Incidence Of Postoperative Morbidity Research Articles

Risk of hepatic steatosis with the preoperative treatment of pancreatic cancer and the short-term postoperative outcomes.

We investigated whether the preoperative treatment of patients with pancreatic cancer is a risk factor for hepatic steatosis (HS), and whether preoperative HS affects the short-term postoperative outcomes. Patients who underwent radical surgery for pancreatic cancer between 2010 and 2023 were enrolled. The patients' medical records were reviewed. Albumin and carbohydrate antigen 19-9 were measured before and after chemotherapy in the patients who received preoperative chemotherapy. A logistic regression univariate analysis was performed to analyze the factors associated with new-onset HS. A total of 230 patients who underwent surgery were included. HS was observed on the date of surgery in 11 (10%) and two (2%) patients with and without preoperative chemotherapy, respectively. Female sex, initially borderline resectable or unresectable disease, history of cholangitis, presence of PEI, long-term (≥ 3months) biliary drainage, preoperative chemotherapy, and serum albumin ≥ 3.9mg/dl before chemotherapy were identified as risk factors for HS. The incidence of postoperative morbidity did not differ between the patients with and without preoperative steatosis. Preoperative chemotherapy, a history of cholangitis, the presence of PEI, and ≥ 3months' duration of biliary drainage were risk factors for the development of HS before surgery for pancreatic cancer. However, preoperative HS did not affect the short-term postoperative outcomes.

Predictive value of prognostic nutritional index on postoperative intensive care requirement and mortality in geriatric hip fracture patients.

The incidence of postoperative morbidity and mortality in hip fracture patients is high and is associated with nutritional deficiencies. This study investigated the predictive value of preoperative prognostic nutritional index (PNI) on postoperative intensive care unit (ICU) requirement and mortality in geriatric hip fracture patients. Geriatric (≥65 years old) hip fracture patients who underwent surgery between January 2021 and September 2023 were evaluated retrospectively. Patients were classified according to the unit followed in the postoperative period (service group and ICU group) and 28-day mortality (mortality group and survivor group). The predictive value of PNI for ICU requirement and mortality and the factors affecting ICU requirement and mortality were investigated. The study included two hundred twenty-two patients, and 66.2% (n=147) were women. In the postoperative period, 47.7% (n=106) of the patients were followed in the ICU and 52.3% (n=116) in the inpatient service. The 28-day mortality of the patients was 6.8% (n=15). PNI was found to be significantly lower in patients followed in the ICU (group ICU) than in those followed in the service (group S) and in patients who died (group mortality) compared to those who lived (group survivor) (p<0.001 and p=0.029, respectively). In multivariate regression analysis, high American Society of Anesthesiologists (ASA) status and low PNI were determined to be independent risk factors for ICU requirement. Acute Physiology and Chronic Health Assessment II score was an independent predictor of mortality. In ROC curve analysis, the cut-off value of PNI in predicting mortality was 32.5, and the area under the curve was 0.660 (95% CI, 0.516-0.803). In geriatric hip fracture patients, preoperative PNI value can be used, like ASA status, in determining postoperative ICU requirements. Nutritional deficiencies are associated with adverse postoperative outcomes in this patient group, and low PNI values (<32.5) help predict in-hospital mortality.

Long-term Results of Totally Laparoscopic Near-total Gastrectomy for Middle-third Gastric Cancer.

In recent years, laparoscopic near-total gastrectomy (LnTG) has emerged as a surgical option for gastric cancer in the middle-third of the stomach. However, its application in locally advanced stages presents technical challenges. This study aims to provide a detailed analysis of the operative outcomes and long-term functional and oncological results of totally LnTG in combination with D2 lymphadenectomy for middle-third gastric cancer. A prospective study was conducted on 79 patients who underwent totally LnTG and D2 lymphadenectomy for middle-third gastric cancer between January 2017 and December 2021. Short-term outcomes included operative characteristics, and the evaluation of gastroesophageal reflux and gastric remnant condition using endoscopy based on the Los Angeles (LA) and Residue-Gastritis-Bile classifications. Long-term oncological outcomes included overall survival and disease-free survival. Totally LnTG was successfully performed in 98.7% of patients without intraoperative complications or conversions to laparotomy. The mean operation time was 202.2±43.0min, and the median blood loss was 50 (50;100)mL. The overall incidence of postoperative morbidities was 16.5%, with one patient experiencing a narrowing of the gastrojejunostomy, successfully treated by endoscopic balloon dilation. All patients had tumor-free resection margins, and there were no mortalities. The 5-year overall survival and disease-free survival rates were 80% and 55%, respectively. Totally LnTG is an effective and feasible approach for gastric cancer in the middle-third of the stomach, yielding favorable short-term outcomes and acceptable long-term results. Routine application of totally LnTG for middle-third gastric cancer is practical and promising.

