Early Surgery Research Articles

Impact of time to surgery on outcomes in patients with advanced esophageal squamous cell carcinoma following neoadjuvant therapy: An exploratory analysis of phase III trial JCOG1109.

458 Background: JCOG1109, a multicenter three-arm phase III trial, evaluated three neoadjuvant treatment regimens for advanced esophageal squamous cell carcinoma (ESCC), cisplatin and 5-fluorouracil (CF), docetaxel, cisplatin, and 5-fluorouracil (DCF), and cisplatin, 5-fluorouracil, and radiation therapy (CF-RT). The trial demonstrated the superiority of neoadjuvant DCF therapy in improving overall survival (OS). This exploratory analysis investigates the impact of the interval time from completion of neoadjuvant therapy to surgery (time to surgery, TTS) on both short- and long-term outcomes across different neoadjuvant therapy regimens. Methods: This analysis included patients from JCOG1109 who underwent surgery after neoadjuvant therapy. Patients were categorized into four TTS subgroups within each arm, based on quartiles of the overall cohort. Short-term outcomes such as perioperative complications, as well as long-term outcomes including OS and progression-free survival (PFS) were evaluated across these TTS subgroups. Results: Of the 601 patients enrolled in JCOG1109, 546 patients proceeded to surgery following neoadjuvant therapy. The median TTS was 35 days (range: 16-81) for the CF arm, 38 days (range: 17-109) for the DCF arm, and 41 days (range: 14-98) for the CF-RT arm. Baseline characteristics were well-balanced across all TTS subgroups in each treatment arm. Short-term outcomes revealed that operative time and overall proportions of postoperative complications were comparable. However, in the CF-RT arm, a longer TTS was associated with increased blood loss (200 ml, 210 ml, 300 ml, 370 ml; p-value for trend test = 0.010) and tended to increase the risk of anastomotic leakage (6%, 7%, 14%, 18%; p-value for trend test = 0.073). No significant differences in OS or PFS were observed across TTS subgroups in any treatment arm, with hazard ratios indicating no clear trend toward improved or worsened long-term outcomes. Conclusions: The timing of surgery following neoadjuvant therapy does not appear to affect long-term prognosis in patients with advanced ESCC, irrespective of the neoadjuvant therapy regimen. However, for patients undergoing neoadjuvant CF-RT, earlier surgery may be advantageous in reducing the risk of increased surgical complexity and anastomotic leakage.

Short-course radiotherapy (SCRT) followed by fruquintinib plus adebrelimab and CAPOX in the total neoadjuvant therapy of locally advanced rectal cancer (LARC): A multicenter, single-arm, open-label, phase II study (UNION TNT).

192 Background: We have demonstrated that neoadjuvant SCRT followed by PD-1 inhibitor plus CAPOX for LARC patients (pts) showed a higher pCR rate and a well-tolerated safety profile in phase III UNION study. Fruquintinib is a potent and highly selective VEGFR inhibitor, which had been approved for previously treated mCRC pts. This study aimed to investigate the efficacy and safety of SCRT followed by fruquintinib plus adebrelimab and CAPOX as a total neoadjuvant therapy for high-risk LARC pts. Methods: In this prospective, open-label, multi-centers, single-arm phase 2 study (NCT06234007), pts diagnosed with newly diagnosed and high risk LARC were recruited. Pts received SCRT (25Gy/5f) followed by six cycles of fruquintinib (4mg, qd, po, q3w,for the initial 6 pts in the safety run-in period, dosage would be adjusted based on dose-limited toxicities in the 1st cycle) combined with adebrelimab (1200mg, iv, d1, q3w) and CAPOX (q3w). Primary endpoint was CR rate (including clinical CR & pathologic CR). Secondary endpoints included 3-year EFS rate, OS, R0 resection rate and safety. Results: As of 30 Aug 2024, 45 pts were enrolled (median age 59 years [range: 24-75], 26 males, 23 clinical T4 stage and 20 clinical N2 stage, 36 with EMVI positive, 31 with MRF positive, 22 tumor located ≤5cm from the anal verge). Up to 20 Sep 2024, all pts completed SCRT, 73.33% (33/45), 57.78% (26/45) and 31.11% (14/45) pts completed two, four and six cycles of combination therapy, respectively. At data cut-off, of 33 pts included in the efficacy analysis, 28 pts underwent MRI examination and mrTRG results were available, the remaining 5 pts had early surgery due to AEs/serious AEs. 35.7% (10/28) and 46.43% (13/28) pts were classified as mrTRG1 and mrTRG2, respectively. Of 19 pts who underwent surgery, R0 rate was achieved in all 19 pts (100%) and pCR was achieved in 12 pts (63.16%). Moreover, 1 pt achieved cCR during neoadjuvant therapy, thus the treatment strategy provided a CR rate of 65% (1 cCR plus 12 pCR divided by 20). Grade 3/4 adverse effects (AEs) occurred in 16 pts (47.06%), and most commonly were lymphocyte count decreased (n=6, 18.18%), diarrhea (n=5, 15.15%) and AST increased (n=2, 6.06%). 4 serious AEs reported with intestinal perforation and all achieved pCR after surgery therapy. No treatment related death was reported. Conclusions: SCRT followed by fruquintinib combined with adebrelimab and CAPOX as a total neoadjuvant therapy showed promising CR rate and favorable pCR for high-risk LARC pts, and the safety profile was generally manageable. This treatment strategy might be a potential option as neoadjuvant therapy for high-risk LARC pts. Updated data will be presented in the future. Clinical trial information: NCT06234007 .

