Invasive Surgery In Patients Research Articles

ThP2.12 - Evaluation of hand-assisted laparoscopic surgery of small intestine neuroendocrine tumors as an alternative surgical treatment for open surgery

Abstract Aims Small intestinal neuroendocrine tumor (SI-NETs) is the most common malignancy of the small bowel. Curative treatment is exclusively operative and explorative laparotomy is still considered to be the standard procedure. The purpose of this retrospective cohort study was to assess the outcome of minimally invasive surgery in patients with SI-NETs, at our endocrine surgery unit in 2019, compared to the open approach. Methods Patients who underwent surgery for SI-NETs between 2013 and 2023 were included. Descriptive variables such as operative time, length of hospital stay, use of analgesia and radiciality were compared primarily between groups of patients operated before and after 2019 and secondarily between open and hand-port assisted laparoscopic surgery (HALS). Results Of 97 patients with SI-NET included in the study, 58 (59.8 %) had an open and 39 (40.2 %) minimal invasive surgery. While difference in the operative time, 121 min (91.3-150.3) vs 108 min (83-141), the length of hospital stay, 6 days (4-7) vs 5 days (4-8) and surgical radicality in patients with stage II-III, 79.3% vs 85%, (p-value 0.313) was not significant, 86.2% of patients with explorative laparotomy required epidural analgesia compared to 23.1% with HALS (p-value = <0.001). Conclusion Hand-port assisted laparoscopic surgery of SI-NETs was assessed to be a feasible approach without compromising radical resection and enhancing postoperative recovery with lower amount of required analgesia postoperatively.

WP5.6 - Beyond the Left Side: Emergency Colonic Stenting for Acute Malignant Large Bowel Obstruction

Abstract Introduction Acute malignant large bowel obstruction (LBO) is traditionally treated by surgical diversion or resection in patients who are fit enough. European guidelines suggest colonic stenting as a bridge to surgery in curative disease. The aim was to examine the safety and efficacy of a change in practice from emergency laparotomy towards colonic stenting for acute malignant LBO. Methods Patients with LBO from 01/01/2019 to 31/12/2022 were included and data was obtained from the NELA database and electronic patient records. Results 42 patients underwent emergency laparotomy (EL) for LBO. 33% (14/42) patients had right-sided tumours (n=14) and/or perforated disease (n=6) where stenting was contraindicated. 28/42 patients (22% of total) went straight to EL for clinical/ organisation factors. 73 patients were stented; 44% (32/73) were at/ proximal to splenic flexure. Perforation rate was 10% (7/73) with 4/7 requiring EL. Failure rate was 14% (10/73) with 6/10 patients requiring EL. 41% (30/73) were stented with curative intent; 70% (21/30) then underwent elective resection. The rate of stoma formation and minimally invasive surgery in patients stented with curative intent was 40% (12/30) and 60% (18/30) respectively (including 9 EL following stent complications). Compared with 88% (37/42) and 19% (8/42) in patients undergoing primary EL. Conclusion Almost 2/3 of patients presenting with acute malignant LBO were suitable for stenting. Stenting reduced the need for a stoma and enabled elective minimally invasive surgery with low complication rates. This rate of colonic stenting was achievable without a 24/7 colonic stenting rota or sub-specialty cover.

Preoperative exercise training decreases complications of minimally invasive lung cancer surgery: A randomized controlled trial

ObjectiveLimited evidence exists regarding the efficacy of preoperative exercise in reducing short-term complications after minimally invasive surgery in patients with non–small cell lung cancer. This study aims to investigate the impact of preoperative exercise on short-term complications after minimally invasive lung resection. MethodsIn this prospective, open-label, randomized (1:1) controlled trial at Xiangya Hospital, China (September 2020 to February 2022), patients were randomly assigned to a preoperative exercise group with 16-day alternate supervised exercise or a control group. The primary outcome assessed was short-term postoperative complications, with a follow-up period of 30 days postsurgery. ResultsA total of 124 patients were recruited (preoperative exercise group n = 62; control n = 62). Finally, 101 patients (preoperative exercise group; n = 51 and control; n = 50) with a median age of 56 years (interquartile range, 50-62 years) completed the study. Compared with the control group, the preoperative exercise group showed fewer postoperative complications (preoperative exercise 3/51 vs control 10/50; odds ratio, 0.17; 95% CI, 0.04-0.86; P = .03) and shorter hospital stays (mean difference, −2; 95% CI, −3 to −1; P = .01). Preoperative exercise significantly improved depression, stress, functional capacity, and quality of life (all P < .05) before surgery. Furthermore, preoperative exercise demonstrated a significantly lower minimum blood pressure during surgery and lower increases in body temperature on day 2 after surgery, neutrophil-to-lymphocyte ratio, and neutrophil count after surgery (all P < .05). Exploratory research on lung tissue RNA sequencing (5 in each group) showed downregulation of the tumor necrosis factor signaling pathway in the preoperative exercise group compared with the control group. ConclusionsPreoperative exercise training decreased short-term postoperative complications in patients with non–small cell lung cancer.

