Major Leakage Research Articles

Visualization of integrated failure consequences of hazardous chemical leakage and explosion

Dangerous chemicals are widely present in various aspects of people's lives, but they often pose risks of leakage and explosion during transportation and storage, resulting in severe casualties and property damage. Firstly, this paper proposes a visualization method applicable to comprehensive failure consequences of hazardous chemical storage tanks. This method considers the toxic hazard range of chemical leaks and the blast overpressure injury range of leak clouds and visualizes the comprehensive failure consequences. Secondly, FLACS is employed to simulate a major leakage and explosion accident at Jinyu Petrochemical Co., Ltd. in Linyi City. The simulation reproduces the leakage and explosion processes and verifies the reliability of the simulation results. Finally, the proposed method is used to visualize the comprehensive failure consequences of this accident, providing comprehensive visual results. The method presented in this paper can serve as a theoretical reference for predicting the development of accidents and clarifying their consequences.

Identifying sulphurous water discharge from legacy oil and gas wells using spectral band analysis of aerial and satellite imagery

Legacy oil and gas wells are a significant source of hydrogen sulphide and methane gas release to the atmosphere. Unanticipated occurrences of gas release in urbanized areas can pose human health risks. Several high hydrogen sulphide-emitting wells have been identified in Norfolk County, Ontario, Canada, based on the remote detection of sulphurous water discharging to the surface along the wellbore. Although oil and gas well records report well status and location, community reports of noxious hydrogen sulphide odours suggest potentially compromised well seals and inaccuracies in their documented location. Given the broad-scale nature of this issue and limitations in site access, a remote-sensing based methodology utilizing satellite and high-resolution aerial photography could support identification of undocumented sulphurous water leaks associated with compromised oil and gas wells and subsequent characterization of hydrological and ecohydrological impacts over time. This study presents a multifaceted approach to identifying sulphurous leaking wells utilizing complimentary remote sensing imagery and image analysis tools within ArcGIS. Southwestern Ontario Orthophotography Project air photos and Sentinel-2 satellite imagery were determined to be the most applicable sources of imagery based on their respective advantages in resolution and revisit time. The application of a normalized difference vegetation index showed that major well leaks could exhibit signs of vegetative scarcity, while minor well leaks may have only a limited impact on vegetation. A band combination utilizing the green and near infrared bands was created to enhance the detection of sulphurous water leaks. Utilizing the identified band combination, a pair of potentially undiscovered leaks were located west of a fluvial river channel. Continued research should attempt to employ an automated approach for discerning additional sulphurous water leaks in the region or at different points in time. Possible techniques may involve the deep learning object and change detection models incorporated in ArcGIS.

Managing a Major Lube Oil Leak on a 150 MW Steam Turbine Power Plant

This paper focuses on the management of a major lube oil leak from bearing box No. 2 at the Sumsel-5 Power Plant. The steam turbine, a super high-pressure has been operational since April 2016. Overhauls in 2019 and 2023 addressed issues such as wear on oil deflectors, abnormal gland sealing clearances, and oil sealing wear. However, oil leakage persisted, necessitating further interventions. Rectification efforts included replacing oil deflectors, adjusting clearance, installing additional venting lines, the addition of a fiber gasket at bearing box No. 2 aimed to reduce and manage oil leakage. These measures resulted in a significant reduction in the oil leakage rate, from approximately 2826 ml/hr to 75 ml/hr during full load operation, representing a decrement of around 97.3%. Additionally, the frequency of lube oil top-ups decreased dramatically, leading to substantial cost savings for the plant. From a safety and environmental perspective, rectification measures mitigated fire hazards and reduced oil wastage, minimizing environmental impact. Regular monitoring of lubrication oil quality further ensures operational reliability. Although complete elimination of the oil leak was not achieved, the turbine continues to operate smoothly under manageable oil leakage conditions.

