Anastomosis Leakage Research Articles

Managing esophageal squamous cell carcinoma after cervical radiotherapy for a head and neck cancer: esophagectomy remains a viable option.

Managing esophageal squamous cell carcinoma (ESCC) in patients with a history of cervical radiotherapy for a head and neck cancer (HNC) often requires a careful evaluation of esophagectomy due to concerns regarding complications and prognosis. This study evaluates the periesophagectomy and oncological outcomes of such patients. Patients diagnosed with ESCC between January 2010 and August 2023 and who had undergone esophagectomy with cervical anastomosis were retrospectively reviewed. Patients were categorized into two groups based on the presence (group 1) or absence (group 2) of a history of radiotherapy for as HNC. After 1: 2 propensity score matching, the perioperative and oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS), were evaluated. A total of 481 patients, 32 in group 1 and 449 in group 2, were included. After matching, group 1 patients and 64 patients in the group 2 were analyzed. All the patients in group 1 were males, and their mean age was 56years. The median radiation dose was 69Gy. The rates of anastomosis leakage, pneumonia, respiratory failure, and reoperation were comparable between the two groups. However, vocal cord palsy occurred more frequently in group 1, particularly in those with recurrent laryngeal nerve lymph node dissection (37.5%). The 3-year OS (69.6% vs. 75.2%; p = 0.26) and RFS (50.8% vs. 55.9%; p = 0.63) were similar between groups 1 and 2. In conclusion, perioperative and oncological outcomes were comparable between ESCC patients with and without prior HNC radiotherapy, supporting esophagectomy as a feasible option.

Anastomotic leakage in hepato-pancreato-biliary surgery

Severe complications following hepato-pancreato-biliary surgery are frequently due to leakage of anastomoses. Local intraoperative and systematic measures can reduce the incidence of leaks and leak-related sequelae. The early identification of leak-related sequelae, such as hemorrhage is pivotal to reduce the mortality risk. Therefore, perioperative risk stratification incorporating surgical and patient risk factors is crucial. The management of anastomotic leaks is complex and an interdisciplinary treatment is therefore recommended. The treatment depends on the institutional expertise, localization, characteristic features of the anastomosis and the onset of insufficiency. This article describes the different concepts of the diagnostics, prevention, consequences and management of anastomotic leakage in hepato-pancreato-biliary surgery in more detail.

Impact of the laparoscopic approach, early closure and preoperative stimulation on outcomes of ileostomy closure after rectal resection

AimTo evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach. MethodsWe performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission. ResultsBetween 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57–113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5–7). Readmission was needed in 6.8% (n = 7) of patients. ConclusionA previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure.

Treatment of chronic sinus tract leakage at rectal anastomosis with anal fistula endoscopy

Objective: To introduce the method of using anal fistula endoscope to treat chronic sinus tract leakage at rectal anastomosis site. Methods: We used anal fistula endoscopy to treat a patient with chronic sinus tract leakage after radical resection of rectal cancer, mainly including the following 5 steps: (1) establishing a water injection circulation system through the anus; (2) scraping off purulent coating and mucosa on the surface of the sinus tract with the brush; (3) hemostasis and removal of necrotic tissue with electrocoagulation rods; (4) filling the sinus tract with bioprotein gel; (5) compressing the sinus tract with transanal drainage tube. Results: The patient is a 70 year old male with rectal cancer. After undergoing 3D laparoscopic assisted radical resection of rectal cancer via abdominal anterior resection (Dixon's procedure) and diverting ileostomy surgery for more than 3 months, leakage of the rectal anastomosis was found through colonoscopy and anal iodine water contrast imaging .The patient started eating and flowing juice 6 hours after surgery, got out of bed 24 hours after surgery, and was discharged 48 hours after the removal of the anal canal. Three months after surgery, colonoscopy and transanal iodine hydrography showed that the sinus repair was intact. The diverting ileostomy was reduced 4 months after surgery. Conclusion: Anal fistula endoscope is safe and feasible for the treatment of chronic sinus tract anastomotic leakage in selected patients.

