Open Group Research Articles

Outcomes of Resectable Locally Advanced Non-Small Cell Lung Cancer After Neoadjuvant Chemoimmunotherapy: A Single Institution Experience

Introduction: Immunotherapy has revolutionized the treatment for locally advanced resectable non-small-cell lung cancer (NSCLC). In clinical trials, the combination of neoadjuvant immunotherapy and chemotherapy has resulted in a higher rate of pathologic complete response in comparison with neoadjuvant chemotherapy alone. Our study aims to describe surgical and oncological outcomes after neoadjuvant chemoimmunotherapy and lung resection at our academic center outside clinical trials. Methods: We retrospectively analyzed 54 patients who received neoadjuvant chemoimmunotherapy and underwent surgical resection from 2018 to 2024. Demographics, pre-operative systemic treatment, surgical approach and postoperative outcomes were evaluated. Results: The median age was 65 years, 46% were female, and 67% of patients had a non-squamous histology, chiefly adenocarcinoma. The most common clinical stage was IIIA (54%). Major findings include a 41% pathologic complete response (pCR) and 52% major pathologic response (MPR) rate. Neoadjuvant chemoimmunotherapy resulted in downstaging in 78% (n = 42) of patients. Most patients (83%) had their operation completed robotically. R0 resection was achieved in 96%. Median length of stay was significantly shorter after robotic operations, with no significant difference in complications compared to the open group. At a median follow up of 16 months, 24 months of recurrence-free survival was estimated at 76% (95% CI: 61–94) and overall survival, 93% (CI: 84–100). Conclusion: At our medical center, induction chemoimmunotherapy followed by anatomic lung resection has resulted in a high rate of complete pathologic response, overall survival and recurrence-free survival. The robotic approach after induction chemoimmunotherapy is safe and associated with shorter length of stay and faster recovery time.

Comparing Open and Robotic Unilateral Transversus Abdominis Release in Incisional Hernias With a Lateral Component: A Single Center Retrospective Study

IntroductionLateral hernias are often more challenging to correct when compared to midline defects, due to the anatomic boundaries of the bony pelvis, retroperitoneum, and costal margin. With the insurgence of robot assisted abdominal wall surgery, these defects have been found more manageable through a minimal invasive repair. In this study, we aim to present our short-term results of incisional hernia repair with a lateral component requiring a unilateral transversus abdominis release, through open surgery versus robot assisted.MethodsA retrospective analysis was performed of our robotic and open abdominal wall repairs of lateral hernias, where a unilateral transversus abdominis release was performed, between January 2017 and December 2023. Patient, hernia and perioperative details are reported.Results54 patients in the open group versus 10 patients in the robotic group were included. Hernia width and hernia surface area were higher in the open group, but not significant. Operation time was similar between open and robotic procedures. In-hospital complications, surgical site infection and clinical seroma rate during the first 30 postoperative days were similar in both groups. There was a clear difference in length of stay, in favor of the robotic group.DiscussionIn our limited series, a robotic approach seems safe and feasible when faced with large lateral hernias. Short-term results show a shorter length of stay using the robotic approach, with no significant difference in short term complications, specifically SSI-rate. However, conclusions are limited due to the low number of patients and additional studies should be performed to account for long term recurrence and increase included patient number.

Advantages of Robotic Total Mesorectal Excision With Partial Prostatectomy Compared With Open Surgery for Rectal Cancer: A Single-Center Retrospective Cohort Study.

