Multiorgan Resection Research Articles

Surgical treatment of recurrent ovarian cancer: A review

Aim. To analyze the data available in the modern literature on the role of repeated cytoreduction in the complex treatment of relapses ovarian cancer (OC).
 Materials and methods. Sources were searched in the following systems Clinicaltrials.gov, PubMed, Medline, NCCN, Scopus, Gynecol Oncol, Elibrary. After analyzing the literature review, 31 sources were used, published from January 1989 to December 2020.
 Results. The main method of treatment relapses of ОС is administration of systemic chemotherapy. The role of surgical treatment has been actively discussed for several decades. According to the available data of retrospective, prospective, randomized trials, performing surgery following chemotherapy had a favorable effect on the long-term results of treatment just in case of achieving complete cytoreduction in comparison with only chemotherapeutic treatment of platinum-sensitive recurrence of ОС. A validated prognostic model helps to perform the selection of suitable patients for surgical treatment, therefore, the correct selection for secondary cytoreduction allows to identify the patients with a high chance of achieving сomplete cytoreduction, which reduces the number of ineffective operations in patients with residual tumors.
 Conclusion. Complete cytoreduction of all macroscopically detectable recurrent tumor lesions in combination with subsequent systemic chemotherapy leads to an improvement in progression-free survival and life expectancy in a carefully selected group of patients with platinum-sensitive recurrent OC. Secondary cytoreduction in platinum-refractory and platinum-resistant relapses deteriorates the prognosis and doesn't lead to an increase in survival rates. Patient selection is the key point in secondary cytoreductive surgery. The choice of the methodology of selection of patients is in the process of discussion. When planning treatment, all patients with recurrent OC should be discussed at multidisciplinary teams with the participation of specialists in related specialties. Considering a surgical treatment option should be performed it in large centers with extensive experience in the surgical treatment of OC, relapses, performing complex multi-organ resections.

Risk factors for anastomotic leakage after anterior resection for rectal cancer (RALAR study): A nationwide retrospective study of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group.

AimAnastomotic leakage after restorative surgery for rectal cancer shows high morbidity and related mortality. Identification of risk factors could change operative planning, with indications for stoma construction. This retrospective multicentre study aims to assess the anastomotic leak rate, identify the independent risk factors and develop a clinical prediction model to calculate the probability of leakage.MethodsThe study used data from 24 Italian referral centres of the Colorectal Cancer Network of the Italian Society of Surgical Oncology. Patients were classified into two groups, AL (anastomotic leak) or NoAL (no anastomotic leak). The effect of patient‐, disease‐, treatment‐ and postoperative outcome‐related factors on anastomotic leak after univariable and multivariable analysis was measured.ResultsA total of 5398 patients were included, 552 in group AL and 4846 in group NoAL. The overall incidence of leaks was 10.2%, with a mean time interval of 6.8 days. The 30‐day leak‐related mortality was 2.6%. Sex, body mass index, tumour location, type of approach, number of cartridges employed, weight loss, clinical T stage and combined multiorgan resection were identified as independent risk factors. The stoma did not reduce the leak rate but significantly decreased leak severity and reoperation rate. A nomogram with a risk score (RALAR score) was developed to predict anastomotic leak risk at the end of resection.ConclusionsWhile a defunctioning stoma did not affect the leak risk, it significantly reduced its severity. Surgeons should recognize independent risk factors for leaks at the end of rectal resection and could calculate a risk score to select high‐risk patients eligible for protective stoma construction.

Giant Retroperitoneal Malignant Peripheral Nerve Sheath Tumor Treated with Multiorgan Resection: a Case Report and Review of the Literature.

Malignant peripheral nerve sheath tumors (MPNST) are rare. Although they originate from Schwann cells or pluripotent neural crest cells, they constitute less than 10% of all soft tissue sarcomas and more than 60% develop on the basis of neurofibromatosis. It is difficult to diagnose MPNST. Although it mostly occurs in the head and neck region or upper extremities, only 1% of cases are located in the retroperitoneal region. The main treatment is surgery, but survival results are not satisfactory even after surgery with R0 resection. They are not sensitive to chemotherapy and radiotherapy and tend to recur locally. The mass detected by imaging in a 57-year-old male patient who admitted to hospital with the complaint of abdominal pain was excised with clear surgical margins. The tumor was located in the left upper quadrant of the abdomen and seemed to invade the pancreas and left kidney in the computed tomography images. The patient had no history of neurofibromatosis or radiation. In this study, it was aimed to present our case diagnosed with retroperitoneal MPNST and treated with multiorgan resection, which is a rare entity, and to increase the awareness of clinicians about the diagnosis, treatment and prognosis of this rare tumor.

