Conventional Resection Research Articles

D3 lymphadenectomy for right colon cancer

Extension of lymphadenectomy in case of right-sided colon cancer surgery is recently broadly discussed. Since the introduction of complete mesocolic excision (CME) with central lymph node resection or lymphadenectomy D3, a number of studies were undertaken to assess the beneficial role of these procedures on overall survival in colon cancer patients. While it is generally known that the number of dissected lymph nodes during cancer-related operation is associated with a better prognosis on overall survival, the results of studies on CME with central lymph node resection or D3 lymphadenectomy are inconclusive. The greater number of harvested lymph nodes warrants positive outcome, however, not every study confirms overall survival improvement. Extended lymphadenectomy has also been associated with a higher number of complications, compared to conventional resection of colonic cancer. In this review, we focus on the detailed description of the surgical technique for D3 lymphadenectomy in the right-sided colorectal cancer (CRC) patients as well as provide a critical appraisal of the quality of the available data in the current literature.

Comparison of endoscope-assisted versus conventional resection of parotid tumors

Endoscopically-assisted partial parotidectomy for benign tumours has been reported, but we have evaluated its feasibility through different concealed incisions compared with conventional parotidectomy. A total of 124 patients with parotid tumours were enrolled in this retrospective study: an endoscopically-assisted group (n=37) compared with a group operated on conventionally (n=87). The incision for endoscopically-assisted partial, total parotidectomy and selective neck dissection was based on location and pathological characters of the parotid tumour. The sex and age of the patients, diameter of the tumour, and histopathological features were comparable between the two groups. The mean length of the incision in the endoscopic group was significantly shorter than that in the conventional group. However, intraoperative blood loss, operating time, and duration of hospital stay were significantly reduced, and postoperative secretion of saliva was significantly improved in the endoscopic group, among whom there were no recurrences of tumour. More importantly, all patients who had endoscopically-assisted operations were satisfied with the cosmetic result. Endoscopically-assisted parotidectomy is superior to conventional resection as judged by postoperative cosmetic and functional outcomes. It is noteworthy that the site of incision depends mainly on location, and on the suspected low grade of malignancy of the parotid tumour seen on preoperative computed tomography and magnetic resonance images.

Is Single-Incision Laparoscopic Liver Surgery Safe and Efficient for the Treatment of Malignant Hepatic Tumors? A Systematic Review.

The objective of this review was to evaluate the safety and efficiency of single-incision laparoscopic liver surgery (SILLS) for malignant liver lesions. A retrospective review of the Medline database was performed, including studies published up to February 2019. Overall, 69 patients (50 males) with a median age of 61years (range, 31-90) from 16 studies underwent SILLS for malignant liver disease and were included in this review. The majority of patients underwent resection for hepatocellular carcinoma (n = 52, 75%), followed by metastatic disease (n = 15, 22%). The hepatic lesions were located in anterolateral liver segments in 62 patients (90%) and in posterosuperior liver segments in 7 patients (10%). Sixty-five patients (94%) underwent minor liver resection. The median blood loss was 200mL (range 0-2500), while 4 patients that underwent single-port resection were converted to either conventional laparoscopy or open resections. Two cases were reported to be associated with postoperative complications in the single-port group (1 [1.7%] grade Dindo-Clavien I-II, 1 [1.7%] grade Dindo-Clavien III-IV), while no complications were noted in the multiport group. All patients successfully underwent R0 resection. SILLS seems to be a safe and efficient treatment modality for malignant liver disease when performed by experienced surgeons in carefully selected patients. More studies are needed to better identify which patients may benefit from such an operative approach.

Transanal resection of rectal cancer: a review

As an alternative to conventional resection of rectal tumors with low morbidity, the transanal approach has become popular and in-demand. It’s been almost 30 years since the techniques for transanal resection have been evolving steadily. The revolution started with the advent of transanal endoscopic microsurgery in the 80’s. Later, the introduction of transanal minimally invasive surgery improved the access and visibility for surgeons across the world. Concerns have been raised about recurrence rates of cancers with transanal approach and success of subsequent salvage operations. This review is an attempt to concise the available techniques, their results and also to bring about a consensus as to whether it is worth to give our patients an option of transanal resection of rectal cancer.