Robotic total mesorectal excision (TME) with resection of adjacent organs has been increasingly used for locally advanced rectal cancer; however, few studies have focused on robotic TME with partial prostatectomy. Therefore, this study aimed to demonstrate the advantages of robotic TME with partial prostatectomy compared with open surgery for rectal cancer. This retrospective cohort study examined consecutive patients with rectal cancer who underwent robotic or open TME with partial prostatectomy at a high-volume center in Japan from April 2003 to March 2022. The patients were divided into robotic (n = 14) and open (n = 11) surgery groups. The short- and long-term outcomes of these patients were compared. More transabdominal partial prostatectomies were performed in the robotic surgery group than in the open surgery group (71.4% vs. 9.1%, p = 0.001). Moreover, sphincter-preserving surgery was performed in 35.7% of patients in the robotic surgery group. The robotic surgery group had shorter operative times (401 min vs. 435 min, p = 0.047), less blood loss (56 mL vs. 484 mL, p < 0.001), lower complication rates (28.6% vs. 72.7%, p = 0.047), and shorter postoperative hospital stays (8 days vs. 18 days, p < 0.001) than the open surgery group. No significant differences were observed in the positive radial margin rate (7.1% vs. 9.1%, p = 1.000) or long-term outcomes between the two groups. Compared with open surgery, robotic TME with partial prostatectomy facilitates transabdominal partial prostatectomy, resulting in more sphincter-preserving surgeries and better short-term outcomes.

Multi-Institutional Comparison of Quality of Life Between Open Versus Endoscopic Skull Base Approaches.

The primary objective of this prospective review was to compare quality of life between patients undergoing endoscopic and open skull base approaches. Prospective Review. Five centers recruited consecutive patients treated surgically for skull base neoplasms between 2012 to 2018. The Skull Base Inventory (SBI), Anterior Skull Base (ASB), and Sinonasal Outcome Test (SNOT-22) were administered up to 12 months post-operatively. Mean change from baseline scores were compared with univariable and multivariable analyses. A total of 180 patients were included: 108 (60%) F and 72 (40%) M, of whom 126 (70%) underwent endoscopic and 54 (30%) underwent open approaches. Patients undergoing endoscopic approaches were more likely to have sellar or clival pathology (68 vs. 15%, p < 0.001). Those undergoing endoscopic approaches had better disease-specific quality of life at one year using the SBI and ASB (mean change from baseline = 7.2 vs. 0.69, p = 0.004; 5.8 vs. -1.1, p = 0.002), respectively. On multivariable analysis, endoscopic approach was associated with greater improvement in overall quality of life (mean difference in change scores from baseline = 6.5, p = 0.009), as well as endocrine (mean difference = 8.3, p = 0.011), neurologic (mean difference = 8.3, p = 0.012), visual (mean difference = 7.9; p = 0.032), financial (mean difference = 9.7, p = 0.03), and spiritual domain scores (mean difference = 4.0, p = 0.035). Subgroup analyses of pituitary and non-pituitary histopathologies demonstrated trends towards greater quality of life at 1-year compared to baseline in the endoscopic approach compared to the open group. Endoscopic approaches are associated with better quality of life compared to open approaches. However, baseline differences in histopathology between the group limit the direct comparison of the open and endoscopic approaches. Future studies with larger and more homogenous samples are required. Level IV evidence.

Clinical predictors of surgical selection for individuals with neck pain

BackgroundNeck pain is one of the leading causes of disability in the United States. However, the nature of cervical spine surgery is multi-factorial and often based upon clinical opinions, leaving clinical indications still to be clearly defined. ObjectiveTo predict which clinical variables most influenced trends toward surgical or conservative management for individuals with neck pain. DesignRetrospective analysis on prospectively collected data. MethodsTwo-hundred seventy individuals participated in the study. A retrospective chart review was performed to identify qualifying participants. Variables captured during data collection included the following: patient demographic information, physical examination (e.g., neurologic examination), physical performance measures, patient-reported outcome measures (Numeric Pain Rating Scale and Neck Disability Index), and chronicity of symptoms. Group allocation was determined by referring physician’s medical diagnosis. A forward step-wise multiple logistic regression analysis was used to develop a final predictor model with p<0.05 considered significant. ResultsThe model showed older age (beta=0.022; Exp(beta)=1.022; p=0.037), longer chronicity of symptoms (beta=0.000; Exp(beta)=1.000; p=0.012), and greater neck disability (beta=0.027; Exp(beta)=1.028; p<0.001) were significant predictors of the operative group. Most notably, patients with a positive neurologic examination were almost four times more likely to be referred to surgery (beta=1.368; Exp(beta)=3.927; p<0.001). ConclusionIn general neck pain patients, older age, longer chronicity of symptoms, greater disability, and a positive neuro exam are clinical predictors of surgical selection, with positive neuro exam increasing the likelihood of surgery four-fold.