Clinical outcomes after vascular reconstruction using synthetic grafts for limb salvage in patients with lower extremity sarcoma: a single-center retrospective experience.

Limb-salvage surgery has become the mainstream approaches for the treatment of sarcoma in the lower extremity. In cases where the sarcoma infiltrates the primary vessel, concurrent resection of the vessels and vascular reconstruction are required to ensure sufficient resection and preservation of limb function. The objective of this study is to assess the clinical outcomes of patients who underwent vascular reconstruction utilizing synthetic grafts for limb salvage, specifically in terms of postoperative complications and limb functional status. Between September 2016 and October 2021, 15 consecutive patients who underwent 15 arterial and 3 venous reconstruction procedures were included in this retrospective study. Incidence of postoperative morbidity, graft patency, rate of limb salvage, and overall survival of patients were analyzed. The median follow-up was 12.5 months (range, 4.5-72.0). Graft thrombosis occurred in 5 patients (33.3%) and graft occlusion occurred in 3 patients (20.0%). The median overall survival was 28.0 months with the estimated 2-year and 5-year overall survival of 57.8% and 43.4% respectively. The 1-year and 2-year estimated patency rates of arterial reconstructions were 82.3% and 62.1%, respectively. None of the included patients with limb amputation were observed as a consequence of severe vascular complications, while two patients underwent amputation due to the repeat recurrence, resulting in a limb salvage rate of 86.7%. Our results show that the combination of vascular reconstruction and oncologic resection is a feasible option for preserving limbs in cases of musculoskeletal sarcoma with vessel involvement in the lower extremity. When vascular reconstruction surgery is performed, synthetic substitutes can be effectively used with low perioperative morbidity and an acceptable rate of limb salvage.

Preoperative disabilty and its relationship with morbidity after cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Disability is defined as functional problems in performing activities of daily living necessary for independent living and reflects the interaction between the individual and the surrounding environment. Disability may affect up to 76% of patients qualified for cardiac surgery. Disabilty as a construct that increases the perioperative risk may contribute to the loss of autonomy, increase dependence on others and reduce the quality of life. In addition, it is associated with longer hospital stays, increased use of healthcare resources, institutionalization and mortality. Purpose Assessment of the relationship between preoperatively assessed disabilty and postoperative morbidity in cardiac surgery patients. Material and Methods The study included 100 patients (60 men, 40 women, mean age 71.69 ± 4.96) scheduled for elective cardiac surgery. The study used a self-designed questionnaire to collect sociodemographic data, an analysis of medical records to collect data on postoperative morbidity, and a standardized tool for disability assessment. In the assessment of disability, the Nagi scale (assessment of difficulty in performing activities such as: pulling or pushing a chair, bending, crouching or kneeling, raising hands above the head, lifting or carrying small objects in the fingers, lifting 5 kg, going up or down stairs, walking 1.5 kg) was used, where significant disability is diagnosed when ≥ 3 points are obtained. The assumed significance level was p &amp;lt; 0.05. Results In the Nagi scale, the study group obtained an average score of M±SD = 3.41±1.83 points before the procedure. Women scored significantly higher on the Nagi scale than men (M±SD = 3.981. ±76 vs. MS±D = 3.03±1.79, p = 0.008). Patients with prolonged respiratory therapy had a significantly higher Nagi score before the procedure than patients without this complication (M±SD = 4.31±1.75 vs. M±SD = 3.04±1.74, p = 0.003). Patients who required hospitalization for more than 14 days before the procedure had a significantly higher score on the Nagi scale than patients without this complication (M±SD = 5.40±1.67 vs. M±SD = 3.31 ±1.79, p = 0.022). Patients with the composite morbidity endpoint had significantly higher Nagi scores before surgery (MS±D = 3.77±1.87 vs. M±SD = 2.88±1.65, p = 0.013). In univariate analysis, the Nagi score (OR: 1.32, 95% CI: 1.04-1.68, p = 0.019) and the Nagi score ≥3 points (OR: 2.96, 95% CI: 1.20-7.28, p = 0.017) were significant predictors of postoperative morbidity. The value of the Nagi scale as a continuous variable (OR: 1.29, 95% CI: 1.02-1.64, p = 0.033) and Nagi ≥3 points (OR: 2.71, 95% CI: 0.48-6.61, p = 0.032) were age- and multimorbidity-independent predictors of postoperative morbidity in the study group. Coclusions. Disabilty identified before the procedure has a negative impact on the incidence of postoperative morbidity in cardiac surgery patients. Assessment of disability before cardiac surgery is important in predicting outcomes.

