Complete Surgery Research Articles

Honeycomb-like Structured Film, a Novel Therapeutic Device, Suppresses Tumor Growth in an In Vivo Ovarian Cancer Model.

Ovarian cancer cell dissemination can lead to the mortality of patients with advanced ovarian cancer. Complete surgery for no gross residual disease contributes to a more favorable prognosis than that of patients with residual disease. HCFs have highly regular porous structures and their 3D porous structures act as scaffolds for cell adhesion. HCFs are fabricated from biodegradable polymers and have been widely used in tissue engineering. This study aimed to show that HCFs suppress tumor growth in an in vivo ovarian cancer model. The HCF pore sizes had a significant influence on tumor growth inhibition, and HCFs induced morphological changes that rounded out ovarian cancer cells. Furthermore, we identified gene ontology (GO) terms and clusters of genes downregulated by HCFs. qPCR analysis demonstrated that a honeycomb structure downregulated the expression of CXCL2, FOXC1, MMP14, and SNAI2, which are involved in cell proliferation, migration, invasion, angiogenesis, focal adhesion, extracellular matrix (ECM), and epithelial-mesenchymal transition (EMT). Collectively, HCFs induced abnormal focal adhesion and cell morphological changes, subsequently inhibiting the differentiation, proliferation and motility of ovarian cancer cells. Our data suggest that HCFs could be a novel device for inhibiting residual tumor growth after surgery, and could reduce surgical invasiveness and improve the prognosis for patients with advanced ovarian cancer.

The effects of neutral argon plasma versus electrocoagulation on tissue in advanced-stage ovarian cancer: a case series

BackgroundThe aim of surgery for advanced-stage ovarian cancer is a complete cytoreduction, because this is the most important independent prognostic factor for prolonged survival. Yet this can be difficult to achieve when there are micrometastases on the intestinal mesentery or intestines. The PlasmaJet device is an instrument to remove these micrometastases, but little is known about the depth of damage in human tissue compared to electrocoagulation devices.MethodsA prospective study was performed for the ex-vivo comparison of the histological depth of thermal damage of neutral argon plasma (PlasmaJet®) and electrocoagulation devices, in a series of 106 histological slides of 17 advanced-stage ovarian cancer patients. Depending on the tissue types resected during complete cytoreductive surgery, samples were collected from reproductive organs (uterus, ovaries), intestines (ileum, colon, rectum) and omentum, intestinal mesentery and peritoneum.ResultsAverage thermal damage depth was 0.15 mm (range 0.03–0.60 mm) after use of neutral argon plasma and 0.33 mm (range 0.08–1.80 mm) after use of electrocoagulation (p < 0.001). Greater disruption of the tissue surface was often observed after electrocoagulation.ConclusionOur case series suggests that the use of neutral argon plasma during cytoreductive surgery produces significantly less thermal damage than electrocoagulation treatment. It is therefore considered a thermally safe alternative, aiding in the achievement of cytoreductive surgery.

Survival analysis and obstetric outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery

ObjectiveThe aim of the present study is to evaluate the long-term outcomes in patients with early stage ovarian cancer undergoing fertility-sparing surgery.MethodsThe present study performed a retrospective analysis of recurrence, pregnancy and survival of a total of 66 patients who were diagnosed with early stage ovarian cancer (stage I) in XXX Faculty of Medicine Hospital between 2004 and 2019. Of these patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical surgery.ResultsOf 66 eligible patients, 16 had undergone fertility-sparing surgery, and the remaining 50 patients had undergone radical complete surgery. When demographic and descriptive data are taken into consideration, the mean age was 32.6 ± 6.76 years in patients undergoing fertility-sparing surgery and 54.05 ± 10.8 years in patients undergoing complete surgery, and the difference between the groups was statistically significant (p = 0.001). Of patients undergoing fertility-sparing surgery, 11 (16.7%) had stage Ia disease (most common), 5 (7.5%) had stage Ic disease, whereas no patient with stage Ib disease was detected. Of patients undergoing complete radical surgery, 32 (48.5%) had stage Ia disease (most common), 1 (1.5%) had stage Ib disease with bilateral ovarian involvement, and stage Ic was the second most common disease stage. Also, stage Ic3 was the most common disease stage (8 patients, 12.1%) among those with stage Ic disease. The rate of recurrence was 4.5% (3 patients) in patients undergoing fertility-sparing surgery, and recurrences occurred at 37 months, 69 months, and 76 months, respectively. A patient with stage Ic3 disease and endometrioid type tumor who developed recurrence at 37 months died at 130 months. Of patients undergoing complete surgery, ten patients (15.2%) developed recurrence, and there was no significant difference between the two groups in terms of recurrence (p = 1.00). At the end of 15-year follow-up period, there was no significant difference between patients undergoing fertility-preserving surgery and those undergoing complete surgery in terms of mortality (p = 0.668).ConclusionThe observation of significant findings in terms of the rate of recurrence and disease-free survival following fertility-sparing surgery in patients with low-risk early stage ovarian cancer suggests that survival is positively affected in early stage ovarian cancer.