Effectiveness of open glottis during second stage of labor on maternal and neonatal outcome among primigravid women- A quasi-experimental study.

This study evaluated the effectiveness of the open glottis breathing technique during the second stage of labor among 600 primigravida women, randomly assigned to either an open glottis group (n=300) or a closed glottis group (n=300). Participants in the open glottis group received training via 3D animated videos. Results demonstrated a significant impact on perineal integrity, with 20.7% of women in the experimental group reporting an intact perineum compared to just 1.7% in the control group. Additionally, the open glottis group experienced shorter labor durations and a decrease in severe neonatal asphyxia, as indicated by improved APGAR scores compared to the closed glottis group. Statistical analysis using the χ² test revealed a highly significant difference in perineal conditions between the two groups, with a χ² value of 65.7 (p < 0.000). The study also identified a significant association between maternal age, residence, and income with the reduction of perineal tears (p < 0.000). Overall, the findings suggest that the modified open glottis breathing technique effectively prevents perineal trauma, shortens the duration of the second stage of labor, and enhances neonatal outcomes. These results highlight the potential benefits of integrating this technique into labor management practices to improve maternal and neonatal health.

Combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament Reconstruction with Semitendinosus Allograft for Pediatric Patients with First-Time Patella Dislocation Yields Low Failure Rates and Improved Functional Outcomes Compared to Non-Operative Treatment.

The purpose of this cohort study is to evaluate the clinical outcomes of non-operative versus operative treatment, consisting of combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament (MPFL/MQTFL) reconstruction, for first-time patellar dislocation in the skeletally immature population through a standardized, rigorous approach. This consecutive retrospective cohort is comprised of all skeletally immature patients that sustained a first-time patellofemoral dislocation. Patients were grouped into non-operative management (bracing and physical therapy) and operative management (MPFL/MQTFL reconstruction) cohorts. The primary outcome, failure, was defined as subsequent dislocation or subluxation. Additional outcomes included demographics, risk factors for patellofemoral instability, functional outcomes (Kujala and IKDC scores), return to sports, and complications. Minimum follow up was 2 years. A correlation analysis attempted to identify potential associations between failure and risk factors. 142 consecutive patients were included with 90 patients in the non-operative and 52 patients in the operative group. Failure rates differed by intervention; those receiving operative management had significantly lower failure rates than conservative management (15.4% versus 58.8%, p<.0001). Kujala and IKDC scores were significantly higher in the operative group, as compared to the non-operative group (91.5±7.8 versus 82.5±12.1, p<.0001 and 89.0±9.3 versus 78.4±12.9, p<.0001, respectively). Tegner activity level was also higher at the operative group (6.0±1.4 versus 4.0±1.4, p<.0001). Return to sport was significantly greater for those in the operative group (88.5% versus 66.2%, p<.001). Return to same level of activity was achieved in higher percentage of patients treated surgically (91.3% versus 69.6%, p=0.0075). Complication rates were more frequent in the operative group compared to the non-operative group (11.5% versus 1.1%, p<.001). MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up, as compared to non-operative management. III.

Psychological burden in patients with sellar masses under conservative and surgical management

The aim of this study was to investigate the level of distress and the quality of life of operated and non-operated patients with pituitary tumors. Patients who presented to a neurosurgical center and two endocrinological services for outpatient follow-up after surgical treatment, as well as those under medical therapy or radiological follow-up without treatment, were invited to participate in the study. Sociodemographic, health-related quality of life and clinical data were assessed. Psychosocial factors were measured using the Distress Thermometer (DT), the Hospital Anxiety and Depression Scale (HADS), the Short Form (SF-36), and the Sino-nasal outcome test (SNOT). Thirty-two postoperative patients and thirty conservatively managed patients (n = 21 under medical treatment, n = 9 watch and wait), mean age 53, SD 19; 56% female participated in the study. Prolactinomas (35%) and non-functioning pituitary adenomas (21%) were the most common findings. There were no significant differences between conservative and operative groups in mean DT score (4.7 (SD 2.45) vs. 4.9 (SD 3.0), p = 0.61), HADS anxiety score (6.4 (SD 3.9) vs. 6.0 (SD 4.3), p = 0.76) or depression score (5.7 (SD 4.8) vs. 4.6 (SD 3.6), p = 0.50). For patients with ACTH-producing adenomas, the mean anxiety score was significantly higher (10.3 (SD 1.9) vs. 5.9 (SD 4.0), p = 0.03). The SNOT score correlated significantly with the DT, HADS-A, and HADS-D scores and therefore was associated with higher psychological distress. The level of self-reported distress in patients with sellar processes was not associated with a specific treatment strategy. ACTH-producing adenomas and manifest nasal symptoms were associated with higher psychological distress.

Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features.

Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population. (1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors. Cross-sectional study; Level of evidence, 3. A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged <18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05. The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm2 vs 126 ± 109 mm2; P < .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P < .001). Patellar and femoral osteochondral fractures were >100 mm2 in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle-trochlear groove distance <20 mm (P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group (P = .027). We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.

Return to work after proximal humeral fractures: a single center study comparing conservative versus operative treatment.

Adequate treatment of proximal humeral fractures (PHF) is essential for restoring shoulder function and expediting return-to-work (RTW). This study aims to assess the impact of conservative and operative treatments on RTW and PHF recovery. In a retrospective case-control study, 858 patients (aged 18-68) treated for PHF between 2018 and 2021 were included. Questionnaires were sent to 342 operatively treated patients (Operative group (OG)) and 191 conservatively treated matched controls (Conservative group (CG)). Assessments covered RTW, functional outcomes (DASH, ASES), and quality of life (EQ-5D). A Kaplan-Meier analysis explored RTW in weeks. With a 61% response rate, 73 eligible participants (40 OG, 33 CG) contributed. Of respondents, 67.1% were female, and 60% were employed pre-trauma. Almost 70% of employed patients RTW, with no significant difference between groups (log rank, p=0.36). Among those returning to work, OG tended to resume 4 weeks later than CG (OG 10.5, IQR 22 vs.CG 6.00, IQR 8 weeks, p=0.07). DASH, ASES, and quality of life VAS scores showed no statistical difference between groups (p=0.542, p=0.257, p=0.530, respectively). The RTW proportion did not differ between operatively and conservatively treated PHF patients, though the former tended to return 4 weeks later. Functional outcomes demonstrated no significant differences. Further adequately powered studies are necessary to establish a standardized aftercare protocol for PHF, enhancing patient care and minimizing work disability.

C60 fullerene improves the contractile activity of the injured rat muscle gastrocnemius

The powerful antioxidant properties of C60fullerenes have been widely used in biomedical nanotechnology. Owing to the negative effects of free radicals in oxidative stress processes, antioxidants are required to protect injured muscles. Here, the effect of water-soluble C60fullerenes (daily oral dose 1 mg kg-1) on the process of restoration of contractile activity of skeletal muscle of rats (muscle gastrocnemius) 15 d after the initiation of open trauma of different severity was studied for the first time. The structural organization of C60fullerene nanoparticles in aqueous solution was analyzed by dynamic light scattering and atomic force microscopy techniques. Such biomechanical parameters ofmuscle gastrocnemiuscontraction as integrated muscle power, levels of generation of its maximum and minimum force, and time interval until reaching 50% of the level of force response of the muscle were analyzed. Such biochemical indices as concentrations of c-reactive protein, creatinine, and lactate in the rat blood, as well as indices of pro- and antioxidant balance (activities of superoxide dismutase and catalase, the concentration of reduced glutathione) in the blood and muscle tissue of experimental animals, were investigated. It was found that application of water-soluble C60fullerenes statistically significantly improves biomechanical parameters of contraction of injuredmuscle gastrocnemiusat the level of 30-45 ± 3%, which is confirmed by normalization of biochemical indices in the blood and muscle tissue of rats at the level of 35-50 ± 3% and 20-37 ± 3%, correspondingly, relative to the open injury group. These findings open the possibility of using C60fullerenes as potential therapeutic nanoagents capable of correcting pathological states of the muscular system during the physiological repair of open injuries.