Gait analysis, trunk movements, and electromyographic patterns after minimally invasive spine surgery for lumbar instability: An observational prospective study

ObjectiveThe aim of the present study was to investigate trunk kinematics and spine muscle activation during walking after minimally invasive surgery in patients with L4-L5 degenerative spondylolisthesis suffering from lumbar instability (LI). MethodsEleven patients suffering from LI and 13 healthy controls (HC) were enrolled. Trunk kinematics and spine muscle activation patterns during walking were collected. Maximal trunk ranges of motion were also recorded from standing position. Assessments were performed pre-operatively (T0), 1 month (T1) and 3 months (T2) after MIS. ResultsWe found significant improvement in spine muscle activation during walking at T2 compared to T0, mainly involving right/left symmetry at the operated level (L4-L5) and up-down synchronization from L3 to S1. Significant improvements in trunk rotation nearing to the HC group during walking were also found at T2 after surgery, though no changes were observed in the maximal range of motion of the trunk during standing. Furthermore, trunk rotation improvement correlated with a lower grade of residual disability. ConclusionsOur findings indicate that trunk rotation improves after surgery, and impaired aspects of spine muscle activation can be improved with surgery. These biomechanical parameters could represent novel tools for monitoring the effect of surgery in LI and preventing impaired spine mobility and muscle activation.

Retracted: Efficacy and Adverse Reactions of Arthroscopic Half-Moon Plate Invasive Surgery in Patients with Acute Knee Pain (AKP): Systematic Review and Meta-Analysis

Retracted: Efficacy and Adverse Reactions of Arthroscopic Half-Moon Plate Invasive Surgery in Patients with Acute Knee Pain (AKP): Systematic Review and Meta-Analysis

Molecular testing in indeterminate thyroid nodules: an additional tool for clinical decision-making.

Thyroid nodules are commonly encountered in clinical practice, affecting up to 50% of the population. The large majority of thyroid lumps are benign incidental findings detected by imaging, while approximately 5-15% harbor malignancy. For a target patient's care, it is of paramount importance to identify and treat thyroid malignancy, while preventing unnecessary invasive surgery in patients with benign lesions. Although fine needle aspiration (FNA) associated with cytological examination provides malignant risk information, 20-30% of diagnoses fall into the "indeterminate thyroid nodule" (ITN) category. ITN clinical management remains a challenging issue for physicians since the ITN risk of malignancy varies from 5% to 40% and most thyroid nodules undergo overtreatment with surgery procedures. ITN molecular testing may better define malignant risk in the single nodule and is able to discriminate with accuracy benign from malignant nodules. Nowadays there are different technologies and different molecular panels, each with its own specificity, sensitivity and predictive values. In view of widespread introduction of molecular testing , some outstanding questions remain and are addressed in the present review such as the presence of molecular panels acting as "rule in" or "rule out" tools, the effective impact of testing results in the clinical decision-making process, and the prohibitive cost of commercial assays associated with the lack of test reimbursement in national health systems.

Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: Review of the Surgical Technique

Objective: To present a patient with situs inversus totals and symptomatic cholelithiasis treated by laparoscopy, highlighting the usefulness of minimally invasive surgery in patients with anatomical variants. Background: Situs Inversus Totalism is a rare genetic disorder that is characterized by the transposition of the thoracoabdominal organs in a sagittal direction, providing a so-called “mirror” image. Methods: Report of a 40-year- old female patient with symptomatic cholelithiasis of 3 months evolution, in whom situs inversus totals was identified, after imaging tests performed. The intervention proceeded without complications and the patient was discharged after 24 hours. Conclusions: Gallbladder lithiasis in situs inversus totals is a rare clinical condition that can be treated safely and effectively by laparoscopy. We believe that an exhaustive preoperative study is convenient to detect possible added anatomical variants in these patients, since their knowledge can help us to design the operation.