Retrospective analysis of surgically treated pT4b gastric cancer with pancreatic head invasion.

BACKGROUNDFor advanced gastric cancer patients with pancreatic head invasion, some studies have suggested that extended multiorgan resections (EMR) improves survival. However, other reports have shown high rates of morbidity and mortality after EMR. EMR for T4b gastric cancer remains controversial.AIMTo evaluate the surgical approach for pT4b gastric cancer with pancreatic head invasion.METHODSA total of 144 consecutive patients with gastric cancer with pancreatic head invasion were surgically treated between 2006 and 2016 at the China National Cancer Center. Gastric cancer was confirmed in 76 patients by postoperative pathology and retrospectively analyzed. The patients were divided into the gastrectomy plus en bloc pancreaticoduodenectomy group (GP group) and gastrectomy alone group (GA group) by comparing the clinicopathological features, surgical outcomes, and prognostic factors of these patients.RESULTSThere were 24 patients (16.8%) in the GP group who had significantly larger lesions (P < 0.001), a higher incidence of advanced N stage (P = 0.030), and less neoadjuvant chemotherapy (P < 0.001) than the GA group had. Postoperative morbidity (33.3% vs 15.3%, P = 0.128) and mortality (4.2% vs 4.8%, P = 1.000) were not significantly different in the GP and GA groups. The overall 3-year survival rate of the patients in the GP group was significantly longer than that in the GA group (47.6%, median 30.3 mo vs 20.4%, median 22.8 mo, P = 0.010). Multivariate analysis identified neoadjuvant chemotherapy [hazard ratio (HR) 0.290, 95% confidence interval (CI): 0.103–0.821, P = 0.020], linitis plastic (HR 2.614, 95% CI: 1.024–6.675, P = 0.033), surgical margin (HR 0.274, 95% CI: 0.102–0.738, P = 0.010), N stage (HR 3.489, 95% CI: 1.334–9.120, P = 0.011), and postoperative chemoradiotherapy (HR 0.369, 95% CI: 0.163–0.836, P = 0.017) as independent predictors of survival in patients with pT4b gastric cancer and pancreatic head invasion. CONCLUSIONCurative resection of the invaded pancreas should be performed to improve survival in selected patients. Invasion of the pancreatic head is not a contraindication for surgery.

Сравнение эффективности комбинированной анестезии с использованием эпидурального морфина и без него на фоне коррекции окислительно-восстановительного метаболизма у онкобольных с мультиорганными оперативными вмешательствами

Актуальность. На сегодня недостаточно данных о послеоперационном эпидуральном обезболивании с использованием морфина и проведении окислительно-восстановительной терапии у онкобольных с мультиорганными оперативными вмешательствами с оценкой показателей иммунитета. Цель работы: изучение интраоперационного использования эпидурального морфина по сравнению с комбинированной общей эпидуральной анестезией, а также проведение окислительно-восстановительной терапии у онкобольных с мультиорганными оперативными вмешательствами с оценкой показателей иммунитета для обеспечения анестезии с опережающей терапией возможных осложнений и получения более комфортного состояния пациентов. Мате­риалы и методы. В ходе работы было обследовано 117 пациентов с местно-распространенным опухолевым процессом желудочно-кишечного тракта с мультиорганными хирургическими вмешательствами по жизненным показаниям (67,6 ± 3,7 года). Все пациенты были разделены на четыре группы в зависимости от типа анестезии и антиоксидантной терапии. Были выделены группы с интраоперационным использованием эпидурального морфина и без него. В качестве антиоксидантной терапии использовали L-орнитин L-аспартат с комплексом кверцетина с повидоном. Измерялись показатели клеточного и гуморального иммунитета на примере субпопуляционного определения относительного количества лимфоцитов CD3+ и IgA до операции и через 4 и 24 часа после операции. Общее качество жизни, связанное со здоровьем, оценивали с применением стандартного «Краткого опросника оценки статуса здоровья» SF-36 по научно обоснованной методологии. Результаты. Полученные результаты свидетельствуют о том, что в группе с использованием эпидурального морфина степень эффективности обезболивания была достаточной, но были зарегистрированы осложнения, в том числе в виде апноэ при использовании морфина и незначительное ухудшение показателей иммунитета. При применении окислительно-восстановительной терапии мы достигли как улучшения качества жизни, так и более значительного улучшения показателей иммунитета. Выводы. Таким образом, проведение комбинированной эпидуральной анестезии без использования морфина на фоне коррекции окислительно-восстановительного метаболизма у онкобольных с мультиорганными оперативными вмешательствами более комфортно для пациентов, менее опасно из-за отсутствия развития апноэ, психоэмоционально и экономически оправдано, что свидетельствует о ее приоритетном использовании.

