Clavien Dindo Research Articles

Self-reported exhaustion and a 4-item physical frailty index to predict the incidence of major complications after onco-geriatric surgery

BackgroundThe aim of this study was to analyze four pre-operative physical frailty indicators from a geriatric assessment (GA) independently and combined in a physical frailty index, in their ability to predict postoperative 30 d-complications. Materials and methodsIn this secondary analysis of data from the published PERATECS study (ClinicalTrials.gov: NCT01278537), the predictive value of four physical frailty indicators from a defined GA battery was examined with univariable and multivariate logistic regression models in a sample of 493 onco-geriatric surgical patients. The primary endpoint was incidence of major (Clavien–Dindo ≥ grade 2 [CD ≥ 2]) complications within 30 postoperative days.Predictors of the first model included self-reported exhaustion (SRE), body mass index (BMI), Timed Up-and-Go (TUG) and handgrip strength (HGS) independently, and a second model combined these four items as a Physical Frailty Index (4i-PFI). Both regression models were adjusted for age, gender, American Society of Anesthesiologists (ASA) status, tumor sites, duration of surgery time and Mini Nutritional Assessment (MNA) score. ResultsA total of 233 patients (47 %) developed CD ≥ 2 complications. In addition to ASA score, length of surgery, and gynecological and upper gastrointestinal tumor sites, the first model showed that SRE (OR 1.866) predicted CD ≥ 2 complications, but not TUG, BMI and HGS. In the second model, the 4i-PFI predicted CD ≥ 2 complications (OR pre-frail = 1.808, frail = 3.787). ConclusionsPhysical frailty indicators as SRE revealed a better ability to predict CD ≥ 2 complications than BMI, TUG and HGS. However, prediction of CD ≥ 2 complications was enhanced when these parameters were combined in a novel 4i-PFI.

Laparoscopic versus open abdominal lymph node dissection for esophageal squamous cell carcinoma: a propensity score matching analysis.

To compare the short- and long-term outcomes of laparoscopic and open abdominal lymph node dissection using propensity score matching (PSM) analysis. The subjects of this retrospective analysis were 459 patients who underwent curative resection for esophageal squamous cell carcinoma (ESCC) between May, 2005 and December, 2019, at our hospital. Patients were divided into two groups: the Laparoscopic (Lap group) and the Open (Open group). Post-PSM, 139 patients from each group were selected for the analysis to compare the short- and long-term outcomes between the groups. The Lap group experienced fewer Clavien-Dindo (CD) Grade ≥ 2 complications (28.1% vs. 40.3%, P = 0.04) and lower rates of abdominal surgical site infections (SSI) (2.9% vs. 7.9%, P = 0.02) than the Open group. The number of lymph nodes harvested was similar in the Lap and Open groups (14.8 ± 7.5 vs. 15.7 ± 8.6, P = 0.34). There was no significant difference in 3-year overall survival rates (81.2% vs. 69.5%, P = 0.12) or relapse-free survival rates (61.1% vs. 58.2%, P = 0.54) between the groups. Laparoscopic abdominal lymph node dissection for ESCC can be performed safely and appears to be beneficial.

Histopathologic response in patients with curative resection with D2 dissection following neoadjuvant treatment for locally advanced gastric and esophagogastric junction adenocarcinoma

AimThis study evaluated pathologic response rate, overall survival (OS), and postoperative complications in locally advanced gastric cancer (GC) and esophagogastric junction (EGJ) adenocarcinoma patients who underwent curative gastric resection D2 lymph node dissection with neoadjuvant treatment. MethodsWe reviewed the medical records of 122 patients with locally advanced GC and EGJ adenocarcinoma who had neoadjuvant treatment and curative resection with D2 dissection between January 2014 and December 2022. Patients were divided into responders and nonresponders. Grades 1a-1b were responders, while 2–3 were non-responders. Patients' clinicopathological features, pathologic response rate, survival, and postoperative complications were evaluated. We assessed complications using the Clavien-Dindo (CD) classification. Total survival was assessed using the Kaplan-Meier model. Overall survival was assessed using univariate and multivariate Cox regression analysis. ResultsThe mean age of the study participants was 61 (N = 89 males; N = 33 females). There were 79 GC and 43 EGJ adenocarcinomas. Overall postoperative complications (CD ≥ II) were 27 %. Postoperative complications were similar in responders and non-responders (p = 0.316). YpT0N0 had a 2.5 % pathological complete response rate. Responders had better overall survival, but there was no statistical difference. ConclusionsBoth responder and non-responder groups have similar postoperative complications. A complete pathologic response is discouraging for assessing neoadjuvant chemotherapy for locally advanced gastric cancer, but a positive treatment response is acceptable. Pathologic response rate helps stage and predict gastric cancer prognosis. Responder groups survive slightly better.