Robotic approach for perihilar cholangiocarcinoma: from Bismuth 1 to vascular resection

BackgroundImplementation of minimally invasive surgical approaches for perihilar cholangiocarcinoma (pCCA) has been relatively slow compared to other indications. This is due to the complexity of the disease and the need of advanced skills for the reconstructive phase. The robot may contribute to close the gap between open and minimally invasive surgery in patients with Klastkin tumors. Study DesignWe report details of our experience with robotic approach in patients affected by pCCA. In particular selection criteria, ERAS management, technical tips and robotic setup are discussed. Finally, results from our cohort are reported. A video clip of a patient that underwent left hepatectomy with en-bloc caudatectomy and portal vein resection at the confluence with end-to-end reconstruction for a pCCA 3-b according to Bismuth-Corlette classification with full robotic approach is enclosed. ResultsFourteen patients underwent robotic resection of pCCA over the three-year interval with a median follow-up interval of 18.7 months. The pre-operative Bismuth-Corlette classification was 1 for two patients (14.2%) and 2 for one patient (7.1%), 3-a for three (21.4%) patients, 3-b for four (28.6%) patients and 4 for four (28.6%) patients. Median estimated blood loss was 150 ml (range 50–800 ml) and median operative time was 490 min (range 390–750 min). The median length of hospital stay after the index operation was 6 days (range 3–91). Final histology revealed a median of 19 (range 11–40) lymph nodes retrieved, with 92.9% R0 resections. 90-days mortality was nihil and 3-year survival exceeds 50%. ConclusionWith adequate preparation, outcomes of robotic approach to pCCA can be safe and in line with the current international benchmark outcomes, as showed in this study, when performed in expert high volume centers for complex major hepatectomy and robotic HPB.

Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial.

The oncological safety of minimally invasive surgery has been questioned for several abdominal cancers. Concerns also exist regarding the use of minimally invasive distal pancreatectomy (MIDP) in patients with resectable pancreatic cancer as randomised trials are lacking. In this international randomised non-inferiority trial, we recruited adults with resectable pancreatic cancer from 35 centres in 12 countries. Patients were randomly assigned to either MIDP (laparoscopic or robotic) or open distal pancreatectomy (ODP). Both patients and pathologists were blinded to the assigned approach. Primary endpoint was radical resection (R0, ≥1mm free margin) in patients who had ultimately undergone resection. Analyses for the primary endpoint were by modified intention-to-treat, excluding patients with missing data on primary endpoint. The pre-defined non-inferiority margin of-7% was compared with the lower limit of the two-sided 90% confidence interval (CI) of absolute difference in the primary endpoint. This trial is registered with the ISRCTN registry (ISRCTN44897265). Between May 8, 2018 and May 7, 2021, 258 patients were randomly assigned to MIDP (131 patients) or ODP (127 patients). Modified intention-to-treat analysis included 114 patients in the MIDP group and 110 patients in the ODP group. An R0 resection occurred in 83 (73%) patients in the MIDP group and in 76 (69%) patients in the ODP group (difference 3.7%, 90% CI-6.2 to 13.6%; pnon-inferiority=0.039). Median lymph node yield was comparable (22.0 [16.0-30.0] vs 23.0 [14.0-32.0] nodes, p=0.86), as was the rate of intraperitoneal recurrence (41% vs 38%, p=0.45). Median follow-up was 23.5 (interquartile range 17.0-30.0) months. Other postoperative outcomes were comparable, including median time to functional recovery (5 [95% CI 4.5-5.5] vs 5 [95% CI 4.7-5.3] days; p=0.22) and overall survival (HR 0.99, 95% CI 0.67-1.46, p=0.94). Serious adverse events were reported in 23 (18%) of 131 patients in the MIDP group vs 28 (22%) of 127 patients in the ODP group. This trial provides evidence on the non-inferiority of MIDP compared to ODP regarding radical resection rates in patients with resectable pancreatic cancer. The present findings support the applicability of minimally invasive surgery in patients with resectable left-sided pancreatic cancer. Medtronic Covidien AG, Johnson & Johnson Medical Limited, Dutch Gastroenterology Society.