Anatomical type analysis of right interlobar artery based on chest thin-slice CT scan and three-dimensional reconstruction

PurposeTo analyse and summarize branching pattern types of the interlobar portion of right pulmonary arteries (RPA) through chest thin-slice CT scans and three-dimensional reconstruction.MethodsA total of 179 patients (58 males and 121 females, with an average age of 53.9 years) at the Thoracic Surgery Department of Ningbo First Hospital were retrospectively included from December 2020 to December 2021. All patients completed preoperative thin-slice CT scans and three-dimensional reconstructions of the chest. The clinical data and branching patterns were collected. Data were analysed using SPSS 21.0.ResultsThe branching pattern types of the interlobar portion of RPA were divided into 4 types according to the order and number of branches: Type I (145/179, 81.0%), Asc. A2, MA, A6; Type II (28/179, 15.6%), Asc. A2 deletion, MA, A6; Type III (5/179, 2.8%), Asc. A2, A6, MA; and Type IV (1/179, 0.6%), MA, Asc. A2, A6. Type I was the most common pattern. Furthermore, according to the number of branches of MA and A6, this pattern can be subdivided into 15 subcategories.ConclusionChest thin-slice CT scans and 3D reconstructions can provide surgeons with accurate lung anatomy, which helps surgeons perform preoperative planning and complete surgery successfully.

Hemithyroidectomy in Papillary Thyroid Cancers: A Prospective, Single Institutional Surgical Audit and Contemplating on the Clinical Implications of 2015 American Thyroid Association Guidelines.

Papillary thyroid carcinoma (PTC) contributes to 88% of thyroid malignancies and its extent of surgical management has been a topic of debate in the past 2 decades. American thyroid association (ATA) recommendations have been periodically updated for its robust and evidence-based management. We present our experience in implementing 2015 ATA guidelines, assessment of surgical outcomes of hemithyroidectomy in PTC ≤ 4cm and contemplating on the potential clinical implications of 2015 ATA guidelines. A prospective study in a cohort of Bethesda class V and VI PTC with nodule ≤ 4cm who underwent Hemithyroidectomy between 2012 and 2020. Data on thyroid nodule evaluation, management, histopathology and follow up were used for risk stratification. Of 37 patients, 27 (72.9%) were low risk and 10 (37%) were intermediate risk ATA group. 4 (40%) intermediate risk patients had structural incomplete response and underwent completion thyroidectomy. 1 (2.7%) out of 4 completion surgery patients required adjuvant radio-ablation iodine (RAI) and 3 patients were under surveillance. Overall, 2 (5.4%) of 37 patients, 1 each from low and intermediate groups were given remnant RAI in view of aggressive histology, old age and unwillingness for a completion surgery. During follow up of 4.94 ± 2.4 years, 35 (94.5%) showed excellent response and 2 (5.4%) showed biochemical incomplete response. The difference in RFS between two groups was statistically significant with p < 0.001. Thyroid preserving surgery combined with real time risk stratification seems appropriate for low and intermediate risk PTC ≤ 4cm.

Hyperthermic Intraperitoneal Chemotherapy Following Cytoreductive Surgery for Colorectal Peritoneal Carcinomatosis Patients: A Review.

