Higher Incidence Of Postoperative Complications Research Articles

Skeletal Muscle Mass Index Reduction Rate as a Prognostic Indicator for Patients Undergoing Pancreatectomy for Pancreatic Cancer.

There have been many studies on skeletal muscle depletion before surgery, and skeletal muscle depletion is a known risk factor for poor prognosis. However, reports on the association between changes in skeletal muscle mass and prognosis after surgery for pancreatic cancer are very few. The data of 137 patients who underwent pancreatectomy for pancreatic cancer between 2005 and 2022 were reviewed. Muscle areas were measured at the third lumbar vertebral level, and skeletal muscle mass index (SMI) reduction rates were calculated. Patients were divided into two groups using receiver operating characteristic (ROC) curve analysis based on the SMI reduction rate with a cutoff of 14% reduction rate. The clinicopathological factors, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups. Survival rates were analyzed both univariately and multivariately to clarify the factors associated with poor prognosis after pancreatectomy. A total of 102 patients met the inclusion criteria. SMI reduction rate ≥14% significantly correlated with advanced age and higher incidence of postoperative complications. In the multivariate Cox regression analysis, preoperative prognostic nutritional index (PNI) <40 and SMI reduction rate ≥14% were significantly associated with poor OS. Tumor size ≥3.0 cm, preoperative neutrophile-lymphocyte ratio ≥3.0, and SMI reduction rate ≥14% were significantly associated with poor RFS. The rate of skeletal muscle mass reduction after pancreatic surgery is an independent prognostic factor for survival in patients with pancreatic cancer.

Infection of surgery for bone and soft tissue sarcoma with biological reconstruction: Data from the Japanese nationwide bone tumor registry

BackgroundAlthough biological reconstruction (such as recycled autograft, vascularized autograft, allograft, or bone transport) is possible for bone defects after malignant bone or soft tissue tumor resection, a high incidence of postoperative complications, including infection, poses a problem. The difficulty in accumulating cases has resulted in a lack of reliable etiological information, such as the incidence and risk factors of postoperative infections. MethodsWe conducted a retrospective study on the nationwide registry data. The primary endpoint was the need for additional surgical intervention for infection control. The overall incidence of postoperative infection and the related risk factors were analyzed. ResultsWe included 707 malignant bone and soft tissue tumors with biological reconstruction, including recycled autograft, vascularized autograft, allograft, bone transport, and combinations of these. The incidence of postoperative infection was 10.8%. Patients reconstructed by pedicled autograft showed a higher incidence of infection, while cases involving the combination of recycled and pedicled autograft or allograft showed a lower incidence. Independent risk factors for infection included age over 17, tumor diameter over 10 cm, the tumor located on the trunk or being high grade, reconstruction by pedicled autograft, and delayed wound healing. ConclusionInfection incidence was comparable to those in previous reports. Several conventional and novel risk factors were extracted by administering nationwide registry data. Data from the nationwide registry was informative for analyzing the incidence of postoperative infection in biological reconstruction with malignant bone and soft tissue tumor resection.

Use of jejunal serosal patch and pyloric exclusion in the management of complex duodenal injury.

Duodenal injuries are relatively rare but remain a management challenge with a high incidence of postoperative complications. Guidelines from the World Society of Emergency Surgery and American Association for the Surgery of Trauma favour a primary repair for less-complex injuries, but the management of more complex duodenal trauma remains controversial with varying techniques supported, including pyloric exclusion, omental or jejunal patch closure, gastrojejunostomy and pancreatoduodenectomy. We describe the techniques used in one case of complex duodenal trauma. The duodenum is approached via a standard laparotomy with Kocherisation. Primary repair of the duodenal perforations is performed using a 3/0 polydioxanone suture (PDS), followed by mobilisation of a loop of mid-jejunum against the area of duodenal trauma over the primary repair as a jejunal serosal patch. The antimesenteric jejunal serosal border is sutured to the serosa of the duodenum (serosa only) using a 3/0 PDS. Pyloric exclusion is then performed through an anterior gastrostomy, to control the volume of gastric juice entering the duodenum. The pylorus is sutured closed using an absorbable suture followed by closure of the anterior gastrostomy using a GIA stapling device.