Current status of lymph node dissection in pyloric-preserving gastrectomy for early gastric cancer

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.

Comparing the Outcomes of Conventional Coronectomy and Graft Coronectomy: A Systematic Review

Introduction: Coronectomy is a widely accepted alternative surgical treatment modality in which only the crown of an impacted tooth is removed, leaving the roots and their associated nerve untouched. Uncertainty remains regarding whether intraoperative bone grafting of the coronectomy socket can reduce the incidence of typical postoperative procedure-related complications. Objective: The purpose of this literature review is to compare the outcomes of conventional coronectomy (CC) and grafted coronectomy (GC) in terms of whether adding a bone graft material after coronectomy of impacted mandibular third molars would decrease the incidence of typical complications. Methods: A total of 13 cases identified from electronic databases were included in this review based on their clinical relevance. Results: In general, there were no significant differences between conventional coronectomy and grafted coronectomy regarding the incidence of postoperative morbidities. However, grafted coronectomy with the placement of a bone graft material in the coronectomy socket could significantly decrease the incidence of root migration requiring re-operation of the exposed roots and reduce the preexisting pocket depth distal to the 2nd molar, especially in patients with mesioangular, impacted or horizontal wisdom teeth. Conclusion: According to the existing literature, grafted coronectomy might offer better clinical outcomes and can minimize the typical procedure-related drawbacks of conventional coronectomy while having similar surgical morbidities.

Laparoscopic Management of Complicated Appendictis

AIMS The aims of this study are to evaluate the effectiveness, feasibility and safety of Laparoscopy formanaging complicated appendicitis and to look for postoperative complications as well as morbidity, in a tertiarycare hospital.OBJECTIVESTo study the Laparoscopic Appendicectomy in cases of Complicated Appendicitis with respect to:1. Mean duration of the surgical procedure.2. Number of days of antibiotics given, post operatively.3. Post -operative day-start of oral feeds.4. The incidence of Postoperative morbidity.5. Analgesics required.MATERIALS AND METHODSThis prospective study was conducted in a tertiary care hospital at Ahmedabad on 50 patients who underwentLaparoscopic appendicectomy between June 2022 to March 2023CONCLUSIONOur study has shown results encouraging the use of laparoscopic appendicectomy in cases of complicatedappendicitis, having found less post- operative morbidity along with early start of post-operative oral feeds anddecrease requirement of post-op antibiotics.Although the laparoscopic method can be technically challenging, but the results have demonstrated itsfeasibility and safety.Although the number of patients enrolled in this study is far too small, preliminary results show that ourexperiences with Laparoscopic appendicectomy in Complicated Appendicitis has been encouraging, althoughtechnically demanding, but with proper surgical technique, it can be done without much of post-op complication.As laparoscopic approach is having less morbidity in our study, we recommend the use of laparoscopy evenwith complicated appendicitis.