Peritoneoectomy and the multiorgan resection in prevalent tumors of abdominal cavity and small pelvis

Objective. To estimate the results of peritoneoectomy and multiorgan resection in the treatment of prevalent tumors of abdominal cavity and small pelvis.&#x0D; Materials and methods. The results of treatment of 246 patiemts with prevalent abdominal cavity tumors were studied. The patients were distributed into two groups: Group I – 209 patients, to whom complete and optimal cytoreduction was performed, and Group II – 37 patients, to whom suboptimal cytoreduction was done. Intraoperative characteristics, the term of stationary stay, postoperative morbidity, lethality, timeliness of intestinal function restoration and the patients’ quality of life were estimated.&#x0D; Results. The cytoreduction volume increase enhances the postoperative morbidity rate, connected predominantly with multiple resection of intestine and surgery of diaphragm. In patients of Group I degradation of the quality of life indices was noted through 1 mo postoperatively.&#x0D; Conclusion. Using multiorgan resection and peritoneoectomy it is possible to achieve complete and optimal volume of cytoreduction. Application of multidisciplinary approach, new operative procedures, modern surgical instruments and energies permit to reduce the postoperative morbidity rate.

Prognostic Benefit of ≥6 Cycles of Neoadjuvant Chemotherapy for Advanced Ovarian, Tubal, and Peritoneal Cancers.

A higher number of neoadjuvant chemotherapy (NACT) cycles translate to a lower risk of morbidity and mortality, but few studies have analyzed the prognostic impact of >4 cycles of NACT. Overall, 52 patients [31 patients, NACT plus interval debulking surgery (IDS); 21 patients, NACT alone owing to progressive disease] who underwent NACT between January 2008 and December 2014 were evaluated. In total, 6, 7-10, and 11-18 cycles of NACT were performed in 52.3%, 27.3%, and 20.5% of the patients, respectively. The median overall survival was 76.0 months (range=36.0-94.0 months), and the median progression-free survival was 26.0 months (range=18.0-54.0 months) in the NACT plus IDS group. At least six cycles of NACT plus IDS are associated with a lower rate of multi-organ resection and a high rate of complete resection or optimal (<1 cm) following IDS.

Correction of redox metabolism and the relationship of markers of systemic chronic inflammation with a measure of overall survival in cancer patients with multiorgan resections