Anterior Staphyloma (Right eye) with Phthisis bulbi (Left eye): A case report

Background Staphyloma is a clinical condition characterized by an ectasia of the outer coats of the eye with an incarceration of the uveal tissue.[1] Phthisis bulbi is an end-stage clinical condition occurring due to severe eye injury or disease damage which leads to scarring, inflammation, atrophy and finally disorganization of globe and intraocular contents. [3,4] Case presentation A 16 years old boy presented in the OPD with protusion of the eyeball (right eye) and shrunken left eye which is present since birth. He had history of trauma to right eye with stick 5 years back following which he complains of further increase in size of the eyeball to attain the present size. His chief complaint was pain in right eye. SLE showed anterior staphyloma (right eye) along with mild congestion, mild blepharitis and pannus. Perception of light was present in right eye. Left eye findings were suggestive of pthisis bulbi with calcification, narrowing of palpebral aperture. The left eye was sightless, sizeless, shapeless and perception of light is negative in left eye. Conclusion Early identification of ophthalmological problems in infancy & prompt intervention is mandatory for anterior staphyloma. A comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and an early and meticulous surgery can optimize results.

Single-Stage Midline Unifocalization Is Associated With Excellent Outcomes in Infants of All Ages.

Tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries are a complex congenital heart defect. For years, our program has recommended early single-stage midline unifocalization at three to six months of age. However, many patients are referred beyond six months. Thus, we sought to evaluate surgical outcomes according to age at repair. We performed a retrospective review of patients who underwent unifocalization from age 3 to 12 months. These patients had not undergone prior surgery at our institution or elsewhere and were also not protocoled into early surgery. Patients were divided in the following groups: 3.0 to 4.9 (n = 61), 5.0 to 5.9 (n = 56), 6.0 to 7.9 (n = 56), and 8.0 to 11.9 (n = 47) months. Competing risk regression analyses were performed. We included 220 patients from 2001 to 2020. Baseline characteristics were not significantly different among the four groups. Overall, single-stage complete repair with bilateral unifocalization, ventricular septal defect closure, atrial septal defect closure, and right ventricular-pulmonary artery (PA) conduit placement was achieved at the index operation in 174 (79%) patients and did not differ across age groups. Early mortality was 4% (n = 9). At one year, 91% (200/220) of the entire cohort was fully septated. Comparing with group 1, group 4 was significantly less likely to undergo any PA reinterventions [hazard ratio (HR) 0.44, 95% CI 0.21-0.92, P = .028] or surgical PA reinterventions [HR 0.12, 95% CI 0.02-0.95, P = .044] following complete repair. Given the excellent outcomes across all ages, surgical timing for single-stage unifocalization should be dictated by clinical and anatomic details, with potential advantage in select clinically appropriate older infants who appear to be at a lower probability of PA reinterventions following full septation.

Letter to the editor regarding "a retrospective chart analysis with 5-year follow-up of early care for geriatric hip fracture patients: why we should continue talking about hip fractures".

