Patients In Surgery Group Research Articles

Laparoscopic versus open extended cholecystectomy with bi-segmentectomy (s4b and s5) in patients with gallbladder cancer.

Introduction:The outcome of laparoscopic extended cholecystectomy (EC) with wedge hepatic resection (LECW) in patients with gallbladder cancer (GBC) has been compared with that of open EC with wedge hepatic resection (OECW), but studies comparing laparoscopic EC with bi-segmentectomy (LECB) with open EC with bi-segmentectomy (OECB) are lacking.Patients and Methods:This retrospective study comprised of 68 patients with GBC who were offered either LECB or OECB from July 2011 to July 2018. Patients were divided into laparoscopic group (LG) and open group (OG), and appropriate statistical methods were used for comparison.Results:Out of the total 68 patients, 30 patients were in LG and 38 patients were in OG. Demographic, clinical and biochemical characteristics were similar except significantly higher number of male patients in OG (P = 0.01). In LG versus OG, the mean operation time was 286 versus 274 min (P = 0.565), mean blood loss was 158 versus 219 ml (P = 0.006) and mean hospital stay was 6.4 versus 9 days (P = 0.0001). The complication rate was 16.6% in LG and 31.5% in OG, but this difference was not statistically significant (P = 0.259). The median number of lymph nodes was 12 in both LG and OG (P = 0.62). Distribution of patients among American Joint Committee on Cancer stages I to IV was similar in both the groups (P = 0.5). Fifty percent of the patients in both the groups received adjuvant treatment (P = 1). In LG versus OG, the recurrence rate was 20% versus 28.9% (P = 0.4), mean recurrence-free survival was 48 months versus 44 months (P = 0.35) and overall survival was 51 months versus 46 months (P = 0.45). In LG versus OG, 1, 3 and 5-year survival was 96% versus 94%, 79% versus 72% and 79% versus 62% (P = 0.45). The median follow-up was statistically significantly shorter (24 vs. 36 months) in LG versus OG (P = 0.0001).Conclusions:The oncological outcome and survival after LECB in patients with resectable GBC is not inferior to that after OECB. Laparoscopic approach has a potential to improve perioperative outcome in patients with GBC.

Palliative bypass surgery in elderly patients with resectable periampullary carcinoma: a report of 45 cases

Background: This study aims to determine whether palliative bypass surgery (choledochojejunostomy and gastrojejunostomy), which has a lower incidence of complications and mortality, remains an option for elderly patients with resectable periampullary carcinoma. Methods: The clinical data of elderly patients with resectable periampullary carcinoma who had been admitted to Qilu Hospital and had undergone palliative bypass surgery in recent years was collected. Factors concerning these patients, including surgical duration, intraoperative haemorrhage, the incidence of complications, mortality, and survival rate, were compared to those in patients who had received radical surgery. Results: Surgical duration, intraoperative haemorrhage, the incidence of complications, pancreatic fistula, abdominal infections, pneumonia, and postoperative hospital stay were found to be more apparent in patients in the radical surgery group than in patients in the palliative bypass surgery group and the difference was statistically significant (P Conclusions: For elderly patients with periampullary carcinoma, palliative bypass surgery offers safety, low risks, a quick recovery, a shorter surgery duration, less intraoperative haemorrhage, and a lower incidence of complications compared to radical surgery. Although it has a lower long-term survival rate compared to radical surgery, palliative surgery remains an option for elderly patients who prefer not to undergo the invasive procedure of radical surgery.

Evaluation of CT angiography vascular localization combined with refined three-dimensional printing in guiding the resection and reconstruction of complex oral cancer

Objective: To evaluate the effect of vascular localization using computerized tomography angiography (CTA) combined with refined three dimensional (3D) printing in guiding the resection and reconstruction of complex oral cancer. Methods: From December 2013 to July 2017, the clinical data of 30 patients with complex oral cancer enrolled in the Hunan Cancer Hospital were retrospectively analyzed. 15 patients received CTA+ 3D assisted surgery, while the other 15 patients underwent traditional surgery. In CTA+ 3D assisted surgery group, CT and Magnetic Resonance Imaging (MRI) data were combined with CTA to print refined solid 3D model and surgical guide plate. The preoperative and intraoperative virtual surgical system and the operative experience were combined for preoperative evaluation and surgery. In traditional surgery group, preoperative evaluation and surgery were performed according to imaging data and surgeons' clinical experience. Operative time, intraoperative blood loss, hospital stay and local recurrence rate were compared between the two groups. Results: In CTA+ 3D assisted surgery group, one patient gave up surgical treatment after intuitively watching the lesion through the 3D model, and the remaining 14 patients underwent surgery as planned. All the 15 patients in traditional surgery group received surgery. But the preoperative plans of three patients were temporarily and passively modified due to insufficient preoperative evaluation. The average intraoperative blood loss was(320.1±27.2)ml in CTA+ 3D assisted surgery group and(430.2±30.3)ml in traditional surgery group. Mean operation time was(440.3±19.2)min and(552.2±23.3)min, respectively. Mean hospitalization time was (20.4±3.2)d and (25.1±3.7)d, respectively. The differences were all statistically significant (all P<0.05). 1 year and 3 years local recurrence rates were 9.1% and 28.6% in CTA+ 3D assisted surgery group, as well as 14.3% and 50.4% in traditional surgery group with statistical significance (P<0.05). Conclusion: For complex oral cancer patients with difficulty in opening the mouth or postoperative recurrence, CTA vascular localization combined with fine 3D printing technology has significant advantages in the surgical process, surgical effect and postoperative evaluation index compared with traditional method using imaging data and clinical experience.