Is duct-to-mucosa pancreaticojejunostomy necessary after pancreaticoduodenectomy: A meta-analysis of randomized controlled trials

The incidence of postoperative pancreatic fistula is influenced by the effectiveness of the pancreaticojejunostomy, and the most suitable pancreaticojejunostomy for pancreaticoduodenectomy remains uncertain. Since grade A postoperative pancreatic fistula is no longer considered a true fistula, the purpose of this meta-analysis was to compare the effectiveness of duct-to-mucosa anastomosis and invagination anastomosis in reducing the incidence of grade B/C postoperative pancreatic fistula. The meta-analysis was conducted using software Review Manager 5.3, and the fixed-effect model was employed for pooled statistic calculations. The Cochrane Collaboration Risk of Bias Tool was utilized for quality assessment. Ten randomized controlled trials from Embase, Web of Science, MEDLINE, and the Cochrane Library (1990.01–2022.10) including 1471 patients, met the inclusion criteria. This meta-analysis has been registered on PROSPERO with the registration number CRD42023491673. The incidence of grade B/C fistula was significantly lower in the invagination group (7.7 %) compared to the duct-to-mucosa group (12.8 %, mostly Cattell manner)(RR = 1.65, 95%CI: 1.14–2.39, P = 0.008; heterogeneity: P = 0.008, I2 = 68 %),heterogeneity among the results was addressed through sensitivity analysis. In patients with a soft pancreas, the incidence of grade B/C fistula was significantly lower in those who underwent invagination anastomosis (10 %) compared to those who underwent duct-to-mucosa anastomosis (41.9 %)(RR = 4.19, 95%CI: 1.33–13.25, P = 0.01).No significant differences were observed in terms of the occurrence of grade B/C fistula in firm pancreas, postoperative mortality, other major postoperative complications, anastomosis time, and postoperative bile leak. Therefore, we concluded that invagination anastomosis is significantly superior to duct-to-mucosa anastomosis in reducing the incidence of grade B/C fistula, especially in patients with a soft pancreas.

Troubleshooting the bypass: intraoperative management of initially failed anastomosis in direct cerebral revascularization surgery.

Direct cerebral revascularization is considered as one of the most technically challenging operations in neurosurgery. Technical errors are often not identified during the case, but only after the recirculation stage, making management crucial at that time of the procedure. In this study, the authors sought to describe troubleshooting of the technical errors encountered in initially failed bypass cases. A retrospective analysis describing a single-surgeon, single-institution experience between 2014 and 2021 was performed, based on operative reports and videos, including a 30-day follow-up period. Initially failed bypass was defined if the bypass was not patent or had a significant leak after recirculation, irrespective of the final result. One hundred thirty-eight bypass cases were reviewed for complex aneurysms (n = 49), moyamoya disease (n = 59), and atherosclerosis (n = 30). Fifty-one initially failed anastomoses were identified; 43 of these were the result of a technical error. Etiologies of these failed anastomoses included a clot (n = 14), vessel kinking (n = 4), spasm (n = 5), suture-related cause (n = 5), inappropriate donor or recipient (n = 3), or lack of demand (n = 8). A major leak was attributed to an uncoagulated side branch (n = 4), vessel injury due to suture/clip placement (n = 1), or inadequate suture line coverage (n = 7). Thirty-seven (86%) of 43 cases were troubleshot successfully, as salvage maneuvers included papaverine vessel massage, donor repositioning, re-anastomosis for occlusion in select cases, local hemostatic agents, and suturing or coagulating side branches in a leak. Thirty-day follow-up revealed similar rates of patency between successfully troubleshot patients (35/37) and the rest of the cases (80/87, p = 0.6). Three major patterns of a noncompatible bypass were found: a major leak, an acute occlusion, or a delayed occlusion. Based on the authors' experience, salvage strategies proved successful, showing an eventual high patency rate. The authors suggest a gradual, structured algorithm to address this stage in surgery that may contribute specifically to cerebrovascular neurosurgeons at the beginning of their careers.

Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.