Anastomotic leaks in colorectal surgery

A leakage of acolorectal anastomosis represents asevere complication in visceral surgery. An anastomotic insufficiency (AI) is apotentially life-threatening complication for patients that carries ahigh risk of subsequent complications and long-term stoma care. Numerous factors influence the risk of AI. Knowing and being able to estimate these factors are essential for successful treatment in colorectal surgery as they help determine the surgical strategy. The recognition of an AI can be challenging for practitioners due to the variability in the clinical presentation. If the presence of AI is suspected appropriate diagnostic measures must therefore be taken. If an AI has occurred acolorectal specialist should definitely be involved in the treatment as this can significantly reduce further complications and the rate of permanent stomas.

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Effectiveness of Early Feeding versus Conventional Protocol after Stoma Reversal in Adult Surgical Practices.

To compare the effectiveness of early feeding and conventional feeding protocol after stoma reversal in adult surgical practices. Randomised controlled trial. Place and Duration of the Study: Department of General Surgery, District Headquarters Hospital Mardan, Pakistan, from January 2020 to July 2022. A total of 72 patients enrolled in the surgical unit for stoma reversal were included in this study. After applying the exclusion criteria, 68 patients were randomised in two equal groups of 34 patients each. In Group A, patients were allowed oral liquid feed within 24 hours after surgery while in Group B oral liquid feed was allowed after 72 to 96 hours when the nasogastric tube was removed and bowel functions were returned. Efficacy, safety, and tolerability were evaluated from outcomes such as postoperative ileus, anastomosis leakage, infection of the wound, and length of hospital stay. The age range in this study was from 18 to 43 years with mean ± SD of 31.602 ± 6.75 years. There were 41 (60.29%) males while 27 (39.71%) females in this study and the male population was dominant in both groups. The results were significantly in favour of Group A, where 28 (82.35%) patients did not have postoperative ileus compared to 17 (50%) patients in Group B (p = 0.004). Wound healing was also significantly better in Group A compared to Group B, where 30 (88.23%) patients had no wound infection compared to 21 (61.76%), respectively (p = 0.001). There was no difference between both groups regarding anastomotic leakage. Length of hospital stay was significantly shorter in Group A (3.117 ± 0.87 days) compared to Group B (5.617 ± 1.43 days) (p = 0.001). Early feeding after stoma reversal is effective, minimises the postoperative complications, and leads to shortening of hospital stay in adult surgical practices. Anastomosis leakage, Early feeding, Length of hospital stay, Stoma reversal.

Surgical outcomes for patients with rectosigmoid hirschsprung disease who underwent transanal endorectal pull-through after 1 year of age

PurposeThis study aimed to compare the differences in postoperative complications and long-term bowel function outcomes between patients with rectosigmoid Hirschsprung disease (HD) who underwent transanal endorectal pull-through (TEPT) beyond infancy (age> 1 year of age) and those during infancy (≤ 1 year of age).MethodsAll patients with rectosigmoid HD at Beijing Children’s Hospital between January 2011 and December 2020 were analyzed retrospectively. They were divided into two groups based on age at TEPT: group A was defined as patients who performed TEPT beyond infancy (age>1 year of age), and group B as patients who performed TEPT during infancy (age ≤ 1 year of age). Clinical details were collected from medical records. Bowel function outcomes were assessed by the Rintala questionnaire (age ≥ 4 years).ResultsA total of 339 patients were included: 216 (63.7%) who operated with TEPT beyond infancy (group A) and 123 (36.3%) during infancy (group B). Regarding postoperative complications, all patients suffering anastomosis leakage following TEPT (7/216, 3.2%) occurred in group A, and the rate of anastomosis leakage in group A was significantly higher than in group B (3.2% vs. 0.0%, p = 0.044). 228 patients (228/327, 69.7%) completed the Rintala questionnaire. There was no significant difference in long-term bowel function outcomes between the two groups.ConclusionCompared with patients who performed TEPT during infancy, those beyond infancy are more likely to suffer anastomosis leakage. however, the long-term bowel function outcomes seem comparable.Type of StudyA retrospective single-center study.Level of evidenceIII.

Pre-Operative Mechanical Bowel Preparation Does Not Affect the Impact of Anastomosis Leakage in Left-Side Colorectal Surgery-A Single Center Observational Study.