Laparoscopy versus open appendectomy for elderly patients, a meta-analysis and systematic review

BackgroundAppendicitis in elderly patients is associated with increased risk of postoperative complications. The choice between laparoscopy and open appendectomy remains controversial in treating elderly patients with appendicitis.MethodsComprehensive search of literature of MEDLINE, Embase, Cochrane Library and ClinicalTrials was done in January 2019. Studies compared laparoscopy and open appendectomy for elderly patients with appendicitis were screened and selected. Postoperative mortality, complications, wound infection, intra-abdominal abscess and operating time, length of hospital stay were extracted and analyzed. The Review Manage 5.3 was used for data analysis.ResultsTwelve studies with 126,237 patients in laparoscopy group and 213,201 patients in open group. Postoperative mortality was significantly lower following laparoscopy (OR, 0.33; 95% CI, 0.28 to 0.39). Postoperative complication and wound infection were reduced following laparoscopy ((OR, 0.65 95% CI, 0.62 to 0.67; OR,0.27, 95% CI, 0.22 to 0.32). Intra-abdominal abscess was similar between LA and OA (OR,0.44;95% CI, 0.19 to 1.03). Duration of surgery was longer following laparoscopy and length of hospital stay was shorter following laparoscopy (MD, 7.25, 95% CI, 3.13 to 11.36; MD,-2.72, 95% CI,-3.31 to − 2.13).ConclusionsNot only laparoscopy is safe and feasible, but also it is related with decreased rates of mortality, post-operative morbidity and shorter hospitalization.

Health-related quality of life after epilepsy surgery: A prospective, controlled follow-up on the Iranian population

Quality of life is affected by factors such as regional differences in access to treatment choices, and rehabilitation. This study aims to assess the result of epilepsy surgery and its impact on QoL in Iran. The data for 60 patients who underwent epilepsy surgery in Loghman-Hakim hospital between 2003 to 2017 were analyzed prospectively through clinical observation. Clinical variables of interest and the WHOQOL-BREF scale to assess QoL were applied. Scores of operated patients were compared to their preoperative scores as well as epileptic patients controlled with antiepileptic drugs (AEDs) and healthy individuals. The mean age of surgery group patients was 33.78 (34 male; 26 female). Twenty seven patients underwent temporal mesial lobectomy, 20 anterior callosotomy, and 13 neocortical resections. The average QoL score in healthy group was 72.48, in AEDs controls was 56.16, and in operated patients was 65.61. In addition, analysis showed a significant increase in postoperative QoL of the surgical group compared to the AEDs controls. Epilepsy surgery could be the best approach in patients suffering from drug-resistant epilepsy even in developing countries, which can result in seizure relief and a reduction in the frequency of disabling seizures.

Survival benefit in bariatric surgery kidney recipients may be mediated through effects on kidney graft function and improvement of co-morbidities: A case-control study

BackgroundData on the benefits of bariatric surgery for morbid obesity among kidney transplant recipients are scarce. ObjectiveTo examine the effect of bariatric surgery on graft function and survival and on obesity-related co-morbidities. SettingUniversity hospital. MethodsThis case-control study used retrospectively collected data of all kidney recipients who underwent bariatric surgery in our institution between November 2011 and August 2016 (n = 30, 11 females). Nonbariatric operated kidney recipients matched for age, sex, and time elapsed since transplantation served as controls (n = 50, 23 females). Main outcomes were renal function, graft loss events, mortality, and obesity-related co-morbidities. ResultsThe mean follow-up duration was 2.4 ± 1.3 years for both groups. At final follow-up, there was an increase in estimated glomerular filtration rates for the bariatric surgery group, and a decrease for the controls (13.4 ± 19.9 and −3.9 ± 15.8 mL/min/1.73 m2, respectively, P < .001). The chronic kidney disease classification improved in 9 bariatric surgery group patients and in 6 controls (P = .1). Two patients in the bariatric surgery group and 6 controls died. Total death or graft function loss during the follow-up was 6.7% and 16.7%, respectively (P = .3). The total numbers of co-morbidities and medications were lower in the bariatric surgery patients (−.7 and −2, respectively) and higher in the controls (+.3 and +1.1; P < .001) at study closure. ConclusionsThere was an improvement in renal function, graft survival, and obesity-related co-morbidities among kidney transplant recipients who underwent bariatric surgery compared with those who did not. These findings support bariatric surgery in this population and warrant prospective studies.