Colorectal peritoneal carcinomatosis (CPC) is an advanced malignancy and is typically associated with a poor prognosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) following complete cytoreductive surgery (CRS) is a novel, advanced loco-regional treatment for colorectal cancer that is currently being used to treat peritoneal carcinomatosis (PC). The present review aims to describe the evidence-based literature on the efficacy and safety of this treatment approach in patients with PC originating from colorectal cancer and to summarize its complications. All published literature regarding the efficacy of HIPEC for the treatment of CPC was reviewed; 16 studies were included in this paper. The overall survival rate for the HIPEC group ranged from 63% to 93%. The overall median survival for the HIPEC and non-HIPEC groups ranged from 13 to 60.1 months and 12.6 to 41.2 months, respectively. The overall median survival of patients in the HIPEC group was comparatively better than those in the non-HIPEC group. There was insufficient evidence to suggest whether this treatment regimen was associated with a high or low morbidity rate in comparison to other groups. However, the mortality rate associated with this treatment regimen was low. In conclusion, the present data provide insufficient evidence regarding the beneficial effects of using HIPEC following CRS treatment. Therefore, further studies are required to determine the benefits of HIPEC for CPC patients.

Robot-Assisted Sacropexy with the Novel HUGO Robot-Assisted Surgery System: Initial Experience and Surgical Setup at a Tertiary Referral Robotic Center.

Introduction and Hypothesis: Robotic sacropexy (RSC) emerged in the last years as a valid alternative to the laparoscopic technique. However, the robotic approach is still limited by platform availability and concerns about cost-effectiveness. Recently, new robotic platforms joined the market, lowering the costs and offering the possibility to expand the robotic approach. The aim of our study was to demonstrate the technical feasibility and safety of the procedure with this new platform along with the description of our surgical setting. Materials and Methods: We reported data on the first five consecutive patients who underwent RSC at Onze Lieve Vrouw Hospital (Aalst, Belgium), performed with the novel HUGO™ Robot-Assisted Surgery (RAS) System. The platform consists of four fully independent carts, an open console, and a system tower equipped for both laparoscopic and robotic surgery. We collected patients' characteristics, intraoperative data, intraoperative complications, and clashes of instruments. Results: All procedures were completed according to the same surgical setting and technique. No need for conversion to open/laparoscopic surgery and/or for additional port placement was required. No intraoperative complications, instrument clashes, or system failure that compromised the surgery's completion were recorded. Median interquartile range docking, operative, and console time were 8 (6-9), 130 (115-165), and 80 (80-115) minutes, respectively. Conclusion: This series represents the first worldwide report of a robot-assisted sacropexy executed with the novel HUGO RAS System. Awaiting future investigation, this preliminary experience provides relevant data in terms of operative room settings and perioperative outcomes that might be helpful for future adopters of this platform.

Analysis of the Safety and Pregnancy Outcomes of Fertility-sparing Surgery in Ovarian Malignant Sex Cord-stromal Tumours: A Multicentre Retrospective Study

AimsTo assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery and explore pregnancy outcomes after FSS in stage I malignant sex cord-stromal tumours (MSCSTs). Materials and methodsWe carried out a multicentre retrospective cohort study on patients who were diagnosed with MSCSTs and the tumour was confined to one ovary. The patients were divided into FSS and radical surgery groups. Inverse probability of treatment weighting (IPTW) was used to balance variables between the two groups. Kaplan–Meier analysis was used to compare the difference in disease-free survival (DFS). Univariate and multivariate Cox regression analysis was used to find risk factors of DFS. Univariate logistic regression analysis was used to assess risk factors of pregnancy. ResultsIn total, 107 patients were included, of whom 54 (50.5%) women underwent FSS and 53 (49.5%) received radical surgery. After IPTW, a pseudo-population of 208 was determined and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7–156 months), 10 patients experienced recurrence and two died. There was no significant difference in DFS between the two groups, both in unweighted (P = 0.969) or weighted cohorts (P = 0.792). In the weighted cohort, stage IC (P = 0.014), tumour diameter >8 cm (P = 0.003), incomplete staging surgery (P = 0.003) and no adjuvant chemotherapy (P < 0.001) were the four high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully; the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P = 0.009) was associated with infertility. ConclusionsOn the premise of complete staging surgery, FSS is safe and feasible in early stage MSCSTs with satisfactory reproductive outcomes.