Despite rapid advances in colorectal surgery, morbidity and mortality rates in elective gastrointestinal surgery play a significant role. For decades, there have been tempestuous discussions on preventative measures to minimize the risk of anastomotic dehiscence. When mechanical bowel preparation before an elective procedure, one of the key hypotheses, was introduced into practice, it was assumed that it would decrease the number of infectious complications and anastomotic dehiscence. The advancements in antibiotic treatment supported the concomitant administration of oral antibiotics and mechanical bowel preparation. In the prospective study conducted at our clinic, we performed left-side colorectal procedures without prior mechanical preparation. All patients enrolled in the study underwent the surgery and were observed in the 3rd Surgical Clinic, Faculty of Medicine, Comenius University in Bratislava, Slovakia, from January 2019 to January 2020. As a control group, we used a similar group of patients with MBP. Our observed group included 87 patients with tumors in the left part of their large intestine (lineal flexure, descendent colon, sigmoid colon, and rectum). Dixon laparoscopic resection was performed in 26 patients. Sigmoid laparoscopic resection was performed in 27 patients. In 12 patients, the procedure was started laparoscopically but had to be converted due to adverse anatomical conditions. The conservative approaches mostly included Dixon resections (19 patients), sigmoid colon resections (5 patients), left-side hemicolectomies (6 patients), and Miles' tumor resections, with rectal amputation (4 patients). Our study highlighted the fact that MBP does not have an unequivocal benefit for patients with colorectal infection, which has an impact on the development of anastomotic dehiscence.

Investigation of Mortality and Morbidity In Patients Associated With Low Anterior Resection and Ghost Ileostomy

Background: Ghost ileostomy is a newly invented method that is used in patients with low anterior resection and colorectal anastomosis. Ghost ileostomy can be used instead of a converting stoma. A converting stoma (CS) is critical after low rectal resection procedures due to its role in preventing anastomosis leakage, especially in patients who are at higher risk, but its complications are non-negligible. The authors approached a study of Ghost ileostomy to identify its probable post-operation morbidity and mortality. The purpose of this study was to assess the prevalence of some post-operation morbidity such as anastomosis bleeding or hematoma, prolonged ileus, pulmonary embolism, intra-abdominal abscess, wound site infection, and other complications. Methods: 26 patients with low anterior resection and colorectal anastomosis due to colon cancer without any risk factor between 2013 and 2014 were selected. Checking of anastomosis leakage after 10-14 days post-operation was analyzed to assess the prevalence of anastomosis leakage and compare post-operation morbidity and mortality. Results: The mean age of cases was 55 years (40 to 65). 16 (61.5%) were male and 10 (38.5%) females. The average BMI is 23.7 and all of the patients are in the normal range. The authors’ mortality rate was negative. 2 patients (0.076%) suffered from prolonged ileus and one patient (0.038%) had a wound site infection. Other postoperation morbidities such as anastomosis bleeding or hematoma, pulmonary embolism, intra-abdominal abscess were negative. The authors had no stoma-related morbidity and also no anastomosis morbidity. Conclusions: Anastomosis leakage is the most common complication in colorectal surgeries. Diverting stoma can decrease complications of anastomosis leakage but there is no evidence of its preventing role. By using ghost ileostomy, the authors can manage selective loop ileostomy and the complications will be reduced. The most reliable way for anastomosis leakage diagnosis is the surgeon’s suspicion. Converting stoma that is used for preventing anastomosis leakage, has significant complications of its own. As the anastomosis leakage does not have a high prevalence, the authors can use ghost ileostomy to reduce the complications and improve the quality of life.

Leakage of Intestinal Anastomoses: A New Solution to the Old Problem

Leakage of intestinal anastomoses remains an issue in view of the increasing number of patients who need reconstructive interventions in different parts of the gastrointestinal tract. Researchers around the world are actively looking for methods of strengthening intestinal anastomoses. The literature presents various approaches to sealing intestinal anastomoses in experimental animals using allografts, biological sealants, polymer film materials, etc. This article classifies and analyzes innovative methods of strengthening intestinal anastomoses to prevent their leakage. We also describe a concept of developing polymer membranes for interventions on hollow organs and our experience in this field of work and making of medical devices at the premises of a university research laboratory.