Bariatric surgery in inflammatory bowel disease: a comparative analysis of 450,000 patients

BackgroundStudies were conducted to investigate the outcomes of bariatric surgery (BS) among inflammatory bowel disease (IBD) patients. ObjectivesWe aimed to analyze previous literature, comparing the outcomes of BS between IBD and non-IBD patients. SettingNot applicable. MethodsPubMed, Scopus, and Web of Science were searched on 25/9/2023 for comparative studies on outcomes of BS in IBD patients. RevMan Software v5.4 was used to conduct the analysis. ResultsOur analysis revealed an insignificant difference in the change of body mass index (BMI) at 1-year post-BS between IBD and non-IBD patients. IBD patients had a higher risk of acute renal failure, hemorrhage, and readmission following BS (RR: 2.16, 95% CI: 1.55–3, RR: 1.57, 95% CI: 1.22–2.04, RR: 1.56, 95% CI: 1.17–2.08, respectively). No significant difference was observed between both groups regarding wounds, leak/intra-abdominal infection, thromboembolic complications, and bowel obstruction. A higher incidence of postoperative complications was seen among IBD patients undergoing RYGB compared with SG (RR: 2.21, 95% CI: 1.43–3.41). There was a significant decline in steroid use following BS in IBD patients (RR: .67, 95% CI: .53–.84). Comparison between UC and Crohn’s disease (CD) revealed insignificant differences in treatment escalation or de-escalation. Both IBD and non-IBD patients had similar lengths of hospitalization. ConclusionsBS is equally effective in IBD and non-IBD patients in terms of weight loss at 1-year follow-up. Nevertheless, IBD patients are at a higher risk of postoperative complications, micronutrient deficiency, and readmission. Both UC and CD reported a decline in steroid use following surgery without a preferential advantage to a particular IBD sub-type.

Bilateral bidirectional cavopulmonary connection: a review of surgical techniques and clinical implications.

The presence of bilateral superior caval veins (bSCVs) could negatively influence the outcome of Fontan patients. In the setting of a bilateral bidirectional Glenn, the selective blood flow to the ipsilateral long with consequent flow stagnation in the connecting portion could lead to poor growth of the central portion of the pulmonary artery, potentially affecting the eligibility for Fontan completion and being associated with a higher incidence of thrombotic complications. Alternative surgical techniques have been described to perform a bidirectional cavopulmonary anastomosis in the presence of bSCVs aiming to achieve a balanced growth of the pulmonary bifurcation. The short-term results of these techniques such as the V- or Y-shape seem to be excellent; however, some anatomical settings could affect the feasibility of these techniques. The so-called "unifocalization" creates a configuration comparable to a "normal" bidirectional Glenn and could be a feasible alternative. However, the long-term results of this technique are not published yet. The positive effect of additional pulsatile pulmonary flow on pulmonary artery growth should be considered in case of bilateral bidirectional Glenn, despite the higher incidence of postoperative complications reported and the difficult calibration of the amount of additional flow. The role of computational fluid dynamic to simulate the surgical strategy in single ventricle patients is promising and could be worthwhile in the setting of bSCVs. In fact, the surgical techniques of bilateral bidirectional Glenn could be simulated testing their feasibility and allowing to identify the more favorable hemodynamic pattern, patient specific. This review article highlights the critical issues related to the presence of bSCVs in univentricular physiology, analyzing pros and cons of the different surgical techniques. Besides reviewing the literature, this manuscript focuses on the role of computational fluid simulation in identifying the most favorable surgical technique with an individualized approach, which could potentially improve the clinical outcome.

Impact of Modified Frailty Index on Readmissions Following Surgery for NSCLC.