Is there any role for single-port right colectomy for cancer?

Single incision laparoscopic surgery (SILS) for colon surgery was first reported in 2008. Since then many retrospective and clinical trials were published comparing the outcomes between conventional multiport laparoscopic colon resections and single incision surgery. The majority of these studies did not show any superiority to single incision surgery over the conventional laparoscopy. On the other hand, the available literature showed some disadvantages to SILS in regards to instrument triangulation and a longer learning curve. In this review article, we will discuss the current status of SILS and compare the outcomes to other techniques of surgery for right colon cancer.

A review and meta-analysis of en-bloc resection of bladder tumor

Objective To systematically assess the efficacy of en-bloc resection of bladder tumor (ERBT) versus conventional transurethral resection of of bladder tumor (TURBt) for non-muscle invasive bladder cancer (NMIBC). Methods Randomized controlled trials (RCTs) regrading the efficacy and safety of ERBT vs. TURBt for NMIBC were retrieved in Pubmed, Cochrane library, Sciverse, CNKI, VIP and Wanfang database from databases establishment to December 2017. According to the including and exclusion criterion, two reviewers independently screened the trials, conducted the Meta-analysis with RevMan 5.3 software. Results A total of 5 RCTs were eligible for the study including 520 cases. The pooled results showed that ERBT had less obturator nerve reflection rate[RR=0.04, 95%CI=(0.01, 0.27), P=0.001], postoperative bladder irrigation time[SMD=-3.12, 95%CI=(-4.15, -2.08), P<0.0001], and period of hospitalization[SMD=-1.82, 95%CI=(-3.50, -0.13), P=0.03]. However, there were no difference in operative time [SMD=0.66, 95%CI=(0.00, 1.33), P=0.05] and period of catheterization [SMD=-1.37, 95%CI=(-2.83, 0.08), P=0.06] between ERBT and TUTBt groups. Otherwise, a significantly lower rate of non-achieve an accurate stage [RR=0.24, 95%CI=(0.10, 0.56), P=0.001] and complication rate [RR=0.35, 95%CI=(0.17, 0.74), P=0.006] in ERBT group, compared with those in TURBt group. No significant difference was observed in recurrence rate between two groups [RR=0.63, 95%CI=(0.37, 1.08), P=0.09]. Conclusions Compared with TURBt, ERBT has more positive tumor ground biopsies rate and higher safety of operation. Therefore, ERBT should be considered as a preferable option for NMIBC. Key words: Urinary Bladder Neoplasms; Cystectomy

Laparoscopic Resection of Primary Tumor with Synchronous Conventional Resection of Liver Metastases in Patients with Stage 4 Colorectal Cancer: A Retrospective Analysis

Laparoscopic Resection of Primary Tumor with Synchronous Conventional Resection of Liver Metastases in Patients with Stage 4 Colorectal Cancer: A Retrospective Analysis

Survival outcomes comparable between endoscopic resection and surgical resection for T1b esophageal adenocarcinoma.