Anastomotic leak after primary repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a well-known complication and can represent a challenging clinical scenario. The present study aimed to evaluate the role of glycopyrrolate as an adjunct in the treatment of anastomotic leak after primary repair of EA Vogt type 3b. A retrospective study was carried out in our tertiary care teaching institute from January 2015 to December 2022. Neonates with EA with distal TEF with primary repair who had developed anastomotic leak, managed by the author(s), were studied. The study included patients with major, minor, and radiological leaks. Glycopyrrolate was administered in the dose of 4 μg/kg 8 hourly. The outcomes of the study were either resolution or progression of the leak. There were 21 patients who were managed with glycopyrrolate in addition to the classical treatment of the anastomotic leak following repair of EA with distal TEF. The male: female ratio was 1:1.1. All the cases had anastomotic leaks with either clinically detectable in the chest tube (15) or radiological leak (6). The leaks were detected early in patients with major leak (mean = 3.2 ± 0.84 days) compared to minor leak (mean =4.9 ± 1.29 days). Radiological leaks were detected in all the neonates on postoperative day 7. In five patients with major leak, there was a negligible reduction in the amount of chest tube output, and were subjected to diversion procedures. There were a total of three deaths out of five in this group. In 10 patients with minor leak, there was complete resolution of anastomotic leak in eight patients (80%); there was one patient each with mortality and diversion procedure. The patients with a radiological leak (6) did not show any deterioration, and they were fed 1-5 days after the esophagogram. Glycopyrrolate may be an advantageous postoperative adjunct in the management of minor and radiological leak after tracheoesophageal repair.

Outcome of Biliary-enteric Reconstruction with Hepaticoduodenostomy Following Choledochal Cyst Resection: A Prospective Study.

The two most commonly performed methods of biliary-enteric reconstruction following choledochal cyst resection are Roux-en-Y hepaticojejunostomy (HJ) and hepaticoduodenostomy (HD). There is a lack of consensus regarding the better technique between them. This study aimed to evaluate the outcomes, efficacy and early complications of HD as a mode of biliary reconstruction after surgical resection of a choledochal cyst. This was a multi-institutional prospective study carried out in high-volume tertiary care teaching institutes from January 2010 to December 2022. All children managed with HD following choledochal cyst resection were analysed for their early complications and outcomes. A total of 74 patients were included in this study. There were 59 (79.73%) females and 15 (20.27%) males. Thirty-nine (52.70%) patients had jaundice at the time of presentation. Magnetic resonance cholangiopancreatography was performed in 57 (77.03%) patients following ultrasonography. Intraoperatively, malrotation was present in 2 (2.70%) patients. In our study, operating time ranged from 60 to 195 min (mean: 118 min). Hospital stays ranged from 8 to 17 days (mean: 11.5 days). The post-operative biliary leak was seen in 7 (9.50%) patients, out of which 6 (8.11%) minor leaks were managed conservatively. Roux-en-Y HJ was performed on 1 (1.35%) patient with a major leak. In our series, 4 (5.40%) patients developed cholangitis; post-operative haemorrhagic nasogastric aspirate 5 (6.76%), post-operative pancreatitis 3 (4.05%) and wound infection 4 (5.40%) were observed and managed conservatively. None of the patients in our study developed an anastomotic stricture, bile gastritis and adhesive small bowel obstruction. Resection of choledochal cyst with HD reconstruction is safe and feasible with short operative time. HD is a viable option for operative management of choledochal cyst with low complication rates and faster recovery.

Using Ground- and Drone-Based Surface Emission Monitoring (SEM) Data to Locate and Infer Landfill Methane Emissions