Timing of surgery remains a topic of debate for hip fracture treatment in the geriatric patient population. The quality indicator "early surgery" was implemented in 2014 at the Department of Trauma Surgery of the University Hospitals Leuven to enhance timely operative treatment. In this follow-up study, we aim to evaluate the performance of this quality indicator, the clinical outcomes, and room for improvement. The charts of 1190 patients surgically treated for an acute hip fracture were reviewed between June 2017 and May 2022 at the University Hospitals Leuven. Primary endpoints were adherence to early surgery, defined as surgery within the next calendar day, and the evaluation of the reasons for deviating from this protocol. Secondary endpoints were length of stay (LOS); intensive care unit (ICU) admission and length of ICU stay; mortality after 30 days, 60 days, 90 days, and 6 months; and 90-day readmission rate. Pearson's Chi-square test and Mann-Whitney U test were used for data analysis. One thousand eighty-four (91.1%) patients received early surgery versus 106 (8.9%) patients who received delayed surgery. The main reasons for surgical delay were the use of anticoagulants (33%), a general health condition not allowing safe surgery and/or existing comorbidities requiring workup prior to surgery (26.4%), and logistical reasons (17.9%). Patient delay and transfer from other hospitals were responsible for respectively 8.5% and 6.6% of delayed surgery. Early surgery resulted in a significantly shorter LOS and ICU stay (12 [8-25] vs. 18 [10-36] and 3 [2, 3, 4, 5, 6] vs. 7 [3-13] days, early vs. delayed surgery, respectively). No significant reduction was observed in ICU admission, mortality, and readmission rate. We have been able to maintain the early surgery hip fracture protocol in approximately 90% of the patients. Comorbidities and anticoagulant use were responsible for delayed surgery in the majority of the patients. Correct implementation of the existing protocol on anticoagulant use could lead to a one-third decrease in the number of delayed surgeries. Subsequently, since the LOS and ICU stay in the delayed surgery group were significantly longer, a further increase of early surgery will lower the current economic burden.

The effectiveness of ERCP in managing preoperative complications of choledochal cysts in children and its role in facilitating early surgical intervention

IntroductionCurrently, there is no established guideline for the application of ERCP in children with choledochal cyst. This study aimed to investigate the safety and effectiveness of ERCP in managing preoperative complications of choledochal cyst in children, as well as the timing for definitive surgery following ERCP.MethodsWe conducted a retrospective review of medical records for 68 pediatric patients who presented with complications of choledochal cyst, including pancreatitis and biliary obstruction combined with cholangitis. All patients underwent ERCP treatment followed by definitive surgery. The primary outcomes assessed included treatment efficacy, post-ERCP complication, and the impact of ERCP on definitive surgical procedures.ResultsAmong the 68 patients studied, 41 presented with pancreatitis, while the remaining patients had biliary obstruction and cholangitis. Sixty-five patients successfully completed their treatments, with 64 experiencing alleviation of symptoms. Significant improvements were observed in serum amylase levels and liver function tests following ERCP. Post-ERCP complications occurred in three cases, including one case of pancreatitis and two cases of infection. The median interval between ERCP and surgery was 11 days. There was no significant difference in primary outcomes, such as surgical duration, rate of minimally invasive surgery, conversion to open surgery, intraoperative bleeding volume, intraoperative blood transfusion, postoperative complications, or average length of hospital stay, between the early surgery group (≤2 weeks) and the late surgery group (>2 weeks).ConclusionsERCP was proved to be a safe and effective intervention for alleviating preoperative complications in pediatric patients with choledochal cyst. Early definitive surgery following ERCP did not significantly impact the perioperative outcomes of pediatric patients.

Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Evaluation and Treatment of Pyogenic Spondylodiscitis of the Spine: AO Spine Knowledge Forum Trauma and Infection.

Literature Review with clinical recommendations. To highlight impactful studies on pyogenic spondylodiscitis (PS), identified by the AO Spine Knowledge Forum Trauma and Infection, with recommendations for their integration into clinical practice. Five influential studies on PS that have the potential to shape current practice in spinal infections were selected and reviewed. Each study was chosen for its contribution to a critical phase in PS management: diagnosis, imaging, surgical vs conservative treatment, and antibiotic duration. Recommendations were graded as strong or conditional following the GRADE methodology. Five studies were highlighted. Article 1: Pluemer et al introduced the Spinal Infection Treatment Evaluation (SITE) Score, a novel scoring tool for standardizing treatment decision-making. Conditional recommendation to incorporate the SITE Score or SISS Score for improved treatment outcomes. Article 2: Maamari et al conducted a meta-analysis comparing imaging modalities, with conditional recommendation to consider 18F-FDG PET/CT to diagnosis PS as an adjunct to MRI which remains the gold standard. Article 3: Thavarajasingam et al demonstrated the potential survival benefit of early surgery in specific PS cases, leading to a strong recommendation for early intervention in appropriate patients. Article 4: Neuhoff et al compared conservative and surgical treatments in well-resourced settings, concluding a strong recommendation for early surgery in appropriate patients. Article 5: Bernard et al evaluated antibiotic treatment duration, with a conditional recommendation for a 6-week course in confirmed cases, based on comparable efficacy to a 12-week regimen. Management of PS remains complex and varied. This perspective provides spine surgeons with evidence-based recommendations to enhance standardization and effectiveness in clinical practice.

The Prevalence of Tear Patterns and Their Effects on Tendon Healing After Arthroscopic Surgery in Patients With Full-Thickness Rotator Cuff Tears.