Intraoperative pyloric drainage is unnecessary during esophagectomies: a meta-analysis and systematic review of randomized controlled trials.

Objective: The topic of this meta-analysis is the comparison of gastric conduit esophageal reconstructions with or without pyloroplasty. Background: Surgical procedures, especially minimal invasive esophagectomy (MIE) can be a curative treatment in the early stages of esophageal cancer. Previously, intraoperative pyloroplasty was routinely performed, but nowadays it became debated again in the light of minimally invasive esophagectomy. Methods: A comprehensive search was performed in multiple databases to identify randomized controlled trials investigating the topic. Two independent authors performed the selection based on predefined criteria. Statistical analysis was performed to assess any significant difference, then the bias and quality of the data were estimated. Results: Nine relevant RCTs consisting of 529 patients with esophageal cancer were identified. No significance was found in mortality [odds ratio (OR): 0.85; p = 0.642], anastomosis leakage (OR: 0.57; p = 0.254), respiratory morbidity (OR: 0.51; p = 0.214) and vomiting (OR: 0.74; p = 0.520), however the results about gastric emptying time (GET) were controversial (weighted mean difference (WMD): -67.71; p = 0.009, OR: 2.75; p = 0.072). Significant heterogeneity was not detected except for GET. Trial sequential analyses (TSA) show that a certain conclusion would require more data except in the binary variables of GET. Conclusion: We conclude that the pyloric drainage procedure is not routinely necessary, but further well-designed studies would be needed, especially in Europe.

Tracheal Anastomosis Leaks Across Suture Techniques and Tensions: A Biomechanical Ex Vivo Study.

Anastomotic leak after tracheal resection may occur while coughing in the early postoperative period. We investigated the varying effects of suturing technique, stretch, and tension on anastomotic leaks during simulated coughs. End-to-end anastomoses were performed using continuous or interrupted sutures on excised porcine larynges. Tracheas were secured to a pressurized system simulating cough forces, submerged in a water bath, and stretched to 1, 2, and 3 cm above baseline. Peak pressure, incomplete cough generation, and observed leakages were recorded. Parameters were analyzed using Analysis of Variance (ANOVA), multiple linear regression, and logistic regression modeling. Peak tension (B = -0.660, p < 0.001) and stretch lengths (B = -0.329, p = 0.006) were associated with variance in peak pressure (R2 = 0.77, F(3,294) = 8.182, p < 0.001). Incomplete coughs increased with higher peak tension (odds ratio [OR] = 15.627, p < 0.001) and stretching to 3 cm above baseline (OR = 4.335, p < 0.007). Similarly, leak occurrences, primarily from the posterior tracheal wall, increased with higher peak tension (OR = 1.787, p < 0.001) and stretching to 3 cm (OR = 2.613, p = 0.017). No significance was identified with suturing technique. Interrupted and continuous suture techniques do not differ in anastomotic strength during simulated coughs. Increased peak tracheal tension is associated with a weaker anastomosis, and tracheal stretch to 3 cm was associated with a weaker anastomosis. Our study supports the commonly held clinical belief that, to create a stronger anastomosis, tension should be minimized, and particular attention should be placed at the posterior tracheal wall during closure. N/A, Benchtop study Laryngoscope, 2024.

Birth weight and thoracoscopic approach for patients with esophageal atresia and tracheoesophageal fistula—a retrospective cohort study