Ground- and drone-based surface emission monitoring (SEM) campaigns were performed at two municipal solid waste landfills, during the same week as mobile tracer correlation method (TCM) testing was used to measure the total methane emissions from the same landfills. The G-SEM and the D-SEM data, along with wind data, were used as input into an inverse modeling approach combined with an optimization-based methane emission estimation method (implemented in a tool called SEM2Flux). This approach involves the use of backward dispersion modeling to estimate the whole-site methane emissions from a given landfill and the identification of locations and emission rates of major leaks. SEM2Flux is designed to exploit the measured surface methane concentration concurrently with wind data and tackle two problems: (1) inferring the estimates of methane rates from individual landfills, and (2) identifying the likely locations of the main emission sources. SEM2Flux results were also compared with emission estimates obtained using TCM. In Landfill B, the average TCM-measured methane emissions was 1178 Kg/h, with a standard deviation of 271 Kg/h. In Landfill C, the average TCM-measured emission rate was 601 Kg/h, with a standard deviation of 292 Kg/h. For both landfills, the D-SEM data yielded statistically similar estimates of methane emissions as the TCM-measured emissions. On the other hand, the G-SEM data yielded comparable estimates of emissions to TCM-measured emissions only for Landfill C, where the D-SEM and G-SEM data were statistically not different. The results of this study showcase the ability of this method using surface concentrations to provide a rapid and simple estimation of fugitive methane emissions from landfills. Such an approach can also be used to assess the effectiveness of different remedial actions in reducing fugitive methane emissions from a given landfill.

Short-Term Outcomes and Quality of Life Following Minimally Invasive Esophagectomy in a Tertiary Care Center in Southern India.

With the advent of multimodality therapy and minimally invasive surgical approaches, patients suffering from carcinoma esophagus are showing promising outcomes. Hence, the frontier needs to be widened to assess the postoperative quality of life (QoL) of those surviving carcinoma esophagus. The objective of the study was to determine the short-term outcomes of minimally invasive esophagectomy (MIE) /hybrid esophagectomies in carcinoma esophagus and the organ-specific QoL in survivors of MIE for carcinoma esophagus, and to compare health-related QoL in patients following MIE for carcinoma esophagus with the general population. A longitudinal study design was used to evaluate the short-term postoperative outcomes of patients undergoing MIE for carcinoma esophagus between July 1, 2021, to July 15, 2022, and analyze the QoL of those patients who survived at one year without tumor recurrence. QoL was assessed using the European Organization for the Research and Treatment of Cancer (EORTC) QoL Questionnaire (EORTC QLQ-C30) and the EORTC QoL Questionnaire - Oesophageal Cancer Module (EORTC QLQ-OES18). A total of 15 patients who underwent minimal invasive/hybrid esophagectomy for esophageal carcinomawere included. Of these, 13 patients underwent hybrid esophagectomy while two patients underwent thoraco-laparoscopic esophagectomy. Squamous cell carcinoma was observed as the most common histological variant (60%) while 33% were adenocarcinoma and 6.7% lymphoma. The most common site of the tumor was the lower one-third esophagus (60%). Nine out of 15 patients developed postoperative complications needing prolonged ICU stay. One major anastomotic leak as well as one conduit necrosis was observed among 15 cases operated. Median length of hospital stay was 16 (IQR 12-24). QoL was assessed among 12 patients at the one-year follow-up excluding mortality cases and patients with tumor recurrence. The patients following MIE for carcinoma esophagus were observed to have low scores in physical functioning, role functioning, and social functionwhen compared with the general population. Cognitive functioning and emotional function were not found to be significantly different. No statistically significant difference was observed in the global health status among the two groups. There was no significant difference found in the general symptoms score comparison of the MIE patients with the general population. When it comes to organ-specific symptom scales, reflux was observed as a major issue among the patients who survived carcinoma esophagus after undergoing MIE. Dysphagia and dry mouth received low scores suggestive of minor issues. Though analysis of global health QoL scores of those with postoperative complications and those who had uneventful recovery at one year revealed a higher score for the latter, it was not statistically significant. Postoperative complications can prolong hospital stay, delay resuming normal work, and affect the global QoL of patients compared with those who recovered uneventfully. Physical and role functions were observed to be deficient among survived patients when compared with the normal population. Nutritional prehabilitation, cutting-edge surgical practice including minimally invasive techniques, minimizing deviation from normal postoperative recovery by high-quality ICU care, and postoperative rehabilitation are the cornerstones to ensure better QoL.