100 Background: Current guidelines recommend esophagectomy for submucosal T1b esophageal cancer. Data regarding efficacy of endoscopic resection (ER) of T1b esophageal cancer are limited. Our goal was to compare survival outcomes of ER as opposed to conventional surgical resection (SR) in a large cohort of patients with T1b cancers from a large national database. Methods: Data were obtained from the large national database maintained by the Commission on Cancer. Patients with T1b esophageal cancers with clinical stage 1A and 1B who underwent ER and SR between 2010 and 2014 were identified using the American Joint Committee on Cancer (AJCC Version 7). Patients undergoing ER and SR were identified. Patients who underwent neoadjuvant therapy or had incomplete survival data were excluded. The primary outcome was survival for age and Deyo-Charlson comorbidity index. We also evaluated 30-Day and 90-Day Mortality outcomes. Results: There were 1071 patients with T1b esophageal cancer with complete mortality data. After selecting and excluding patients above, 141 patients were identified who underwent EET and 286 who underwent esophagectomy. Average age was 71.5 years in the ER group and 64.5 years in the SR group (p &lt; 0.001). In the group, 30-Day mortality after surgery was 1/134 (0.8%, 7 missing) compared to surgery with 30-Day mortality of 6/283 (2.1%, 3 missing) (P = 0.308). 90-Day mortality after surgery for the ER group was 3/134 (2.2%, 7 missing) compared with the surgery with 90-Day mortality of 11/281 (3.9%, 5 missing) (P = 0.377). Adjusted for age and Deyo-Charlson comorbidity index, there was a HR of 1.051 (95% CI 0.695-1.589, p = 0.815) for mortality associated with surgery compared with ER. Mean follow-up of 42.6 months for the ER group and 55.7 months for surgery group. Conclusions: Based on the data from a large national cancer data base ER seems to be comparable to SR in terms of short term (30 day and 90 day) mortality. Overall survival seems to be similar in both groups Prospectively done randomized studies comparing ER versus SR are desirable.

Extracorporeal resections and autotransplantation of the liver: an experience of 4 clinical cases

Aim. To evaluate short-term outcomes of ex situ, ex vivo liver resection in patients with lesion of liver veins confluence and inferior vena cava who were undesirable for conventional liver resection. Matherial and methods. There were 4 procedures of ex situ liver resection and autotransplantation without veno-venous bypass. Results. Postoperative complications developed in all cases, complications grade IIIa and over — in 50% of patients. Three patients are alive without signs of disease, follow-up ranged from 8 months to 2 years. One patient died after surgery. Conclusion . Comprehensive planning of such procedures is a key for good early and long-term postoperative outcomes. It is strongly recommended to perform liver autotransplantation in well experienced specialize center due to difficult and traumatic surgery.

Introduction of complete mesocolic excision with central vascular ligation as standardized surgical treatment for colon cancer in Greece. Results of a pilot study and bi-institutional cooperation.

IntroductionComplete mesocolic excision (CME) is generally accepted as state of the art in colon cancer surgery. However, the long-term impact of CME has not been systematically examined. Therefore cohort studies might be a possible way to clarify any differences between conventional resections and CME. Following bilateral cooperation between the Department of Surgery/University Hospital of Erlangen and the 1st Surgical Department of the General Hospital of Nikaia/Piraeus, including teaching activities for introduction of CME, a cohort study was performed, considering surgical quality criteria and clinical outcome.Material and methodsAll patients with colon carcinomas (CME group, n = 31) referred to the 1st Surgical Department of General Hospital, Nikaia/Piraeus, Greece for surgery from January 2012 to December 2013 were prospectively analyzed and compared with patients who underwent conventional surgery for colon cancer between January 2008 and December 2011 (non-CME group, n = 35). Patients’ follow-up was at least 48 months.ResultsThere were significantly better results in terms of lymph node yield (CME group: 29.6 vs. non-CME group: 17.85; p < 0.001) and lymph node ratio (LNR) (CME group: 0.12 vs. non-CME group: 0.24; p < 0.001) and recurrence-free survival in favor of the CME group (CME group: n = 0 vs. non-CME group: n = 5) without any increase in surgical morbidity (CME group: n = 6 vs. non-CME group: n = 11; p = 0.10).ConclusionsComplete mesocolic excision appears to offer a superior oncological result without any increase of postoperative morbidity and mortality. Furthermore, CME represents a surgical technique which can be established in a surgical department after previous teaching without increasing the postoperative complication rate.

Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective comparative cohort study

BackgroundTo investigate morbidity and mortality following complete mesocolic excision (CME) and central vascular ligation (CVL) in patients undergoing right colectomy.MethodsData from consecutive patients undergoing elective right colectomy at a university-affiliated referral centre were retrospectively analysed. Patients who underwent conventional right-sided colonic cancer surgery (January 2001–April 2009, n = 84) were compared to patients who underwent CME/CVL (May 2009–January 2015, n = 71). The primary end point was anastomotic leak. Secondary end points were delayed gastric emptying, severe respiratory failure, mortality and length of hospital stay.ResultsNo significant difference was found in the rate of anastomotic leak (1.2% in the conventional versus 5.6% in the CME/CVL group, p = 0.108). Patients in the CME/CVL group had a higher 90-day mortality rate (7.0% versus 0.0%, p = 0.019). Four out of five deceased patients suffered from aspiration with consecutive respiratory failure. There was a tendency towards delayed gastric emptying in the CME/CVL group (12.7% versus 7.1%, p = 0.246). Clavien-Dindo complication grades ≥ 2 were similar in both groups with 16 (19%) in the conventional and 15 (21.1%) in the CME/CVL group (p = 0.747). CME/CVL patients had a shorter mean length of stay with 11 versus 14 days (p < 0.001).ConclusionsComplete mesocolic excision with central vascular ligation in right colectomy seems to have a higher aspiration rate leading to severe respiratory failure and to higher mortality compared to conventional resection methods. Patient selection for this procedure may therefore be crucial.

Efficacy and Safety of Hypofractionated Stereotactic Radiosurgery for Perioptic Lesions

Treatment of lesions in close proximity to the optic pathways remains challenging with either conventional resection or with stereotactic radiosurgery (SRS). Hypofractionation has been considered as an alternate treatment. A benefit of hypofractionation for perioptic lesions can be expected because of the low alpha/beta ratio of the optic pathway of 1.11 Gy [submitted to ASTRO 2018]. Between 2011 and 2017 a total of 54 patients with perioptic lesions (27 pituitary adenomas, 16 meningiomas, 7 craniopharyngiomas, 1 cavernoma, 1 AVM, 1 metastasis and 1 sarcoma) were treated with hypofractionation (4 treatments with 5 session with mean margin dose to lesion 5x6.75 Gy, 45 treatments with 4 sessions: 4x5.34 Gy, and 5 treatments with 3 sessions: 3x6.20 Gy) at our Gamma Knife center. Mean age was 46y [11-78y], mean lesion volume was 10.26cc [0.42-40.82cc] Treatments were performed with the stereotactic frame left on during the whole treatment period. All treatments concluded satisfactorily and were well tolerated. Spatial frame displacement was measured <0.3mm using CT images. Exact delineation of the optic pathways was performed on high resolution 3D T1 images and additionally since 2016 by applying FGATIR sequences [submitted to ASTRO 2018] using a 3 Tesla scanner. Dose Volume Histograms were elaborated separately for chiasm, both optic nerves and tracts. After a mean imaging follow up period of 22 months [4-64m], local control was achieved in all but 1 lesion (craniopharyngioma), 12 lesions stayed stable. An overall mean reduction in volume of 2.30% per month was observed (pituitary adenomas: mean reduction 3.13%/m, meningiomas: mean reduction 1.09%/m). Mean maximum optic dose for the 3 fractionation schedules was 5x6.15Gy, 4x5.84Gy, 3x7.42Gy. Mean follow up period for vision evaluation was 19 months [5-53m]. Improved vision was observed in 10 cases, worsened vision in 2 cases: 1 caused by increased tumor volume, 1 case was confirmed for RION (maximum point chiasm dose 4x6.4Gy, optic tracts received up to 4x6.3Gy and 4x6.2Gy, respectively). According to our preliminary results, hypofractionated SRS can be considered as an efficient and relatively safe alternate for the treatment of lesions in close proximity of the optic pathways. Additionally to the benefit of the steep dose gradient in stereotactic radiosurgery, hypofractionation permits an even more aggressive treatment of lesions close to the visual system, profiting from its low alpha/beta ratio.

