High Postoperative Morbidity Research Articles

Association of Preoperative Physical Activity with Short- and Long-Term Outcomes in Patients Undergoing Palliative Resection for Metastatic Colorectal Cancer: An Inverse Probability of Treatment Weighting Analysis.

Simple SummaryPhysical activity is linked to the risk and the prognosis of colorectal cancer. However, the impact of preoperative physical activity on postoperative short-term and long-term outcomes is limited. The aim of our study was to elucidate the relationship of preoperative physical activity and postoperative outcomes in metastatic colorectal cancer patients who underwent palliative resection. After the inverse probability of the treatment weighting process, the metabolic equivalent of task < 12 group had a higher postoperative morbidity rate and mortality rate. No significant difference was found in overall survival. In patients undergoing palliative resection for metastatic colorectal cancer, preoperative leisure-time physical activity with the metabolic equivalent of task ≥ 12 was associated with reduced short-term postoperative morbidity and mortality; however, no difference was detected in long-term survival.A lack of physical activity is a generally accepted risk factor for colorectal cancer. However, research on the effect of preoperative physical activity on postoperative and long-term outcomes is limited, especially in patients with stage IV colorectal cancer who underwent palliative surgery. Patients who underwent bowel resection for stage IV primary colorectal cancer between January 1995 and December 2016 were retrospectively enrolled. A total of 2185 patients were divided into two groups according to preoperative leisure-time weekly physical activity as assessed by metabolic equivalent of task (MET) values: MET < 12 (n = 1845) and MET ≥ 12 (n = 340). Inverse probability of treatment weighting (IPTW) was used to reduce imbalance and selection biases between the two groups. After the IPTW process, the MET < 12 group showed a higher postoperative morbidity rate (18.7% vs. 10.6%; p < 0.001) and mortality rate (2.4% vs. 0.6%; p < 0.001) than the MET ≥ 12 group. No significant difference was found in overall survival. Weekly preoperative leisure-time physical activity with MET ≥ 12 was associated with reduced short-term postoperative morbidity and mortality in patients undergoing palliative resection for metastatic colorectal cancer. However, no difference was detected in long-term survival.

Retrospective Cohort Analysis of the Effect of Antimicrobial Stewardship on Postoperative Antibiotic Therapy in Complicated Intra-Abdominal Infections: Short-Course Therapy Does Not Compromise Patients’ Safety

Background: Recent evidence suggests that short-course postoperative antibiotic therapy (PAT) of intra-abdominal infections is non-inferior considering clinical outcomes. The aim of this study was to compare the outcome of short vs. long PAT in complicated intra-abdominal infections (cIAIs) without sepsis. Methods: We performed a single center-quality improvement study at a 1500 bed sized university hospital in Bavaria, Germany, with evaluation of the length of antibiotic therapy after emergency surgery on cIAIs with adequate source control during 2016 to 2018. We reviewed a total of 260 cases (160 short duration vs. 100 long duration). The antibiotic prescribing quality was assessed by our in-house antimicrobial stewardship team (AMS). Results: No significant differences of patient characteristics were observed between short and long PAT. The frequency of long PAT declined during the observation period from 48.1% to 26.3%. Prolongation of PAT was not linked with any clinical benefits, on the contrary clinical outcome of patients receiving longer regimes were associated with higher postoperative morbidity. AMS identified additional educational targets to improve antibiotic prescribing quality on general wards like unnecessary postoperative switches of antibiotic regimes, e.g., unrequired switches to oral antibiotics as well as prolongation of PAT due to elevated CRP. Conclusion: Short-course antibiotic therapy after successful surgical source control in cIAIs is safe, and long-duration PAT has no beneficial effects.