COMPARATIVE ANALYSIS OF CONVENTIONAL AND MINIMALLY INVASIVE TECHNIQUES IN THE TREATMENT OF FEMORAL HERNIAS

Despite the advances in medicine regarding diagnosis and therapeutic options, the treatment of femoral hernias remains a challenge for the surgeon. In the past, this type of hernia was repaired with conventional surgery. Today, mini-invasive techniques are preferred method of choice by many surgeons. The aim of our study is to compare the results of open and minimally invasive surgery in patients with femoral hernias.In the present study we include patients with primary unilateral femoral hernias operated in the Surgical Department of EUROHOSPITAL- Plovdiv and the Department of General Surgery of University Hospital “St. George” for the period January 2018 to December 2022. The patients were divided into two groups - conventional and minimally invasive operations. Comparative analysis was performed regarding sex, age, duration of operative intervention, postoperative pain, hospital stay and complications.33 patients in total were diagnosed and operated for femoral hernias for a period of 5 years. Of these, 16 patients were operated conventionally and 17 underwent laparoscopic surgery. Patients in the minimally-invasive group had a significantly shorter hospital stay (2.1 vs 3.0 days) and less postoperative pain (1.8 vs 3.6 on the 1 to 5 scale). The incidence of the postoperative complications was similar in both groups.Surgery is the only method of treatment of femoral hernias. Nowadays, minimally invasive techniques became a method of choice compared with conventional surgery. We believe that laparoscopic operations for femoral hernia, performed by experienced surgeon, are effective and safe and could be applied to all type of patients.

Perioperative pain management for minimally invasive surgery in patients with opioid use disorder

Perioperative pain management for minimally invasive surgery in patients with opioid use disorder

Retracted: Evaluation of Vertebral Function and Long-Term Quality of Life after Percutaneous Minimally Invasive Surgery in Patients with Thoracolumbar Spine Fractures.

[This retracts the article DOI: 10.1155/2022/2723542.].

Clavien-Dindo classification and risk prediction model of complications after robot-assisted radical hysterectomy for cervical cancer.

Although significant progress has been made with surgical methods, the incidence of complications after minimally invasive surgery in patients with cervical cancer remains high. Established as a standardized system, Clavien-Dindo classification (CDC) has been applied in a variety of surgical fields. This study is designed to evaluate the complications after robot-assisted radical hysterectomy (RRH) for cervical cancer using CDC and further establish a prediction model. This is a study on the development of prediction model based on retrospective data. Patients with cervical cancer who received RRH treatment in our hospital from January 2016 to April 2019 were invited to participate in the study. The demographic data, laboratory and imaging examination results and postoperative complications were collected, and the logistic regression model was applied to analyze the risk factors possibly related to complications to establish a prediction model. 753 patients received RRH. The overall incidence of complications was 32.7%, most of which were grade I and grade II (accounting for 30.6%). The results of multivariate analysis showed that the preoperative neoadjuvant chemotherapy (OR = 1.693, 95%CI: 1.210-2.370, P = 0.002), preoperative ALT (OR = 1.028, 95%CI: 1.017-1.039, P < 0.001), preoperative urea nitrogen (OR = 0.868, 95%CI: 0.773-0.974, P = 0.016), preoperative total bilirubin (OR = 0.958, 95%CI: 0.925-0.993, P = 0.0.018), and preoperative albumin (OR = 0.937, 95%CI: 0.898-0.979, P = 0.003) were related to the occurrence of postoperative complications. The area under the curve (AUC) of receiver-operating characteristic (ROC) in the prediction model of RRH postoperative complications established based on these five factors was 0.827 with 95% CI of 0.794-0.860. In patients undergoing robot-assisted radical hysterectomy for cervical cancer, preoperative ALT level, urea nitrogen level, total bilirubin level, albumin level, and neoadjuvant chemotherapy were significantly related to the occurrence of postoperative complications. The regression prediction model established on this basis showed good prediction performance with certain clinical promotion and reference value.