Clinical Variables Associated with Lymphedema Surgery: Physiologic versus Excisional.

As surgical interventions for lymphedema become increasingly available, it is important to understand characteristics of patients that undergo lymphedema surgery. The goal of this study was to define clinical variables of patients evaluated at a medical center who underwent lymphedema surgery to better inform which referred patients are surgical candidates. A cross-sectional observational study was performed on patients referred to plastic surgery for lymphedema between January 2016 and June 2023. The operative group included patients who underwent lymphedema surgery, including physiologic surgery (PS) and excisional surgery (ES). The nonoperative group consisted of patients referred for lymphedema who did not undergo lymphatic surgery. Patient records were collected, and between-group comparisons were performed. A total of 285 total patients were identified (n = 66 operative, n = 219 nonoperative). The operative cohort had higher body mass index (BMI) than the nonoperative (33.5 vs. 31.2 kg/m2, p < 0.035) and was more likely to have undergone physical therapy/occupational therapy (68.2 vs. 53.4%, p = 0.005). Within the operative cohort (PS = 37, ES = 29), PS patients were more likely to be White (91.9 vs. 69.0%, p = 0.043) and have lower BMI (32 vs. 42.7 kg/m2, p = 0.007). PS patients were diagnosed for a longer period (8 vs. 3 years, p = 0.03) before seeing a plastic surgeon, more commonly had upper extremity lymphedema (43.2 vs. 13.8%, p = 0.016) and presented at an earlier lymphedema stage (stage 1 64.9 vs. 27.6%, p = 0.002). PS patients were more likely to have prior radiation (56.8 vs. 20.7%, p = 0.005), previous surgery (75.5 vs. 48.3%, p = 0.038), and prior lymphatic intervention (67.6 vs. 17.2%, p < 0.001) near the affected area. Defining patient characteristics associated with surgical intervention for lymphedema can aid surgeons to increase the proportion of patients seen in clinic who are surgical candidates. Factors relating to oncological and surgical history in the affected area may suggest a patient is more likely to undergo PS.

A comparative study of the effect of capsular repair in the Latarjet procedure

BackgroundLong term studies have shown the Latarjet procedure to be successful in preventing re-dislocation in primary and recurrent anterior inferior shoulder instability. It provides stability through the sling effect of the conjoint tendon and the bone block. It is unclear whether augmentation with capsular repair provides an added benefit or leads to restricted range of external rotation. The primary aim of this study is to evaluate the effect of capsular repair in the open Latarjet procedure on rotational range of active external rotation in 90 degrees abduction (RoM-ER90). The secondary aim is to evaluate the effect on clinical outcomes including post-operative apprehension, instability, proprioception and shoulder function scores.MethodsThis is a multi-national retrospective cohort study including patients with a minimum of 6-months follow-up post Latarjet procedure performed between 2016 and 2020 recruited from 3 units in Australia and France. Range of motion was measured using a Proteck goniometer. Clinical outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI), Oxford shoulder, Oxford instability, Walch-Duplay and Rowe scores. Shoulder proprioception was assessed by the active relocation test described by Glendon et al.ResultsForty-four patients were included, median age was 29.5 years and 91% male. Three groups were assessed, open latarjet with no capsular repair (OL n = 11), open latarjet with capsular repair (OLCR n = 20), and arthroscopic Latarjet without capsular repair (AL n = 13). There was no apparent effect of capsular repair on the ROM-ER 90 in the open groups with a median (interquartile range) of 78° (72°, 90°) for OL and 84° (75°, 90°; P = 0.87) for OLCR groups. Capsular repair and arthroscopic approach did not affect the proportion of patients reporting shoulder apprehension (P = 0.52 and 0.48 respectively). There was no difference in proprioception between operative and non-operative sides for the OL group (P = 0.43). Proprioception was poorer on the operative side for the OLCR group (P = 0.04) but better on the operative side for the AL group (P = 0.08). WOSI scores for the open surgical groups were similar (OL = 78, OLCR = 80, P = 0.91) and when combined (median WOSI = 79) demonstrated greater stability than the AL group (P = 0.009). There was no evidence of an effect of capsular repair or arthroscopic approach on the Walch-Duplay, Oxford Instability, or Rowe scores.ConclusionsThere is no significant difference in ROM-ER 90 or WOSI score in patients who undergo the Latarjet procedure with and without capsular repair. The arthroscopic Latarjet may preserve proprioception but did not improve shoulder stability compared to the open Latarjet.Level of evidenceIII, retrospective cohort study.