Gastrointestinal reconstruction by intestinal auto-transplantation after radical resection of neoplasms involving superior mesenteric artery: a preliminary consideration

When abdominal neoplasms originating from the pancreas or nearby organs locally involving the superior mesenteric artery (SMA), complete resection is still the only hope for cure. However, SMA resection and reconstruction is a complex surgical procedure associated with high postoperative morbidity and mortality. Intestinal autotransplantation has recently emerged in clinical practice as a treatment option for selected patients with neoplasms involving the SMA. The original procedure involved en bloc removal of a tumor together with the intestine, ex vivo resection and reconstruction of gastrointestinal tract by an intestinal autograft. To further refine this complex procedure, a modified method was developed in which a segmental bowel autograft is selected and harvested first during the initial stage of the operation, and radical resection of the neoplasm is carried out thereafter. The modification would better protect a healthy bowel autograft from potential damage due to prolonged warm ischemia and allow the subsequent lengthy process of dissection to be performed in an unrushed manner. Furthermore, this alteration would better adhere to the general principles of minimal tumor manipulation during operation and potentially decrease the risks of tumor implantation during in vitro organ perfusion. Although intestinal autotransplantation has expanded eligibility for resection of otherwise unresectable lesions involving the SMA, its operative complexity, high risks, and post-operative complications largely limit its clinical applications.

Role of Sarcopenia in Prediction of Early Postoperative Complication after Pancreaticoduodenectomy

Introduction: Pancreaticoduodenctomy is a complex procedure having high postoperative morbidity. Sarcopenia is newly identified marker of frailty. We performed this study to assess whether preoperative sarcopenia has an impact on postoperative complications

Presenting features and overall survival of chondrosarcoma of the pelvis

IntroductionChondrosarcoma is the second most common sarcoma of bone. This sarcoma is generally unresponsive to chemotherapy and radiation and is primarily managed through surgical excision. Pelvic chondrosarcoma presents a distinct therapeutic challenge due the complexity of resection, frequent recurrence and metastasis, and high post-operative morbidity. MethodsThe SEER database was queried for pelvic chondrosarcoma diagnosed between 2004 and 2015. Cases were described by age, sex, tumor size, extension, grade, metastasis, and therapeutic intervention. These same variables were assessed for the upper extremities, lower extremities, skull and facial bones, thoracic bones, and vertebral column. ResultsIn total, 472 cases of pelvic chondrosarcoma were identified, representing 18.4% out of 2571 cases of chondrosarcoma distributed throughout the skeletal system. Among pelvic cases, 288 were male and 184 were female, with a median age of diagnosis of 54. Median tumor size was 96 mm, 64.9% of tumors were considered extracompartmental, and 11.3% of tumors were metastatic at time of diagnosis. The 2, 5, and 10-year survival rates for all cases of primary chondrosarcoma of the pelvis are 76.7%, 61.8%, and 52.2%, respectively. Survival was worse for patients with metastasis, male sex, age >60, tumor size >8 cm, dedifferentiated histology, and no surgical resection. On multivariate assessment high grade and metastasis most significantly predicted worse overall survival. ConclusionPelvic chondrosarcoma commonly presents with high-risk features including larger tumor size, extracompartmental extension, and metastatic disease at diagnosis, predicting worse overall survival compared to non-pelvic tumors, and were the least amenable to surgical resection.

Predictors of Disease Recurrence Following Clearance of Bilobar Colorectal Liver Metastases: An International Multicentre Study