Step by step technique of Stentless Florence Robotic Intracorporeal Neobladder (FloRIN), does the ureteral management influence functional outcomes?

Benefits and harms of avoid the sent placement during IntraCorporeal Neobladder configuration are still debated. Our objective was to describe the step-by-step technique of Florence intracorporeal neobladder (FloRIN) configuration performed with stentless procedure focusing on perioperative and mid-term functional outcomes. In this single institution prospective randomized 1:1 series all consecutive patients underwent Robot-Assisted Radical Cystectomy (RARC) and FloRIN reconfiguration from January 2021 to March 2021 were enrolled. Functional perioperative and mid-term outcomes were gathered. Postoperative complications were graded according to Clavien-Dindo classification and divided in early (<30 days from discharge) and delayed (>30 days). Overall, 10 patients were included in the analysis. Of these, the 50.0% was treated with Stentless FloRIN. In terms of baseline features, no differences were recorded between the two groups. Median age was 65 and 66 years while median BMI was 27 and 25 in the stentless and in the stent group, respectively. Concerning intraoperative variables, no intraoperative complications as well as open conversion occurred among both groups. As regard introperative features, a shorter console time was associated with stentless procedure (331 min vs 365 min). In terms of perioperative outcomes, canalization and time to drainage removal didn't differ between groups while length of hospital stay was significantly lower in stentless group 10 days versus 14 days. Early and delayed postoperative complication rate was not influenced by the ureteral management at a preliminary assessment with comparable rates of Clavien Dindo ⩾ 3a between the two groups. Mid-term functional outcomes did not differ between groups in terms of kidney function loss. FloRIN with Stentless technique showed functional and perioperative preliminary outcomes comparable with the standard ureteral management strategy. Further series with longer functional follow-up assessment will be needed to confirm our preliminary results.

Aquablation versus HoLEP in patients with benign prostatic hyperplasia: a comparative prospective non-randomized study

PurposeThe question of best surgical treatment for lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) remains controversial. We compared the outcomes of aquablation and holmium laser enucleation of the prostate ("HoLEP") in a prospective cohort.MethodsPatients with BPH underwent aquablation or HoLEP according to their preference between June 2020 and April 2022. Prostate volume (“PV”), laboratory results, postvoid residual volume, uroflowmetry, IPSS, ICIQ-SF, MSHQ-EjD, EES and IIEF were evaluated preoperatively and at three, six and 12 months postoperatively. We also analyzed perioperative characteristics and complications via the Clavien Dindo („CD“) classification.ResultsWe included 40 patients, 16 of whom underwent aquablation and 24 HoLEP. Mean age was 67 years (SD 7.4). Baseline characteristics were balanced across groups, except the HoLEP patients’ larger PV. IPSS fell from 20.3 (SD 7.1) at baseline to 6.3 (SD 4.2) at 12 months (p < 0.001) without differences between aquablation and HoLEP. HoLEP was associated with shorter operation time (59.5 (SD 18.6) vs. 87.2 (SD 14.8) minutes, p < 0.001) and led to better PV reduction over all timepoints. At three months, aquablation’s results were better regarding ejaculatory (p = 0.02, MSHQ-EjD) and continence function (p < 0.001, ICIQ-SF). Beyond three months, erectile, ejaculatory, continence function and LUTS reduction did not differ significantly between aquablation and HoLEP. CD ≥ grade 3b complications were noted in six patients in aquablation group while only one in HoLEP group (p = < 0.01).ConclusionsWhile aquablation revealed temporary benefits regarding ejaculation and continence at three months, HoLEP was superior concerning operation time, the safety profile and volumetric results.