Analyzing the risk factors that predict readmissions can potentially lead to more individualized patient care. The 11-factor modified frailty index is a valuable tool for predicting postoperative outcomes following surgery. The objective of this study is to determine whether the frailty index can effectively predict readmissions within 90 days after lung resection surgery in cancer patients within a single health care institution. Patients who underwent elective pulmonary resection for nonsmall cell lung cancer (NSCLC) between January 2012 and December 2020 were selected from the hospital's database. Patients who were readmitted after surgery were compared to those who were not, based on their data. Propensity score matching was employed to enhance sample homogeneity, and further analyses were conducted on this newly balanced sample. A total of 439 patients, with an age range of 68 to 77 and a mean age of 72, were identified. Among them, 55 patients (12.5%) experienced unplanned readmissions within 90 days, with an average hospital stay of 29.4 days. Respiratory failure, pneumonia, and cardiac issues accounted for approximately 67% of these readmissions. After propensity score matching, it was evident that frail patients had a significantly higher risk of readmission. Additionally, frail patients had a higher incidence of postoperative complications and exhibited poorer survival outcomes with statistical significance. The 11-item modified frailty index is a reliable predictor of readmissions following pulmonary resection in NSCLC patients. Furthermore, it is significantly associated with both survival and postoperative complications.

Specialized Laparoscopic Devices in the Treatment of Hydatic Hepatic Cysts: A Retrospective Analysis and Review of the Literature.

Background and objective While hydatid disease is associated with a high prevalence only in certain endemic areas, it can be encountered in any geographical region. The characteristics of this parasitic disease, and its implications during development, such as the risk of seeding, and the complications caused by cyst rupture, means that its therapeutic management should adhere to strict principles and may sometimes require approaches specially tailed for this type of pathology. In this study, we aimed to provide a comparative analysis of conventional laparoscopic techniques vs. treatment withspecialized instrumentation in these patients. Methods Our study involveda retrospective evaluationof a cohort comprising 41 patients diagnosed with hepatic hydatid cysts, who underwent procedures with both conventional laparoscopic techniques and specialized instrumentation tailored for this particular pathology. Furthermore, we conducted a comprehensive review of the literature examining alternative types of laparoscopic instrumentation specifically crafted for the management of hydatid cysts. This review employed an extensive search utilizing PubMed and Google Scholar databases. Results The examination of cases within our study revealed a high prevalence of hydatid disease among male patients (63.41%) and a predominance of instances originating from rural regions necessitating emergent admissions (p<0.05). Notably, in 58.54% of cases, surgical interventions employed specialized instrumentation, with a notable discrepancy in conversion rates to open surgery favoring the standard approach: 12.2% vs. 2.44% (p=0.025). Additionally, the laparoscopic approach was associated with prolonged surgical durations compared to the dedicated technique (p=0.002), besides a higher incidence of postoperative complications (12.2% vs 7.32%). Furthermore, patients undergoing laparoscopic procedures with standard instrumentation experienced lengthier hospital stays (p=0.002). Our comprehensive review of the literature identified six distinct surgical methodologies utilizing specifically tailored instrumentation for addressing hydatid cysts. Analysis of these findings underscored a preference for single localizations and selective cases. Postoperative complication rates ranged from 6.66% to 22.22%, with conversion rates to open surgery reaching up to 23.33%, and recurrence rates observed to be as high as 7.81%. Conclusions The patented approach, which uses special trocars that provide stable anchorage and allow a safe puncture-aspiration, reaspiration, and fragmentation processes, has superior characteristics compared to the laparoscopic approach with standard instrumentation. Comparative analysis with other similar procedures described in the literature has shown similar results regarding the frequency of complications, with our technique being superior in terms of approaching multiple cysts and recurrence rate. It has been successfully applied even in unselected cases.