Microwave ablation combined with transcatheter arterial chemoembolization is effective for treating unresectable hepatoblastoma in infants and children

The present study is to evaluate the feasibility and efficacy of microwave ablation (MWA) combined with transcatheter arterial chemoembolization (TACE) in the treatment for unresectable hepatoblastoma in infants and children. A total of 17 patients with PRETEXT stage III and IV hepatoblastoma that was unresectable by conventional resection were included in the present study. The patients were treated with TACE, MWA, and chemotherapy. All cases were diagnosed by computed tomography (CT) and liver tumor biopsy before TACE procedure. All patients received 2 courses of TACE and 1 to 2 times of MWA. Finally, several cycles of chemotherapy were arranged. Among the 17 patients, 14 were alive and had normal alpha-fetoprotein (AFP) levels. The other 3 patients died from tumor progression. The follow-up periods ranged from 10 to 68 months. Complete ablation was achieved in the 14 patients (14/17, 82.35%). Most patients were well tolerated during the whole course except for 1 patient with pneumonedema after TACE and another 1 with biloma after MWA. No marked chemotherapeutic agent-induced toxicity occurred. After chemotherapy or TACE, transient blood indicators and symptoms were observed as follows: myelosuppression, abnormal liver function, gross hematuria, fever, and abdominal pain. Transient symptoms after MWA were fever, abdominal pain, and massive gross hematuria. The present study demonstrates that MWA combined with TACE is a safe and effective method for treating unresectable hepatoblastoma in infants and children with controllable side effects.

Comparison between conventional colectomy and complete mesocolic excision for colon cancer: a systematic review and pooled analysis : A review of CME versus conventional colectomies.

Complete mesocolic excision (CME) is advocated based on oncologic superiority, but not commonly performed in North America. Many data are case series with few comparative studies. Our aim was to perform a systematic review comparing outcomes between CME and non-CME colectomy. A systematic review was performed according to PRISMA guidelines of MEDLINE, EMBASE, HealthStar, Web of Science, and Cochrane Library. Studies were included if they compared conventional resection (non-CME) to CME for colon cancer. Quality was assessed using methodological index for non-randomized studies (MINORS). The main outcome measures were short-term morbidity and oncologic outcomes. Weighted pooled means and proportions with 95% CI were calculated using a random-effects model when appropriate. Out of 825 unique citations, 23 studies underwent full-text reviews and 14 met inclusion criteria. Mean MINORS score was 13.3 (range 11-15). The mean sample size in CME group was 1166 (range 45-3756) and 945 (range 40-3425) in non-CME. Four papers reported plane of dissection, with CME plane achieved in 85.8% (95% CI 79.8-91.7). Mean OR time in CME group was 167min (163-171) and 138min (135-142) in conventional group. Perioperative morbidity was reported in six studies, with pooled overall complications of 22.5% (95% CI 18.4-26.6) for CME and 19.6 (95% CI 13.6-25.5) for non-CME. Anastomotic leak occurred in 6.0% (95% CI 2.2-9.7) of CME resections versus 6.0% (95% CI 4.1-7.9) in non-CME. CME had more lymph nodes, longer distance to high tie, and specimen length in all studies. Nine studies compared long-term oncologic outcomes and only three reported statistically significant higher disease-free or overall survival in favor of CME. Local recurrence was lower after CME in two of four studies. The quality of evidence is limited and does not consistently support the superiority of CME. Better data are needed before CME can be recommended as the standard of care for colon cancer resections.

Chronische Pankreatitis – ein Update aus Sicht des Chirurgen

Continuously rising incidence and prevalence, frequent hospitalisation, development of opioid dependence, and early retirement of young people demonstrate the enormous socioeconomic impact of chronic pancreatitis. The aims of therapy include pain relief, improved quality of life, management of complications, cancer prevention and preservation of function. Since medical and endoscopic approaches of conservative therapy have proved to be ineffective in the long term, surgery remains the mainstay of treatment and should be considered as early as possible. Surgery encompasses a wide spectrum of methods, ranging from simple drainage procedures and conventional resections to various hybrid techniques. The choice of optimal surgical management should consider the unique pathomorphologic changes of each patient and be performed at a high-volume pancreas centre. This review presents the current evidence-based state of knowledge about chronic pancreatitis from a surgical point of view with a practical summary of therapeutic strategies according to the available guidelines and considering the most recent literature.

Long-term Functional Outcome After Right-Sided Complete Mesocolic Excision Compared With Conventional Colon Cancer Surgery: A Population-Based Questionnaire Study.

