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The enhanced recovery after surgery program in elderly patients over 75 years of age undergoing elective colorectal cancer surgery

AbstractAimThe enhanced recovery after surgery (ERAS) program has been well established for patients undergoing colorectal surgery. However, there has been a lack of studies on its use for elderly patients. Our unit implemented the ERAS program in September 2018. The aim of this study is to evaluate the outcome of the ERAS program in patients over 75 years who are undergoing colorectal surgery.Patients and MethodsIn this retrospective study, we compared all patients aged 75 and above who were admitted to Queen Elizabeth Hospital for elective colorectal cancer surgery before the implementation of the ERAS program (1 January 2016 to 31 August 2018) with those treated after its implementation (1 April 2019 to March 2022). The primary end point was the post‐operative length of stay. The secondary end points were wound infection, retention of urine, pneumonia, deep vein thrombosis, pulmonary embolism, use of total parenteral nutrition, acute coronary syndrome, blood transfusion, reoperation, in‐hospital mortality, unplanned readmission within 28 days and Clinical Fragility Score.ResultsA total of 258 patients were included. The median length of stay was 8.4 days in the pre‐ERAS group vs 6.8 days in the ERAS group. In‐patient death (1.4% in the pre‐ERAS group vs 0.9% in the ERAS group) and readmission rate (7.7% in the pre‐ERAS group vs 12.2% in the ERAS group) were similar between the two groups. About 31.5% of patients in the pre‐ERAS group had higher Clinical Fragility Scale post‐operatively as compared with 7.8% in the ERAS group.ConclusionThe ERAS program shortened the length of hospital stay by 1.6 days, and patients had lower Clinical Fragility Scale post‐operatively. Adverse events were not increased. The ERAS program can be safely applied to elderly patients with colorectal cancer.

Neoadjuvant chemotherapy vs. upfront surgery for resectable colorectal liver metastases: a systemic review and meta‐analysis

AbstractPurposeTo compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastasesMethodsThe following electronic databases were searched for systematic literature: PubMed, Cochrane Library and Google Scholar. Studies that compared neoadjuvant chemotherapy and upfront surgery; patients with resectable metastases at the time of presentation were included; the long‐term results, including OS and DFS, were reported; and early adverse postoperative events, including 30‐day mortality and overall postoperative complications, were identified.ResultsOver 24 studies with 8,700 patients were analyzed; divided into the neoadjuvant chemotherapy group 3,490 patients (40.1%) and the upfront surgery group 5,172 patients (59.4%) respectively. The meta‐analysis showed no statistically significant difference in term of overall morbidities (OR: 1.19; 95% CI: 0.84–1.67) and mortality (OR: 1.48; 95% CI: 0.75–2.92) between the neoadjuvant chemotherapy and upfront surgery group. However, the meta–analysis showed a favorable OS in the upfront surgery group (OR: 1.21; 95% CI: 1.06–1.38) and favorable DFS in the upfront surgery group (OR: 1.71; 95% CI: 1.38–2.12; Figure 4), including the subgroup of 1, 3, 5–year DFS (OR: 1.38; 95% CI: 1.06–1.8, OR: 2.06; 95% CI: 1.35–3.14, and OR: 1.65; 95% CI: 1.18–2.29, respectively).ConclusionNeoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.This article is protected by copyright. All rights reserved.

Infrahyoid flap—a good substitute for free flaps in oral reconstruction during the <scp>COVID</scp>‐19 pandemic

AbstractAimDuring the coronavirus disease 2019 (COVID‐19) pandemic, experts have recommended simplifying the process of reconstruction following the extirpation of head and neck cancer by favouring the use of pedicled flaps over free flaps. This approach reduces the duration of the operation and mitigates the risk of free flap failure, which can be exacerbated by the hypercoagulopathy state seen in infected patients. We aim to contribute our experience with the pedicled infrahyoid flap, a procedure not previously reported in Hong Kong.Patients and MethodsWe conducted a retrospective study including patients who underwent infrahyoid flap reconstruction following resection of oral cavity cancer. Data for a total of nine patients were retrospectively retrieved from the hospital's computerised systems, and these patients were evaluated for demographic information, clinicopathologic parameters as well as oral function and reconstruction outcomes.ResultsAmong the nine infrahyoid flaps used, eight were myocutaneous flaps and one was a muscle flap. The dimensions of the flap skin ranged from 24.0 to 46.72 cm2. All of the flaps, with the exception of one case that experienced epidermolysis of the flap skin, exhibited complete survival. Fortunately, the epidermolysis healed without complications, such as the development of an orocutaneous fistula. The average time required for flap harvesting was approximately 1 hour. All nine patients were able to resume oral feeding and achieved satisfactory speech outcomes. Seven of these patients survived without any tumour recurrence, but unfortunately, two patients died due to lung metastases.ConclusionsThe infrahyoid flap proves to be a viable alternative to free flaps for the repair of medium‐sized oral defects, especially in compromised patients and during the COVID‐19 pandemic.