Introduction: Presence of bilobar colorectal liver metastases (BiCRLM) is a relatively poor prognostic indicator. With careful pre-operative planning, tumour clearance is offered for increased number of patients with BiCRLM. Some of the options are associated with higher postoperative morbidity, mortality rates and it is important to identify patients who benefit from such interventions. The study aims to assess the clinical and pathological determinants of recurrent disease in patients with BiCRLM. Study period and data collection: An international multicentre study was set up with endorsement from the EAHPBA. Predefined electronic case report forms were made available from BiCRLM.org website. Patients with at least two lesions each on the right and left hemiliver (minimum four) and considered for clearance of liver disease (single+/-two-stage hepatectomy+/-ablation) between 2012 and 2018 were recruited. Recurrence patterns and factors influencing recurrence were evaluated using stepwise regression analysis. Results: A total of 1243 patients were included. Recurrence was encountered in 77.3% (liver: site of previous resection/ablation:24%; liver: new location:50%; lungs:31%; peritoneum:11%. Median time to recurrence from liver surgery was 10.1months. 40% died with cancer at a median follow-up duration of 20 months. T-stage(p=0.24) and N-stage(0.18) of primary, chemotherapy at primary resection(0.02), number of liver lesions(p=0.001) and their radiological response(p=0.04), margin status of liver resection (0.004) had significant influence on the above outcomes. Conclusion: TN staging of primary, liver tumor load, chemosensitivity, margin positivity influence the oncological outcomes following clearance of BiCRLM. These factors should be taken into consideration in selection and surgical planning of patients with BiCRLM.

Pancreaticoduodenectomy Following Preoperative Acute Pancreatitis (PrAP) in Periampullary and Pancreatic Cancers: Implications and Outcomes

Introduction: Preoperative Acute Pancreatitis (PrAP) in periampullary and pancreatic cancers is uncommon. However, it may have significant implications on management and outcome of these patients. Study compares outcomes in patients of periampullary and pancreatic cancer with PrAP to those without. Method: Perioperative outcomes of 17 patients who presented as pancreatic/peri ampullary cancer with associated acute pancreatitis (PrAP group) were analyzed and compared with 85 matched patients without AP (PC group). Results: Out of 17 patients, 10, 4 and 3 patients had mild, intermediate and severe acute pancreatitis (SAP) respectively. The median duration between diagnosis and surgery was 75 days. Causes of PrAP in these patients included ERCP in 6 patients, obstructive pancreatitis in 6, choledocholithiasis in 1, pancreas divisum in 1 and 3 in cases cause could not be known. When compared to PC group, the overall morbidity (88.2 vs 58.8% , p value- 0.02), major morbidity (clavein grade IIIa or higher) (52.9% vs 27.1%, p -0.036), CR-POPF (47.1% vs 15.3%, p value- 0.003) were significantly higher in PrAP group. Patients with SAP had significantly higher delay in surgery (206 vs 69 days, p -0.0001), more CR-POPF (100 vs 30.8%, p-0.01) and major morbidity (100% vs 38.5%, p-0.03) as compared to those with mid/intermediate pancreatitis. Conclusion: PrAP patients have significantly high post-operative morbidity and CR-POPF ate as compared to patients without pancreatitis. Amongst PrAP patients those with SAP patients have significantly higher morbidity as compared to those with mild or intermediate pancreatitis.

Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients.

PurposeThe standard of care for early rectal cancer is radical surgery; however, it carries high postoperative morbidity. This study aimed to assess the short-term and oncological outcomes of local excision and adjuvant radiotherapy in patients with high-risk pathological stage (p) T1 rectal cancer.MethodsFifty-five patients underwent local excision with adjuvant radiotherapy or radical resection for high-risk T1 rectal cancer. Patients with adenocarcinoma within 10 cm from the anal verge; pT1 with high-risk features (grade 3–4); a tumor size of ≥3 cm; a positive margin; a lymphovascular or perineural invasion; or a submucosal invasion depth of ≥SM2 were included.ResultsThe rates of postoperative complications and stoma formation were higher in the radical surgery group (P = 0.021 and P = 0.003, respectively). No significant differences were observed in the overall survival and disease-free survival (DFS) between the 2 groups (P = 0.301 and P = 0.076, respectively). Vascular invasion was a significantly poor prognostic factor for DFS (P = 0.033). The presence of 3 or more high-risk features was associated with a poor DFS (P = 0.002).ConclusionLocal excision with adjuvant radiotherapy significantly reduces the risk of complications and stoma formation. It is also an alternative option for patients with fewer than 3 high-risk features.