Complete repeat cytoreduction under regional anesthesia in a patient with myasthenia gravis: a clinical case

The article summarizes the published data on the prevalence, pathogenesis, features of clinical presentation, and treatment of myasthenia gravis and myasthenic crises. Particular attention is paid to the anesthesia method choice and perioperative management of patients with myasthenia gravis. A clinical case of successful combined spinal-epidural anesthesia for complete repeat cytoreductive surgery in a patient with moderate myasthenia gravis is presented.

Gender Disparities and Differences Among Urologists Included in Top Doctor Lists

To understand gender trends among urologists included in "Top Doctor" lists as more women practice urology, we (1) Evaluated whether Top Doctor lists reflect a contemporary distribution of urologists by gender; (2) Describe regional differences in gender composition of lists; (3) Report similarities and differences among men and women Top Doctors. All urologists in regional Top Doctor Castle Connolly lists published in magazines between January 1, 2020 and June 22, 2021 were included. Physician attributes were abstracted. American Urological Association (AUA) census data was used to compare the number of men and women Top Doctor urologists to the number of practicing men and women urologists within each list's zip codes. Log odds ratios (OR) and (95% confidence intervals) were used to compare likelihood of list inclusion by gender overall and by region. Four hundred and ninety-four Top Doctor urologists from 25 lists were analyzed, of which 42 (8.50%) were women. Women urologists comprised 0%-27.8% of each list, with 7 lists (28.0%) including zero women urologists. Using AUA census data, OR for list inclusion of men urologists compared to women was 1.31 (1.01, 1.70) overall, with OR=0.78 (0.36, 1.72) in the West, OR=1.39 (1.03, 1.89) South, OR=1.46 (0.8, 2.67) Northeast, OR=1.90 (0.50, 7.18) Midwest. Women top urologists completed fellowship more often than men (66.7%, 55.1%) and were significantly more likely to complete female pelvic medicine and reconstructive surgery (FPMRS) fellowship (P <.001). Men urologists were significantly more likely to be included in Top Doctor lists than women urologists. Top women urologists were significantly more likely to complete FPMRS fellowship.

Hypofractionated stereotactic body radiation therapy (SBRT) in pediatric patients: results of a national prospective multicenter study

<h3>Objectives</h3> Efficiency and toxicity of hypofractionated Stereotactic Body Radiation Therapy (SBRT) in pediatric situations need to be assessed. We conducted a prospective multicentric National study on SBRT in young patients (1.5-20 y.) <h3>Methods</h3> Indications of SBRT had to be approved by a multi-disciplinary tumor board. SBRT indications were either locally relapsed ependymoma after complete surgery (randomization between 24 Gy/3 fr or 25 Gy/5 fr, isodose 80%), or brain, lung or spinal metastases of any origin after incomplete or no resection in first-line, or in re-irradiation (re-RT) situations The main objective was to evaluate the 6-month local control (LC) rate (RECIST 1.1). Secondary objectives were to evaluate 1 and 2-year LC rates, acute (< 3 months) and medium-term toxicities (3-24 months) using NCI-CTC-v-4.0. <h3>Results</h3> Sixty-one patients, median age 13y., (range 3-20) were included in 10 institutions (12/2013-12/2019). Four patients did finally not receive SBRT and were excluded from the analysis. Eighteen patients (32%) were irradiated in first intention (5 brain, 5 lung, 8 spinal lesions, median dose 35 Gy/5fr, isodose 80%. Thirty-nine patients (68 %) were included for re-RT: 14 patients (7 patients/randomization arm) for post-operative SBRT for locally relapsed ependymoma, 25 patients for re-RT in other situations (brain, spine, lung…) (median dose 25 Gy/5 fr, isodose 80%). No pt required general anesthesia. Median follow-up was 24 months (22-28 months). Six-month, 1- and 2-year local control rates will be reported during the congress (undergoing analysis). Gr.2 and 3 acute RT toxicities were observed in 7 and 1 (epilepsy) patients respectively. Medium-term RT toxicity was identified in 4 patients (gr.2) and 1 patients (gr.3, brain radio-necrosis). No grade 4/5 was reported. <h3>Conclusion</h3> SBRT is feasible and safe in childhood in selected brain, lung and spine treatment or in selected cases of re-RT. More details (especially efficiency) will be available for the congress.