Acute appendicitis during the fifth wave of the <scp>COVID</scp>‐19 pandemic in a local cluster: A retrospective cohort study

AbstractIntroductionAcute appendicitis is a common surgical emergency. This study aims to determine whether there are any delays in patients attending the emergency department, potentially leading to an increase in the rates of complicated appendicitis and post‐operative complications during the fifth wave of the coronavirus disease 2019 (COVID‐19) pandemic in a local cluster in Hong Kong.MethodsIn this retrospective cohort study, we analysed 138 patients diagnosed with acute appendicitis during the fifth wave of the COVID‐19 pandemic and pre‐COVID‐19 period. The main study parameters were the duration between the onset of symptoms and attendance to the accident and emergency department, severity of appendicitis, post‐operative complication(s), operation time and total hospital length of stay.ResultsThere was no delay in presentation between the two groups of patients. The rates of complicated appendicitis and post‐operative complications were comparable between the two groups. There was a significantly shorter length of stay for patients with acute appendicitis patients during the fifth wave of the pandemic.ConclusionThe perspective of the general public towards the COVID‐19 pandemic is changing. Increased understanding of the COVID‐19 infection and availability of antiviral medications against COVID‐19 could be useful to eliminate patient's anxiety when attending medical care in public hospitals.

C‐reactive protein as an early predictor of anastomotic dehiscence in various types of reconstruction in elective abdominal surgery

AbstractObjectiveThe most important factor in abdominal surgery is the successful healing of the intestinal anastomosis performed. This study aims to evaluate the role of C‐reactive protein (CRP) in predicting anastomotic dehiscence in the first week following surgery.MethodsThe study included 100 patients surgically treated over a period of 1 year. Postoperative (p/o) values of CRP, leukocyte (white blood cells [WBCs]) and body temperature (BT) were measured in relation to the development of p/o complications.ResultsCRP p/o values were significantly higher in patients with complications and proved helpful in predicting p/o complications, while WBC and BT were not. For the development of anastomotic leakage, receiver operating characteristic curve shows the earliest diagnostic accuracy on the third p/o day with the cut‐off value of 115.1 mg/L; however, the largest area under the curve was on the fifth p/o day with a cut‐off value of 59.2 mg/L, a sensitivity of 89%, a specificity of 61%, a positive predictive value (PPV) of 21.9 and a negative predictive value (NPV) of 100.ConclusionsMeasurement of p/o CRP values may indicate problematic healing of digestive tract anastomosis before the appearance of clinical signs. High sensitivity and high NPV allow us to rule out p/o complications and anastomotic dehiscence with great certainty and safely discharge these patients from the hospital.

A short report regarding an economic and anatomy‐based simulated skin model

AbstractBackgroundConventionally, the Objective Structured Clinical Examination (OSCE) requires the recruitment of patients with appropriate physical signs, which became impossible during the fifth wave of the local COVID‐19 pandemic. To host the final OSCE without any actual patients, our department developed a skin model from readily available materials.SettingOne of the final‐year surgical OSCE stations focused on the identification and management of benign subcutaneous lesions, including sebaceous cysts (also called epidermal inclusion cysts) and lipomas.The designThe model starts with a low‐cost skin model from Limbs &amp; Things (cost: US $6.9–10/piece). The sebaceous cyst model involved dissection of the superficial ‘skin’ flap. The lesion was re‐created using gel held by a plastic wall created by a glove fingertip sealed off by silk sutures. Additional modifications were made to the lipoma model to differentiate these two types of lesions. The pass rate in this station was similar to that of actual patients. Assessment of the models by experienced surgeons showed that they were easy to differentiate and suitable for teaching and assessment.ConclusionThis anatomy‐based, low‐cost skin model is easily reproducible and might serve as a good adjunct for clinical year teaching and assessment.