Background. According to the literature, multiorgan resections are carried out with the most radical removal of healthy tissue. Therefore, there is a need for the most favorable preparation of the patient with perioperative therapy to reduce further complications with obtaining improved clinical and pathological prognostic indicators to increase the overall survival. Purpose: correction of redox metabolism based on the data of the oxidative modification of proteins, degree of their catabolic reaction, and data on the enzymatic state and lipid peroxidation in cancer patients with multiorgan resections on the gastrointestinal tract under conditions of perioperative intensive care. Materials and methods. The study involved 117 cancer patients aged 67.6 ± 3.7 years with locally advanced tumor processes of the gastrointestinal tract. Studies have been conducted on the enzymatic state, lipid peroxidation and oxidative modification of proteins, both in terms of the degree of fragmentation of their products in spontaneous and iron-induced reactions, and the level of medium-weight protein molecules. Serum levels of circulating tumor necrosis factor alpha, interleukin-6 and -8 were determined. Survival analysis was performed using the Kaplan-Meier method. Results. The study of patients has shown an improvement in the indicators of oxidative modification of proteins and lipid peroxidation. Survival in cancer patients with multiorgan resections demonstrated dependence on the levels of tumor necrosis factor alpha, interleukin-6 and -8 in the blood serum. Conclusions. Conducting perioperative intensive care makes it possible to reliably restore indicators of the enzymatic state, lipid peroxidation and oxidative protein modification products (on the fourth day and second week, p &lt; 0.05). This gives us grounds for recommending the determination of these parameters in the group of cancer patients and the implementation of metabolic intensive care. In the group of L-ornithine L-aspartate and quercetin combination with povidone, the lowest indicators of systemic chronic inflammation and the best overall survival were found.

Long-term renal functional outcomes following ureteroureterostomy performed during multi-organ resection for non-urothelial cancers.

ObjectivesTo evaluate the long‐term renal function outcomes after ureteroureterostomy (UU) in patients undergoing multi‐organ resection for non‐urothelial cancers. The secondary aim was to examine the length of ureteric defect that can be successfully bridged with UU.Patients and methodsWe retrospectively reviewed the charts of patients who underwent UU between 1995 and 2012 at our institution. Renal imaging studies performed before and after UU were used to determine whether hydronephrosis was present. Renal function was assessed by comparing estimated glomerular filtration rate (eGFR) before and at the last follow‐up after UU.ResultsNineteen patients underwent UU during multi‐organ resection for non‐urothelial cancers. Median follow‐up time was 62 months. Overall, UU had a high success rate, with one patient (5.2%) developing progressive hydronephrosis with a >20% drop in eGFR from baseline due to UU failure. Four additional patients developed progressive hydronephrosis due to cancer recurrence involving the UU. There were no statistically significant differences between pre‐ and post‐UU eGFR in these patient cohort. All patients with a ureteric defect of ≤5 cm underwent successful reconstruction.ConclusionsUU maintains long‐term renal function in the majority of patients undergoing multi‐organ resection for non‐urothelial cancers and can be successfully utilized if the resected ureteric length is ≤5 cm.

Pancreatic malignancy in the backdrop of chronic pancreatitis: How much to push the boundaries to achieve R0 resection

Abstract Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.

Superior vena cava resection and plastic repair as a part of surgical and combined treatment of lung cancer

This article summarizes our own experience of reconstructive operations with resection and plastic repair of the superior vena cava in the field of locally advanced lung cancer surgery. Both technical aspects and methodological approaches of this type of combined interventions are described in detail. Data from 45 patients who underwent wedge (21) and circular (24) superior vena cava resections were analyzed. In most (65%) cases, venous resection and reconstruction were combined with multi-organ resections of other anatomical structures of the chest cavity. 87% of patients received combined treatment in different directions. Postoperative complications were registered in 40% of cases, and the mortality rate was 13%. The unfavorable postoperative prognostic factors were followings: old age, pneumonectomy, combination of vein angioplasty with carinal resection. The 5-year survival rate was 18.5%, with a median survival of 19.4 + 4.6 months. The results allow us to recommend such operations in highly specialized clinics that have extensive experience in tracheobronchial angioplastic surgery and highly-qualified anesthesia care providers. Multimodal treatment allows to achieve satisfactory long-term results.

A Rare Presentation of a Large Embryonal Rhabdomyosarcoma at Retroperitoneal Region with Intra-thoracic Extension & Misdiagnosed as Lower Respiratory Tract Infection: A Case Report