Enhanced Recovery After Surgery in Immediate DIEP Flap Breast Reconstruction: Reducing Length of Stay and Opioid Use

Background: To improve patient outcomes amid reduced healthcare resources during the COVID-19 pandemic, a single Canadian cancer center implemented an Enhanced Recovery After Surgery (ERAS) protocol for autologous DIEP flap breast reconstruction. Methods: This retrospective cohort study included 100 consecutive patients undergoing microsurgical breast reconstruction with DIEP flaps using the ERAS protocol and 100 patients using a standard protocol. Primary outcomes were the hospital length of stay and opioid use. Secondary outcomes included postoperative complications, laxative and antiemetic consumption. Results: In this study, 80% of the patients had immediate reconstruction, while the remaining patients received either delayed immediate or delayed reconstruction. Patients in the ERAS group had shorter hospital stays (2.8 vs 4.5 days; P &lt; 0.001) and lower total opioid use (50.2 vs 136.3 mg; P &lt; 0.001). This reduction was also observed when breaking down opiates per day of hospitalization (30.2 vs 18.2 mg; P &lt; 0.001), and in the first 24 postoperatively hours (35.7 vs 67.6 mg; P &lt; 0.001). The control group had a higher incidence of postoperative complications, including seroma, partial and total flap necrosis, compared to the ERAS group. However, readmission rates were similar between the two groups. Conclusion: Implementing the ERAS protocol for DIEP flap breast reconstruction can significantly reduce hospital length of stay and postoperative opioid requirements without increasing the risk of adverse events. This pattern holds true for immediate reconstructions with DIEP flaps.

Stage-by-stage analysis of the effect of blood transfusion on survival after curative hepatectomy for hepatocellular carcinoma-a retrospective study.

This study is to examine the impact of perioperative (intraoperative/postoperative) blood transfusion on the outcomes of curative hepatectomy for hepatocellular carcinoma. Hepatectomy is a well-established curative treatment for hepatocellular carcinoma, and blood transfusion cannot always be avoided in treating the disease. A retrospective study of patients having curative hepatectomy for hepatocellular carcinoma from January 2010 to December 2019 at a single center was conducted. The patients were stratified by their disease stage. Patients with and without perioperative blood transfusion were matched by propensity-score matching and compared for each disease stage. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival for each stage. A total of 846 patients were studied. Among them, 125 received perioperative blood transfusion and 720 did not. Patients with blood transfusion had worse disease-free and overall survival. After stratification and matching, the ratios of transfusion to non-transfusion were 33:165 (stage 1), 28:140 (stage 2), and 45:90 (stage 3). Perioperative blood transfusion was associated with a higher incidence of postoperative complications in all three disease stages (p = 0.004/0.006/0.017), and hence longer hospitalization (p < 0.001 in all stages), but had no significant impact on hospital mortality (p = 0.119/0.118/0.723), 90-day mortality (p = 0.259/0.118/0.723), disease-free survival (p = 0.128/0.826/0.511), or overall survival (p = 0.869/0.122/0.122) in any disease stage. Prognostic factors for overall survival included tumor size, tumor number, alpha-fetoprotein level, and postoperative complication of grade ≥ 3A. Perioperative blood transfusion was associated with a higher incidence of complications but had no significant impact on survival after curative hepatectomy for hepatocellular carcinoma.

Short- and Long-Term Outcomes of Neoadjuvant Chemoradiotherapy Followed by Pancreatoduodenectomy in Elderly Patients with Resectable and Borderline Resectable Pancreatic Cancer: A Retrospective Study.

Background: The efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by pancreatoduodenectomy (PD) in elderly patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: This retrospective analysis of prospectively collected data examined the effect of NACRT followed by PD in elderly patients with PDAC. A total of 112 patients with resectable (R-) and borderline resectable (BR-) PDAC, who were planned for PD and received NACRT between 2009 and 2022, were assessed. Changes induced by NACRT, surgical outcomes, nutritional status, renal and endocrine functions, and prognosis were compared between elderly (≥75 years, n = 43) and non-elderly (<75 years, n = 69) patients over two years following PD. Results: Completion and adverse event rates during NACRT, nutritional status, renal function, endocrine function over two years postoperatively, and prognosis did not significantly differ between the two groups. Low prognostic index after NACRT and the absence of postoperative adjuvant chemotherapy may be adverse prognostic indicators for elderly patients undergoing NACRT for R- and BR-PDAC. Conclusions: Despite a higher incidence of postoperative complications, NACRT followed by PD can be safely performed in elderly patients, resulting in a prognosis similar to that in non-elderly patients.