ЭВОЛЮЦИЯ ПОДХОДОВ К ХИРУРГИЧЕСКОМУ ЛЕЧЕНИЮ ДЕТЕЙ С РАБДОМИОСАРКОМОЙ ПАРАМЕНИНГЕАЛЬНОЙ ЛОКАЛИЗАЦИИИ: ВЛИЯНИЕ МАЛОИНВАЗИВНОЙ ХИРУРГИИ НА ПРОГНОЗ ПО ОСНОВНОМУ ЗАБОЛЕВАНИЮ В СТРУКТУРЕ МУЛЬТИМОДАЛЬНОЙ РИСК-АДАПТИРОВАННОЙ ТЕРАПИИ

The article analyzes the bibliographical data regarding the possibilities of minimally invasive surgery for patients with parameningeal rabdomyosarcoma (RMS) and its influence on the prognosis for the underlying disease in terms of traditional techniques of surgical intervention. The role of surgical treatment in the context of the multimodal approach in the treatment of parameningeal RMS has been analyzed in detail, as well as carried out the analysis of the evolution of these approaches both from a historical perspective and from the point of view of developments in Russia and worldwide.

Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study.

PurposeNew vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs.MethodsThis study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA).ResultsA total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values.ConclusionsIn this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.

Efficacy and Adverse Reactions of Arthroscopic Half-Moon Plate Invasive Surgery in Patients with Acute Knee Pain (AKP): Systematic Review and Meta-Analysis.

Objective To evaluate the efficacy and adverse reactions of arthroscopic half-moon plate invasive surgery (DEB) in patients with knee pain (AKP) using meta-analysis techniques. Methods The computer retrieves from the English databases PubMed, EMBASE, Cochrane Library, and Web of Science and the Chinese databases China Knowledge Network, Wanfang Database, VIP Database, and China Biomedical Literature Database to collect information about DEB therapeutic AKP randomized controlled trial. Develop criteria for documentation inclusion and exclusion, evaluate the quality and bias risk of literature, and compare differences in efficacy and adverse responses before and after DEB treatment and other conservative treatments. Results A total of 14 randomized controlled trials and 1464 AKP patients were included in the study, with follow-up duration of 1-12 months. The total knee scores for DEB at 1, 3, 6, and 12 months after treatment were significantly better than baseline levels (1 month: WMD = 34.56, P = 0.02; 3 months: WMD = 27.73, P = 0.0001; 6 months: SMD = 2.38, P = 0.0001; 12 months: SMD = 1.69, P = 0.001). At 6 months of follow-up, DEB improved knee function better than HA (SMD = 0.47, P = 0.003), and during follow-up for 12 months, DEB relieved knee pain (SMD = 0.55, P = 0.0007) and improved knee function (SMD = 0.88, P = 0.0001) which is significantly better than HA. DEB was less effective at improving knee function in 1, 3, and 12 months than DEB joint HA injections (1 month P = 004; 3 months P = 0.01; 12 months P = 0.03). At 6 and 12 months of follow-up, DEB was better at pain relief and improved function than ozone (P > 0.05). DEB and glucocorticosteroids have similar effects in pain relief and improved function at various follow-up times. In terms of adverse reactions, DEB does not increase the risk of adverse events compared to HA (OR = 0.96, P = 0.85). Conclusion Compared to HA and ozone, DEB is a more effective treatment for AKP joints, while DEB is combined with HA. The clinical efficacy of injection therapy AKP is better than that of DEB alone.

Preoperative imaging in primary hyperparathyroidism: Are 11 C-Choline PET/CT and 99m Tc-MIBI/123 Iodide subtraction SPECT/CT interchangeable or do they supplement each other?