Thirty- and 90-Day Morbidity and Mortality by Clavien-Dindo after Surgery for Antireflux and Hiatal Hernia.

The historic morbidity and mortality rates of antireflux and hiatal hernia operation are reported as 3% to 21% and 0.2% to 0.5%, respectively. These data come from either large national and population level or small institutional studies, with the former focusing on broad 30-day outcomes while lacking granular data on complications and their severity. Institutional studies tend to focus on long-term and quality-of-life outcomes. Our objective is to describe and evaluate the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset. We retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days. All complications were graded using the Clavien-Dindo (CD) grading system. The highest grade of complication was used per patient during 30- and 31- to 90-day intervals. Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were CD less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338). Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity. However, the majority of complications patients experience are minor (CD less than 3a) and are easily managed. A minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent.

Robot-assisted partial nephrectomy in patients aged 75 years or older – comparing the risk of complications with their younger counterparts

Background & aimMore elderly patients are diagnosed with kidney tumors where partial nephrectomy is technically possible. We investigated whether patients ≥ 75 years old had an increased risk of complications following robot-assisted partial nephrectomy (RAPN) compared to younger patients.MethodsRetrospective, consecutive study including patients who underwent RAPN between May 2016 – April 2023. Preoperative data, operative data and complications within 90 days were recorded by patient record review. Complications were classified according to Clavien-Dindo (CD).Results451 patients underwent RAPN and a postoperative complication was recorded in 131 (29%) patients of which 28 (6%) were CD ≥ III. Any postoperative complication was recorded in 24/113 patients (21%) < 55 years, 40/127 patients (31%) 55–64 years, 45/151 patients (42%) 65–74 years, and 22/60 patients (37%) ≥ 75 years. Comparable numbers for a CD ≥ III postoperative complication were 2/113 (2%) < 55 years, 6/127 (7%) 55–64 years, 12/151 (8%) 65–74 years, and 5/60 (8%) ≥ 75 years. In multivariate logistic regression analysis, patients ≥ 75 years had a non-significant increased risk of complications when controlling for preoperative variables (OR 1.82 [95% CI 0.80–4.13]) or perioperative variables (OR 1.98 [95% CI 0.86–4.58]) compared to patients < 55 years. Two patients died postoperatively. Both were ≥ 75 years (2/60, 3%).Discussion and conclusionsSelected patients ≥ 75 years can undergo RAPN without a significantly increased risk of postoperative complications. However, a mortality rate of 3% in this age group indicates that these patients are frail when postoperative complications occur.

Treatment Outcomes in Octogenarians with Chronic Limb-Threatening Ischemia after Infrainguinal Bypass Surgery or Endovascular Therapy

ObjectiveThis study aimed to analyze the clinical outcomes after revascularization for CLTI in patients aged ≥80 years and <80 years. MethodsWe retrospectively analyzed multicenter data of 789 patients who underwent infrainguinal revascularization for CLTI between 2015 and 2021. The endpoints were 2-year overall survival (OS), amputation free survival (AFS), limb salvage (LS), and postoperative complications. ResultsA total of 90 patients aged ≥80 years and 200 patients aged <80 years underwent bypass surgery (BSX), and 205 patients aged ≥80 years and 294 patients aged <80 years underwent endovascular therapy (EVT). Before the propensity score matching (PSM), multivariate analyses showed that age ≥80 years, lower body mass index (BMI) and serum albumin levels, nonambulatory status, and end-stage renal disease were independent risk factors for 2-year mortality in the BSX and EVT groups. After PSM, the 2-year OS was better in the <80 years cohort than in the ≥80 years cohort in both the BSX and EVT groups (P = .018 and P = .035, respectively). There was no difference in the 2-year LS rates between the <80 years and the ≥80 years cohorts in both the BSX and EVT groups (P = .621 and P = .287, respectively). According to the number of risk factors, except for age ≥80 years, there was no difference in the 2-year AFS rates between the <80 years and ≥80 years cohorts for the BSX and EVT groups with 0–1 risk factor (P = .957 and P = .655, respectively). However, the 2-year AFS rate was poor, especially in the ≥80 years cohort in the BSX with 2–4 risk factors (P = .015). The Clavien–Dindo ≥IV complication rates tended to be higher in the ≥80 years cohort than in the <80 years cohort only in the BSX with 2–4 risk factors (P = .056). ConclusionsPatients with CLTI aged ≥80 years had poorer OS than those aged <80. However, there was no difference in LS between the ≥80 years and <80 years cohorts in both the BSX and EVT groups. Although age ≥80 years was associated with poorer OS, patients with 0–1 risk factor may benefit from revascularization, including BSX, because no difference was observed in AFS or Clavien–Dindo ≥IV complications.