Complete mesocolic excision improves the long-term outcome of colon cancer but might carry a risk of bowel dysfunction. This study aimed to investigate whether right-sided complete mesocolic excision is associated with an increased risk of long-term bowel dysfunction and reduced quality of life compared with conventional colon cancer resections. Data were extracted from a population-based study comparing complete mesocolic excision and conventional colon cancer resections and from a national questionnaire survey regarding functional outcome. Elective right-sided colon resections for stage I to III colon adenocarcinoma were performed at 4 university colorectal centers between June 2008 and December 2014. Seven hundred sixty-two patients were eligible to receive the questionnaire in November 2015. The primary outcomes measured were the risk of diarrhea (Bristol stool scale score of 6-7), 4 or more bowel movements daily, and the impact of bowel function on quality of life. Secondary outcomes were other bowel symptoms, chronic pain, and quality of life measured by the European Organisation for Research and Treatment of Cancer QLQ-C30. One hundred forty-one (63.8%) and 324 (59.9%) patients undergoing complete mesocolic excision and conventional resections responded after a median of 3.99 (interquartile range, 2.11-5.32) and 4.11 (interquartile range, 3.01-5.53) years (p = 0.04). Complete mesocolic excision was not associated with increased risk of diarrhea (adjusted OR, 1.07; 95% CI, 0.57-1.95; p = 0.84), 4 or more bowel movements daily (adjusted OR, 1.16; 95% CI, 0.57-2.24; p = 0.68), or lower quality of life (adjusted OR, 0.84; 95% CI, 0.49-1.40; p = 0.50). Complete mesocolic excision was associated nonsignificantly with nocturnal bowel movements, but not associated with chronic pain or other secondary outcomes. This study was limited by the retrospective design with unknown baseline symptoms. Responding patients were younger but without obvious selection bias. The outcome "diarrhea" seemed somehow sensitive to information bias. Right-sided complete mesocolic excision seems associated with neither bowel dysfunction nor impaired quality of life when compared with conventional surgery. See Video Abstract at http://links.lww.com/DCR/A665.

The Impact of Compressed Femtosecond Laser Pulse Durations on Neuronal Tissue Used for Two-Photon Excitation Through an Endoscope

Accurate intraoperative tumour margin assessment is a major challenge in neurooncology, where sparse tumours beyond the bulk tumour are left undetected under conventional resection. Non-linear optical imaging can diagnose tissue at the sub-micron level and provide functional label-free histopathology in vivo. For this reason, a non-linear endomicroscope is being developed to characterize brain tissue intraoperatively based on multiple endogenous optical contrasts such as spectrally- and temporally-resolved fluorescence. To produce highly sensitive optical signatures that are specific to a given tissue type, short femtosecond pulsed lasers are required for efficient two-photon excitation. Yet, the potential of causing bio-damage has not been studied on neuronal tissue. Therefore, as a prerequisite to clinically testing the non-linear endomicroscope in vivo, the effect of short laser pulse durations (40–340 fs) on ex vivo brain tissue was investigated by monitoring the intensity, the spectral, and the lifetime properties of endogenous fluorophores under 800 and 890 nm two-photon excitation using a bi-modal non-linear endoscope. These properties were also validated by imaging samples on a benchtop multiphoton microscope. Our results show that under a constant mean laser power, excitation pulses as short as 40 fs do not negatively alter the biochemical/ biophysical properties of tissue even for prolonged irradiation.

The risk of long‐term bowel dysfunction after resection for sigmoid adenocarcinoma: a cross‐sectional survey comparing complete mesocolic excision with conventional surgery