William Forrest Johnston, MD, FACS, FASCRS.

William (Forrest) Johnston, MD, is a Colon and Rectal Surgeon and Assistant Program Director for the Colon and Rectal Surgery Fellowship at the Ochsner Clinic in New Orleans, LA. He was born in Winston-Salem, North Carolina, and moved to Galveston, Texas, at a young age. Living on a small island on the Gulf Coast, he enjoyed surfing and working for the Beach Patrol. He then went to Wake Forest University in North Carolina for under graduation, where he majored in Chemistry and Religion. Next, he went back to Texas to join Medical School at Baylor College of Medicine in Houston before moving to University of Virginia for his General Surgery residency. Initially he wanted to be a vascular surgeon and performed extensive research in that field. When he finished with the laboratory work, he changed his path to pursue colorectal surgery. He went on to complete Colorectal Surgery fellowship at the Lahey Clinic in Burlington, Massachusetts. Following his fellowship, he began his first faculty position at the Ochsner Clinic, where he has served since 2017.

8734 Endometriosis Surgery: Factors Associated with Complete and Incomplete Management

<h3>Study Objective</h3> Incomplete surgery for endometriosis is associated with increased disease severity, however, there is limited data on potential reasons. This study aims to elucidate patient and surgical factors associated with previous incomplete and complete surgery. <h3>Design</h3> A retrospective cohort study of patients referred to a minimally invasive gynecologist over 1-year. Patients with complete and incomplete surgical treatments were compared. Exposure variables included referral reason, symptomatology, and severity of endometriosis and adhesions noted during surgery. <h3>Setting</h3> Tertiary-center endometriosis clinic. <h3>Patients or Participants</h3> Inclusion criteria included female gender assigned at birth, previous endometriosis surgery, and age 18 or greater. Charts were excluded if referral reason was unrelated to endometriosis. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> One-hundred and twenty-nine charts met the criteria. Common reasons for referral included endometriosis (82.9%) and pelvic pain (70.5%), while reported symptoms included pelvic pain (80.6%) and dysmenorrhea (62.8%). Surgical information was collected from the initial consultation, and 75 (58.1%) charts included operative notes. Disease severity was reported by previous surgeons in 55 (42.6%) cases: mild/minimal in 14 (14/55, 25.5%), moderate in 8 (8/55, 14.5%) and severe in 33 (33/50, 60%). Adhesions were present in 50 (38.8%) cases. Surgical management was complete in 55 (42.6%) cases and incomplete in 31 (24.0%) based on operative history. In 43 (33.3%) cases, completeness could not be determined from available information. When incomplete, reasons cited included extent of disease (9/31, 29.0%), proximity to ureter (4/31, 12.9%), bowels (4/31, 12.9%), pelvic sidewall (2/31, 6.5%), procedure beyond consent (2/31, 6.5%) and adhesions (1/31, 3.2%). In 9 (9/31, 29.0%) cases, no reason was provided by the surgeon. <h3>Conclusion</h3> This review showed that incomplete surgery was often due to disease proximity to pelvic structures noted at the time of surgery. Further analysis assessing each factors' relationship with incomplete surgery and assessment of outstanding operative notes will provide more information to decrease incomplete surgery risk.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Factors in Locally Advanced Rectal Cancer