The Role of Modern Cardiac-Specific Biomarkers in Assessing the Risk of Developing Complications of Cardiovascular Diseases During Surgical Operations Not Related to Cardiac Intervention

Despite significant tactic’s improvements of perioperative management of patients undergoing non-cardiac surgery, there is still a high incidence of postoperative complications. So more accurate risk stratification is necessary before surgery in order to possibly reduce such risk. In addition to assessing the risk associated with surgery, the risk associated with the patient, which may be due to the presence of certain diseases, primarily cardiovascular, is also assessed. There are currently evidences of the validity of determining the level of biomarkers in the blood in certain groups of patients during operations not related to cardiac intervention, which makes it possible to clarify the scope of necessary diagnostic interventions in preparation for surgery, as well as to diagnose complications of heart disease in the postoperative period.

Efficacy of perioperative FOLFIRINOX chemotherapy versus FLOT chemotherapy in patients with resectable adenocarcinoma of the stomach or gastroesophageal junction (SIEWERT types II–III, cT4aN0M0, T1–4cN+ cM0): preliminary results of the study

Introduction: The main current approach to the treatment of patients with resectable cancer of the stomach and gastroesophageal junction (GEJ) is perioperative FLOT chemotherapy. The mFOLFIRINOX regimen has been shown to be effective and safe in disseminated adenocarcinoma of the stomach and GEJ. This article presents preliminary results of the efficacy and safety assessment of perioperative FOLFIRINOX chemotherapy in patients with resectable cancer of the stomach and gastroesophageal junction.Materials and Methods: The FOLFIRINOX / FLOT study is a phase 2 / 3 open-label, randomized trial. Study enrollment was started in January 2019 and is currently ongoing. The inclusion criteria are: histologically confirmed resectable adenocarcinoma of the stomach or gastroesophageal junction, Siewert types II–III, clinical stage cT4aN0M0, cT1–4N1–3M0 or cT2–4N0–3M0, with total or subtotal involvement of the stomach. The following regimens were used for perioperative chemotherapy: FLOT — docetaxel 50 mg / m2 on day 1, oxaliplatin 85 mg / m2 on day 1, leucovorin 200 mg / 2 on day 1, 5FU 2600 mg / m2 × 24 hours starting on day 1, or mFOLFIRINOX — irinotecan 180 mg / m2 on day 1, oxaliplatin 85 mg / 2 on day 1, leucovorin 200 mg / m2 on day 1, 5FU 250 mg / m2 bolus on day 1 and then 2200 mg / m2 × 48 hours on day 1. The primary endpoint was 5‑year overall survival.Results: All planned preoperative courses of chemotherapy had been administered to 25 (86 %) patients in the FLOT group (n = 29) and 22 (92 %) patients in the FOLFIRINOX group (n = 24). Four (12 %) and 2 (8 %) patients in the FLOT and FOLFIRINOX groups, respectively, discontinued the treatment. The surgical staging was used in 48 patients (91 %) (25 [86 %] in the FLOT group and 23 [96 %] in the FOLFIRINOX group). Complete tumor regression (Mandard grade 1) had been achieved in 4 patients (2 [7 %] in the FLOT group and 2 [8 %] in the FOLFIRINOX group). Postoperative complications were detected in 2 patients (8 %) in the FLOT group and 4 (17 %) in the FOLFRIRNOX group. Thirty-three patients (62 %) received all scheduled postoperative treatment courses (n = 19, 66 % for FLOT and n = 14, 58 % for FOLFIRINOX).Conclusions: The preliminary results of the FOLFIRINOX / FLOT study showed comparable tolerability of the regimens and comparable complete pathological response rates. However, there was a higher incidence of postoperative complications detected among patients who received the FOLFIRINOX regimen compared to the FLOT group.

Effect of Orem's Management Model on Patients Undergoing Percutaneous Nephrolithotomy for Kidney Calculi: A Multicenter Retrospective Trial.

