n=725) of those with AKA had a limb fitted (p=0.854). All other rehabilitation outcomes were similar between groups. Conclusion: High volume centres have better surgical outcomes but appear to select patients not likely to limb fit. Despite this, similar proportions of patients did subsequently limb fit between groups, which may suggest superior rehabilitation potential for TKA compared with AKA, although the numbers performed in Scotland are very small. Prospective randomised studies are urgently needed to inform clinical practice.

Minimally invasive surgery for endometrial cancer: Does operative start time impact surgical and oncologic outcomes?

Left colon cancer obstruction treatment is a debated topic in the literature. Stent placement is effective as a bridge-to-surgery strategy, but there are some concerns about the oncological safety for the reported higher risk of local and peritoneal recurrence. This study aims to compare the surgical and oncological outcomes of patients treated with stent followed by elective surgery with those treated with primary resection. This is a retrospective observational study. We included patients of both sexes, ≥18 years old, with a histological diagnosis of intestinal adenocarcinoma, and admitted to our hospital for left colon cancer obstruction demonstrated by CT scan without metastasis or perforation. They were treated through primary resection (PR) or stent placement followed by elective surgery (SR). The two groups were compared for general characteristics, surgical outcomes, and oncological outcomes (metastasis and local recurrence) at 30 days, 90 days, 1 year, and 3 years. Post-operative quality of life (QoL) was also investigated. The SR group showed a shorter hospital stay, a lower post-operative mortality, a lower stoma rate at 1 year, and a higher number of minimally invasive procedures. Oncological outcomes were not different compared to the PR group. The SR group demonstrated better QoL in two out of six items on the EQ-5D-5L test. Stent placement as a bridge-to-surgery strategy is feasible and provides better surgical outcomes in terms of post-operative complications, surgical approach, stoma rate, and QoL. Oncological outcomes were not reported differently, but further studies should be conducted to better evaluate this aspect.

To evaluate (1) Audiological and surgical outcomes in patients with otosclerosis following cochlear implantation. (2) surgical difficulties and outcomes between both groups. (3) Audiological outcomes between both groups. Retrospective study conducted at Otology and Skull Base Surgery Center. Data were analyzed from 111 patients with otosclerosis (114 ears) who underwent cochlear implant surgery using the cochlear implant database. Demographic characteristics (age, sex, and operated ear), auditory outcomes, and operative details (extent of cochlear ossification, surgical approach [posterior tympanotomy or subtotal petrosectomy], electrode insertion [partial/complete, scala tympani or vestibuli], and complications) were analyzed Auditory outcomes were assessed over at least one year follow-up period using pure tone audiometry and speech discrimination scores. Patients were divided into two groups (with and without cochlear ossification) to compare auditory outcomes and surgical outcomes. The mean age of patients with ossified and non-ossified cochlea was 60.04 and 62.22years respectively. Sixty-five of 114 ears had cochlear ossification, with complete round window involvement in 75.4% of these patients, while the rest had partial or complete basal turn ossification. Subtotal petrosectomy was performed in 63.1% and 28.6% of ossified and non-ossified cochlea respectively while the rest underwent cochlear implantation through posterior tympanotomy. Only one case had scala vestibuli insertion and four had incomplete electrode insertion. Six patients underwent re-implantation due to infection, device failure, and erosion of the posterior canal wall. Auditory outcomes among patients with ossified otosclerosis were slightly better than those without ossification but this difference was not statistically significant. Cochlear implantation for otosclerosis yields excellent auditory outcomes with a low rate of surgical complications, despite the high incidence of cochlear ossification.