Single Port Radical Prostatectomy as a Viable Option for Highly Complex Patients: A Single Center Experience

ObjectiveTo explore the safety and feasibility of the Da Vinci® Single-Port (SP) platform in Robotic-Assisted Radical Prostatectomy (SP-RARP), aiming to provide a viable option for patients with surgical and medical complexities that might otherwise limit their access to common minimally invasive technique. MethodsData from 60 medically and surgically highly complex patients undergoing SP-RARP between December 2018 and December 2023 were analyzed. Variables included patient characteristics, surgical history, intraoperative and postoperative outcomes. Statistical analysis was conducted using Stata® 17.0. ResultsFifty-three percent of cases had a hostile abdomen (HA) (≥1 major abdominal surgery), and 47% were medically highly complex (American Society of Anesthesiologists score ≥3, Charlson Comorbidity Index ≥5 and a Body Mass Index ≥30). The extraperitoneal approach was used in 56% of HA cases and 68% of MHC cases. Intraoperative complications occurred in 12%, exclusively with the transperitoneal approach in HA cases. Postoperative complications (Clavien Dindo ≥3) were 6% and 14%, respectively, with no significant difference between approaches. Same-day discharge was possible in 44% of HA cases and 54% of MHC cases, with significant statistical differences favoring the extraperitoneal approach in both groups. ConclusionSP-RARP, particularly the extraperitoneal approach, is a viable option for highly complex and challenging cases, providing acceptable oncological and functional outcomes. Prospective studies are crucial for further validating the safety and feasibility of SP-RARP in this patient population.

Clinicopathological Features and Survival Outcomes of Resected Lung Adenosquamous Carcinoma: Results From a Nationwide Japanese Registry Data

ObjectivesThe objective of this study was to clarify the clinicopathological features and prognostic factors of resected lung adenosquamous carcinoma (ASC) using a nationwide multi-institutional database. MethodsWe retrospectively reviewed the records of 15,542 patients who underwent complete R0 resection for ASC (n = 326), adenocarcinoma (AC, n = 11,820), or squamous cell carcinoma (SC, n = 3396) from a Japanese lung cancer registry in 2010. To reduce the selection bias, an inverse probability of treatment weighting (IPTW) method using a propensity score was implemented. ResultsThe ASC group showed worse recurrence-free and overall survival (RFS and OS) than both the AC and SC groups (5-year OS: 57.5% in ASC, 83.9% in AC [< 0.001], and 62.3% in SC [P = .086]). In multivariate analyses, prognostic factors that affected OS for ASC included male, p-stage II-III, and postoperative complications within 30 days (grade ≥ 3 in the Clavien–Dindo classification). The sensitizing EGFR mutation was detected in 28 (21.5%) of 130 screened patients with ASC, but it did not affect either RFS, OS, or postrecurrence survival. Although more patients in the ASC group received adjuvant chemotherapy compared to the AC and SC groups, both multivariate and IPTW-adjusted analyses did not show positive impact of adjuvant chemotherapy on RFS and OS in ASC. ConclusionsIn this nationwide registry study, lung ASC was more aggressive than both AC and SC. No apparent survival impact of conventional adjuvant chemotherapy prompted us to investigate novel adjuvant strategies to optimize survival outcomes.