Comparison of short-and long-term outcomes between endovascular and open repair for descending thoracic aortic aneurysm: a systematic review and meta-analysis.

This systematic review and meta-analysis aimed to evaluate and compare the efficacy of endovascular versus open repair for the treatment of patients with descending thoracic aortic aneurysm (DTAA). A systematic search of the PubMed, Embase, and Cochrane Library databases for relevant studies was performed. Outcome data, including postoperative mortality and morbidity, operative details, all-cause survival, freedom from aortic-related survival and freedom from aortic-related re-intervention, were independently extracted by two authors in a standardized way. Twenty-nine studies comprising 49972 patients (22049 endovascular repair; 27923 open repair) were included. Endovascular repair was associated with a significantly lower postoperative mortality rate [odd ratio (OR): 0.57, 95% confidence interval (CI): 0.45-0.72; I2=72.58%] and morbidity. In terms of long-term survival, endovascular repair yielded better freedom from aortic-related survival [hazard ratio (HR): 0.71, 95% CI: 0.54-0.93, P =0.012] but inferior freedom from aortic-related reintervention (HR: 2.10, 95% CI: 1.45-3.04, P < 0.001). Landmark analysis revealed that the open repair group experienced better all-cause survival beyond 16months (HR: 1.64, 95% CI: 1.53-1.75, P < 0.001). In addition, in the subgroup of patients with intact DTAA, those who underwent open repair exhibited a higher rate of postoperative mortality (OR: 0.58, 95% CI: 0.38-0.88; I2=83.34%) but had better all-cause survival beyond 7months (HR: 1.72, 95% CI: 1.61-1.84, P < 0.001) than those who underwent endovascular repair. Among patients treated for DTAA, endovascular repair was associated with better freedom from aortic-related survival, a lower risk for postoperative mortality and morbidity, and shorter lengths of intervention, intensive care unit stay, and hospital stay than those who underwent open repair. Open repair yielded significantly better long-term all-cause survival and freedom from aortic-related re-intervention than endovascular repair.

Short-term outcomes of open versus laparoscopic surgery in patients with metachronous colorectal cancer

BackgroundFew studies have assessed the safety and efficacy of laparoscopic surgery in patients with metachronous colorectal cancer (MCRC). This study aims to evaluate the safety and outcomes of laparoscopic surgery in MCRC patients who have previously undergone colorectal cancer surgery.MethodsWe compared the short-term outcomes of open versus laparoscopic surgery in patients with MCRC between October 2007 and October 2022.ResultsAmong the 59 MCRC patients, 25 underwent laparoscopic surgery, whereas 34 received open surgery. The proportion of patients who underwent prior open surgeries was significantly greater in the open group than in the laparoscopic group (91.2% vs. 24.0%, p < 0.001). Three patients (12.0%) in the laparoscopic group required conversion to laparotomy due to severe intra-abdominal adhesions, all of whom had a history of open surgery for colorectal cancer. Compared to the open surgery group, the laparoscopic group presented significantly less estimated blood loss (56.80 ± 115.47 vs. 136.47 ± 158.61 ml, p = 0.038), a shorter time to the first flatus (2.20 ± 0.76 vs. 3.50 ± 0.62 days, p < 0.001), a shorter time to the first stool (2.92 ± 0.64 vs. 4.32 ± 0.64 days, p < 0.001), and a shorter postoperative hospitalization duration (7.24 ± 2.42 vs. 10.79 ± 3.50 days, p < 0.001).ConclusionLaparoscopic surgery for MCRC patients is a safe and less invasive alternative to open surgery, resulting in reduced estimated blood loss, faster recovery of bowel function, and shorter postoperative hospitalization.