To achieve successful anatomic rotator cuff repair with minimal tension, both the tear pattern and tear size should be considered. However, little information is available concerning the frequency of tear patterns and their effects on tendon healing. To evaluate the distribution of tear patterns in full-thickness rotator cuff tears and whether these patterns affect tendon healing after arthroscopic repair. Case-control study; Level of evidence, 3. Between 2014 and 2021, patients who underwent arthroscopic surgery for symptomatic full-thickness rotator cuff tears with a minimum 2-year follow-up with postoperative magnetic resonance imaging or ultrasound were retrospectively reviewed. After the debridement of degenerative tendon tissue during arthroscopic surgery, the tear pattern was classified as crescent, U, or anterior or posterior L shaped. Intergroup differences in clinical and radiological characteristics were analyzed. In the subgroup analysis, patients were divided into 2 subgroups: small-to-medium or large-to-massive tears. Among the 1037 patients with a full-thickness rotator cuff tear, the most common tear pattern was crescent shaped (39.6%), followed by posterior L, U, and anterior L shaped (26.0%, 21.4%, and 12.9%, respectively). In the subgroup analysis, 713 patients (68.8%) had small-to-medium tears, while 324 (31.2%) had large-to-massive tears. The proportion of large-to-massive tears was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (24.8%, 28.8%, 52.2%, and 32.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The anterior L-shaped tear pattern had a significantly higher retear rate than the other tear patterns in small-to-medium tears (7.8%, 13.0%, 28.0%, and 10.6% for crescent, U, and anterior and posterior L shaped, respectively; P < .001). The rate of revision surgery because of a symptomatic retear within 2 years after primary surgery was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (3.8%, 7.5%, 21.6%, and 0.0% for crescent, U, and anterior and posterior L shaped, respectively; P = .002). The prevalence of tear patterns varied depending on the tear size. In small-to-medium tears, the anterior L-shaped tear pattern had the lowest incidence among the tear patterns; however, it had a significantly higher retear rate. Furthermore, the anterior L-shaped tear pattern had a higher incidence of retears requiring early revision surgery than the other tear patterns.

P0753 Early surgery in pediatric-onset ileocecal Crohn’s disease is associated with less unfavourable disease course: a retrospective population-based study

Abstract Background Early surgery in Crohn’s disease (CD) seems to be efficient and safe in recently diagnosed adult ileocecal CD as compared to anti-tumor necrosis factor (anti-TNF) therapy. However, its role in the first-line treatment of paediatric-onset CD remains unknown. We aimed to compare long-term disease course in paediatric-onset CD treated within one year of diagnosis with ileocecal resection (ICR) or anti-TNF therapy. Methods We conducted a retrospective study using a population-based cohort of patients aged of less than 17 years old at the diagnosis of ileocecal CD and treated with ICR or anti-TNF therapy within one year of diagnosis. The primary outcome was unfavourable disease course defined as CD-related hospitalization, major CD-related surgery, systemic corticosteroids or perineal CD. We collected ICR characteristics, post-operative complications and clinical remission (Harvey Bradshaw score &amp;lt; 4 without biologic therapy or new surgery). Cumulative incidence was calculated at 1, 3 and 5 years. We performed a Cox regression model with a propensity score. Results are expressed with 95% confidence intervals. Results From January 1988 and December 2011, 1007 patients were identified. 134 patients with ileocecal involvement at diagnosis were included, 67 patients in the ICR group and 67 in the anti-TNF group. The median follow-up was 6.0 years, IQR (3.2-11.1). Only 19% patients in the anti-TNF group had complicated behaviour as compared to 94% in the ICR group (p&amp;lt;0.001) at diagnosis. The mean length of the surgical specimen was 33.5 cm (IQR: (4-95)) and surgeries were performed in emergency in 20% of the patients.The incidence rate of unfavourable disease course was 80 per 1000 person-years [54-113] in the ICR group, and 270 per 1000 person-years [196-363] in the anti-TNF group with a cumulative incidence of 17%, [7-26], 26% [14-37] and 30% [17-41] respectively at 1, 3 and 5 years in the ICR group, versus 24% [13-33], 54% [40-65] and 71% [55-81] in the anti-TNF group (p &amp;lt;0.0001). When including the propensity score, patients in the ICR group had better disease course than patients in the anti-TNF group with a hazard ratio (HR) of 0.16 [0.08-0.35] over time. Clinical remission was achieved in 83% of patients in the ICR group and 41% in the anti-TNF group (p &amp;lt;0.001) at 5 years. Sixteen patients (23%) experienced an early postoperative complication, including 6 (9%) severe complications (Clavien-Dindo ≥ 3). Only emergency surgery was associated with late complications (HR = 6.9 [2.3-20.6]). Conclusion Early surgery in paediatric-onset ileocecal CD was significantly associated with less unfavourable outcome and seemed safe. These data support the role of early elective surgery in the first-line treatment of paediatric-onset ileocecal CD.