PKP/PVP combine chemotherapy in the treatment of multiple myeloma patients with vertebral pathological fractures: minimum 3-year follow-up of 108 cases

BackgroundMultiple myeloma (MM) is a blood system malignant tumor, which often leads to osteolytic bone destruction, and the vertebral column is the primary site of involvement. However, the efficacy and prognosis of percutaneous kyphoplasty/vertebroplasty (PKP/PVP) for simple vertebral pathological fractures in patients with multiple myeloma are not yet unified. The primary objective of this study was to investigate the efficacy and prognosis of PKP/PVP in the treatment of multiple myeloma patients with vertebral pathological fractures.MethodsA total of 108 patients with MM from Beijing Chao-Yang Hospital from 2007 to 2013 were enrolled. Of these, 52 patients underwent PKP/PVP surgery and chemotherapy (surgery group) and 56 received only chemotherapy (chemotherapy group). The age, gender, International Staging System (ISS), fracture location, segment, visual analog scale (VAS), Oswestry Disability Index (ODI), comprehensive treatment satisfaction, stem cell transplantation, overall survival (OS), mortality rate, and the cause of death of patients were recorded; the mean follow-up time was 42.46 months.ResultsThe average age of patients in surgery and chemotherapy groups was 60.8 years and 58.1 years, and the mean survival time was 41.98 months and 43.30 months, respectively. The VAS score at 1 month and last follow-up after treatment in surgery group were significantly lower than those in the chemotherapy group (P < 0.05); the ODI at 1 month after treatment in the surgery group was significantly lower than that in the chemotherapy group (P < 0.05); no significant difference was observed in the 3-year mortality rate between surgery and chemotherapy groups. The number of patients who developed activity disorder in the surgery group was significantly less than that in the chemotherapy group (P < 0.05). The OS of patients in ISS stage III was significantly less than that in ISS stages I and II (P < 0.05).ConclusionsPKP/PVP surgery can greatly relieve the pain caused by fractures, reduce the risk of being completely bedridden and pulmonary infection, and improve the quality of life of patients; however, it did not affect mortality rate and overall survival time in patients.Trial registrationAs this was a retrospective study, it did not require ethical approval; all patients had signed informed consent when they received treatment, and all treatment options were voluntary.

A Comparative Study of Conservative and Surgical Management of Displaced Midshaft Clavicle Fracture

Introduction: Since long, closed midshaft clavicle fractures, whether undisplaced or displaced, have been treated conservatively with figure of “8” bandage and sling. However, in the past few decades, management trends show an uprise in surgical management of displaced midshaft clavicle fracture with rigid internal fixation providing early pain relief and avoiding deformity, non-union (NU), and sequelae. Materials and Methods: A total of 60 patients with displaced midshaft clavicle fracture were included in the study. Patients were randomly allocated to the non-operative and operative group with 30 patients in each group. Non-operative management was performed with clavicle brace (figure of 8 bandage) while open reduction internal fixation with plate fixation was the preferred operative treatment. Patients were followed up at 2, 4, and 6 weeks and then at 3, 6, and 12 months. Outcome analysis included standard clinical follow-up, the constant shoulder (CS) score and the disabilities of the arm, shoulder, and hand (DASH) score, and plain radiographs. Statistical analysis was done using Student’s “t” test and SPSS software. The results were considered to be significant at P &lt; 0.05. Results: There was a statistically significant difference in functional outcome between the two groups at 3-month follow-up (CS; P = 0.0469 and DASH; P = 0.0406), though no such difference was recorded at 1-year follow-up (CS; P = 0.2731 and DASH; P = 0.4915). It implies that the patients in operative group improved functionally and returned to normal activities earlier than the non-operative group. Even patient satisfaction regarding shoulder appearance (cosmesis) was more in the operative group (100%) than in non-operative group (60%). The complications were more in the non-operative group (23), such as symptomatic malunion in 2 cases (8%), NU in 5 cases (20%), shortening in 3 cases (12%), and muscle wasting in 2 cases (8%), whereas only four complications were recorded in the operative group, of which two were implant related. Conclusion: Surgical management of displaced midshaft clavicle fracture has definite short-term benefits with respect to functional outcome, early return to preinjury activities, and a lower rate of malunion and NU. Furthermore, due to difficulties of non-operative treatment including pain and instability at fracture site, tightness of clavicle brace, difficulties in self-hygiene, and high percentage of NU, especially in high-energy fractures; operative treatment is a good option in displaced midshaft clavicle fracture, especially in active adult patients. Keywords: Clavicle fracture, Conservative management, Surgical management.