Early Enteral Feeding Versus Delayed Enteral Nutrition: Effects On Morbidity After Intestinal Surgery; A Prospective Study

Routine practice after bowel anastomoses has been to keep patient nil per oral till the return of bowel sound with a belief that this will prevent postoperative nausea and vomiting and protect the anastomotic site where, however this trend had been changed to encourage enteral feeding as early as possible as various studies has shown early enteral feeding to be beneficial in terms of nutritional, immunological aspect and for faster postoperative recovery of patient.&#x0D; Objective; To study and compare the effects of early enteral feeding with those of conventional management in postoperative patients undergoing intestinal primary suturing or direct repair.&#x0D; Patients and methods ; A prospective interventional study conducted for 135 patients with an age range between 15 – 67 years old who admitted to the general surgery Department in AlKindy Teaching Hospital, Baghdad, Iraq for the period between 1st of March 2019 and 1st October 2021. The patients were randomly assigned to schedule with starting oral feeding on the first day after surgery, referred to as early feeding group and those with delayed oral feeding till first passage of flatus and bowel movement, referred to as regular feeding group and compared overall prevalence of postoperative complication, length of hospital stay and outcome of surgery in these two groups.&#x0D; Result; There was less post operative complication in early feeding group as compaired with regular feeding group patients. Twenty percent patients developed post operative vomiting in early feeding group and sixteen percent patients in regular feeding group. Post operative fever occurred in five percent patients in early feeding group while sixteen percent patients in regular feeding group sufferd from postoperative fever. Abdominal distension noted in five percent patients in early feeding group while sixteen percent patients in regular feeding group. The average length of hospital stay in patient belong to early feeding group was 2-5 day while patient in regular feeding group stayed in hospital for average 3-8 days. &#x0D; Conclusion; There is more benefit from early oral feeding than delay oral feeding strategy in incidence of postoperative morbidity and period of hospital stay after intestinal surgery.

Robotic versus open extended cholecystectomy for T1a-T3 gallbladder cancer: A matched comparison.

The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a-T3 gallbladder cancer. From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients' demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed. The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85, P = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41, P = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21, P = 0.031). In addition, the REC group exhibited a shorter time to first ambulation (P = 0.043), a shorter time to drainage tube removal (P = 0.038), and a shorter postoperative stay (P = 0.037), but hospital costs were significantly higher in the REC group (P < 0.001). However, no statistically significant difference was found in the operation time (P = 0.134), intraoperative blood loss (P = 0.467), or incidence of postoperative morbidity (P = 0.227) or mortality (P = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%, P = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%, P = 0.619). REC can be an effective and safe alternative to OEC for selected patients with T1a-T3 gallbladder cancer with respect to short- and long-term outcomes.

578. ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING OESOPHAGECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract Esophagectomy remains the main stay of treatment in localized esophageal carcinoma. Radical Esophagectomy is associated with high morbidity and mortality. To minimise peri and post-operative complications and accelerate recovery, concept of ERAS has been introduced. Standardized ERAS guidelines were lacking in esophagectomy patients until the ERAS society published their guidelines in late 2018. This is a prospective observational study were ERAS protocol was followed for all patients undergoing esophagectomy during the study period (July 2020 to November 2021). Aim of the study was to compare the post-operative morbidity and mortality associated with ERAS protocol to published historical data from same institute. All patients undergoing esophagectomy for carcinoma of esophagus and GEJ were included and all the components of ERAS protocol as specified in the published guidelines were followed during the study. Out of 52 patients, 36 underwent minimal invasive procedure and 15 had open surgery. Median age was 59.5 years. Average blood loss for thoracic part was 150 ml and 100ml for the abdominal. 37/52 (71.15%) were extubated and rest were electively ventilated till next morning. Median post-operative ICU stay was one day (1-2) and over all hospital stay was 10 days (9-12). Overall morbidity was 11/52 (21.15%) with major morbidity in 4/52 (7.69%); there was no mortality. 2/52 (3.84%) had anastomotic leak. It was possible to follow the ERAS protocol for patients undergoing esophagectomy. The incidence of post-operative morbidity and mortality was no different from that seen in patients undergoing similar surgery before the implementation of ERAS protocol. The probable reason is many of the components of ERAS protocol were followed in our practice routinely. Notwithstanding our results, ERAS program is a collective responsibility and should be recommended in all patients undergoing esophagectomy to improve post-operative outcomes.