P1120 ‘Early’ surgery for ileocaecal Crohn’s disease: a study of the patient perspective

Abstract Background Surgery for Crohn’s disease (CD) is considered when medical therapy is unsuccessful. However earlier bowel resection may offer more stable remission for localised luminal ileocaecal disease. The adoption of earlier surgery into practice comes with challenges, reflected by the difficulty in recruiting participants into trials of surgical treatment. We aimed to establish the acceptability of, and potential barriers to, early surgery from a patient perspective through a multicentre qualitative study. Methods Patients with ileocaecal CD from 8 centres across the United Kingdom (including both specialist IBD centres and non-specialist hospitals) were recruited, using purposive sampling, to participate in semi-structured interviews. Interviews were audio-recorded and transcribed. Recruitment continued until data saturation was achieved. Data were analysed thematically; 50% of the data were coded independently by two researchers. Results Twenty-nine participants were interviewed (14 males, 17 with a previous bowel resection, median time since diagnosis 6 years (8 months – 10 years), median age 34 years (22-71), 4 non-white patients). The themes and subthemes identified are summarised in Table 1. Participants with a previous bowel resection reported that surgery was not offered to them until they had tried several drugs or until disease complications had ensued; they described a poor quality of life prior to their operation. Surgery-naïve patients viewed a bowel resection as a last resort measure. There were many accounts of surgery being framed negatively by clinicians when offering treatment. Only one patient was aware of the benefits of early surgery. However, even participants with a good surgical outcome viewed surgery negatively; patients generally wanted to avoid an operation because of the risk of a stoma and the potential for complications. Conclusion This is the first study investigating the gap between the evidence-base and clinical practice around the management of luminal ileocaecal CD. Patients’ views of treatment are influenced by their clinicians’. In our previous study investigating the clinician perspective on early surgery, clinician-participants were proponents of early surgery. This is in contrast with the findings of this study where patients reported being offered a resection late in the pathway. Surgery should be discussed sooner with patients, ideally as part of a multidisciplinary team consultation. It is possible that patients will still prefer medical therapy to surgery. This has implications for the design of future trials comparing surgery to medical therapy for ileocaecal CD – recruitment into randomised trials may remain difficult in the face of strong patient (and/or clinician) preferences. References Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, et al. Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol. 2017;2(11):785-92. Husnoo N, Gana, T, Hague AG, Khan Z, Morgan JL, Wyld L, Brown SR. Is early bowel resection better than medical therapy for ileocolonic Crohn’s disease? A systematic review and meta-analysis. Colorectal Dis. 2023; 25(6): 1090-1101. Husnoo N, Morgan JL, Wyld L, Brown SR, P230: The challenges of implementing early surgery for terminal ileal Crohn’s disease – a qualitative study of the clinician perspective, British Journal of Surgery, Volume 111, Issue Supplement_2, March 2024, znae046.119,

P0927 Surgery as a Treatment Option for CD: A Nationwide Cohort Study

Abstract Background Although surgery is often reserved for individuals with refractory Crohn’s disease (CD), recent data suggest that intestinal resection in select individuals may obviate the need for future CD-related treatment, particularly among older adults. Despite this, limited data characterizing these patients exist. Methods We performed a nationwide cohort study using the Swedish National Patient Register and the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort to identify all individuals who underwent a first CD-related intestinal resection between 2007-2018 (allows for five years of follow-up among all individuals). Intestinal resection for dysplasia and/or malignancy were excluded in order to identify those with ongoing CD-related disease activity. Our primary outcome was the need for an IBD-related treatment (medical therapy, surgery, and/or IBD-related hospitalization) within the five years following intestinal resection; subgroup analysis was performed among older adults. Univariable and multivariable logistic regression were used to calculate odds ratios (ORs). Results Overall, there were a total of 1,760 individuals included. The average age at surgery was 41.4 years, and the median duration of disease prior to resection was 0.5 years (IQR: 0.0-2.1 years). At 5-years, 341 (19.4%) of individuals did not require an IBD-related treatment; of those who required treatment, 2.3% had another intestinal resection, 15.8% had an IBD-related hospitalization, and the majority required corticosteroids, an immunomodulator, and/or an advanced therapy. On multivariable analysis, longer disease duration (aOR 1.07, 95%CI 1.01-1.15), the absence of COPD (suggesting no smoking: aOR 4.35, 95%CI 1.32-14.3), and being bio-naïve (aOR 2.97, 95%CI 1.11-8.00) prior to surgery increased the odds of remaining IBD-treatment/hospitalization free for 5-years post intestinal resection (Table 1). On subgroup analysis among adults ≥ 50 years-old (given data suggest this group may derive the most benefit from elective surgery), longer disease duration (aOR 1.10, 95%CI 1.00-1.22), as well as the absence of COPD (aOR 4.76, 95%CI 1.43-16.70) were associated with a higher odds of remaining IBD-treatment/hospitalization free. Conclusion Individuals with CD who have a longer disease duration, do not smoke, and are bio-naive, may be more likely to remain treatment free in the five years following intestinal resection; similar results were observed among older adults with CD. These data can help identify individuals in which surgery may obviate the need for future CD-therapy, though future studies should assess whether earlier surgery among these individuals can improve long-term clinical outcomes.