Prognostic significance of preoperative radiotherapy in stage II and III rectal cancer patients: A Strobe-compliant study of SEER 18 registries database (1988-2011).

Preoperative radiation therapy has been regarded as the optional neoadjuvant treatment to decrease local recurrence of rectal cancer in addition to surgery. However, its benefit in survival remained obscure. This study was aimed to measure the efficacy of preoperative radiation therapy for survival in stage II and III rectal cancer patients. Retrospective cohort study used the database of Surveillance, Epidemiology and End Results program of the National Cancer Institute in the United States from 1988 to 2011. A total of 49439 patients diagnosed with primary rectal cancer who underwent surgery were included. Clinicopathological characteristics and rectal cancer-specific survival between surgery alone group and surgery plus preoperative radiation therapy group were compared. Rectal cancer patients in surgery plus preoperative radiation therapy group had significantly better survival than those in surgery alone group (72.70% vs. 66.61%, P < 0.001), as well as stratified by stages (stage II: 77.4% vs. 74.3%, P < 0.001; stage III: 68.3% vs. 58.6%, P < 0.001). However, this beneficial impact was only observed after 2000s (P < 0.001). Multivariate survival analysis revealed that preoperative radiation therapy was an independent predictor for better survival in stage III (hazard ratio, 0.795; 95% CI, 0.753-0.840; P < 0.001), but not in stage II (P = 0.70). Preoperative radiation therapy might bring a better survival in stage II and III rectal cancer patients, but only as an independent predictor for stage III patients. As time progressed, preoperative radiation therapy might yield more profit for stage II and III rectal cancer patients.

Comparison of surgery and surgery plus corticosteroid therapy in idiopathic granulomatous mastitis, prospective randomized study

Aim: To compare therapeutic effectiveness of surgery alone with surgery plus corticosteroid in patients with granulomatous mastitis.Material and Methods: The study included 30 patients aged 23-60 years. The patients were randomly assigned into two groups by lot. In-group 1, the patients received 375 mg ampicillin-sulbactam (twice daily, p.o.) for a week; than 32 mg prednisolone was started which was gradually tapered (biweekly by 8 mg) over 8 weeks. Surgery was performed 2 weeks after tapering. In-group 2, the patients received 375 mg ampicillin-sulbactam (twice daily, p.o.) for a week and underwent surgery. During 2-years follow-up, all patients were assessed for etiological factors and recurrence.Results: No significant differences was found in demographic characteristics, smoking habits, oral contraceptive use, presenting complaints, physical examination findings, localization and diagnostic tools used between groups. During follow-up, recurrence was seen in one patient (6.7%) in surgery group and in 3 patients (20%) in steroid group but no significant difference was detected between groups (p>0.05). Conclusion: In patients with granulomatous mastitis, systemic steroid therapy is an effective modality in patients unresponsive to antibiotic therapy after ruling out tuberculosis.

Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest-breast approach.

Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest-breast approach. We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique. All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20min, P = 0.000; 125 ± 21 vs. 80 ± 14min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period. It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest-breast approach. In particular, this technique avoids a large scar on the patient's neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.

Treatment of cervical ossification of the posterior longitudinal ligament by modified laminoplasty with C3 laminectomy and C7 spinous process retention

Objective To observe the clinical efficacy of modified laminoplasty with C3 laminectomy and C7 spinous process retention in the treatment of cervical ossification of the posterior longitudinal ligament(OPLL). Methods From Febru-ary 2014 to March 2016, 133 cases of OPLL were admitted, and 42 OPLLs were included according to the inclusion and exclusion criteria. A case-control study was conducted. Twenty-two cases were included in modified group and 20 cases in traditional group. There were 13 males and 9 females in the modified surgery group, and the average age was 56.2±9.75 years (39-77 years).Modi-fied surgery was conducted with C3 laminectomy, C4-C6 laminoplasty, resection at the upper part of the C7 lamina and retaining the C7 spinous process. Meanwhile, there were 12 males and 8 females in the traditional surgery group, with an average age of 53.7±8.23 years (41-75 years). Patients in the traditional surgery group were treated with standard C3-C7 laminoplasty. The mean follow-up was 22.9±4.5 (15-29) months. The JOA, NDI scores of the two groups were recorded preoperatively and postoperatively. The physiological curvature and activity of the cervical spine before and after operation were observed, and the incidence of axonal symptoms and postoperative complications in both groups were recorded. Results The follow-up period was 15-28 months, with an average of (23.2 ± 4.8) months. There was no significant difference between the base line of two groups before operation. At the last follow-up, the JOA and NDI scores of the two groups were significantly improved. There was no difference of JOA scores be-tween the two groups at the last follow-up, while the NDI sores at the modified group(6.56±4.78) was superior to the traditional group(9.25±7.63). The VAS score at the first day after surgery in modified group was lower than that of the traditional group. The average cervical curvature of the patients in the modified surgery group and the standard surgery group were 12.32°±8.26° and 11.56°±8.05°, respectively. There was no significant difference between the two groups. The postoperative range of movement (ROM) of cervical spine was 39.68°±9.52° in modified group and 33.51°±10.39° in traditional group(P<0.05). Eight patients (19%) had augmentation of axial symptoms, including 3 patients in the modified surgery group(13.6%) and 5 patients in the stan-dard surgery group (30%). There was no significant difference between the two groups. During the follow-up period, there were no complications such as cerebrospinal fluid leakage, spinal cord injury, wound infection, laminar collapse, postoperative closure, in-ternal fixation loss or fracture. Conclusion The modified laminectomy with C3 laminectomy and C7 spinous process retentionis minimally invasive, whichachieved satisfactory decompression effect, reduced the incidence of postoperative axial symptoms and maintained the cervical ROM. Key words: Cervical vertebrae; Ossification of posterior longitudinal ligament; Decompression, surgical