Introduction: We are reporting a case of 18 year old boy who presented with features of lower respiratory tract infections and labelled as suffering from left suprarenal gland tumor. However, after complete evaluation, it is diagnosed as left retroperitoneal tumor extending into left thoracic cavity with involvement of left lower lobe lung. He underwent debulking surgery. Rhabdomyosarcoma (RMS ) originates from immature striated muscle and it is considered as the most aggressive malignant mesenchymal tumor. The most common location of RMS is head and neck region. The retroperitoneal presentation of embryonal RMS is extremely rare. The four histological features of RMS, classified by WHO are embryonal, alveolar, pleomorphic and spindle cell or sclerosing. Pleomorphic RMS has worse prognosis. The incidence of embryonal tumors is higher in males with bimodal age distribution, between 2-6 years and second peak between 10-18 years. Their detection is incidental when the size is small and as the size enlarges, symptoms helps in detection. Due to its rarity at retroperitoneal location, there is a lack of literature over the adjuvant treatment. As the size enlarges at retroperitoneal region, enblock resection with clear margins becomes a difficult task and if planned for R0 resection, multiorgan resection escalates surgical morbidity rate. Conclusion: It is a rare location of embryonal rhabdomyosarcoma at retroperitoneal region with rare presentation of intra-thoracic infiltration. R0 resection is the principle goal of surgical excision of retroperitoneal sarcoma.

Incidence and risk factors of postoperative complications after robotic gastrectomy for gastric cancer: an analysis of 817 cases based on 10-year experience in a large-scale center.

In this study, we investigated the incidence and risk factors for postoperative complications after robotic gastrectomy (RG) in patients with gastric cancer. A total of 817 patients who underwent RG for gastric cancer between March 2010 and August 2019 were analyzed retrospectively. Postoperative complications were categorized according to the Clavien-Dindo classification, and possible risk factors were evaluated. Among 817 patients who underwent RG, overall, severe, local and systemic complication rates were 13.8, 4.2, 7.0 and 6.9%, respectively. Multivariable analysis revealed that an age of 70years or older (P < 0.001) and multiorgan resection (P = 0.031) were independent risk factors for the occurrence of overall complications. Multivariable analysis showed that an age of 70years or older (P = 0.005) and surgeons' experience ≤ 25 cases(P = 0.004) were independent risk factors for severe complications. Regarding local complications, an age of 70years or older (P < 0.001), multiorgan resection (P = 0.010) and surgeons' experience ≤ 25 cases (P = 0.005) were identified as independent risk factors. An age of 70years or older (P < 0.001), a BMI of 25 or higher (P = 0.045) and the presence of comorbidity (P = 0.029) were identified as independent risk factors for systemic complications. The present study demonstrated that RG is a safe and feasible procedure for the treatment of gastric cancer, and it has an acceptable postoperative morbidity. Elderly patients and insufficient surgeon experience were two major risk factors for the occurrence of complications following RG. We suggest that surgeons choose patients in good condition during their RG learning phase to reduce learning-associated morbidity.

DIFFERENCE IN PREDICTORS OF ANASTOMOTIC LEAKAGE DEPENDING ON THE LEVEL OF ANASTOMOSIS AFTER COLORECTAL CANCER SURGERY.

SUMMARYAnastomotic leak (AL) after colorectal cancer surgery is one of the most serious postoperative complications which has major impact on outcomes. The aim of this study was to investigate preoperative and intraoperative risk factors for AL, as well as to examine whether there are differences in risk factors for AL depending on the primary tumor location. We retrospectively reviewed records of patients having undergone colorectal surgical procedures for malignancies between January 2013 and December 2017 in a single institution. Only procedures with primary anastomosis were included. Of the 153 patients, AL occurred in 10.6% of patients with primary tumor in the sigmoid colon and rectum, and in 8.2% of patients with primary tumor in the proximal sections of the colon. On univariate analysis, delayed oral intake and more advanced histologic stages of the tumor were significantly correlated with AL in patients with tumors in the sigmoid colon and rectum, and multiorgan resection and distant metastases in patients with tumors in the proximal sections of the colon. In conclusion, risk factors for the occurrence of AL vary depending on the primary tumor location and further investigation is needed to provide better insight into these differences.

Early Complications after Gastrectomies for Locally Advanced Gastric Cancer.