Can primary retroperitoneal sarcoma benefit from aggressive resection when it is smaller than a baseball? ——A propensity score-matched analysis

Background and objectivesMultivisceral resection (MVR) is advocated by some high-volume sarcoma centers. The objective of this study was to investigate the therapeutic effect of MVR in primary retroperitoneal sarcoma (RPS) with tumor burden less than 10 ​cm. MethodsA retrospective analysis of patients with primary RPS who underwent radical surgical resection from 2009 to 2021 with lesions smaller than the size of a baseball (10 ​cm) was carried out. The incidence of postoperative morbidity and postoperative local recurrence-free survival rate of the MVR group and the non-MVR group were compared by propensity score-matching analysis. ResultsA total of 319 patients with primary RPS underwent surgical resection, of which 95 patients (29.8%) had a tumor burden less than 10 ​cm, with 24 patients (25.3%) involved in the MVR group and 71 patients (74.7%) in the non-MVR group. After matching, the two groups showed no statistical difference at baseline, while the MVR group reported more postoperative complications (P ​= ​0.008) and a longer median postoperative hospital stay (P ​= ​0.002). In terms of local recurrence-free survival, there were no statistical difference between the two groups (P ​= ​0.269). ConclusionsPrimary RPS patients with tumors smaller than baseball may not benefit from aggressive surgical strategy.

The Comparison of Inflation of Cuff with 1% Propofol, 4% Lignocaine, or 0.9% Saline on Laryngotracheal Morbidity.

While administering general anesthesia requiring endotracheal intubation, it is a common practice to inflate the cuff with air. Continuous pressure exerted by cuff on mucosa may lead to postoperative complaints such as sore throat, cough, and dysphagia, which are very disturbing to the patient. Hence, we hypothesized that inflation of cuff with propofol may reduce the incidence of these complications as a result of cushioning effect as well as non-diffusion of nitrous oxide into it. Our aim was to compare the effects of inflation of endotracheal tube cuff with 0.9% saline, 4% lignocaine, and 1% propofol on the incidence of postoperative morbidity in terms of cough, sore throat, dysphonia, and dysphagia with general anesthesia using nitrous oxide. Patients scheduled for elective surgery under general anesthesia were randomly allocated into four equal groups of thirty each as per cuff inflation media: air (Group A), 0.9% saline (Group S), 4% lidocaine (Group L), and 1% propofol (Group P). The incidence of cough was noted at 15, 30 and 60 min after extubating. The occurrence and severity of postoperative sore throat (POST) was evaluated at 2, 6, and 24 h after extubating. The incidence of cough was maximum in Group A and minimum in Group P (P < 0.05). The occurrence of POST was highest in Group A, followed by Group S and Group L, and least in Group P. The hemodynamic parameters were comparable with no statistical difference in all the four groups (P < 0.05). The intracuff 1% propofol is superior to 4% xylocaine and normal saline in the prevention of cough and sore throat postoperatively, whereas inflation of cuff with air leads to maximum incidence of these complications.

Racial disparities in postoperative morbidity and mortality among high-risk pediatric surgical patients.

Study objectiveWith increasing improvement in perioperative care, post-surgical complication and mortality rates have continued to decline in the United States. Nonetheless, not all racial groups have benefitted equally from this transformative improvement in postoperative outcomes. We tested the hypothesis that among a cohort of “sick” (ASA physical status 4 or 5) Black and White children, there would be no systematic difference in the incidence of postoperative morbidity and mortality. DesignRetrospective cohort study. SettingInstitutions participating in the National Surgical Quality Improvement Program-Pediatric (2012–2019). PatientsBlack and White children who underwent inpatient operations and were assigned ASA physical status 4 or 5. Measurementsrisk adjusted odds ratios for 30-day postoperative mortality and complications using multivariable logistic regression models, controlling for various baseline covariates. Main resultsThere were 16,097 children included in the analytic cohort (77.0% White and 23.0% Black). After adjusting for baseline covariates, Black children were estimated to be 20% more likely than their White counterparts to die within 30 days after surgery (9.3% vs. 7.2%, adjusted-OR: 1.20, 95% CI: 1.05–1.38, P = 0.007). Black children were also more likely to develop pulmonary complications compared to their White peers (52.1% vs. 44.6%, adjusted-OR: 1.13, 95%CI: 1.04, 1.23, P = 0.005). Being Black also conferred an estimated 28% relative greater odds of developing cardiovascular complications (4.6% vs. 3.3%, 95%CI: 1.06, 1.54, P = 0.010). Finally, being Black conferred an estimated 33% relative greater odds of requiring an extended LOS compared to Whites (50.7% vs. 38.7%, adjusted-OR: 1.33, 95% CI: 1.22–1.46, P < 0.001). ConclusionIn this cohort of children with high ASA physical status, Black children compared to their White peers experienced significantly higher rates of 30-day postoperative morbidity and mortality. These findings suggest that racial differences in postoperative outcomes among the sickest pediatric surgical patients may not be entirely explained by preoperative health status.

Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages

BackgroundAlthough laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. MethodsA retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People’s Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. ResultsBy using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. ConclusionsFor GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay.

Analgesic effects of ultrasound-guided fourquadrant transversus abdominis plane in patients with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a prospective, randomized, controlled study.

BackgroundPostoperative pain occurring after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is difficult to control because of extensive surgical injuries and long incisions. We assessed whether the addition of a four-quadrant transabdominal plane (4Q-TAP) block could help in analgesic control.MethodsSeventy-two patients scheduled to undergo elective CRS with HIPEC and intravenous patient-controlled analgesia (IV PCA) were enrolled. The patients received 4Q-TAP blocks in a 10 ml mixture of 2% lidocaine and 0.75% ropivacaine per site (4Q-TAP group, n = 36) or normal saline (control group, n = 33). Oxycodone in the post-anesthesia care unit (PACU) and pethidine or tramadol in the ward were used as rescue analgesics. The primary outcome was less than 3 times of rescue analgesic administration (%) in the ward for 5 postoperative days. Secondary endpoints included oxycodone requirement in PACU, fentanyl doses of IV PCA, morphine milligram equivalent (MME) of total opioid use, hospital stay, and postoperative complications. ResultsDuring 5 postoperative days, there was no difference in pain scores and total rescue analgesic administration between two groups. However, the use of oxycodone in PACU (P = 0.011), fentanyl requirement in IV PCA (P = 0.029), and MME/kg of total opioid use (median, 2.35 vs. 3.21 mg/kg, P = 0.009) were significantly smaller in the 4Q-TAP group. Hospital stay and incidence of postoperative morbidity were similar in both groups. ConclusionsThe 4Q-TAP block enhanced multimodal analgesia and decreased opioid requirements in patients with CRS with HIPEC, but did not change postoperative recovery outcomes.

Prognostic significance of preoperative Naples prognostic score on short- and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma.

The Naples prognostic score (NPS) is an effective and objective tool to assess the immune-nutritional status of patients with malignant tumors. The aim of this study was to investigate the clinical significance of preoperative NPS on short- and long-term outcomes after pancreatoduodenectomy (PD) for ampullary carcinoma. We retrospectively analyzed 404 consecutive patients with ampullary carcinoma who underwent PD between January 2012 and June 2018. Preoperative NPS was calculated from serum albumin and total cholesterol concentrations, and the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio (LMR). Patients were then divided into three groups according to their NPS. Clinicopathological variables, postoperative outcomes, and survival data were compared between the three groups. Univariate and multivariate Cox analysis of overall survival (OS) and recurrence-free survival (RFS) were also conducted, and time-dependent receiver operating characteristic (ROC) curves were created to evaluate the discriminatory ability of the prognostic scoring systems. Patients with higher NPS had worse prognosis, and significant OS difference (group 0 vs. 1, P=0.02; group 1 vs. 2, P<0.001; group 0 vs. 2, P<0.001) and RFS difference (group 0 vs. 1, P=0.088; group 1 vs. 2, P<0.001; group 0 vs. 2, P<0.001). Multivariate analysis revealed that NPS was an independent significant predictor of OS (grade 2 vs. grade 1 or 0, hazard ratio: 3.067; P<0.001) and RFS (grade 2 vs. grade 1 or 0, hazard ratio: 2.732; P<0.001). The time-dependent receiver operating curve analysis showed that NPS had better prognostic performance for OS and RFS than other prognostic models. Additionally, significant differences in the incidence of postoperative morbidity were observed between the three groups, and the NPS was an independent risk factor of overall postoperative complications (grade 2 vs. grade 1 or 0, odds ratio: 1.692; P=0.02). The NPS was an independent predictor of overall- and RFS in patients undergoing PD for ampullary carcinoma, and was independently associated with the incidence of postoperative complications.