Outcomes of tumour related epilepsy in a specialised epilepsy surgery unit

IntroductionSeizures are an important cause of morbidity in patients with low grade gliomas with approximately 40% of cases drug resistant. The pathogenesis is quite complex and poorly understood. The treatment aims vary between almost purely epilepsy considerations and those that are primarily oncologic. AimTo determine whether patients who present with seizures and are found to have a low grade glioma have better outcomes when managed through a specialized epilepsy unit compared to the general neurosurgical service. MethodsA review of the prospectively collected database was performed over a 10 year period to identify 48 adult patients who present with a seizure and were subsequently found to have a low grade glioma. These patients were analysed with respect to management through the specialized epilepsy service or the general neurosurgical service. The primary outcome was Engel classification between the two groups. Secondary outcomes included recurrence, postoperative deficits, delay to surgery, histology, grade and extent of resection. OutcomesThe patients managed through the epilepsy service had significantly higher rate of favourable Engel outcomes (I and II) compared to the general neurosurgery service (OR: 13.2, 95% CI: 1.239–140.679; P = 0.033). The epilepsy surgery group patients had a significantly higher delay to surgery (P < 0.001). The patients in the epilepsy service had a significantly higher resection ratio compared to the general neurosurgery service (73% vs 127%, P = 0.014). Rates of recurrence were not different between the two groups. ConclusionPatients with tumour related epilepsy who undergo an intensive presurgical evaluation may obtain better seizure related outcomes.

Short course antibiotic prophylaxis to prevent surgical site infections in HPB surgeries. Are we giving too much? A prospective study

Introduction: Use of antibiotics in perioperative period is common practice to prevent septic complications and surgical site infections. Methods: We prospectively evaluated protocol of single dose preoperative antibiotic for laproscopic surgeries and 48-h prophylactic antibiotic for open hepato-pancreatico-biliary surgeries. Surgical Site infections were defined as any culture positive discharge from the main surgical wound or complications like bile leaks through the wound or drain. Categories of surgeries were decided according to CDC protocol. Results: Out of 94 patients 2 patient had undergone grade 1 (clean) surgery, 43 patients grade 2 surgery (clean contaminated), 28 patients grade 3 (contaminated) surgery, and 8 patient had grade 4 (dirty) surgery. Total 11 patient developed surgical site infections giving over all SSI rates of 11.7 percent. No Patients in grade 1 or grade 2 surgeries developed surgical site infections. 9 patients in grade 3 (32 percent) surgeries and 3 patient in grade 4 (37.5 percent) surgeries developed surgical site infections. No patient in laproscopic surgery group developed surgical site infections, which is comparable to international data. Open surgery was significantly associated with SSI rates(p = 0.04). Contaminated and dirty (grade 3 and grade 4) surgeries were significantly associated with surgical site infections. (p = 0.030). morbidity and mortality rates were 13.8 percent and 9.4 percent respectively. SSI was significantly associated with grade-3, grade-4 complications. (p < 0.01) and mortality (p < 0.01). Conclusion: Short course prophylactic antibiotics protocol has similar SSI rates and can reduce hospitalization and cost. Short course prophylactic antibiotic protocol also helps in reducing antimicrobial resistance.