Background: The post-operative results as well as the short and middle-term outcome of surgical procedures for gastric cancer depend on several general and local conditions, mainly on the stage of neoplasia. Delayed diagnosis and intervention are correlated with a high rate of postoperative morbidity and mortality. Methods: 76 consecutive patients underwent surgical treatment for gastric cancer over a time span of 5 years (2015-2019), in the 1st Surgical Department of "Dr.I.Cantacuzino" Clinical Hospital. There have been 46 distal gastrectomies, 12 DI total gastrectomies and 18 DII total gastrectomies, 8 of them with multi-organ resection. Results: Among them, 50 patients had a favorable evolution, 7 developed complications which were manageable through a conservative approach, while 19 needed one or more reinterventions. We encountered 10 cases of severe sepsis and MSOF, followed by exitus. Conclusions: The surgical treatment of locally advanced gastric cancer poses many challenges both in terms of postoperative evolution and oncologic prognosis.

Risk factors and outcomes of conversion in minimally invasive distal pancreatectomy: a systematic review

PurposeThe reported conversion rates for minimally invasive distal pancreatectomy (MIDP) range widely from 2 to 38%. The identification of risk factors for conversion may help surgeons during preoperative planning and patient counseling. Moreover, the impact of conversion on outcomes of MIDP is unknown.MethodsA systematic review was conducted as part of the 2019 Miami International Evidence-Based Guidelines on Minimally Invasive Pancreas Resection (IG-MIPR). The PubMed, Cochrane, and Embase databases were searched for studies concerning conversion to open surgery in MIDP.ResultsOf the 828 studies screened, eight met the eligibility criteria, resulting in a combined dataset including 2592 patients after MIDP. The overall conversion rate was 17.1% (range 13.0–32.7%) with heterogeneity between studies associated with the definition of conversion adopted. Only one study divided conversion into elective and emergency conversion. The main indications for conversion were vascular involvement (23.7%), concern for oncological radicality (21.9%), and bleeding (18.9%). The reported risk factors for conversion included a malignancy as an indication for surgery, the proximity of the tumor to vascular structures in preoperative imaging, higher BMI or visceral fat, and multi-organ resection or extended resection. Contrasting results were seen in terms of blood loss and length of stay in comparing converted MIDP and completed MIDP patients.ConclusionThe identified risk factors for conversion from this study can be used for patient selection and counseling. Surgeon experience should be considered when contemplating MIDP for a complex patient. Future studies should divide conversion into elective and emergency conversion.

Examining Perioperative Risk Associated with Simultaneous Resection of Primary Neuroendocrine Tumors and Synchronous Hepatic Metastases.

Surgical debulking of primary neuroendocrine tumors (NETs) and hepatic resection of metastatic NET disease may each independently improve overall survival. However, evidence for combined primary site debulking and metastasectomy on survival and impact on short-term perioperative outcomes is limited. The 2014-2016 ACS-NSQIP targeted hepatectomy database was queried for all patients undergoing liver resection for metastatic NET. Secondary procedure codes were evaluated for major concurrent operations. Multivariable analysis was performed to determine risk factors for 30-day morbidity and mortality. A total of 472 patients were identified, of whom 153 (32.4%) underwent ≥1 additional concurrent major operation. The most common concurrent procedures were small bowel resection (14.6%), partial colectomy (8.9%), and radical lymphadenectomy (7.4%). Among all patients, overall 30-day mortality and morbidity were 1.5% and 25.6%, respectively. Modifiable and treatment-related factors associated with increased major postoperative morbidity risk included >10% weight loss within six months of surgery (p = 0.05), increasing number of hepatic lesions treated (p = 0.05), and biliary reconstruction (p = 0.001). No major concurrent procedure was associated with increased 30-day morbidity (all p > 0.05). Approximately one-third of patients with stage IV NET underwent combined hepatic and multi-organ resection. Although modifiable and treatment-related factors predictive of perioperative morbidity were identified, performance of concurrent major procedures did not increase perioperative morbidity. These results support consideration of multi-organ resection in carefully selected patients with metastatic NET.