Alveolar Bone Quality in Individuals With Cleft Lip and Palate With Missing Lateral Incisors: Orthodontic Space Closure Versus Space Opening.

The purpose of this study was to quantitatively assess the alveolar bone support of teeth adjacent to the cleft site in individuals with nonsyndromic cleft lip and palate (CLP) who have undergone either orthodontic space closure or space opening for missing lateral incisors. A cross-sectional retrospective study. University orthodontic clinic serving individuals with CLP. Twenty-eight individuals with nonsyndromic CLP who were missing lateral incisors divided into 2 groups: space closure (21 subjects) and space opening (7 subjects). Orthodontic space closure or space opening for replacement of missing lateral incisors in individuals with nonsyndromic CLP. Buccal and palatal alveolar bone thickness were measured at 5 mm and 10 mm above the cementoenamel junction (CEJ) for cleft-adjacent central incisors and canines. Additionally, buccal, lingual, and proximal alveolar bony coverage ratio on cleft-side central incisors and canines were recorded. No significant differences were observed in alveolar bone thickness and bony coverage between the space closure group and the space opening group, except for the buccal thickness 5 mm above the CEJ, which was thinner in the space closure group. The overall alveolar bone support in the grafted alveolus in both the space closure and space opening groups were comparable.

Comparison between minimally invasive surgery and open surgery in managing localized adrenocortical carcinoma treatment: Aretrospective propensity-matched study.

It was controversial to use open surgery or minimally invasive surgery (MIS) for adrenocortical carcinoma (ACC). This retrospective study aimed to evaluate the impact on prognosis between MIS and open surgery in patients with clinical stage I-II ACC. Patients with stage I-II ACC from December 2000 to October 2022 were retrospectively studied. The primary endpoint was recurrence-free survival time calculated by the Kaplan-Meier curves. In total, 95 patients were enrolled in this study (50 open surgery and 45 MIS). Propensity score matching identified 32 matched pairs of patients. Compared with the open surgery group, the MIS group had a shorter median operative time (150.0 vs. 120.0 min, p = 0.014), the lesser median volume of intraoperative blood loss (200.0 vs. 60.0 mL, p = 0.006), lower incidence of postoperative complications (59.4% vs. 28.1%, p = 0.023), and shorter median postoperative length of hospital stay (8.0 vs. 7.0 days, p = 0.001). After a median follow-up time of 20.5 months, no significant differences were observed in the local recurrence rate (62.5% vs. 78.1%), distant metastasis rate (15.6% vs. 6.3%), and median time to recurrence (15.0 vs. 20.0 months) between the two groups. The median recurrence-free survival time between the open surgery and MIS groups did not significantly differ (16.0 vs. 21.0 months). MIS might be a feasible option for treating localized ACC at a high patient's volume center with experienced surgeons.

The Association of Fracture Displacement and Surgical Intervention in Isolated Zygomatic Arch Fractures.

In the evaluation of isolated zygomatic arch (ZA) fractures, a standardized guideline for recommending operative intervention is lacking. The study purpose was to measure the association between fracture displacement and operative treatment following isolated ZA fractures. This is a retrospective cohort study identifying adult subjects with isolated ZA fractures presenting to the emergency department between September 2011 and October 2022. Subjects with non-ZA zygomaticomaxillary complex fractures or concurrent facial fractures were excluded. The predictor is maximal fracture displacement in centimeters measured on axial computed tomography imaging. The main outcome variable is operative management defined as recommendation of operative versus nonoperative intervention. Covariates collected include patient demographics; consisting of age, sex, past medical history (hypertension and diabetes); injury mechanism; social history (tobacco and alcohol use); presenting signs and symptoms (trismus, facial swelling, paresthesias, malar depression, and bony-step offs). Native overlying soft-tissue thickness was also measured on computed tomography imaging. Bivariate and multivariate statistical analyses were used to investigate differences between nonoperative and operative groups. Receiver operating characteristic curve was utilized to determine the discriminative fracture displacement for operative intervention. All statistical tests were performed with a significance level set at P<.05. The sample was composed of 86 subjects with an average age of 47.0±19.1years old. The mean fracture displacement was 0.29±0.21cm. Overall, 22 (25.6%) subjects were recommended operative intervention while 64 (74.4%) were managed nonoperatively. On bivariate analysis, mean fracture displacement was higher in the operative (0.51±0.14cm) versus nonoperative groups (0.21±0.18cm, P<.001). A significantly greater number of patients in the operative cohort presented with trismus, facial swelling and malar depression. Native soft-tissue thickness was not associated with operative intervention. On receiver operating characteristic curve analysis, the displacement that discriminated operative intervention was 0.36cm with a sensitivity of 86.4% and specificity of 81.3% (area under the curve 0.9). Isolated ZA fractures with a displacement of 0.36cm or greater are associated with operative intervention. Measurement of fracture displacement may aid in clinical decision-making.