Treatment of Maisonneuve fracturewitharthroscopic-assistant plate-screw fixation of the syndesmosis

Objective To investigate the effect of the treatment for Maisonneuve fracture with arthroscopic-assistant plate-screw fixation ofsyndesmosis. Methods From January 2015 to December 2016, totally 22 patients with Maisonneuve fracture were treated in Shanghai Jiao Tong University Affiliated Six People′s Hospital. Eleven patients in minimal invasive surgery (MIS)group were treated by the arthroscopic-assistant plate-screw fixation ofthe syndesmotic injury. Another 11 patients in the control group were performed a classic syndesmosis screw fixation. Plain radiographic examination was carried out during the follow-up. Functional evaluation was measured according to the American Orthopedic Foot Ankle Society (AOFAS) ankle hindfoot score and the Visual analogue scale(VAS). A t test was applied for the statistic analysis of post-operative outcome between the two groups at 6th and 12th month. Results The patients were followed for an average 18 months (range from 12 to 24 months) except one of MIS group.The X-ray demonstrated the solid bone union occurred on the 12th week in MIS group and 12.5th week in the control group. The implants of syndesmosis were removed at 12th week post-operatively. No cases of re-diastasis occurred during the follow-up. There was significant difference with in the groups. In the MIS group, the AOFAS ankle hindfoot score was (85.9±4.1) points at 6th month post-operatively, and increased to (90.8±3.7) at 12th month (P<0.05). VAS score was (2.4±1.2) at 6th month and (1.1±0.7) at 12th month after the operation(P<0.05). In the control group, the AOFAS ankle hindfoot score was (81.1±4.7) points at 6th month after operation, and increased to (89.1±3.4) at 12th month after operation (P<0.05). VAS score was (3.2±1.3) at the 6th month and (1.0±1.0) at the 12th month after operation(P<0.05). However, for the outcome comparison between the two groups, only the AOFAS ankle hindfoot score of 6th month post-operatively in MIS group was better than the control group (P<0.05), other results, had no significant difference.Nocomplications of implant failure, nonunion, malunion or post-traumatic arthritis were occurred during the follow-up. Conclusion The treatment of Maisonneuve fracture by arthroscopic-assistant plate-screw fixation proved to have an advantage of minimal invasion and accurate reduction and fixation, which is a safe and effective surgical method. Key words: Ankle joint; Fracture; Fracture fixation, internal; Arthroscopes

Impact of neoadjuvant therapy on the number of harvested lymph nodes in D2 radical resection of the proximal locally advanced gastric cancer

Objective To explore the impact of neoadjuvant therapy on the number of harvested lymph nodes in D2 radical resection of the proximal locally advanced gastric cancer (GC). Methods The retrospective cohort study was conducted. The clinicopathological data of 319 patients with proximal locally advanced GC who were admitted to the Beijing Cancer Hospital from January 2013 to September 2016 were collected. Of 319 patients, 200 underwent D2 radical resection of GC and didn′t undergo neoadjuvant therapy who were divided into the surgery group, 88 underwent neoadjuvant chemotherapy into the chemotherapy group, and 31 underwent neoadjuvant chemoradiotherapy into the chemoradiotherapy group. Observation indicators and evaluation criteria: comparison of postoperative pathological results among 3 groups, according to tumor staging guideline of American Joint Committee on Cancer (AJCC) (8th version) Measurement data with normal distribution were represented as ±s, comparisons among groups were analyzed using the ANOVA. Measurement data with skewed distribution were described as M (range), comparisons among groups were analyzed using the ANOVA, and pairwise comparisons were analyzed using nonparametric test. Comparisons of count data among groups were analyzed using the exact chi-square test, and pairwise comparisons were analyzed using the chi-square partition method. Results Comparison of postoperative pathological results among 3 groups: stage T0, T1a, T1b, T2, T3, T4a and T4b of T staging were respectively detected in 0, 2, 10, 24, 99, 58, 7 patients in the surgery group and 5, 1, 2, 11, 41, 26, 2 patients in the chemotherapy group and 5, 1, 2, 8, 10, 4, 1 patients in the chemoradiotherapy group. Stage N0, N1, N2, N3a and N3b of N staging 56, 41, 34, 47, 22 patients in the surgery group and 29, 17, 27, 10, 5 patients in the chemotherapy group and 18, 10, 2, 1, 0 in the chemoradiotherapy group. Cases with and without lymphovascular invasion were respectively 124, 76 in the surgery group and 43, 45 in the chemotherapy group and 6, 25 in the chemoradiotherapy group. Total number of harvested lymph nodes, number of lymph node metastases and rate of lymph node metastasis in the surgery, chemotherapy and chemoradiotherapy groups were respectively 31 (range, 15-87), 30 (range, 15-62), 21 (range, 15-36) and 3 (range, 0-39), 2 (range, 0-37), 0 (range, 0-7) and 9.2% (range, 0-91.3%), 7.7% (range, 0-78.7%), 0 (range, 0-30.4%). There were statistically significant differences in the T staging, N staging, with and without lymphovascular invasion, total number of harvested lymph nodes, number of lymph node metastases and rate of lymph node metastasis among groups (χ2=35.799, 32.489, 21.076, Z=27.120, 22.088, 16.947, P 0.05) . There were statistically significant differences in the N staging, with and without lymphovascular invasion, total number of harvested lymph nodes, number of lymph node metastases and rate of lymph node metastasis between chemotherapy group and chemoradiotherapy group (χ2=14.027, 8.313, P 0.05). Conclusion Neoadjuvant chemoradiotherapy could reduce the total number of harvested lymph nodes and number of lymph node metastases after radical resection of proximal locally advanced GC. Key words: Gastric neoplasms; Proximal gastric cancer; Radical resection; Neoadjuvant chemotherapy; Neoadjuvant chemoradiotherapy; Lymph nodes harvested

Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study

PurposeIn spite of the unique advantages of minimally invasive treatment, laparoscopic surgery is not recommended in T4 colon cancer patients with the concern of technical feasibility and suboptimal oncologic outcomes. We used the database of our center to reevaluate laparoscopic surgery's value in T4 colon cancer and compared with open surgery in both short- and long-term outcomes. MethodsWe conducted a retrospective and propensity score-matched study of pathological T4 colon cancer patients who received laparoscopic surgery or open surgery from March 2011 to August 2015. ResultsA total of 411 pathological T4 colon cancer patients were identified. Propensity score matching (PSM) resulted in 86 patients in laparoscopic group and 86 patients in open group. Our study showed longer operation time, less blood loss and less length of postsurgical stay compared with open surgeries (167 ± 56 min vs. 111 ± 50.1 min, P < 0.001; 72 ± 61.5 mL vs. 113 ± 113.9 mL, P = 0.004; 7.3 ± 2.1 days vs. 7.9 ± 2.1 days, P = 0.046, respectively). 7 (8.2%) patients underwent conversions to open surgery. 5-years of DFS and OS showed no statistic difference between the two groups. The 1-, 3-, and 5-years OS rates were 89.4%, 77.5% and 73.2% for laparoscopic surgery and 95.2%, 82.7% and 73.9% for open surgery (P = 0.618). The 1-, 3-, and 5-years OS rates were 89.5%, 77.2% and 61.7% for laparoscopic surgery and 91.7%, 75.3% and 66.8% for open surgery (P = 0.903). ConclusionOur analysis demonstrates that there is no statistic difference in short- and long-oncologic outcomes in our center and it is a reliable evidence to support the clinical application of laparoscopic surgery in T4 colon cancer patients. Still, considering the lack of randomized controlled trails, conducting large prospective multi-center population-based studies is not only required, but also pressing.

Incidence of end-stage renal disease following bariatric surgery in the Swedish Obese Subjects Study.

BackgroundObesity is a major public health problem leading to co-morbidities such as diabetes, hypertension and kidney failure. Bariatric surgery results in pronounced and maintained weight loss and prevention of obesity-related diseases and their complications. Most studies of bariatric surgery on kidney disease show improvements after surgery. However, long-term studies analyzing hard end-points are lacking. Here we report on the long-term effects of bariatric surgery compared to usual obesity care on incidence of end-stage renal disease (ESRD) alone and in combination with chronic kidney disease stage 4 (CKD4/ESRD).Methods4047 patients were included in the Swedish Obese Subjects (SOS) study. Inclusion criteria were age 37–60 years and BMI≥34 in men and BMI≥38 in women. Patients in the bariatric surgery group (N=2010) underwent banding (18%), vertical banded gastroplasty (69%) or gastric bypass (13%); controls (N=2037) received usual obesity care. In this analysis, patients were followed up for a median time of 18 years. The incidence of ESRD and CKD4 was obtained by crosschecking the SOS database with the Swedish National Patient Register.ResultsDuring follow-up, ESRD occurred in 13 patients in the surgery group and in 26 patients in the control group (adjusted hazard ratio (HR) = 0.27; 95% CI 0.12 – 0.60; p=0.001). The number of CKD4/ESRD events was 23 in the surgery group and 39 in the control group (adjusted HR = 0.33; 95% CI 0.18 – 0.62; p<0.001). In both analyses, bariatric surgery had a more favorable effect in patients with baseline serum insulin levels above median compared to those with lower insulin levels (interaction p=0.010). Treatment benefit of bariatric surgery was also greater in patients with macroalbuminuria at baseline compared to those without macroalbuminuria (interaction p<0.001).ConclusionsOur study showed for the first time that bariatric surgery is associated with a long-term protection against ESRD and CKD4/ESRD.