Introduction: The standard therapy for locally advanced rectal cancer (LARC) is based on neoadjuvant chemoradiotherapy (nCRT) with fluoropyrimidines. There are different biomarkers used as prognostic factors in these tumors. Some studies advocate the use of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors in this clinical scenario. The aim of the study was to evaluate NLR and PLR as prognostic factors of disease-free survival (DFS) and overall survival (OS) and as predictive factors of pathologic complete response (pCR) using Ryan tumor regression scoring system on surgical specimens, in patients with locally advanced rectal adenocarcinoma who received nCRT and radical surgery. Methods: We retrospectively evaluated patients with locally advanced rectal adenocarcinoma (T3-T4, N1-N3, M0 according to the TNM classification, AJCC 8th edition) who received nCRT based on fluoropyrimidines and radical surgery. Complete blood cell count before nCRT was obtained to calculate NLR and PLR. We made subgroups of patients according to NLR and PLR. We obtained the cut-off point for these ratios based on receiver operating characteristic analysis. We analyzed OS and DFS using the Kaplan-Meier method and Cox proportional hazard models. The relationships between NLR/PLR and pCR, along with other clinical-pathological characteristics, were evaluated by Pearson’s χ² or Fisher’s exact test as appropriate. Multivariate analyses were performed using Cox proportional hazard regression models. Results: Between February 2012 and February 2017, 100 consecutive patients were treated according to the reported schedules. Median age was 76 years (68–83). All patients received radiotherapy up to 50.4 Gy and 5-FU-based chemotherapy. 100% completed nCRT and surgery, 38% had elevated basal NLR (cut-off >1.95), and 50% had elevated basal PLR (cut-off >133). After a median follow-up of 72 months (55–88), a lower DFS was obtained in the high NLR subgroup (log-rank, Mantel-Cox 5.165, p = 0.023) and in the high PLR subgroup (log-rank, Mantel-Cox 13.971, p = 0.001). Multivariate analysis showed that PLR (p = 0.006) was a strong significant predictor of DFS. A lower OS was observed in the high NLR and PLR subgroup without significant differences (log-rank, Mantel-Cox 1.245, p = 0.265; 0.578, p = 0.447). No significant differences were obtained in any of the subgroup analysis regarding pCR rates. Conclusion: In light of our results, both NLR and PLR could be considered prognostic factors for DFS in patients with LARC that receive treatment with nCRT followed by surgery.

Hyperthermic Intraperitoneal Chemotherapy and Recirculation with CO2: A Safe Technique.

Introduction: Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) has evolved as a treatment for peritoneal carcinomatosis in various tumors after a careful and complete cytoreductive surgery, and it demonstrated much better and longer survival than more traditional therapeutic schemas. Our objective has been to examine the safety, efficacy and survival achieved with closed technique with CO2-agitation system Combat PRS® (Peritoneal Recirculation System: PRS). To achieve this, we compared the appearance of adverse events, mortality and survival with the described using classic techniques (open, closed without CO2-agitation) for the treatment of selected patients with peritoneal carcinomatosis; Materials and methods: We studied overall survival, disease-free survival and safety (morbidity and mortality) of the administration of HIPEC through a closed method technique with CO2 recirculation (Combat PRS®) in 482 patients from 11 Spanish hospitals; Results: The mortality of our technique (1.66%) was similar to other published techniques (open, closed). Morbidity exhibited a 9.96% rate of Clavien-Dindo (CD) III/IV complications in 482 patients, which was lower than in other series. Survival (overall survival (OS) and disease-free survival (DFS)) was similar to previously published results: 86% 1y-OS, 54% 3y-OS, 77% 1y-DFS and 31% 3y-DFS; Conclusion: The procedure with closed PRS with CO2 agitation is as safe as standard open and closed procedures for the administration of HIPEC after complete cytoreductive surgery, with similar and very low mortality (1.66%) and lower morbidity (9.96% CD III and IV in our series vs range of 20–40% in the majority of different series); only Kusamura had similar results, with 12% in 205 patients, using the closed technique without CO2 agitation).

Surgical management of retrorectal tumors: a single-center 12 years' experience.

Retrorectal tumors (RTs) are rare tumors that arise in the space between the mesorectum and the pelvic wall and often originate in embryonic tissues. The primary treatment for these tumors is complete excision surgery, and choosing the best surgical approach is very important. In this study, we retrospectively collected the data of 15 patients with RTs who underwent surgery in the surgical ward of Imam Khomeini Hospital in Tehran for 12 years to share our experiences of patients' treatment and compare different surgical approaches. A total of 5 tumors were malignant, 10 were benign, and most of the tumors were congenital. Malignant tumors were seen in older patients. Three surgical procedures were performed on patients. Three patients underwent abdominal approach surgery, and 8 patients underwent posterior surgery. A combined surgical approach was performed on 4 patients. Two patients underwent laparoscopic surgery. The abdominal approach had the least long-term complication, and the combined approach had the most complications; laparoscopic surgery reduced the length of hospital stay and complications after surgery. A multidisciplinary team collaboration using magnetic resonance imaging details is necessary to determine a surgical treatment approach. It could reduce the need for a preoperative biopsy. However, every approach has its advantages and disadvantages. In the main, they have no superiority over each other, and individualized treatment is the key.