A novel approach for managing the incisions of tibial plateau fractures with soft tissue swelling

To investigate the feasibility and clinical efficacy of a novel approach to managing the incisions used to treat tibial plateau fractures (TPFs) with soft tissue swelling. We retrospectively enrolled 64 patients with TPFs who underwent surgery at the Second Hospital of Shandong University. Patients were divided into two groups: Group A (n = 32) underwent early surgery with the novel incision management technique, and Group B (n = 32) underwent conventional surgery after swelling reduction. The perioperative data of the two groups were compared, including the time from injury to surgery, one-stage operation time, intraoperative blood loss, number of dressing changes, wound healing time, and hospitalization time. Preoperative and postoperative complications were assessed in both groups, and pain condition, degree of arthritis, limb function, imaging results, and quality of life were evaluated using validated scales. The time from injury to surgery, number of dressing changes, and hospitalization time in Group A were significantly lower than those in Group B (P < 0.05). There were no significant differences in one-stage operation time, intraoperative blood loss, or wound healing time between the two groups (P > 0.05). There were fewer preoperative and postoperative complications in Group A than in Group B (P < 0.05). The VAS and WOMAC scores were reduced in both groups (P < 0.05); Group A had lower VAS scores two weeks after surgery. There was no statistically significant difference in the WOMAC score between the groups. The modified Rasmussen functional and radiological scores were elevated in both groups (P < 0.05). There was no statistically significant difference between the two groups for the modified Rasmussen functional or radiological score at any of the time points (P > 0.05). In addition, the two groups did not differ in quality of life (P > 0.05). For patients with tibial plateau fractures without congestive blisters, open reduction and internal fixation at the early stage of swelling and wide-spacing interrupted suture and negative pressure wound therapy (NPWT) closure of the wound could help obtain excellent to good functional outcomes with fewer complications. This novel incision management approach and concept expands the surgical indications for these fractures.

The effect of SARS-CoV-2 Omicron BA. 5.2 infection on perioperative physiological indicators in orthopedic patients

ObjectiveThe aim of this study was to investigate the effect of SARS-CoV-2 Omicron BA. 5.2 (hereafter referred to as Omicron BA. 5.2) infection on perioperative physiological indices and to provide clinical considerations for the precautions needed for patients who tested negative for SARS-CoV-2 infection perioperatively.MethodsPatients who underwent time-limited surgery (surgery that must be performed within a certain time) at the Department of Orthopedics of our hospital from September 1, 2022, to March 31, 2023, were divided into an observation group (those with Omicron BA 5.2 and a negative nucleic acid test after December 7, 2022, n = 100) and a control group (those negative for SARS-CoV-2 infection before December 7, 2022, n = 100). Changes in the following factors were compared within and between the two groups: heart rate, mean arterial pressure, oxygenation index at the time of entry into the operating room, incision of the skin and exit from the operating room and the neutrophil‒lymphocyte ratio (NLR), platelet‒lymphocyte ratio (PLR), systemic immune inflammation index (SII), D-dimer level, and fibrinogen degradation product (FDP) level. Changes in interleukin-6 and calcitonin levels were assessed the day after surgery, and multivariate regression analysis of the meaningful results was conducted.ResultsHeart rate, mean arterial pressure, oxygenation index, NLR, PLR, SII, interleukin-6 and calcitonin were similar between the two groups (P > 0.05). The observation group had higher postoperative D-dimer and FDP levels (P < 0.05). Multivariate regression analysis revealed that Omicron BA 5.2 infection, older age and a history of cerebral infarction were associated with increased D-dimer and FDP levels, and their odds ratios (ORs) and confidence intervals are 3.339 [95% CI, 1.372–8.419], P = 0.008; OR, 1.080 [95% CI, 1.023–1.139]; P = 0.005; OR, 10.644 [95% CI, 1.352–83.320], P = 0.025, respectively.ConclusionOmicron BA. 5.2 Infection affects the perioperative coagulation function of orthopedic patients, thereby inducing a hypercoagulable state characterized by significant elevations in D-dimer and FDP levels and increasing the risk of venous thrombosis. This infection had no obvious effect on other physiological indices. Early surgery is feasible, but thrombotic events need to be considered.