Monopolar electrocautery versus scalpel for pancreatic neck transection during open pancreatoduodenectomy: A retrospective, registry-based study

BackgroundThe method of transecting the pancreatic parenchyma during pancreatic resection may influence the rate of complications, including pancreatic fistula and bleeding. The objective of this study was to compare the transection of the pancreatic parenchyma during pancreatoduodenectomy with monopolar electrocautery versus scalpel in terms of postoperative complications. MethodsA retrospective analysis of patients with open pancreatoduodenectomy from the German DGAV StuDoQ|Pancreas registry (January 2013 to December 2021) was performed. Transection of the pancreatic parenchyma with a scalpel versus monopolar electrocautery was compared regarding postoperative pancreatic fistula B/C, post-pancreatectomy hemorrhage B/C, and major complications (Clavien–Dindo classification ≥3) rates. Multivariable analysis with adjustment for potential confounders and surgical center cluster effect was performed. ResultsOverall, 6,752 patients were included in the study. In 4,072 (60.3%), transection was performed with a scalpel and, in 2,680 (39.7%), with electrocautery. Transection with electrocautery was associated with higher postoperative pancreatic fistula B/C (15.4% vs 12.8%; P = .003), post-pancreatectomy hemorrhage B/C (11% vs 7.4%; P < .001), and major complications (33.4% vs 29.6%; P = .001) rates. In the multivariable analysis, after adjustment for potential confounders and surgical center, the association of the transection method with postoperative pancreatic fistula B/C (odds ratio = 1.01; 95% CI, 0.79–1.2; P = .962), post-pancreatectomy hemorrhage B/C (odds ratio = 1.23; 95% CI, 0.94–1.6; P = .127), and major complications (odds ratio = 1.09; 95% CI, 0.93–1.27; P = .297) was not significant. ConclusionThe study found no significant association between transection of the pancreatic parenchyma during open pancreatoduodenectomy with a scalpel compared with monopolar electrocautery regarding pancreatic fistula, postoperative bleeding, or overall major complication rates.

30-day morbidity and mortality of revisional bariatric surgery – An international multi-centre collaborative (BROAD) study

IntroductionRevisional bariatric surgery (RBS) for insufficient weight loss/weight regain or metabolic relapse is increasing worldwide. There is currently no large multinational, prospective data on 30-day morbidity and mortality of RBS. In this study, we aimed to evaluate the 30-day morbidity and mortality of RBS at participating centres. MethodsAn international steering group was formed to oversee the study. The steering group members invited bariatric surgeons worldwide to participate in this study. Ethical approval was obtained at the lead centre. Data were collected prospectively on all consecutive RBS patients operated between 15th May 2021 to 31st December 2021. Revisions for complications were excluded. ResultsA total of 65 global centres submitted data on 750 patients. Sleeve gastrectomy (n = 369, 49.2 %) was the most common primary surgery for which revision was performed. Revisional procedures performed included Roux-en-Y gastric bypass (RYGB) in 41.1 % (n = 308) patients, One anastomosis gastric bypass (OAGB) in 19.3 % (n = 145), Sleeve Gastrectomy (SG) in 16.7 % (n = 125) and other procedures in 22.9 % (n = 172) patients. Indications for revision included weight regain in 615(81.8 %) patients, inadequate weight loss in 127(16.9 %), inadequate diabetes control in 47(6.3 %) and diabetes relapse in 27(3.6 %). 30-day complications were seen in 80(10.7 %) patients. Forty-nine (6.5 %) complications were Clavien Dindo grade 3 or higher. Two patients (0.3 %) died within 30 days of RBS. ConclusionRBS for insufficient weight loss/weight regain or metabolic relapse is associated with 10.7 % morbidity and 0.3 % mortality. Sleeve gastrectomy is the most common primary procedure to undergo revisional bariatric surgery, while Roux-en-Y gastric bypass is the most commonly performed revision.

Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study

IntroductionIt is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC).The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report. MethodsObservational and prospective cohort study.The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI). ResultsThe percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively.The combination of sources improved CCI agreement by 8%–40% in the overall series and 39.1–89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %–67.5% in operations of greater complexity.The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively. ConclusionsThe combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

Outcomes of Resection Anastomosis versus Hartmann’s Procedure in Sigmoid Volvulus

AIM: This study seeks to ascertain the comparative efficacy between the Hartmann procedure (HP) and resection anastomosis (RA), with or without concurrent fecal diversion, as surgical interventions for Sigmoid Volvulus (SV). The primary objective is to discern the procedure associated with a more favorable clinical outcome. MATERIAL AND METHOD: The study cohort comprised individuals who underwent surgical intervention for SV within the timeframe of 2010 to 2022 at our clinical facility. Demographic particulars encompassing gender and age, as well as comorbid conditions, ASA scores, procedural modalities, postoperative untoward events, and duration of inpatient care, were sourced from the patient database. Evaluation of postoperative complications, occurring within the 30-day window post-surgery, was undertaken in conformity with the Clavien Dindo (CD) classification schema. Statistical analyses encompassing the Mann Whitney U test and chi-square test were applied for data interpretation. Variables with p-values below 0.05 were deemed to possess statistical significance. RESULTS: The study encompassed a total of 125 patients, of whom 99 (79.2%) were male. Among these, 51 (40.8%) patients were allocated to the HP group, while 74 (59.2%) were assigned to the RA group. Concerning hospitalization duration, the median period was 8 (2-30) days in the HP group and 10 (3-35) days in the RA group (p=0.013). In accordance with the CD Classification, 68 (54.4%) patients encountered complications linked to the surgical procedure, with 11 (8.8%) patients experiencing procedure-associated mortality. Despite the observed statistically significant inter-group variance, it was discerned that HP exhibited a superior performance in terms of complications when compared to RA (p=0.048). CONCLUSION: Significantly reduced durations of hospitalization and fewer occurrences of postoperative complications were observed within the cohort undergoing the Hartmann's procedure. As a result, we advocate that clinicians consider prioritizing the implementation of Hartmann's procedure for patients undergoing surgical intervention for SV.

Management of giant colorectal polyps (≥3 cm) by endoscopic submucosal dissection (ESD) versus surgery: a propensity score–based analysis

AbstractAimGiant colorectal polyps (≥3 cm) can be managed by endoscopic excision or surgical resection. There has been a shift to endoscopic submucosal dissection (ESD) for the treatment of such lesions as the expertise in advanced therapeutic endoscopy develops. This study aims to compare the outcome and safety profile of ESD against surgical resection for patients with giant colorectal polyps.MethodsWe performed a retrospective review on patients with giant colorectal polyps removed by either ESD or surgery over a 10‐year period (from May 2010 to September 2020) in a regional hospital in Hong Kong. Propensity score matching was performed based on patient demographics and polyp characteristics. Outcomes including polyp histology, complication rates, length of hospital stay, and re‐admission rates were analysed.ResultsFifty‐one patients (ESD group: 34, surgery group: 17) were included in the analysis. The mean polyp diameter was 3.35 cm (ESD group) and 3.53 cm (surgery group). The median procedure time was comparable (160 vs 167 min; P = .251) and the most common polyp histological type was tubulovillous adenoma (44.1% vs 47.1%; P = .130) for both groups. A shorter median length of stay (1 day vs 6 days; P = .028) and lower re‐admission rate (0% vs 5.9%; P &lt; .001) were observed in the ESD group, whereas a higher major complication rate (Clavien–Dindo classification grade IIIa or above; 2.9% vs 11.7%; P = .013) was observed in the surgery group.ConclusionsESD is a safe and effective treatment for giant colonic polyps with ESD size ≥3 cm. It has the advantage of lower complication rates, shorter length of hospital stays, and lower re‐admission rates compared with surgical resection.