Aorto-duodenal fistula secondary to aortic graft replacement

Secondary aorto-duodenal fistula (SADF) is a rare and serious event occurring in up to 45% of aortic prosthesis infections. The clinical manifestations are variable ranging from isolated signs of graft infection such as fever to massive gastrointestinal bleeding. The diagnosis is based on CT scan and is generally oriented by an inconstant association of indirect signs. Despite a high early severe postoperative morbidity and mortality, especially in presence of a preoperative shock, emergency surgery allows for the diagnosis and treatment of SADF with multidisciplinary management allowing favorable midterm outcomes among surviving patients. The images that we present in this manuscript highlight some indirect signs of SADF on CT scan that should alert clinicians to warrant on time surgical management with an illustration of per operative diagnosis of the fistula.

Totally laparoscopic resolution of gallstone ileus: A case report.

IntroductionGallstone ileus is an uncommon complication of long-term cholelithiasis. Emergent operations for gallstone ileus are associated with high postoperative morbidity. When feasible, the minimally invasive approach might help to improve the postoperative outcomes.Presentation of caseA 63-year-old female was admitted for abdominal pain and vomiting. Computed tomography (CT) scan showed a cholecystoduodenal fistula and a 5 × 3 cm gallstone in the jejunum causing obstruction. An emergent laparoscopy was performed, and a gallstone was found inside the jejunum 40 cm distal to the ligament of Treitz. The 5 cm gallstone was extracted through an antimesenteric enterotomy. The jejunum was then closed transversally using interrupted sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day 3.DiscussionSurgery is the mainstream treatment for gallstone ileus. Multiple operations and surgical approaches have been described: enterolithotomy (EL), one-stage surgery (EL, cholecystectomy, and fistula closure), bowel resection, and two-stage surgery (EL and delayed cholecystectomy with fistula closure). The choice of the procedure depends on the patient's characteristics, comorbidities, and experience of the surgical team.ConclusionIn the emergency setting, a simple enterolithotomy with primary closure seems to be the optimal approach to solve the intestinal obstruction with low postoperative morbidity. The laparoscopic approach to gallstone ileus results in additional benefits for patients' recovery.

Rescue of Failed Aortic Repair with Fenestrated Endovascular Device

The incidence of failed endovascular (EVAR) and open repair (OR) is increasing. Redo aortic repair is required in 10% of patients. Extension of the proximal sealing zone above the visceral arteries to adequate, healthier thoracic aorta using a fenestrated graft (FEVAR) can rescue a failing repair. A custom-made device can treat proximal type 1a endoleaks or proximal dilatation post endovascular or open repair, respectively. The aim of this investigation was to present a single-centre experience with FEVAR for patients with a failing aortic repair. A prospectively maintained database of FEVAR patients treated with a ZenithⓇ Fenestrated endovascular (ZFEN) device (Cook Medical LLC, Bloomington, Indiana, USA) was interrogated for individuals who had the device implanted as a rescue therapy after prior endovascular (EVAR) or open repair (OR). Statistical analysis was performed with SPSS v 25 software. Between January 1, 2011 and March 31, 2019, 17 ZFEN devices were implanted. 10 patients had a type 1a endoleak from a prior EVAR and 7 patients had proximal disease progression after prior OR. There were 12 males and 5 females, median age of 75 (interquartile range, IQR 7). 76.4% (n=13) of patients had an American Society of Anaesthesiologists (ASA) grade of 3. Primary technical success was 70.5% (n=12). Of the remainder, 4 cases (24%) had a type III endoleak at completion angiogram; of which, 2 patients (12%) required re-intervention within 30 days. One further case (6%) had primary assisted technical success as stenting of a flow limiting dissection flap in an iliac vessel was required. Peri-operative rate of deployment related complications and systemic complications were 5.8% (n=1) and 35% (n=6), respectively. Median length of hospital stay was 11 days (IQR 11). There was no mortality within the study follow up. Overall 30-day re-intervention rate was 23.5%. Overall survival was 92% at one year. FEVAR is a safe but technically challenging option for rescue of failing aortic repairs. These are a high-risk group of patients and this is reflected in the high post-operative morbidity rate. Technical success was high and 30-day mortality was low.