Percutaneous nephrolithotomy (PCNL) is the standard procedure for treating upper urinary tract calculi and complex kidney calculi >2 cm in diameter, though it has a high incidence of postoperative complications. This study aimed to investigate the effect of Orem's management model on patients undergoing PCNL. This retrospective study included 465 patients who underwent PCNL from February 2022 to February 2023 from two tertiary hospitals. After excluding 16 patients based on exclusion criteria, 449 patients remained. The observation group (n = 227) received Orem's management model, while the control group (n = 222) underwent conventional surgical management. Primary outcomes included postoperative recovery time and the incidence of postoperative complications, while secondary outcomes such as postoperative pain levels (measured via a numerical rating scale) and self-care ability assessed through the exercise of self-care agency were obtained through medical records and physical examinations. Compared to the control group, the observation group achieved faster outcomes for the first anal exsufflation, first ambulation, and discharge, and a lower incidence of postoperative complications (p < 0.05). Post-management, the observation group had lower numerical rating scale scores and higher exercise of self-care agency scores (p < 0.001). Orem's management model accelerates postoperative recovery, alleviates pain, and reduces postoperative complications in patients undergoing PCNL. Moreover, this model enhances self-care ability, though its effectiveness is limited to patients with non-recurrent renal calculi and normal renal function. Further exploration of its broader application is needed.

Short-term outcomes after third-time lung transplantation: A single institution experience

Reoperative lung transplantation (LTx) survival has improved over time such that a growing number of patients may present for third-time LTx (L3Tx). To understand the safety of L3Tx, we evaluated perioperative outcomes and 3-year survival after L3Tx at a high-volume US LTx center. This retrospective study included all patients who underwent bilateral L3Tx at our institution. Using an optimal matching technique, a primary LTx (L1Tx) cohort was matched 1:2 and a second-time LTx (L2Tx) cohort 1:1. Recipient, operative, and donor characteristics, perioperative outcomes, and 3-year survival were compared among L1Tx, L2Tx, and L3Tx groups. Eleven L3Tx, 11 L2Tx, and 22 L1Tx recipients were included. Among L3Tx recipients, median age at transplant was 37years and most (73%) had cystic fibrosis. L3Tx was performed median 6.0 and 10.6years after L2Tx and L1Tx, respectively. Compared to L1Tx and L2Tx recipients, L3Tx recipients had greater intraoperative transfusion requirements, a higher incidence of postoperative complications, and a higher rate of unplanned reoperation. Rates of grade 3 primary graft dysfunction at 72hours, extracorporeal membrane oxygenation at 72hours, reintubation, and in-hospital mortality were similar among groups. There were no differences in 3-year patient (log-rank p=0.61) or rejection-free survival (log-rank p=0.34) after L1Tx, L2Tx, and L3Tx. At our institution, L3Tx was associated with similar perioperative outcomes and 3-year patient survival compared to L1Tx and L2Tx. L3Tx represents the only safe treatment option for patients with allograft failure after L2Tx; however, further investigation is needed to understand the long-term survival and durability of L3Tx.

Evaluating the Long-Term Outcomes of Periodontal Surgery vs. Non-Surgical Treatment in Aggressive Periodontitis.

Aggressive periodontitis is a severe form of periodontal disease characterized by rapid tissue destruction and tooth loss. The optimal treatment approach for managing this condition remains a topic of debate. A retrospective cohort study was conducted, involving patients diagnosed with aggressive periodontitis who received either surgical or non-surgical treatment between 2010 and 2020. Clinical and radiographic data were collected at baseline and regular intervals over a 5-year follow-up period. Surgical interventions included flap surgery, guided tissue regeneration, and bone grafting, while non-surgical treatments comprised scaling and root planning with or without adjunctive antibiotics. The primary outcomes assessed included changes in probing depth, clinical attachment level, tooth loss, and patient-reported quality of life measures. A total of 120 patients were included in the study, with 60 patients in each treatment group. The surgical group demonstrated significantly greater reductions in probing depth and gains in clinical attachment level compared to the non-surgical group (P < 0.05). Tooth loss was significantly lower in the surgical group over the 5 years (P < 0.01). Patient-reported outcomes also favored the surgical group, with improved oral health-related quality of life. However, the surgical group had a higher incidence of postoperative complications. This study suggests that periodontal surgery yields superior long-term outcomes in the management of aggressive periodontitis compared to non-surgical treatment.