Transurethral water vapour therapy (Rezūm) for catheter‐dependent men secondary to benign prostatic hyperplasia: A retrospective study in a Hong Kong population

AbstractAimRezūm is a novel treatment for patients with moderate to severe lower urinary tract symptoms as a result of benign prostatic hyperplasia (BPH). Recently, it has expanded to patients with urinary retention causing catheter dependence and the results are promising in Whites. However, it is unclear how effective Rezūm is in the Chinese population. Here, we report our experience in performing Rezūm on catheter‐dependent Chinese men with BPH and evaluate its safety and efficacy.MethodsA retrospective review of catheter‐dependent patients with BPH who underwent Rezūm from January to August 2022 was conducted. We evaluated the success rate of trial without catheter (TWOC) and compared pre‐ and post‐operative (at 6 months) uroflowmetry results, International Prostate Symptoms Score (IPSS), IPSS Quality of Life Score (IPSS QoL), and prostate volume.ResultsSixty‐three patients had Rezūm performed (44 and 19 patients had refractory urinary retention and obstructive uropathy, respectively) with a mean age of 74 years and a mean prostate size of 53.9 mL. The first attempt at TWOC was successful in 53 patients (85.5%; range 15–44 days post‐operation). By 98 days after the operation, all patients could void spontaneously. The 6‐month follow‐up showed that IPSS and IPSS QoL scores decreased by a mean of 9.0 and 1.8 points, respectively (both P &lt; .01). The mean pre‐operative post‐voided residual urine was reduced by 559 mL (P &lt; .01), with a mean prostate size reduction of 9.4 mL (P &lt; .01). Seven patients had non‐serious complications (Grade 1–2 Clavien–Dindo classification) within 30 days of operation.ConclusionRezūm was shown to be effective and safe in catheter‐dependent Chinese men with BPH.

The survival benefit of metastasectomy for metastatic non-clear cell renal cell carcinoma: a retrospective cohort study

PurposeThe aim of this study was to explore the benefit the metastasectomy for patients with metastatic non-clear cell carcinoma (non-ccRCC).MethodsThis study enrolled 120 patients with confirmed metastatic non-ccRCC from the RCC database of our center from 2008 to 2021. Patients without metastasectomy were grouped as radical nephrectomy without metastasectomy patients. The clinical outcomes included overall survival (OS) and progression-free survival (PFS). Cox regression and Kaplan–Meier analyses were used to assess potential factors that predict clinical benefits from metastasectomy.ResultsA total of 100 patients received radical nephrectomy alone, while the remaining 20 patients underwent both radical nephrectomy and metastasectomy. There was no significant difference in age between the two groups. Out of 100 patients who underwent radical nephrectomy, 60 were male, and out of 20 patients who had both radical nephrectomy and metastasectomy, 12 were male. Patients who underwent systemic therapy plus radical nephrectomy and metastasectomy had significantly better PFS (27.1 vs. 14.0, p = 0.032) and OS (67.3 vs. 24.0, p = 0.043) than those who underwent systemic therapy plus radical nephrectomy alone. Furthermore, for patients without liver metastasis (n = 54), systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.028) and OS (p = 0.043). Similarly, for patients with metachronous metastasis, systemic therapy plus radical nephrectomy and metastasectomy improved both PFS (p = 0.043) and OS (p = 0.032). None of the patients experienced serious perioperative complications (Clavien–Dindo Classification ≥ III grade).ConclusionMetastasectomy in patients with metastatic non-ccRCC may provide clinical benefits in terms of improved PFS and OS, especially in patients without liver metastasis and those with metachronous metastasis.