Timing of Surgery and Postoperative Outcomes in Esophagectomy for Squamous Cell Carcinoma: A Prospective Study in North India.

Neoadjuvant chemotherapy followed by esophagectomy is the usual approach to manage esophageal squamous cell carcinoma (ESCC). The optimal interval to operate after completion of neoadjuvant chemoradiotherapy (NACRT) still remains controversial. A prospective study was conducted to observe and compare postoperative complications and pathological outcomes in patients with squamous cell carcinoma of the esophagus who underwent NACRT followed by surgery within 8weeks or after 8weeks of NACRT completion. The pathological complete response was assessed using the Mandard tumor regression grade. Morbidity and mortality were compared and were graded using the Clavien-Dindo scale. The study included 50 patients, 19 patients in the < 8-week group and 31 in the > 8-week group study. Patients underwent thoracoscopy-assisted esophagectomy with neoesophagus formation using gastric conduit. There was a significant difference in mortality between the two groups, with three mortalities in the < 8-week group and none in the other group (p = 0.022). Postoperative complications and pathological outcomes did not have a statistically significant difference between the two groups. The pathological response in ESCC cases does not appear to be impacted by the interval between NACRT and surgery; nevertheless, early surgery was associated with a higher risk of mortality.

Inflammatory bowel diseases in the elderly population: epidemiology, long-term disease course, surgery rates, and biological use-data from the Veszprem county cohort between 1977 and 2020.

Limited data are available on long-term disease outcomes in elderly-onset (EO) inflammatory bowel diseases (IBD) from well-defined population-based cohorts. Our aim was to analyze incidence, disease course, surgery rates, and therapeutic strategies of EO IBD in a prospective population-based cohort. Elderly-onset inflammatory bowel diseases were defined if diagnosis was established at ≥60 years of age. Patient inclusion lasted between 1977 and 2018. Study endpoints were compared between elderly- and adult-onset (AO) patients and different therapeutic eras. Data from medical records were prospectively collected and regularly reviewed, as part of the well-established Veszprem IBD cohort. Data from 946 Crohn's disease (CD) and 1370 ulcerative colitis (UC) patients were analyzed. The proportion of EO CD and UC patients was 6.1% (58/946) and 13.4% (183/1370) in the total cohort. Biological therapy exposure was significantly lower in EO CD compared to AO [pLogRank = 0.003], but similar exposure was seen amongst UC patients [pLogRank = 0.770]. Early surgery rates (≤1 year from diagnosis) were significantly higher in EO CD patients compared to AO (27.6% vs 15.6%; P < .001). However, there was no statistically significant difference in overall resective surgery rates between the EO and AO cohorts in CD [pLogRank = 0.838], nor colectomy rates differed in UC [pLogRank = 0.435]. Disease phenotype progression in CD and UC were both lower in EO disease [pLogRank = 0.015; pLogRank = 0.022]. Elderly-onset inflammatory bowel diseases represents an increasing proportion of IBD patients, with high exposure to biologicals in EO UC. Overall surgery rates were similar in EO and AO cohorts, however, early surgeries in CD were higher in EO patients.

Pseudo-anévrisme du trigone mitro-aortique : Cas clinique et revue de littérature

We report the case of a 63-year-old patient who underwent aortic valve replacement with a biological valve for a bicuspid aortic stenosis, and LIMA-IVA single-bypass surgery. Two weeks later, he presented with Enterococcus faecillis bacteremia, attributed to left pyelonephritis and successfully treated with Amoxicillin. Two months after his surgery, he had a new bacteremia due to Enterococcus faecalis and we discovered a pseudo-aneurysm of the mitro-aortic trigone. Our patient is treated medically at first, before benefiting from the "Hemi-Commando" procedure. The mitro-aortic trigone is a fibrous area, located between the left half of the noncoronary cusp and the left coronary cusp of the aortic valve and the anterior leaflet of the mitral valve [1]. This area, important in the maintenance of mitral and aortic functions, [ii] is poorly vascularized and therefore very susceptible to infections and trauma [2]. Erosion of the aortic ring leads to the formation of a subvalvular abcess, secondarily detergated en then leads to the destruction of the trigone. Pseudoaneurysm is a rare complication of aortic valve surgery and endocarditis. Given the risk of rupture, early surgery is recommended.

Early Surgery and Screw-Only Osteosyntheses in Minimally Invasive Treatment of Calcaneal Fractures-Risk or Benefit for Our Patients?