Health risk analysis of benzene, toluene, ethylbenzene, and xylene (BTEX) in groundwater in Yogyakarta City, Indonesia

Benzene, Toluene, Ethylbenzene, and Xylene (BTEX) are persistent and bio-accumulative compounds that occur in petroleum-based products. Benzene is categorized as a carcinogenic substance while ethylbenzene is potentially carcinogenic. One of the sources of BTEX contamination in the environment is gas stations. The leakage of underground storage tanks (UST) of gas stations is a potential source of groundwater contamination, while in many areas, it is the main source of daily water consumption. The long-term consumption of this BTEX-contaminated groundwater may generate health risks. This paper will present the health risk analysis of the consumption of BTEX-contaminated groundwater taken from dug wells near a gas station in Yogyakarta City which has a history of major leakage. Analysis of BTEX in groundwater samples has been already presented in the previous study. Data for intake calculation was acquired through questionnaires and interviews on water consumption patterns. Risk analysis was conducted for both the carcinogenic effect of benzene and the non-carcinogenic effect for all BTEX compounds. Health risk analysis on BTEX exposure in groundwater resulted in the Hazard Quotient (HQ) value for all compounds which were still less than one, meanwhile, the Excess Cancer Risk (ECR) for benzene was less than 10-4. The result indicates the low health risk associated with the consumption of BTEX-contaminated groundwater in the study area.

General nomenclature of air leak patterns: A proposal

Leakage is a common issue with PAP therapy and may contribute to short-term non-compliance with treatment. PAP manufacturers use different methods to estimate and report air leaks (median, mean, p90, p95, % of important air leak, time spent on major leaks), which makes the analysis and comparisons challenging. Leak intensity is a well-known parameter of major importance as it can significantly affect the performance of PAP devices. However, there is a lack of knowledge regarding another leakage parameter, namely the leakage pattern. As of now, there is no standard classification for leak patterns in real-life settings. Our objective was to develop and propose a comprehensive nomenclature for leakage patterns observed during nasal auto-PAP therapy.We examined 50 ventilatory polygraphy recordings conducted with auto-PAP, based on data from a prior study in which the unintentional leak flow was precisely measured over time. We have categorized leaks into two main types: continuous leaks, which appear and persist for an extended period, and discontinuous leaks, which vanish more rapidly. Continuous leaks can have both abrupt or gradual apparitions and terminations. Their "shape" can be either interrupted or constant. Discontinuous leaks can have both abrupt or gradual apparitions and terminations. Due to the relatively short observation scale (less than 5 min minutes), this type of leakage is not characterized by a specific shape between apparition and termination.This nomenclature could be a valuable tool that facilitates comparative bench tests or clinical studies. This tool could support manufacturers in developing precise algorithms for leak compensation, residual AHI estimation and the accuracy of CPAP monitoring data. Lastly, establishing a standardized approach for describing and categorizing air leakage patterns could assist clinicians in identifying device-related issues, such as patient discomfort arising from specific types of leakage.

Comparison of off-clamp microwave scissors-based sutureless partial nephrectomy versus on-clamp conventional partial nephrectomy in a canine model.

To compare the usefulness and safety of off-clamp microwave scissors-based sutureless partial nephrectomy (MSPN) with on-clamp conventional partial nephrectomy (cPN) in dogs. We performed off-clamp MSPN using microwave scissors (MWS) in six dogs, and on-clamp cPN in three dogs, in two-stage experiments. The bilateral kidney upper poles were resected via a midline incision under general anesthesia. After 14 days of follow-up, the lower pole resections were performed. The renal calyces exposed during renal resections were sealed and transected using MWS in off-clamp MSPN and were sutured in on-clamp cPN. In the off-clamp MSPN group, the generator's power output of MWS was set as either 50 W or 60 W for each kidney side. We compared the procedure time (PT), ischemic time (IT), blood loss (BL), and normal nephron loss (NNL) between the two techniques using the Mann-Whitney U-test. We successfully performed 24 off-clamp MSPNs and 12 on-clamp cPNs. The off-clamp MSPN was significantly superior to on-clamp cPN in avoiding renal ischemia (median IT, 0 min vs. 8.6 min, p < 0.001) and reducing PT (median PT, 5.8 min vs. 11.5 min, p < 0.001) and NNL (median NNL, 5.3 mm vs. 6.0 mm, p = 0.006) with comparable BL (median BL, 20.9 ml vs. 23.2 ml, p = 0.804). No bleeding and major urine leakage were noted during the reoperations. Off-clamp MSPN outperforms on-clamp cPN in lowering the risks of postoperative renal function impairment in dogs.