Postoperative morbidity after simultaneous versus staged resection of synchronous colorectal liver metastases: Impact of hepatic tumor burden

BackgroundWe sought to characterize the risk of postoperative complications relative to the surgical approach and overall synchronous colorectal liver metastases tumor burden score. MethodsPatients with synchronous colorectal liver metastases who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. Propensity score matching was employed to control for heterogeneity between the 2 groups. A virtual twins analysis was performed to identify potential subgroups of patients who might benefit more from staged versus simultaneous resection. ResultsAmong 976 patients who underwent liver resection for synchronous colorectal liver metastases, 589 patients (60.3%) had a staged approach, whereas 387 (39.7%) patients underwent simultaneous resection of the primary tumor and synchronous colorectal liver metastases. After propensity score matching, 295 patients who underwent each surgical approach were analyzed. Overall, the incidence of postoperative complications was 34.1% (n = 201). Among patients with high tumor burden scores, the surgical approach was associated with a higher incidence of postoperative complications; in contrast, among patients with low or medium tumor burden scores, the likelihood of complications did not differ based on the surgical approach. Virtual twins analysis demonstrated that preoperative tumor burden score was important to identify which subgroup of patients benefited most from staged versus simultaneous resection. Simultaneous resection was associated with better outcomes among patients with a tumor burden score <9 and a node-negative right-sided primary tumor; in contrast, staged resection was associated with better outcomes among patients with node-positive left-sided primary tumors and higher tumor burden score. ConclusionAmong patients with high tumor burden scores, simultaneous resection of the primary tumor and liver metastases was associated with an increased incidence of postoperative complications.

Dynamic hip screw in proximal femoral fractures followed by “single-stage” hip arthroplasty—retrospective analysis

The aim of this study is to present the results of single-stage total hip arthroplasty (THA) after Dynamic Hip Screw (DHS) failure, or secondary posttraumatic osteoarthrosis. From 2003 to 2020, 15 THAs were performed in group of 15 patients for the treatment of DHS failure, or for late complications following femoral neck and pertrochanteric fractures. The mean follow-up period after arthroplasty was 46.9 months (range 7–139). The patients were evaluated retrospectively—both clinically and radiographically, focussing on the demography, infection rate and other complications (revision surgery), during the year 2023. 9 males and 6 females were included in the study, with a mean age of 56.5 years (range 29–93) at the time of primary osteosynthesis. Each of them had proximal femoral fracture treated primarily with a DHS and then late one-stage revision surgery, with hardware removal and THA implantation. The median time between DHS osteosynthesis and THA was 41.2 months (range 4–114). Four patients (26.6%) had complications after THA, with the need for revision in two cases (13.3%). Dislocation rate was 6.6% (one case), with the need for repeated-revision of THA. The infection rate was 6.6% (one patient) with the need for revision of THA. Peroperative periprosthetic femoral fracture was observed in 13.3% (two patients) without any other problems. Six patients (40%) died during the follow-up period. Single-stage total hip arthroplasty with concomitant hardware removal bears a high- mortality rate, with a higher incidence of postoperative complications compared to elective THA.

Intraoperative Blood Loss Impacts Recurrence and Survival in Patients With Locally Advanced Esophageal Cancer.