Invited commentary

This study is a retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) vascular module database. The authors compared the 30-day reintervention and mortality rates after endovascular aneurysm repair (EVAR) and open repair for 5877 abdominal aortic aneurysms (AAAs). Surprisingly, the 30-day reintervention rate was higher after open repair than after EVAR. Also, reintervention was associated with a 12 times higher mortality after either procedure. There have been a number of large-scale randomized controlled trials comparing open repair vs EVAR, but most are outdated and have not investigated the 30-day reintervention rate and its impact on mortality; therefore, this study provides valuable and updated information. In this study, even though the authors have selected only infrarenal AAA and have not included juxtarenal and pararenal AAAs, and although the open group patients were younger than the EVAR group, it is likely that the open group consisted of AAAs including those with shorter proximal neck, concomitant aortoiliac occlusive disease, shaggy aorta, and angulated anatomy, all of which make EVAR difficult. Because of this selection bias, it is likely that the open group consisted of more difficult AAAs, and this probably affected the poor outcome in the open group. Having said that, and despite these shortcomings, I believe that this study is bright news for EVAR technology, for which confidence had somewhat been lost following publication of the long-term results of the EVAR 1 trial.1Patel R. Sweeting M.J. Powell J.T. Greenhalgh R.M. EVAR trial investigatorsEndovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomized controlled trial.Lancet. 2016; 388: 2366-2374Abstract Full Text Full Text PDF PubMed Scopus (600) Google Scholar The current study confirms that with modern devices and improved techniques, EVAR can be performed with extremely low mortality, open conversion, and early reintervention rate. On the contrary, this study showed an alarmingly high reoperation rate after open repair, even considering the aforementioned selection bias. This may be due to deterioration of open AAA repair training and performance, something that we have been concerned about since EVAR became the first-line treatment and the number of open repairs decreased dramatically. This alarming finding has been confirmed in a recent international study, and this observation appears to be real.2Budtz-Lilly J. Venermo M. Debus S. Behrendt C.A. Altreuther M. Beiles B. et al.Assessment of international outcomes of intact abdominal aortic aneurysm repair over 9 years.Eur J Vasc Endovasc Surg. 2017; 54: 13-20Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar The study also showed that reoperation was higher in patients who underwent open repair, those who had larger AAAs, and those with hypertension and chronic kidney disease. These data should be considered to further improve the care of AAAs, which is exactly the goal of the NSQIP program. In summary, although this study is retrospective and nonrandomized and suffers from selection bias, it represents modern AAA practice in the United States and shows progressively improving EVAR outcome and, on the contrary, dwindling and deteriorating open repair, something that the vascular surgeons need to take seriously. I would like to thank the NSQIP program and the authors for providing us valuable information that has pointed out what we need to do to improve the overall care of AAAs. The opinions or views expressed in this commentary are those of the authors and do not necessarily reflect the opinions or recommendations of the Journal of Vascular Surgery or the Society for Vascular Surgery. Early reintervention after open and endovascular abdominal aortic aneurysm repair is associated with high mortalityJournal of Vascular SurgeryVol. 67Issue 2PreviewAlthough reinterventions are generally considered more common after endovascular aneurysm repair (EVAR) than after open surgical repair (OSR), less is known about reintervention in the early postoperative period. Furthermore, there are few data regarding the impact of early reintervention on 30-day mortality. We sought to evaluate the rates and types of reintervention after abdominal aortic aneurysm (AAA) repair and the impact of reintervention on postoperative mortality. Full-Text PDF Open Archive

Primary Surgery Compared to Post Chemotherapy Surgery for Patients with Locally Advanced Breast Cancer

Purpose: To compare primary surgery and surgery after neoadjuvant chemotherapy (NCT) in locally advanced breast cancer (LABC) patients. Methods: Between January 2011 & December 2015, 112 patients with LABC were treated at KAAH & OC-Jeddah-KSA, Of whom 42 were treated by NCT followed by surgery either mastectomy or conservative surgery, then adjuvant chemotherapy and radiotherapy. The rest patients (70) were treated by primary surgery (mastectomy or conservative resection) and followed by adjuvant chemotherapy and radiotherapy. All patients received adjuvant antiestrogen. Patients were followed for a median duration of 33 months. Disease-free survival (DFS) and overall survival (OAS) were studied for all patients, compared between both groups and related to the extent of surgery and menopausal status. Results: median age was 46.5 years for all patients; 48 years, and 46 years for NCT and primary surgery groups respectively. Median DFS was 15 months for all patients, 16 & 15 months for NCT and primary surgery groups. Median OAS was 24 months for all patients, 22 & 24 months for NCT and primary surgery groups. Difference in DFS & OAS were highly significant in favour of postmenopausal patients (p = 0.05 for DFS & p = 0.03 for OAS) while in primary surgery group the differences between pre and postmenopausal patients in DFS & OAS were statistically insignificant (p = 0.4). NCT followed by surgery group patients showed significant improvement in DFS & OAS in patients performed conservative surgery while in primary surgery group the difference was insignificant. Freedom of disease was seen in 28.6% in the NCT group and 37.1% for the primary surgery group. Conclusion: Surgery post-neoadjuvant chemotherapy neither prolongs DFS nor OAS in comparison with primary surgery followed by adjuvant chemotherapy. Postmenopausal patients felt much better than premenopausal patients regarding DFS & OAS.