BackgroundThis study aimed to analyze the results, feasibility and safety of the thoracoscopic approach for patients with esophageal atresia with tracheoesophageal fistula (EA/TEF) depending on the patient’s birth weight.MethodsThe study involved only type C and D EA/TEF. Among the analyzed parameters were the patients’ characteristics, surgical treatment and post-operative complications: early mortality, anastomosis leakage, anastomosis strictures, chylothorax, TEF recurrence, and the need for fundoplication or gastrostomy.Results145 consecutive newborns underwent thoracoscopic EA with TEF repair. They were divided into three groups—A (N = 12 with a birth weight < 1500 g), B (N = 23 with a birth weight ≥ 1500 g but < 2000 g), and C—control group (N = 110 with a birth weight ≥ 2000 g). Primary one-stage anastomosis was performed in 11/12 (91.7%) patients—group A, 19/23 (82.6%)—group B and 110 (100%)—group C. Early mortality was 3/12 (25%)—group A, 2/23 (8.7%)—group B, and 2/110 (1.8%)—group C and was not directly related to the surgical repair. There were no significant differences in operative time and the following complications: anastomotic leakage, recurrent TEF, esophageal strictures, and chylothorax. There were no conversions to an open surgery. Fundoplication was required in 0%—group A, 4/21 (19.0%)—group B, and 2/108 (1.9%)—group C survivors. Gastrostomy was performed in 1/9 (11.1%)—group A, 3/21 (14.3%)—group B and 0%—group C.ConclusionIn an experienced surgeon’s hands, even in the smallest newborns, the thoracoscopic approach may be safe, feasible, and worthy of consideration. Birth weight seems to be not a direct contraindication to the thoracoscopic approach.

Protective defunctioning stoma in bowel segmental resection at the time of total hysterectomy for endometriosis: when less is more

PurposeTo compare postoperative complications in women undergoing total hysterectomy with segmental resection (TH-SR) for intestinal endometriosis with or without protective defunctioning stoma (PDS) confection.MethodsRetrospective cohort study conducted at the Gynecologic department of University Hospital of Lille (France) from January 2008 to January 2022 in patients undergone TH-SR for bowel endometriosis.Results100 women were considered for the analysis. PDS were performed in 56 women. The rate of rectal resections was significantly higher in the PDS group (p = 0.03). The mean operative time, AAGL scores and length of hospital stay were significantly higher in the PDS group (p = 0.002). The rate of grade III complication according to Clavien-Dindo classification was higher in the PDS group (p = 0.03). Among digestive complications, one case of anastomosis leakage (1.8%) and one case of recto-vaginal fistula (2.3%) was recorded in the non-PDS group, 4 cases of anastomosis stenosis were recorded in the PDS group (7.1%). Persisting bladder atony requiring self-catheterization over one month was the most common disturb (4.6% in the non-PDS group and 7.1% in the PDS group, p = 0.58). The distance of digestive lesion from anal margin was the only risk factor for digestive complications, persistent bladder atony, Clavien-Dindo IIIA and IIIB complications at the multivariate analysis (p = 0.04 and p = 0.06 respectively).ConclusionNo statistically significant differences were found in the rate of digestive complications in case of total hysterectomy and concomitant segmental resection when performing or not preventing stoma.

456 Comparison of Postoperative Outcomes Between Robotic and Laparoscopic Surgery for Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Abstract Aim To evaluate comparative outcomes of robotic versus laparoscopic bowel resection in patients with inflammatory bowel disease (IBD). Method A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing robotic versus laparoscopic resection for IBD were included. Primary outcomes were post-operative complications rate. Operative time, conversion to open, length of hospital stays, and mortality were the evaluated outcome parameters. Results Eleven studies with total number of 5,566 patients divided between those undergoing robotic (n=365) and conventional laparoscopic (n=5,201) surgery. Moreover, subgroup analysis for sub-total colectomy group showed shorter LOS [MD: -1.62, P=0.03]. Overall complications rate was significantly higher in the laparoscopy group compared to robotic group [OR: 0.48, P=0.03], however the operative time was longer in the robotic group [MD: 40.61, P=0.00001]. Pooled analysis showed comparable results regarding conversion to open [OR: 0.46, P=0.15], anastomosis leak [OR: 0.92, P=0.84], abdominal abscess / collection [OR: 0.34, P=0.21], and mortality [RD: 0.00, P=1.00]. Conclusions Compared to laparoscopic approach, Robotic surgery provides a significantly lower rate of post-operative complications and shorter LOS at the expense of operative time with similar 30-day Mortality.