Deep Learning Plus Three-Dimensional Printing in the Management of Giant (&gt;15 cm) Sporadic Renal Angiomyolipoma: An Initial Report

ObjectiveTo evaluate the feasibility and effectivity of deep learning (DL) plus three-dimensional (3D) printing in the management of giant sporadic renal angiomyolipoma (RAML).MethodsThe medical records of patients with giant (>15 cm) RAML were retrospectively reviewed from January 2011 to December 2020. 3D visualized and printed kidney models were performed by DL algorithms and 3D printing technology, respectively. Patient demographics and intra- and postoperative outcomes were compared between those with 3D-assisted surgery (3D group) or routine ones (control group).ResultsAmong 372 sporadic RAML patients, 31 with giant ones were eligible for analysis. The median age was 40.6 (18–70) years old, and the median tumor size was 18.2 (15–28) cm. Seventeen of 31 (54.8%) had a surgical kidney removal. Overall, 11 underwent 3D-assisted surgeries and 20 underwent routine ones. A significant higher success rate of partial nephrectomy (PN) was noted in the 3D group (72.7% vs. 30.0%). Patients in the 3D group presented a lower reduction in renal function but experienced a longer operation time, a greater estimated blood loss, and a higher postoperative morbidity. Subgroup analysis was conducted between patients undergoing PN with or without 3D assistance. Despite no significant difference, patients with 3D-assisted PN had a slightly larger tumor size and higher nephrectomy score, possibly contributing to a relatively higher rate of complications. However, 3D-assisted PN lead to a shorter warm ischemia time and a lower renal function loss without significant difference. Another subgroup analysis between patients under 3D-assisted PN or 3D-assisted RN showed no statistically significant difference. However, the nearness of tumor to the second branch of renal artery was relatively shorter in 3D-assisted PN subgroup than that in 3D-assisted RN subgroup, and the difference between them was close to significant.Conclusions3D visualized and printed kidney models appear to be additional tools to assist operational management and avoid a high rate of kidney removal for giant sporadic RAMLs.

Negative-pressure wound therapy after stoma reversal in colorectal surgery: a randomized controlled trial.

BackgroundStoma-reversal surgery is associated with high postoperative morbidity, including wound complications and surgical-site infections (SSIs). This study aims to assess whether the application of negative-pressure wound therapy (NPWT) can improve wound healing compared with conventional wound dressing.MethodsThis was a single-centre, superiority, open-label, parallel, individually randomized controlled trial. Patients undergoing stoma reversal were randomized (1 : 1) to receive NPWT or conventional wound dressing. The primary endpoint of the study was the rate of wound complications and SSIs after stoma closure. The secondary endpoints were postoperative wound pain, rate of wound healing after 30 days from stoma closure, and wound aesthetic satisfaction.ResultsBetween June 2019 and January 2021, 50 patients were allocated to the NPWT group (all received NPWT, 49 were analysed); 50 patients were allocated to the conventional wound dressing group (48 received the treatment, 45 were analysed). No significant difference was found in wound-complication rate (10 per cent NPWT versus 16 per cent controls; odds ratio 0.61 (95 per cent c.i. 0.18 to 2.10), P = 0.542) and incisional SSI rate (8 per cent NPWT versus 7 per cent controls; odds ratio 1.24 (95 per cent c.i. 0.26 to 5.99), P = 1.000). The NPWT group showed less pain, higher aesthetic satisfaction (P < 0.0001), and a higher proportion of wound healing (92 versus 78 per cent; P = 0.081) compared with the control group.ConclusionNPWT does not reduce the incidence of SSI after stoma-reversal surgery compared with conventional wound dressing. However, NPWT improved the healing of uninfected wounds, reduced wound pain and led to better aesthetic outcomes.Registration number: NCT037812016 (clinicaltrials.gov).