Laparoscopic versus open repair of perforated peptic ulcers: analysis of outcomes and identification of predictive factors of conversion

BackgroundThe surgical treatment for perforated peptic ulcers (PPUs) can be safely performed laparoscopically. This study aimed to compare the outcomes of patients who received different surgical approaches for PPU and to identify the predictive factors for conversion to open surgery.MethodsThis retrospective study analyzed patients treated for PPUs from 2002 to 2020. Three groups were identified: a complete laparoscopic surgery group (LG), a conversion to open group (CG), and a primary open group (OG). After univariate comparisons, a multivariate analysis was conducted to identify the predictive factors for conversion.ResultsOf the 175 patients that underwent surgery for PPU, 104 (59.4%) received a laparoscopic-first approach, and 27 (25.9%) required a conversion to open surgery. Patients treated directly with an open approach were older (p < 0.0001), had more comorbidities (p < 0.0001), and more frequently had a previous laparotomy (p = 0.0001). In the OG group, in-hospital mortality and ICU need were significantly higher, while the postoperative stay was longer. Previous abdominal surgery (OR 0.086, 95% CI 0.012–0.626; p = 0.015), ulcer size (OR 0.045, 95% CI 0.010–0.210; p < 0.0001), and a posterior ulcer location (OR 0.015, 95% CI 0.001–0.400; p = 0.012) were predictive factors for conversion to an open approach.ConclusionThis study confirms the benefits of the laparoscopic approach for the treatment of PPUs. Previous laparotomies, a greater ulcer size, and a posterior location of the ulcer are risk factors for conversion to open surgery during laparoscopic repair.

Comparing the short-term results of the improved triangular anastomosis technique for complete laparoscopic radical resection of sigmoid colon cancer and laparoscopic-assisted small incision colon reconstruction: A CONSORT study.

The laparoscopic approaches using the triangular anastomosis technique for sigmoid colon cancer (SCC) are rare. This CONSORT study explored the short-term effects of laparoscopic radical resection of SCC with modified triangular anastomosis technique and laparoscopic-assisted small incision colon cancer reconstruction surgery. From April 2019 to January 2021, a total of 86 patients with SCC who were admitted to Luopu County People’s Hospital were selected and received radical resection. Patients were divided into 2 groups using a random number table method: in the control group, patients underwent laparoscopic-assisted small-incision reconstruction surgery, and patients in the observation group underwent complete laparoscopic surgery with modified triangular anastomosis technique. The 2 groups were compared in perioperative related indicators and postoperative complications. After 3 months follow-up, local tumor recurrence and metastasis, abdominal wall puncture and implantation, and death were observed. Compared to the control group, shorter operation time, gastrointestinal reconstruction time, postoperative exhaust time, hospitalization time, and less intraoperative blood loss, and lower probability of complications were observed in the observation group (P < .05). However, there was no significant difference in the number of lymph node dissections between the 2 groups (P > .05). After 3 months of follow-up, no local tumor recurrence, distant tumor metastasis, abdominal wall puncture implantation, and death were found in the 2 groups of patients. It is indicated that the improved triangular anastomosis technique for complete laparoscopic radical resection of SCC is effective in treatment for SCC.

Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers

Simple summaryLow-grade serous ovarian cancer (LGSOC) represents an uncommon histotype of serous ovarian cancer (accounting for approximately 5% of all ovarian cancer) with a distinct behavior compared to its high-grade serous counterpart, characterized by a better prognosis and low response rate to chemotherapeutic agents. Similar to high-grade serous ovarian cancer, cytoreductive surgery is considered crucial for patient survival. This retrospective study aimed to analyze the outcomes of women affected by advanced stages (III–IV FIGO) of LGSOC from two high-volume oncological centers for ovarian neoplasm. In particular, we sought to evaluate the impact on survival outcomes of optimal cytoreductive surgery [i.e., residual disease (RD) <10 mm at the end of surgery]. The results of our work confirm the role of complete cytoreduction (i.e., no evidence of disease after surgery) in the survival of patients and even the positive prognostic role of a minimal RD (i.e., <10 mm), whenever complete cytoreduction cannot be achieved.BackgroundLow-grade serous ovarian cancer (LGSOC) is a rare entity with different behavior compared to high-grade serous (HGSOC). Because of its general low chemosensitivity, complete cytoreductive surgery with no residual disease is crucial in advanced stage LGSOC. We evaluated the impact of optimal cytoreduction on survival outcome both at first diagnosis and at recurrence.MethodsWe retrospectively studied consecutive patients diagnosed with advanced LGSOCs who underwent cytoreductive surgery in two oncological centers from January 1994 to December 2018. Survival curves were estimated by the Kaplan–Meier method, and 95% confidence intervals (95% CI) were estimated using the Greenwood formula.ResultsA total of 92 patients were included (median age was 47 years, IQR 35–64). The median overall survival (OS) was 142.3 months in patients with no residual disease (RD), 86.4 months for RD 1–10 mm and 35.2 months for RD >10 mm (p = 0.002). Progression-free survival (PFS) was inversely related to RD after primary cytoreductive surgery (RD = 0 vs RD = 1–10 mm vs RD >10 mm, p = 0.002). On multivariate analysis, RD 1–10 mm (HR = 2.30, 95% CI 1.30–4.06, p = 0.004), RD >10 mm (HR = 3.89, 95% CI 1.92–7.88, p = 0.0004), FIGO stage IV (p = 0.001), and neoadjuvant chemotherapy (NACT) (p = 0.010) were independent predictors of PFS. RD >10 mm (HR = 3.13, 95% CI 1.52–6.46, p = 0.004), FIGO stage IV (p <0.0001) and NACT (p = 0.030) were significantly associated with a lower OS.ConclusionsOptimal cytoreductive surgery improves survival outcomes in advanced stage LGSOC s . When complete debulking is impossible, a RD <10 mm confers better OS compared to an RD >10 mm in this setting of patients.

520. EFFICACY AND SAFETY OF NEOADJUVANT CHEMOTHERAPY AND IMMUNOTHERAPY IN LOCALLY RESECTABLE ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Compared with neoadjuvant chemotherapy, concurrent chemoradiotherapy can significantly increase pCR rate and improve overall survival of Locally Advanced ESCC. However, the major pattern of failure is distant metastasis, and the increased risk of adverse events and surgery. Adding PD-1 inhibitor to the chemotherapy have shown significant clinical benefits and become the standard of care for first-line treatment of ESCC. We investigate the efficacy and safety of neoadjuvant PD-1 blockade combined with chemotherapy in real world. We performed a retrospective, single institution review of all resectable locally advanced ESCC patients who received neoadjuvant sintilimab combined with chemotherapy and completed surgery in the sixth medical center of PLA general hospital from December 2019 to February 2022. The primary outcome was pCR rate in both the primary tumor and lymph nodes. Secondary outcomes were R0 resection rate, MPR rate, tumor downstaging rate, surgical complications, and treatment-related adverse events (TRAEs). 37 Patients aged between 47 to 76 years old (median age, 62) were collected. 3(8.1%) were diagnosed with stage II ESCC, 30(81.1%) with stage III, and 7(18.9%) with stage IVA (AJCC 8th). 30(81.1%) were male. 31 patients received 2 cycles and 6 patients received 3 cycles. 5(13.5%) patients obtained pCR. 7(18.9%) patients obtained pCR in primary tumor. 36(97.3%) patients obtained R0 resection. MPR (PCR included) was achieved in 18 (48.6%) patients. 28(75.7%) patients achieved clinical downstaging, and 64.9 (%) achieved pathological downstaging. Grade 3-4 TRAEs occurred in 7(18.9%) patients, and grade 3-4 surgical complications occurred in 1(2.7%) patient. These real-world data revealed that neoadjuvant sintilimab plus chemotherapy could provide benefits with good tolerability for resectable locally advanced ESCC, and warrants further exploration in prospective clinical studies.