Safety and complications of continuation of aspirin therapy in patients undergoing robot-assisted laparoscopic simple prostatectomy

To evaluate the safety and feasibility of continued perioperative aspirin at the time of robotic assisted simple prostatectomy (RASP). We performed a retrospective review of our IRB approved institutional database of patients who underwent RASP between 2013 and 2022. Comparative groups included patients taking aspirin in the perioperative period and those not taking aspirin pre-operatively. The primary outcome was any post-operative bleeding related complication using the modified Clavien–Dindo classification. Secondary outcomes included the identification of risk factors for increased blood loss in the entire study population, operative time, and blood transfusion requirement. 143 patients underwent RASP of which 55 (38.5%) patients continued perioperative aspirin therapy and 88 (61.5%) patients did not. Baseline demographics were similar between groups. Patients taking perioperative aspirin had a higher rate of hypertension (74.5% vs 58.0%, p = 0.04) and other cardiovascular disease (30.9% vs 11.4%, p = 0.007). Postoperative complications were similar between the groups (Clavien-Dindo ≥ 3; p = 0.43). Median blood loss (150 cc vs 150 cc, p = 0.38), percentage drop in hemoglobin (13.4 vs 13.2, p = 0.94) and blood transfusion rate (3.6 vs 1.1, p = 0.56) were also similar between groups. The median blood loss was 150 ml for the whole study population. On regression analysis, neither aspirin nor any other variable was associated with increased blood loss (> 150 ml). Aspirin can be safely continued perioperatively in patients undergoing RASP without any risk of bleeding related complications, blood loss, or increased transfusion rate.

Minimally invasive versus open multivisceral resection for rectal cancer clinically invading adjacent organs: a propensity score-matched analysis

BackgroundMinimally invasive surgery (MIS), such as laparoscopic and robotic surgery for rectal cancer, is performed worldwide. However, limited information is available on the advantages of MIS over open surgery for multivisceral resection for cases clinically invading adjacent organs.Patients and methodsThis was a retrospective propensity score-matching study of consecutive clinical T4b rectal cancer patients who underwent curative intent surgery between 2006 and 2021 at the University of Tokyo Hospital.ResultsSixty-nine patients who underwent multivisceral resection were analyzed. Thirty-three patients underwent MIS (the MIS group), while 36 underwent open surgery (the open group). Twenty-three patients were matched to each group. Conversion was required in 2 patients who underwent MIS (8.7%). R0 resection was achieved in 87.0% and 91.3% of patients in the MIS and open groups, respectively. The MIS group had significantly less blood loss (170 vs. 1130 mL; p < 0.0001), fewer Clavien–Dindo grade ≥ 2 postoperative complications (30.4% vs. 65.2%; p = 0.0170), and a shorter postoperative hospital stay (20 vs. 26 days; p = 0.0269) than the open group. The 3-year cancer-specific survival rate, relapse-free survival rate, and cumulative incidence of local recurrence were 75.7, 35.9, and 13.9%, respectively, in the MIS group and 84.5, 45.4, and 27.1%, respectively, in the open group, which were not significantly different (p = 0.8462, 0.4344, and 0.2976, respectively).ConclusionMIS had several short-term advantages over open surgery, such as lower complication rates, faster recovery, and a shorter hospital stay, in rectal cancer patients who underwent multivisceral resection.Graphical abstract

Pressurised Intraperitoneal Aerosolised Chemotherapy-Results from the First Hundred Consecutive Procedures.

PIPAC is a new and promising technique for the intraperitoneal administration of chemotherapy. It can be used in patients with various peritoneal cancer metastases. It is mainly a palliative treatment, but there is some neoadjuvant treatment potential. We have operated on 41 patients with various intra-abdominal cancers. PIPAC was performed every 6 weeks. The indication was extension of peritoneal carcinomatosis beyond the criteria for cytoreductive surgery and HIPEC. The effect was evaluated according to the peritoneal cancer index, the peritoneal regression grading score and the amount of ascites. Complications were classified according to the Clavien-Dindo system. We have performed 100 PIPAC procedures. There were two major complications, classified as Clavien Dindo III (2%). The number of procedures varied from 1 to 6. Five patients switched to cytoreductive surgery and HIPEC, and one was indicated for the watch and wait strategy due to total regression according to PRGS. Three patients are still continuing treatment. The others stopped treatment mainly because of progression of the disease and loss of metastases. We observed a reduction in ascites production soon after PIPAC application. PIPAC is a safe and well-tolerated treatment modality. It is mainly a palliative treatment that can improve the quality of life by reducing the production of ascites, but in about 10% of cases, it can reduce the extent of the disease and allow for further radical treatment.