A novel dynamic risk assessment method for the petrochemical industry using bow-tie analysis and Bayesian network analysis method based on the methodological framework of ARAMIS project

In order to obtain the actual risk level and assess the performance of the safety barriers, bow-tie (BT) approach proposed by ARAMIS project is applied to accident scenarios identification and risk analysis, but this approach has limitations in dynamic risk assessment due to its static nature. This study takes the floating roof tank as the research object, and further proposes a dynamic risk assessment method based on the methodology proposed by the ARAMIS project. The BT model of the major leak of external floating roof tank was established by comprehensive consideration of the barrier functions and the logical relationship between causes and events. Furthermore, The BT to Bayesian network (BN) mapping algorithm was proposed to characterize system dynamics and uncertainty. The analysis results show that not only the dynamic assessment of the risk level for safety barriers in different states can be implemented, but also whether the current overall safety protection capability of the system is sufficient can be judged. The proposed method and findings can help managers identify safety barriers that play a key role in various accident risks, and provide effective support for risk management decision-making and implementation of preventive strategies.

Left Atrial Appendage Occlusion Under Miniaturized Transesophageal Echocardiographic Guidance and Conscious Sedation: Multicenter European Experience

BackgroundLeft atrial appendage occlusion (LAAO) procedures are widely guided by standard transesophageal echocardiography (TEE) probes, requiring general anesthesia in most patients. The use of miniaturized TEE probes allows for LAAO guidance under local anesthesia and offers an attractive imaging alternative to standard TEE probes. ObjectivesThe aim of this study was to assess the safety and efficacy of miniaturized TEE probes for procedural guidance of LAAO. MethodsMulticenter retrospective observational study of LAAO procedures performed under miniaturized TEE guidance and conscious sedation. The primary efficacy endpoint was technical success. The secondary efficacy endpoint was procedural success (technical success without major periprocedural complications). The safety outcome was a composite of major periprocedural complications. ResultsA total of 546 consecutive LAAO procedures were performed in 5 European centers. Technical success was achieved in 534 (98.0%) patients. Sixteen major periprocedural complications occurred in 15 (2.9%) patients, yielding a procedural success rate of 97.0%. Conversion to general anesthesia was required in 4 (0.7%) patients. Short-term imaging follow-up was available in 422 patients with an incidence of major (>5 mm) TEE-detected residual leaks of 0.7%, complete LAA occlusion of 82.2% on cardiac computed tomography, and device-related thrombus of 5%. As compared with procedural 2-dimensional imaging for device sizing, preprocedural assessment by 3-dimensional imaging resulted in improved technical success (100% vs 95.0%; P < 0.001). ConclusionsLAAO under conscious sedation and miniaturized TEE guidance is safe and feasible with a high rate of technical success and a low rate of periprocedural complications.

Daily detection and quantification of methane leaks using Sentinel-3: a tiered satellite observation approach with Sentinel-2 and Sentinel-5p