Factors affecting temporary stoma outcomes at a major Saudi University Hospital

Background: Temporary stoma formation for fecal diversion is commonly performed in surgery. The rate of stoma-related complications is high, and the risk increases in patients with prolonged time to closure. Thus, identifying factors that influence the time to stoma closure and the rate of its complications would aid in implementing preventive measures. We aimed to determine predictors affecting the time to stoma closure and to identify risk factors for developing complications following stoma reversal.Methods: A retrospective review including all adult patients who underwent stoma closure from 2012-2018 at our institution was conducted. Multivariate regression analysis was used to determine risk factors affecting time to stoma closure and developing complications after reversal surgery.Results: A total of 63 patients were included. Of those, 50.8% were diagnosed with malignancy. The median time to stoma closure was 222.5 days (interquartile range i.e. IQR 12-2228).Having an American society of anesthesiologists (ASA) class IV was the only significant predictor of prolonged time to closure. For cancer patients, developing complications following stoma formation surgery, and receiving adjuvant therapy significantly increased the time to stoma reversal. In contrast, cancer patients who underwent multi-organ resection had shorter time to closure. The rate of complications following stoma reversal was 30.2%. Having a colostomy and requiring readmission after stoma formation surgery increased the risk of developing complications related to stoma reversal.Conclusions: Multiple factors can impact the time to stoma closure and increase the risk of developing complication related to stoma closure. Awareness about these factors and development of preventive strategies is recommended.

Urinary Reconstructions in Patıents with Locally Advanced Rectosigmoid Cancers, a Single Center Experience

Urinary system resections due to rectosigmoid cancers are an issue where the number of experienced surgeons is low because they are not performed frequently.The selection and application of the type of reconstruction after resection are technical procedures that should be performed by experienced cancer surgeons and urologists.&#x0D; Aims: It was aimed to present the urine reconstruction methods and results applied in local advanced rectal and sigmoid colon cancer surgeries performed by the same team for many years.&#x0D; Study Design: Patients who were operated for rectosigmoid region tumor and had urinary resection-reconstruction between 2016-2020 were reviewed. The demographic data of the patients, clinicopathological notes, reconstruction types, postoperative urinary leakage and fistula rates were examined and noted.&#x0D; Methodology: Retrospective patient document analysis using electronic hospital file system and clinical notes.&#x0D; Results: 37 patients were included in the study within the criteria. 17 (46%) of the patients were male and 20 (54%) were female. The mean age of the patients was 58.6 ± 16 years. The most common reconstruction procedures were Ureteroneocystostomy and bladder reconstruction. The least used method was ureteroureterostomy uteretostomy. It was observed that urine leakage / fistula developed in 11 (29.7%) of 37 patients included in the study.&#x0D; Conclusion: Although the rate of urological complications is also affected by the chosen technique, it may also be affected by factors such as the presence of preoperative hydronephrosis, multiorgan resections, and age.

SURGICAL MANAGEMENT OF ADENOCARCINOMA OF ESOPHAGOGASTRIC JUNCTION - A TERTIARY CARE CENTRE EXPERIENCE IN SOUTH INDIA

OBJECTIVE The incidence of adenocarcinoma of esophagogastric junction is on the rise. The optimal treatment strategy for these tumours has not been clearly established. The aim of this study is to analyse the clinical presentations, management and outcomes following surgery in patients with adenocarcinoma of the esophagogastric junction presenting to a tertiary care centre in South India. METHODS Retrospective analysis of prospectively maintained database was performed. Data of all patients operated for adenocarcinoma of esophagogastric junction was analysed with regards to surgical management and clinico-pathological outcomes. RESULTS Fifty two patients underwent surgery for esophagogastric junction malignancy in our institution from January 2015 to December 2018. Among them, type I, type II and type III tumours contributed to 6, 16 and 30 patients, respectively. Thirty-four patients (65.4%) were male. Mean age of the patients was 57 years. Six patients (11.5%) received neoadjuvant therapy. Fourteen patients (26.9%) were found to have unresectable or metastatic disease during surgery. Six patients (11.5%) underwent multiorgan resection. Mean tumour length was 5.4cm. Number of lymph nodes retrieved ranged from 2 to 25. Majority of the patients had stage 3 disease on histopathological examination. Major postoperative morbidity (Clavien Dindo grade ≥ 3) was seen in 9 patients. Reoperation was required in 4 patients. In-hospital mortality rate was 11.53%. On follow up, locoregional recurrence was documented in 5 patients. CONCLUSION Esophagogastric junction adenocarcinoma is an aggressive malignancy with high incidence of unresectable or metastatic disease. Majority of patients presented with larger tumours and at an advanced stage of the disease leading to poor outcomes.