ObjectivePreoperative location of hyperfunctioning parathyroid glands (HPGs) is vital when planning minimally invasive surgery in patients with primary hyperparathyroidism (PHPT). Dual‐isotope subtraction scintigraphy with 99mTc‐MIBI/123Iodide using SPECT/CT and planar pinhole imaging (Di‐SPECT) has shown high sensitivity, but is challenged by high radiation dose, time consumption and cost. 11C‐Choline PET/CT (faster with a lower radiation dose) is non‐inferior to Di‐SPECT. We aim to clarify to what extent the two are interchangeable and how often there are discrepancies.DesignThis is a prospective, GCP‐controlled cohort study.Patients and MeasurementsOne hundred patients diagnosed with PHPT were included and underwent both imaging modalities before parathyroidectomy. Clinical implications of differences between imaging findings and negative imaging results were assessed. Surgical findings confirmed by biochemistry and pathology served as reference standard.ResultsAmong the 90 patients cured by parathyroidectomy, sensitivity was 82% (95% confidence interval [CI]: 74%–88%) and 87% (95% CI: 79%–92%) for Choline PET and Di‐SPECT, respectively, p = .88. In seven cases at least one imaging modality found no HPG. Of these, neither modality found any true HPGs and only two were cured by surgery. When a positive finding in one modality was incorrect, the alternative modality was correct in approximately half of the cases.ConclusionCholine PET and Di‐SPECT performed equally well and are both appropriate as first‐line imaging modalities for preoperative imaging of PHPT. When the first‐line modality fails to locate an HPG, additional preoperative imaging with the alternate modality offers no benefit. However, if parathyroidectomy is unsuccessful, additional imaging with the alternate modality has merit before repeat surgery.

Mid- and low-rectal cancer: laparoscopic vs open treatment-short- and long-term results. Meta-analysis of randomized controlled trials.

The laparoscopic approach in the treatment of mid- or low-rectal cancer is still controversial. Compared with open surgery, laparoscopic resection of extraperitoneal cancer is associated with improved short-time non-oncological outcomes, although high-level evidence showing similar short- and long-term oncological outcomes is scarce. The aim of our paper is to study the oncological and non-oncological outcomes of laparoscopic versus open surgery for extraperitoneal rectal cancer. A systematic review of MedLine, EMBASE, and CENTRAL from January 1990 to October 2020 was performed by combining various key words. Only randomized controlled trials (RCTs) comparing laparoscopic versus open surgery for extraperitoneal rectal cancer were included. The quality of RCTs was assessed using the Cochrane reviewer's handbook. This meta-analysis was based on the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. This study analyzes laparoscopic versus open surgery for extraperitoneal rectal cancer. Primary outcomes were oncological parameters. Fifteen RCTs comprising 4,411 patients matched the selection criteria. Meta-analysis showed a significant difference between laparoscopic and open surgery in short-time non-oncological outcomes. Although laparoscopic approach increased operation time, it decreases significantly the blood loss and length of hospital stay. No significant difference was noted regarding short- and long-term oncological outcomes, but 4 and 5years disease-free survival were statistically higher in the open group. There are still questions about the long-term oncological outcomes of laparoscopic surgery for extraperitoneal rectal cancer being comparable to the open technique. Considering that all surgical resections have been performed in high volume centers by expert surgeons, the minimally invasive surgery in patients with extraperitoneal cancer could still be not considered equivalent to open surgery in terms of oncological radicality.

Adjuvant Radiotherapy After Minimally Invasive Surgery in Patients With Stage IA1-IIA1 Cervical Cancer.

To estimate whether adjuvant radiotherapy is necessary for patients with stage IA1-IIA1 cervical cancer after laparoscopic hysterectomy, 221 patients were retrospectively analyzed. Sixty-two of them were treated with laparoscopic hysterectomy and adjuvant radiotherapy (group A), 115 underwent open surgery (group B) and 44 received laparoscopic hysterectomy alone (group C). Results showed that the 3-year local recurrence-free survival (LRFS) rates of group A, B and C were 98.4%, 97.4% and 86.4%, respectively. The LRFS rates of group A and B surpassed C (A vs. B, p=0.634; A vs. C, p=0.011; B vs. C, p=0.006). The inter-group differences of 3-year overall survival (OS) and distant metastasis free survival (DMFS) were not statistically significant. In subgroup analysis of stage IB disease, the 3-year LRFS rates of group A, B and C were 100%, 98.8% and 83.1%, the 3-year OS rates of group A, B and C were 100%, 98.9% and 91.5%, respectively. The 3-year LRFS and OS rates of group A and B were significantly superior to group C (p<0.05). Our findings suggest that adjuvant radiotherapy can reduce the risk of recurrence for women with early-stage cervical cancer after laparoscopic hysterectomy and bring survival benefits for patients with stage IB disease.

Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable implant, except cases of chronical periprosthetic infection. The aim of this study was to evaluate efficiency of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.