Background: This study aims to analyze the outcomes following the minimally invasive surgery of calcaneal fractures using screw-only osteosynthesis, as well as the impact of surgical timing. Methods: Between 2015 and 2020, 155 patients with 168 fractures were included. According to the Sanders classification, 48.21% of fractures were classified as Sanders 2, 33.33% as Sanders 3, and 10.11% as Sanders 4 fractures, with the remaining fractures unclassified. A total of 117 cases were treated on the day of admission or the following day. The surgeries followed a standardized protocol for fracture analysis, positioning, and X-ray techniques, primarily using a percutaneous approach with stab incisions. Osteosynthesis was mainly performed using screws, with five cases treated with K-wires for open fractures. Results: The mean Boehler's angle improved from 8.52° preoperatively to 25.00° postoperatively. Three superficial infections were observed. Deep infections occurred in three cases, all following open fractures. Secondary dislocation was noted in five patients-one due to a deep infection, and four attributed to clear technical failures. One case involved a questionable indication for a screw change (7.3 mm screw) after two weeks due to perforation of the medial wall. A total of 79 fractures were followed up for an average of 4 years and 3 months. The mean AOFAS score was 91.3, and the mean FAOS score was 88.7. Surgery within 7 days after admission showed no significant impact on the outcomes. Conclusions: Minimally invasive screw-only osteosynthesis with early surgical intervention offers favorable outcomes with minimal risk.

Outcomes of Tongue Reduction Surgery in Beckwith-Wiedemann Syndrome: A Systematic Review.

Macroglossia is a frequent clinical feature of Beckwith-Wiedemann syndrome (BWS), a congenital overgrowth disorder. Macroglossia can lead to abnormal breathing, feeding, speech, and dentoskeletal development. Partial glossectomy is a common intervention aimed at reducing these abnormalities. The optimal timing of partial glossectomy remains controversial due to the potential need for secondary surgery and the ongoing growth of the tongue in early childhood. After PRISMA-ScR and PRISMA-S reporting standards, this systematic review included English language studies of patients with BWS who underwent partial glossectomy. Data were extracted, including patient age, clinical outcomes, and follow-up. Study evidence levels were categorized based on a recognized hierarchy, and bias was assessed using the MINORS criteria. Early tongue reduction surgery (<24mo) was associated with a lower incidence of class 3 occlusion and anterior open bite compared with later surgery. Improvements in speech intelligibility, tongue mobility, and breathing outcomes, including a reduction in obstructive sleep apnea, were observed, especially in early surgical groups. Feeding and drooling outcomes improved across both early and late surgical interventions, although no direct comparisons were made between the 2. Overall, tongue reduction surgery demonstrated benefits in functional outcomes, whereas dentoskeletal improvements remained variable. Although there is a lack of consensus to the optimal age for the procedure, overall tongue reduction surgery in BWS seems to have functional benefits, including in speech, feeding, and breathing. Dentoskeletal outcomes are more variable. Variability in macroglossia severity, surgical technique, and surgeon experience may account for differences in reported outcomes across studies.

Comparison of the effect of early versus late surgical strategies on outcomes in patients with hand enchondromas complicated with pathological fractures.

This study aimed to evaluate the advantages and disadvantages of early versus delayed single-stage surgery in patients with hand enchondromas who developed pathological fractures, focusing on local tumor control and hand function, to determine the optimal timing for surgery. Delayed surgical curettage may offer advantages regarding both local tumor control and hand function outcomes.Thirty-five patients who developed pathological fractures due to solitary hand enchondromas and underwent surgical treatment between 2015 and 2021 were analysed. Patients were divided into two groups based on the timing of surgery. Patients who underwent surgical treatment immediately after a pathological fracture were assigned to the early-surgery group, and those who underwent surgical treatment after waiting for fracture union were assigned to the late-surgery group. Demographic data, lesion characteristics, and fixation methods were analysed. Parameters affecting outcome measurements were analysed, including visual pain scale, fracture healing time, recurrence, ROM, time to return to daily activities, and secondary surgical procedures.The study included 35 patients, of whom 24 were female, with a median age of 33 years. Fifteen patients were included in the early-surgery group and 20 in the late-surgery group, with a follow-up period of 36.3 and 38.9 months, respectively. The duration of surgery, time to fracture union, and total physical therapy duration during treatment were lower in the late-surgery group (p<0.05). At the final follow-up, the mean loss of ROM was 17.6˚ in the early-surgery group and 3.3˚ in the late-surgery group (p=0.00). The rate of secondary surgery was higher in the early-surgery group (p=0.040).In patients with hand enchondromas presenting with pathological fractures, early surgery resulted in higher complication rates, poorer functional outcomes, and an increased need for secondary surgeries.

In asymptomatic severe AS, early surgery vs. conservative therapy reduced a composite of death, MI, stroke, or HF hospitalization at 63 mo.

GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text].