The impact of anastomotic leakage on the quality of life of patients after surgery for rectal cancer

AIM: to assess the impact of colorectal anastomotic leakage on the severity of low anterior rectal resection syndrome and the quality of life.PATIENTS AND METHODS: the results of 375 patients with rectal tumors were analyzed. In 26 patients, surgery was complicated by anastomosis failure. For a assessment of the quality of life of patients with anastomotic leakage, each patient was matched with a pair from the group of respondents with an uncomplicated postoperative period. The quality of life was assessed in all patients using the EORTC QLQ-C30 questionnaire with the Cr-29 module.RESULTS: patients with anastomosis leakage have more severe low anterior rectal resection syndrome — 29 (17;34), versus 20 (9;28) points (p = 0.03) and a lower global score (p = 0.01), physical (p = 0.01) and social (p = 0.04) functioning. The symptom scales of the EORTC QLQ-C30 questionnaire, supplemented by the Cr-29 module, had significant differences between groups on the scales of body image (p = 0.01), fecal incontinence (p = 0.04) and embarrassment (p = 0.01).CONCLUSION: colorectal anastomosis leakage negatively affects the quality of life of patients.

Possibilities and prospects of artificial intelligence in the treatment of colorectal cancer (review)

AIM: to study modern approaches to the application of machine learning and deep learning technologies for the management of patients with colorectal cancer.MATERIALS AND METHODS: after screening 398 publications, 112 articles were selected and the full text of the works was studied. After studying the full texts of the articles, the works were selected, machine learning models in which showed an accuracy of more than 80%. The results of 41 original publications were used to write this review.RESULTS: several areas have been identified that are the most promising for the use of artificial intelligence technologies in the management of patients with colorectal cancer. They are predicting the response to neoadjuvant treatment, predicting the risks of metastasis and recurrence of the disease, predicting the toxicity of chemotherapy, assessing the risks of leakage of colorectal anastomoses. As the most promising factors that can be used to train models, researchers consider clinical parameters, the immune environment of the tumor, tumor RNA signatures, as well as visual pathomorphological characteristics. The models for predicting the risk of liver metastases in patients with stage T1 (AUC = 0.9631), as well as models aimed at assessing the risk of 30-day mortality during chemotherapy (AUC = 0.924), were characterized with the greatest accuracy. Most of the technologies discussed in this paper are software products trained on data sets of different quality and quantity, which are able to suggest a treatment scenario based on predictive models, and, in fact, can be used as a doctor’s assistant with very limited functionality.CONCLUSION: the current level of digital technologies in oncology and in the treatment of colorectal cancer does not allow us to talk about a strong AI capable of making decisions about the treatment of patients without medical supervision. Personalized treatment based on the microbiotic and mutation spectrum and, for example, personal pharmacokinetics, so far look fantastic, but certainly promising for future developments.

Impact of the laparoscopic approach, early closure and preoperative stimulation on outcomes of ileostomy closure after rectal resection

AimTo evaluate the clinical outcome of early closure of a protective ileostomy and preoperative stimulation of the efferent limb in a cohort of patients with rectal cancer treated surgically, primarily using the laparoscopic approach. MethodsWe performed an observational retrospective cohort study in a prospectively recorded series of patients with rectal cancer who underwent laparoscopic surgery with a protective loop ileostomy between 2017 and 2022. Ileostomy closure was programmed for within 3 months after surgery. All patients underwent stimulation of the efferent limb. Primary outcomes were morbidity and mortality, length of stay (LOS), and re-admission. ResultsBetween 2017 and 2022, 108 patients underwent resection for rectal cancer and protective ileostomy. The laparoscopic approach was performed in 84.3% of patients (n = 91). Permanent ileostomy was performed in 5 patients (4.6%). Ileostomy closure was thus performed in 95.4% of patients (n = 103). Median time to closure was 74.5 days (range 57–113). In 63.1% (n = 65) of patients, reconstructive surgery was performed within 90 days. Prior to closure, efferent limb stimulation was performed in 77.8% (n = 84) of patients. Global morbidity was 26.2% (n = 27) (85.19%, n = 23 Clavien-Dindo I and 7.41%, n = 2 Clavien-Dindo II). The main causes of morbidity were postoperative ileus (10.7%, n = 11) and rectal bleeding (8.7%, n = 9). Anastomosis leakage occurred in 2 patients. Median hospital stay was 6 days (5–7). Readmission was needed in 6.8% (n = 7) of patients. ConclusionA previous laparoscopic approach, early closure and stimulation of the efferent limb could be a useful strategy to reduce the morbidity and mortality of temporary ileostomy closure.

Ten-Year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps

Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.