Short- and long-term outcomes of laparoscopic versus open abdominoperineal resection for rectal cancer: A propensity score matching analysis based on 1852 cases.

Randomized studies have demonstrated that laparoscopic abdominoperineal resection is not inferior to open abdominoperineal resection for rectal cancer. Evaluate the immediate and extended results of laparoscopic abdominoperineal resection versus open abdominoperineal resection for rectal cancer. From January 2006 to December 2017, a total of 1852 patients with rectal cancer who had undergone abdominoperineal resection were enrolled in this investigation. The groups were matched in a 1:1 ratio using propensity score matching. The primary endpoints were overall survival and disease-free survival. The secondary endpoints were pathology and short-term postoperative outcomes. Compared to the open abdominoperineal resection group, the laparoscopic abdominoperineal resection group exhibited a higher rate of positive circumferential resection margins (P < 0.001) and fewer postoperative complications (P < 0.001). 5-year disease-free survival (P = 0.449) and overall survival rates (P = 0.664) were comparable. Age (P < 0.001), comorbidity (P = 0.040), (y)pT (P = 0.024), (y)pN (P < 0.001), lymphovascular invasion (P = 0.003) and positive circumferential resection margins (P = 0.014) were independent prognostic risks for overall survival. The pathological outcomes of laparoscopic abdominoperineal resection are inferior compared to open abdominoperineal resection. However, they demonstrate comparable long-term oncological outcomes, and laparoscopic abdominoperineal resection offers certain short-term advantages over the open approach.

The efficacy of open transanal drainage tube against anastomotic leakage in left-sided colorectal cancer surgery: a propensity score matching study

Background/AimThe effectiveness of a transanal drainage tube (TAT) for the prevention of anastomotic leakage after double stapling technique (DST) anastomosis in colorectal cancer has been reported. Previously, TATs had been placed and connected to drainage bags. It was considered that a higher decompression effect could be expected by inserting an open-type TAT, without connection to a drainage bag. In this study, the relation between anastomotic leakage and the application of this type of TAT in left-sided colorectal cancer surgery was investigated, using propensity score matching (PSM).Materials and methodsFrom January 2016 to July 2023, 233 consecutive patients underwent radical surgery for sigmoid colon and rectal cancers and reconstruction using DST at Osaka Metropolitan University Hospital. Patients were divided into two groups: those who had a closed TAT inserted (CLOSED group), and those who had an open TAT inserted (OPEN group).ResultsOverall, open TATs were inserted in 43 patients, and closed TATs were inserted in 190 patients. PSM was performed between the OPEN and CLOSED groups on the basis of the following 13 factors: age, sex, BMI, diabetes mellitus (DM), smoking history, modified Glasgow prognostic score (mGPS), ASA-PS, location of distal tumor edge, operative procedure, surgical approach, operative time, intraoperative blood loss, and pathological stage. The multivariate analysis of significant factors identified a BMI of 25 or more, a location of distal edge on middle to lower rectum, and a closed TAT, as independent risk factors for anastomotic leakage (HR: 8.72; p = 0.038, HR: 10.06; p = 0.034 and HR: 17.43; p = 0.033).ConclusionAn open TAT may be effective in preventing anastomotic leakage in left-sided colorectal cancer surgery.