Intraoperative blood loss (IBL) has been reported to decrease survival after surgical resection of some malignancies; however, there are few reports on the effects of IBL on recurrence and survival in locally advanced esophageal cancer. Therefore, we investigated the relationship between IBL and postoperative recurrence and overall survival in patients who underwent surgery for esophageal cancer. One hundred and ninety-eight patients with locally advanced esophageal cancer who underwent preoperative adjuvant chemotherapy and curative resection as standard treatment were included in this study. Based on a defined cut-off value for IBL, 27 and 171 patients were classified into the high and low IBL groups, respectively. The relationship between each group and clinicopathological factors, postoperative recurrence, and overall survival were investigated. In terms of the relationship between IBL and clinicopathological factors, the high IBL group had significantly more patients with pathological T4, longer operative time, and higher incidence of postoperative complications than the low IBL group. Both recurrence-free and overall survival were significantly worse in the high IBL group than in the low IBL group. Furthermore, multivariate analysis identified high IBL as an independent factor for predicting poor reference free survival and overall survival. Heavy IBL in patients with locally advanced esophageal cancer may be a useful predictor of postoperative recurrence and overall survival.

The outcomes of proximal femur replacement with hemiarthroplasty after tumor resection in individuals with Parkinson's disease.

Patients with neurological disorders often experience a high incidence of postoperative complications following proximal femur replacement (PFR) surgery. The orthopaedist faces a significant difficulty in treating Parkinson's disease (PD) because of the weakened bone condition, excessive muscle tension, and increased risk of fractures. The objective of this research is to assess the impact of PD on PFR following tumor removal. A retrospective study was conducted from 2010 to 2020, focusing on a solitary institution, analyzing 9 patients diagnosed with PD who underwent PFR with hemiarthroplasty as a result of tumor removal. The study consists of 2 men and 7 women, with an average age of 71 (SD, 12) years. We assessed the outcomes after surgery in terms of pain management, quality of life, functional ability, occurrence of complications, and survival durations. All nine patients underwent planned surgeries. Intraoperative complications was not observed. The average length of the follow-up period was 24 (SD, 20) months, ranging from 8 to 72 months. Despite the fact that 8 patients passed away due to tumor progression, the endoprostheses were still well at that point. The preoperative VAS score of 7 (SD, 1.87) decreased to a postoperative score of 2 (SD, 1.32). The KPS was improved to73 (SD, 7) from 52 (SD, 14), postoperatively. Post-surgery, there were notable enhancements in both pain levels and the overall quality of life scores. Following the surgical procedure, individuals are able to ambulate steadily, resuming their regular daily routines. Living patients had an average MSTS score of 21 (SD, 2.5), ranging from 17 to 25. In total, there were four (44.4%) patients suffered complications after surgery, comprising of one wound dehiscence, one prosthetic fracture, one hip dislocation, and one local recurrence. Significant improvements in function and pain relief can be achieved through PFR with hemiarthroplasty following tumor removal in patients with PD. The implementation of thorough preparation and carefull nursing results in reduced complications and improved outcomes in PD patients.

Differences of clinical features and outcomes between male and female elderly patients in gastric cancer

Although the average life span differs between males and females, little is known about differences in clinical features and short and long-term outcomes between elderly male and female gastric cancer patients. This study was designed to clarify these issues to identify the possibility for sex-based treatment strategies in elderly gastric cancer patients. This study included 295 consecutive elderly gastric cancer patients (75 years or older) who underwent curative gastrectomy between 1997 and 2016. We defined postoperative complications as Clavien–Dindo classification grade II or higher. Comorbidities were present in 67% of all patients. Males tended to have more comorbidities than females (P = 0.077). Male patients had significantly more upper gastric cancers (P = 0.001), a higher incidence of postoperative complications (P = 0.045), and poorer prognoses than females (P = 0.003). Multivariate analysis revealed that being male was an independent risk factor for postoperative complications (Odds ratio 2.5, P = 0.045) and a poor prognostic factor (Hazard ratio 1.81, P = 0.008). Patients who underwent limited surgery without postoperative complications tended to have a better prognosis than patients receiving standard surgery with postoperative complications (3-year overall survival: 78% vs. 55%, P = 0.156). Male was an independent risk factor for postoperative complications and an independent poor prognostic factor in elderly gastric cancer patients. To avoid postoperative complications, the limited surgery might be justified for high-risk elderly male patients.