Surgery for pancreatic cancer: current controversies and challenges.

Two areas that remain the focus of improvement in pancreatic cancer include high post-operative morbidity and inability to uniformly translate surgical success into long-term survival. This narrative review addresses specific aspects of pancreatic cancer surgery, including neoadjuvant therapy, vascular resections, extended pancreatectomy, extent of lymphadenectomy and current status of minimally invasive surgery. R0 resection confers longer disease-free survival and overall survival. Vascular and adjacent organ resections should be undertaken after neoadjuvant therapy, only if R0 resection can be ensured based on high-quality preoperative imaging, and that too, with acceptable post-operative morbidity. Extended lymphadenectomy doesnot offer any advantage over standard lymphadenectomy. Althoughminimally invasive distal pancreatectomies offers some short-term benefits over open distal pancreatectomy, safety remains a concern with minimally invasive pancreatoduodenectomy. Strict adherence to principles and judicious utilization of surgery within a multimodality framework is the way forward.

Pancreatic cancer in 2021: What you need to know to win.

Pancreatic cancer is one of the solid tumors with the worst prognosis. Five-year survival rate is less than 10%. Surgical resection is the only potentially curative treatment, but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients. Moreover, surgery is still associated with high post-operative morbidity, while other therapies still offer very disappointing results. This article reviews every aspect of pancreatic cancer, focusing on the elements that can improve prognosis. It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge.

Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report.

IntroductionCirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis.Presentation of caseA 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein.DiscussionThere have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely.ConclusionHybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.

The Prognostic Value of Low Muscle Mass in Pancreatic Cancer Patients: A Systematic Review and Meta-Analysis.

Low muscle mass is associated with reduced survival in patients with different cancer types. The interest in preoperative sarcopenia and pancreatic cancer has risen in the last decade as muscle mass loss seems to be associated with poorer survival, higher postoperative morbidity, and mortality. The aim of the present study was to review the literature to compare the impact of low muscle mass on the outcomes of patients undergoing surgery for pancreatic adenocarcinoma. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 10 articles were analyzed in detail and included in the meta-analysis. Data were retrieved on 2811 patients undergoing surgery for pancreatic cancer. Meta-analysis identified that patients with low muscle mass demonstrated a significantly reduced OS when compared to patients without alterations of the muscle mass (ROM 0.86; 95% CI: 0.81–0.91, p < 0.001), resulting in a 14% loss for the former. Meta-analysis failed to identify an increase in the postoperative complications and length of stay of patients with low muscle mass. Our analysis confirms the role of low muscle mass in influencing oncologic outcomes in pancreatic cancer. Its role on surgical outcomes remains to be established.

Central Pancreatectomy for Central Pancreatic Lesions: A Single-Institution Experience.