The twin Sentinel-3 satellites have multi-band radiometers which observe in methane-sensitive shortwave infrared bands with daily global coverage and 500 m ground pixel resolution. We investigate the methane observation capability of Sentinel-3 and how its coverage-resolution combination fits between Sentinel-5p and Sentinel-2 within a tiered observation approach for methane leak monitoring. Sentinel-5p measures methane with high precision and daily global coverage, allowing worldwide leak detection but with a coarse spatial resolution of 7 km × 5.5 km. The Sentinel-2 twin satellites have multi-band instruments that can identify source locations of major leaks (> 1 t/h) with their methane observations of 20 m resolution under favorable observational conditions, but these satellites lack daily global coverage.We show that methane enhancements can be retrieved from the shortwave infrared band measurements of Sentinel-3. We report the lowest emission detections by Sentinel-3 in the 8-20 t/h range, depending on location and wind conditions. We demonstrate Sentinel-3's capability of identification and monitoring of methane leaks using two case studies. Near Moscow, Sentinel-3 shows that two major short-term leaks, separated by 30 km, occurred simultaneously at a gas pipeline and appear as a single methane plume in Sentinel-5p data. For another Sentinel-5p leak detection near the Hassi Messaoud oil/gas field in Algeria, Sentinel-3 identifies the leaking facility emitting continuously for 6 days, and Sentinel-2 pinpoints the source of the leak at an oil/gas well. Sentinel-2 and Sentinel-3 also show the 6-day leak was followed by a four-month period of burning of the leaking gas, suggesting a gas well blowout to be the cause of the leak. We find similar source rate quantifications from plume detections by Sentinel-3 and Sentinel-2 for these leaks, demonstrating Sentinel-3's utility for emission quantification. We show that zooming in with Sentinel-3 and Sentinel-2 in synergy allows precise identification, quantification, and monitoring of the sources corresponding to methane plumes observed in Sentinel-5p's global scans.

Projected cancer burden, challenges, and barriers to cancer prevention and control activities in the state of Telangana.

The Telangana cancer care program is a proactive, comprehensive initiative encompassing infrastructure development, human resource skilling and ensuring financial protection to those below poverty line. The broad aim of this exercise was to identify modalities to augment the Telangana State Cancer Control Plan to implement a sustainable comprehensive cancer care model for Telangana. We conducted in-depth interviews of stakeholders (17 patients and 25 health care providers) to identify barriers and challenges to access existing cancer care system in Telangana; calculated the magnitude of cancer and commensurate workload (in terms of visits to tertiary cancer care system for cancer management and human and equipment requirement) for the next 15 years (from 2022 to 2037). Using the anecdotal evidence and information from stakeholders' interviews, we developed patient-journey funnels for oral, breast, and cervical cancer patients to highlight patient leakages at various levels of cancer care. We estimated a 13%, 28%, and 44.7% increase in the number of new cancer cases and the resultant workload (number of visits to health care centre, chemotherapy sessions, radiotherapy sessions, surgeries, specialized human resources and equipment), for the year 2027, 2032, and 2037, respectively, compared to the year 2022. The stakeholders mentioned 'delayed access' to healthcare system as the main reason for the poor prognosis of patients. The common reasons cited for 'delayed access' were: poor cancer-literacy including prevailing myths and misconception, financial barriers, and rural residence. The patient journey funnel for cancer care revealed a major leakage from 'screened-positive' to 'diagnosis confirmation' step. The estimated patient leakage varied from ~70% to 90% from 'screened-positive' till 'treatment completion'. In this study, we anticipated a steady increase in the number of new cancers cases and resultant workload for the state of Telangana from the year 2022 to 2037. This may further be accompanied with limited access or utilization of cancer care system. To manage this public health issue, government should take appropriate measures to improve cancer literacy at the community level as well as increase human resources and necessary equipment.

C38 EARLY AND MID-TERM RESULTS FROM THE RESILIA AORTIC TISSUE VALVE ITALIAN REGISTRY (RES-ITA)

Abstract Objective The objective of our study is to evaluate safety, hemodynamic performance and durability of the new generation aortic bioprosthesis with Resilia Tissue. Methods RES-ITA Registry is the Italian multicenter registry created in 2017, enrolling patients who underwent isolated or combined AVR with Resilia tissue valve. The Registry was recently recognized by SICCH as the official national registry of Resilia tissue valve implantations, with Potenza’s Cardiac Surgery Unit as its coordinating center. Isolated AVR (50%) was performed predominantly through an upper J mini-sternotomy or a right anterior mini-thoracotomy, while combined procedures (50%) were performed in full sternotomy and included associated CABG, ascending aorta surgery, mitral valve repair or replacement, aortic annulus enlargement. For all patients, clinical and echocardiographic assessment were evaluated at discharge, 30 days, 6 months and every year after surgery. Results Between June 2017 and March 2022, about 1000 patients were included, coming from 13 Italian cardiac surgery centers. During last year, 6 more Italian centers have asked to join the Registry. Mean age was 57±11 years. Mean Euroscore II was 2.24±3.01%. Redo surgery was performed in 11%. Most frequently implanted valve sizes were 23 mm (30%), 25 mm (27.7%) and 27 mm (19%). Two-year freedom from all-cause mortality for isolated AVR and for all patients was 97.4±1.3% and 95.7±1.1%, respectively. Two-year freedom from major paravalvular leaks (≥2+/4) was 98.4±0.8; freedom from prosthesis thrombosis was 96.7±2 and freedom from prosthesis dysfunction (according to VARC-2 criteria) was 96.7±1.7. Mean gradient was 13.3±8.3 mmHg and maximum gradient was 23.2±16.2 mmHg at 2-year follow-up. Conclusions The new generation aortic prosthesis with RESILIA tissue demonstrates versatility of use, safety, good early and mid-term outcomes and hemodynamic performance. Further investigations and longer follow-up are needed to evaluate long-term durability.

Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts.

Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) - true population of interest, anastomosis performed with a three-row circular stapler; group (B) - control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15-0.73; P =0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17-0.87; P =0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24-0.91; P =0.026). The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage.

Feasibility of simultaneous development of laparoscopic and robotic pancreaticoduodenectomy

Laparoscopic (LPD) and robotic pancreaticoduodenectomy (RPD) are both challenging procedures. The feasibility and safety of simultaneously developing LPD and RPD remain unreported. We retrospectively reviewed the data of patients undergoing LPD or RPD between 2014 and 2021. A total of 114 patients underwent minimally invasive pancreaticoduodenectomy (MIPD): 39 LPDs and 75 RPDs. The learning process of LPD and RPD were similar. The cutoff points of the learning curve were LPD, 13th patient (the 27th patient of MIPD), and RPD, 18th patient (the 31st patient of MIPD) according the cumulative sum analysis of operative time. A decrease in the operative time was associated with the case sequence (p < 0.001) but not with the surgical approach (p = 0.36). The overall surgical outcomes were comparable between both the LPD and RPD groups. When evaluating the learning curve impact on MIPD, LPD had higher major complication (≧ Clavien–Dindo grade III), bile leak and wound infection rates in the pre-learning curve phase than those in the after-learning curve phase, while RPD had similar surgical outcomes between two phases. Simultaneous development of LPD and RPD is feasible and safe for experienced surgeons, with similar learning process and comparable surgical outcomes.

Minimally Invasive Anatomic Liver Resection for Hepatocellular Carcinoma Using the Extrahepatic Glissonian Approach: Surgical Techniques and Comparison of Outcomes with the Open Approach and between the Laparoscopic and Robotic Approaches.

Surgical techniques and outcomes of minimally invasive anatomic liver resection (AR) using the extrahepatic Glissonian approach for hepatocellular carcinoma (HCC) are undefined. In 327 HCC cases undergoing 185 open (OAR) and 142 minimally invasive (MIAR; 102 laparoscopic and 40 robotic) ARs, perioperative and long-term outcomes were compared between the approaches, using propensity score matching. After matching (91:91), compared to OAR, MIAR was significantly associated with longer operative time (643 vs. 579 min, p = 0.028); less blood loss (274 vs. 955 g, p < 0.0001); a lower transfusion rate (17.6% vs. 47.3%, p < 0.0001); lower rates of major 90-day morbidity (4.4% vs. 20.9%, p = 0.0008), bile leak or collection (1.1% vs. 11.0%, p = 0.005), and 90-day mortality (0% vs. 4.4%, p = 0.043); and shorter hospital stay (15 vs. 29 days, p < 0.0001). On the other hand, laparoscopic and robotic AR cohorts after matching (31:31) had comparable perioperative outcomes. Overall and recurrence-free survivals after AR for newly developed HCC were comparable between OAR and MIAR, with potentially improved survivals in MIAR. The survivals were comparable between laparoscopic and robotic AR. MIAR was technically standardized using the extrahepatic Glissonian approach. MIAR was safe, feasible, and oncologically acceptable and would be the first choice of AR in selected HCC patients.