To investigate whether complete mesocolic excision (CME) might carry a higher risk of bowel dysfunction and subsequent reduction in quality of life compared with conventional resection. A cross-sectional questionnaire study based on data from a national survey regarding long-term bowel function and a population-based cohort study comparing CME (study group) with conventional resection (control group). A total of 622 patients undergoing elective resection for Stage I-III sigmoid adenocarcinoma at four university colorectal centres between June 2008 and December 2014 were eligible to receive the questionnaire in mid-November 2015. Primary outcomes were four or more bowel movements daily, nocturnal bowel movements, unproductive call to stool, obstructive sensation and impact of bowel function on quality of life (QOL). One hundred and twenty-seven (69.0%) and 289 (66.0%) patients in the study and control groups, respectively, responded to the questionnaire after medians of 4.41 [interquartile range (IQR) 2.50, 5.83] and 4.57 (IQR 3.15, 5.82) years, respectively (P = 0.048). CME was not associated with: increased risk of four or more bowel movements daily [adjusted OR 1.14 (95% CI 0.59-2.14; P = 0.68)], nocturnal bowel movements [adjusted OR 1.31 (0.66-2.53; P = 0.43)], unproductive call to stool [adjusted OR 0.99 (0.54-1.77; P = 0.97)] or obstructive sensation [adjusted OR 1.01 (0.56-1.78; P = 0.96)]. While one in five patients in both groups had moderate to severe impact of bowel function on QOL, there was no association with CME. For patients with sigmoid cancer, CME is associated with neither higher risk of bowel dysfunction nor impaired QOL.

Stress biomarkers in minimally invasive and conventional colorectal resections

Introduction: Any surgical procedure develops a stress situation for the patient, which can modulate the individual outcome. At present, there is only limited information about stress response in colorectal resections by laparoscopic compared to conventional surgery. Therefore, our objectives were the feasibility and the investigation of stress biomarkers including copeptin and steroid hormones before, during and after colorectal surgery.Methods: Eleven patients underwent minimally invasive and ten patients conventionally open colorectal surgery. Blood samples were collected before, during and 24 h after surgery and copeptin, NT-proBNP, cortisol, cortisone, interleukin-6 and glucose were analyzed.Results: Both, minimally invasive and conventional-open colorectal surgery caused a fast but heterogeneous response of stress biomarkers. However, the postoperative decrease of cortisol, cortisone and glucose differed between both groups. The stress biomarkers decreased faster down to baseline after minimally invasive surgery, while in open surgery cortisol, cortisone and glucose did not return to baseline within 24 h after operation.Conclusions: We show in this feasibility study for the first time an increase of copeptin in combination with glucocorticoids as stress biomarkers by open surgery compared to minimally invasive procedures in patients undergoing colorectal surgery. Exceeding an individual threshold of ‘stress burden’ may have unfavorable effects on the long-time clinical outcome.

RESHAPES: Increasing AAST EGS grade is associated with anastomosis type.

Threatened, perforated, and infarcted bowel is managed with conventional resection and anastomosis (hand sewn [HS] or stapled [ST]). The SHAPES analysis demonstrated equivalence between HS and ST techniques, yet surgeons appeared to prefer HS for the critically ill. We hypothesized that HS is more frequent in patients with higher disease severity as measured by the American Association for the Surgery of Trauma Emergency General Surgery (AAST EGS) grading system. We performed a post hoc analysis of the SHAPES database. Operative reports were submitted by volunteering SHAPES centers. Final AAST grade was compared with various outcomes including duration of stay, physiologic/laboratory data, anastomosis type, anastomosis failure (dehiscence, abscess, or fistula), and mortality. A total of 391 patients were reviewed, with a mean age (±SD) of 61.2 ± 16.8 years, 47% women. Disease severity distribution was as follows: grade I (n = 0, 0%), grade II (n = 106, 27%), grade III (n = 113, 29%), grade IV (n = 123, 31%), and grade V (n = 49, 13%). Increasing AAST grade was associated with acidosis and hypothermia. There was an association between higher AAST grade and likelihood of HS anastomosis. On regression, factors associated with mortality included development of anastomosis complication and vasopressor use but not increasing AAST EGS grade or anastomotic technique. This is the first study to use standardized anatomic injury grades for patients undergoing urgent/emergent bowel resection in EGS. Higher AAST severity scores are associated with key clinical outcomes in EGS diseases requiring bowel resection and anastomosis. Anastomotic-specific complications were not associated with higher AAST grade; however, mortality was influenced by anastomosis complication and vasopressor use. Future EGS studies should routinely include AAST grading as a method for reliable comparison of injury between groups. Prognostic, level III.