BackgroundPancreaticoduodenectomy and distal pancreatectomy are radical procedures for pancreatic lesions with high postoperative morbidity and mortality even in experienced hands. Central pancreatectomy is an alternative less radical procedure for centrally located pancreatic lesions that are benign or have a low malignant potential. It involves removing the central portion of the pancreas and has the advantage of preserving the pancreatic parenchyma, thereby decreasing the postoperative endocrine and exocrine insufficiencies.MethodsWe conducted a prospective study of six cases of central pancreatectomy in the Department of Surgical Gastroenterology and Liver Transplant, Government Stanley Medical College, India, between the years 2015 and 2019. All patients with lesions in the neck and proximal body of the pancreas were clinically and radiologically evaluated, and those with benign or borderline malignant lesions underwent central pancreatectomy by a standardized technique.ResultsThe mean age of the patients was 27.8 years (range: 14 years - 37 years). Most of the patients were females (66.6%). The most common presenting symptom was abdominal pain, and the most common diagnosis was solid pseudopapillary neoplasm (83.3%). The mean diameter of the lesion was 6.1 cm. All patients underwent pancreaticojejunostomy of the distal stump. The median operative time and the blood loss were 310 minutes and 85 ml, respectively. Two patients developed biochemical postoperative pancreatic fistula, and in the long-term follow-up, none of them developed endocrine or exocrine insufficiency.ConclusionCentral pancreatectomy is a safe and effective alternative for benign and low-grade lesions in the neck and body of the pancreas in which the head of the pancreas and a significant portion of the distal body and tail of the pancreas is uninvolved. Standardization of this pancreas-preserving procedure will result in better outcomes.

Comparison between the tie-over and Karydakis procedure in chronic sacrococcygeal pilonidal sinus

Background and Aims: Pilonidal sinus in the sacrococcygeal region is a disease with high postoperative morbidity and discomfort for the patient. Although there are various therapeutic modalities to manage these patients, Controversy for choosing the best surgical technique in order to decrease the recurrence rate, patient discomfort, and Duration of disability after surgery still exists. Therefore, the objective of the present study was to compare results reached from two methods of surgery, tie-over procedure (TOP) and Karydakis procedure(KP) for the treatment of sacrococcygeal pilonidal sinus. Methods: In this study, 70 patients with a diagnosis of pilonidal sinus disease treated randomly with surgical excision and TOP or KP, in two 35 patients group, in the educational hospital by the same surgeon, between 2009 and 2010, and followed up until December 2019. Results: Achieved data after excision of sacrococcygeal pilonidal sinus indicate that primary closure of the wound by tie-over sutures have a better result than KP in order of Pain sore during the first month after surgery (P&lt; 0.001), Duration of disability (P &lt;0.001), wound repair time (P &lt;0.001) and Patient satisfaction(P=0.019). Conclusion: Overall, these results show the TOP instead of KP, because higher acceptance results may be an alternative better for the treatment of chronic pilonidal sinus for the patients who have surgery scheduled for them.

Is it worthy to perform elective total pancreatectomy considering morbidity or mortality?: An experience from a high-volume center

Total pancreatectomy (TP) is mostly performed for diseases involving the entire pancreas including various pathology. However, there is still a reluctance to perform TP due to high postoperative morbidity or mortality, and life-long endocrine and exocrine pancreatic insufficiency. This retrospective study aimed to evaluate postoperative outcomes in a high-volume center and identify the risk factors affecting major morbidity and mortality after TP. From 1995 to 2015, a total of 142 patients who underwent elective TP at Samsung Medical Center were included in this study. One-stage TP was defined as elective primary TP, and in whom an intraoperative decision to extend the planned resection to TP, whereas 2-stage TP was elective completion TP due to recurred tumor. Patients who underwent TP in an emergency setting were excluded. Postoperative mobidity or pancreatectomy-specific complication was defined according to Clavien-Dindo classification (CDC) or ISGPF classification. There were no statistically significant differences between 1-stage TP (n = 128) and 2-stage TP (n = 14) in clinical, operative, pathologic variables. Overall major morbidity more than CDC ≥ 3 or ISGPF grade B/C were occurred in 25 patients (17.6%). The readmission rate within 90-day including DM control was 20.4%. There was no in-hospital mortality among all enrolled patients. Multiple underlying diseases (OR, 3.350; 95% CI, 1.244-9.019; p = 0.017) and longer operative time (OR, 1.005; 95% CI, 1.000-1.010; p = 0.041) were identified an independent risk factors for major morbidity after multivariable analysis. TP are safe and feasible procedures with satisfactory early surgical outcomes when performed at high-volume center.