Open Access
A prediction model for after postoperative outcome in SARS-CоV-2 patients: a retrospective observation study

Introduction. Coronavirus infection can complicate the perioperative course of any surgical intervention, posing an acute problem in surgical patients with COVID-19. At the same time, the risk factors and their contribution to the adverse outcome remain obscure.Objectives. This study aims to identify risk factors for postoperative death in patients diagnosed with SARS-CoV-2.Materials and methods. The study offers a retrospective analysis of data from 1029 patients at the Krasnodar Regional Clinical Hospital № 2, which had been converted into a COVID-19 treatment facility.Results. A total of 421 (41 %) patients underwent high-risk surgery. Mortality in the study cohort reached 21.2 %. Factors such as the ASA baseline physical status, age, surgery duration and the degree of lung damage seen on CT scans (CT-3 and CT-4) serve as independent predictors of death. Using these parameters makes it possible to predict perioperative mortality with high accuracy (AUROC = 0.814).Conclusion. The study examined risk factors for poor outcomes in surgery patients with COVID-19 and developed a model to predict death in this group of patients. The frequency of adverse outcomes after surgical treatment of patients with SARS-CоV-2 was relatively high, the predictors of death being advanced age, baseline physical status, surgery severity and duration, as well as the volume of lung damage seen on CT scans. The developed model allows accurate prediction of an unfavourable outcome.

Distal biceps tendon ruptures: clinical features, diagnostic strategy and treatment options

Relevance. This paper reviews the latest evidence concerning distal biceps tendon repair, particularly aspects such as tear type, patient demographics, diagnostic clues, surgical indications, the anatomy of distal tendon insertion, radial tuberosity, single- vs double-incision reconstruction, fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw) and postoperative outcomes.Material and methods. The MEDLINE, Cochrane, Web of Science, Scopus and Elibrary online databases were searched using the keywords ‘distal biceps tendon’, ‘elbow’, ‘intramedullary’, ‘partial’. ‘complete’, ‘review’ and ‘rupture’. Sixty publications on distal biceps tendon rupture treatment were identified that appeared over 60 years, between 1951 and October 2021.Results and discussion. The review has demonstrated that complete deltoid ligament (DBT) tears are predominantly diagnosed clinically, while medical imaging has proven to be a valuable adjunct for diagnosing partial tears. Advances in clinical and medical imaging of partial tears have the potential to expedite the diagnostic process and guide treatment strategies. Primary repair is commonly employed for complete tears, utilizing either a single-incision or double-incision approach, resulting in favorable clinical outcomes. However, the double-incision technique carries a higher risk of heterotopic ossification, whereas the single-incision approach presents a greater risk of nerve-related complications. To mitigate the risk of posterior interosseous nerve lesions in single-incision repairs, intramedullary fixation may serve as a viable solution. Additionally, DBT endoscopy holds promise for the treatment of low-grade partial tears and tendinosis.

Arthroscopic repair of the supraspinatus tendon with single-stage decompression of the suprascapular nerve at the superscapular notch

The history of shoulder problems dates back to ancient times, and the shoulder joint plays a significant role in various aspects of human life. Throughout history, doctors have been providing assistance to individuals experiencing shoulder pain. In the 20th century, significant advancements were made in shoulder surgery, driven by an improved understanding of joint biomechanics and the recognition of new diagnostic methods. Arthroscopy, a minimally invasive surgical technique, was first used for diagnosing shoulder conditions only about 30 years ago. Since then, it has replaced many open surgical procedures due to its enhanced visualization capabilities and lower invasiveness, leading to reduced injury rates. Suprascapular nerve decompression at the suprascapular notch is an example of a procedure that has benefited from arthroscopy. Dr. Laurent Lafosse's detailed description of arthroscopic manipulation in 2007 has been crucial in advancing this technique.This article aims to shed light on the pathogenesis of suprascapular nerve compression at the suprascapular notch following supraspinatus tendon retraction and examine the potential complications of suprascapular neuropathy. The principal author of this article has successfully performed 20 supraspinatus tendon repair operations with simultaneous decompression of the suprascapular nerve at the suprascapular notch, achieving positive outcomes in the postoperative period.