Evaluation of anemia as a postoperative risk factor in the evolution of patients with gastric resection for malignancies

Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

111 CLINICAL IMPORTANCE OF MEAN CORPUSCULAR VOLUME AS A PROGNOSTIC MARKER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract High MCV is suggested to be relevant to the incidence and prognosis of several malignancies. However, few studies investigating the correlation between MCV and survival outcome of esophageal cancer have been conducted. Methods This study included 570 patients with esophageal cancer who underwent radical esophagectomy between April 2005 and December 2017. Patients were divided into two groups according to the standard value of pretreatment MCV: normal (83–99 fL) and high (&amp;gt;99 fL) groups. Clinical backgrounds, short-term outcomes, and prognostic outcomes post-esophagectomy were retrospectively compared between the groups. Results Of all patients, 410 (71.9%) had normal MCV, and 160 (28.1%) had high MCV. High MCV was significantly associated with lower body mass index, higher frequency of habitual alcohol and tobacco use, and higher incidence of multiple primary malignancies other than esophageal cancer. High MCV also correlated with higher incidence of postoperative morbidity of the Clavien–Dindo classification ≥II and pulmonary morbidity. Overall survival was significantly worse in patients with high MCV. Multivariate analysis suggested that high MCV was an independent risk factor for worse survival outcome (hazard ratio, 1.54; 95% confidence interval, 1.098–2.151; p = 0.012). Conclusion Patients with high MCV have various disadvantages in clinical background that can adversely affect both short-term and long-term outcomes after esophagectomy. MCV can become a predictive marker to estimate survival outcome after esophagectomy for esophageal cancer.

Clinical and Postoperative Outcomes of Cancer Surgeries during the COVID-19 Pandemic: A Comparative Study with its Pre-COVID Surgical Audit at Five Major Tertiary Care Hospitals’ Cancer Departments in India

Abstract Introduction There has been an exponential rise in number of coronavirus disease 2019 (COVID-19)-positive infections since March 23, 2020. However, cancer management cannot take a backseat. Objective The aim of this study was to identify any difference in the complication and mortality rates for the cancer patients operated during the ongoing COVID-19 pandemic. Materials and Methods This was a retrospective study of a prospectively maintained database of five centers situated in different parts of India. Variables such as demographics, intraoperative, and postoperative complications were compared between COVID-19 (group A—March 23, 2020–May 22, 2020) and pre-COVID time period (group B—January 1 to January 31, 2020). Results One-hundred sixty-eight cancer surgeries were performed in group B as compared with 148 patients who underwent oncosurgeries in group A. Sixty-two percent lesser cancer surgeries were performed in the COVID-19 period as compared with the specific pre-COVID-19 period. There was no significant difference in age group, gender, comorbidities, and type of cancer surgeries. Except for the duration of surgery, all other intraoperative parameters like blood loss and intraoperative parameters were similar in both the groups. Minimally invasive procedures were significantly lesser in group A. Postoperative parameters including period of intensive care unit stay, rate of infection, need for the change of antibiotics, and culture growth were similar for both the groups. While minor complication like Clavien-Dindo classification type 2 was significantly higher for group A, all other complication rates were similar in the groups. Also, postoperatively no COVID-19-related symptoms were encountered in the study group. A subset analysis was done among the study groups between those tested preoperatively for COVID-19 versus those untested showed no difference in intraoperative and postoperative parameters. No health-care worker was infected from the patient during the time period of this study. Conclusion Our study shows that there is no significant difference in the incidence of postoperative morbidity and mortality rates in surgeries performed during COVID-19 pandemic as compared with non-COVID-19 time period.