Postoperative Morbidity Research Articles

Radical neck dissection

Radical neck dissection was originally developed as an “en bloc” lymphadenectomy technique for malignancies of the head and neck and is sometimes utilized in current management for bulky disease not otherwise amenable to preservation therapy and for salvage disease. Although the majority of neck dissections are no longer radical, optimal technique is important as is the understanding of postoperative care. Historic and current literature was reviewed in order to provide the most up-to-date descriptions and considerations when performing this operating. Surgical technique is described as well as modern indications and contraindications. Common complication and options for minimizing postoperative morbidities are discussed. While the paradigm for en bloc resection of head and neck malignancy has changed, radical neck dissection remains a useful tool in the armamentarium of the contemporary head and neck surgeon for select cases.

Extent of resection and underlying liver disease influence the accuracy of the preoperative risk assessment with the American College of Surgeons Risk Calculator

BackgroundLiver surgery is associated with a significant risk of postoperative complications, depending on the extent of liver resection and the underlying liver disease. Therefore, adequate patient selection is crucial. This study aimed to assess the accuracy of the American College of Surgeons Risk Calculator (ACS-RC) by considering liver parenchyma quality and the type of liver resection. MethodsPatients who underwent open or minimally invasive liver resection for benign or malignant indications between January 2019 and March 2023 at the University Hospital Basel were included. Brier score and feature importance analysis were performed to investigate the accuracy of the ACS-RC. ResultsA total of 376 patients were included in the study, 214 (57%) who underwent partial hepatectomy, 89 (24%) who underwent hemihepatectomy, and 73 (19%) who underwent trisegmentectomy. Most patients had underlying liver diseases, with 143 (38%) patients having fibrosis, 75 patients (20%) having steatosis, and 61 patients (16%) having cirrhosis. The ACS-RC adequately predicted surgical site infection (Brier score of 0.035), urinary tract infection (Brier score of 0.038), and death (Brier score of 0.046), and moderate accuracy was achieved for serious complications (Brier score of 0.216) and overall complications (Brier score of 0.180). Compared with the overall cohort, the prediction was limited in patients with cirrhosis, fibrosis, and steatosis and in those who underwent hemihepatectomy and trisegmentectomy. The inclusion of liver parenchyma quality improved the prediction accuracy. ConclusionThe ACS-RC is a reliable tool for estimating 30-day postoperative morbidity, particularly for patients with healthy liver parenchyma undergoing partial liver resection. However, accurate perioperative risk prediction should be adjusted for underlying liver disease and extended liver resections.

Gamma-knife radiosurgery for jugular foramen schwannomas. A systematic review and meta-analysis

IntroductionJugular Foramen Schwannomas (JFS) have been traditionally treated with surgical resection with an associated significant post-operative morbidity. Stereotactic radiosurgery has been investigated as potentially minimally invasive alternative to microsurgery. The aim of this study was to provide a systematic review and meta-analysis of the available literature regarding the outcomes of cases of JFS treated with radiosurgery. MethodsA literature review until 28th of March 2023 was performed. All studies looking at the outcomes of radiosurgery for the treatment of JFS were included. Studies including non-vestibular schwannomas without clear distinction of the tumour type were excluded. Risk of bias was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scale. ResultsEight (8) studies with a total of 375 patients met the inclusion and exclusion criteria and were included in the analysis. Pooled overall tumour control rate was 93.2 % (95 % CI 89.8–96.6) after a weighted mean follow-up of 54.07 months (95 % CI 46.8–61.3). Patient free survival was reported only in 4 studies and ranged from 87 % to 97 % and 76.9–93.8 % in 5 and 10 years respectively. The radiation induced cranial nerve deficits rates after GKRS were 3.6 % (95%CI 1.7, 5.5 %). ConclusionAccording to our findings, radiosurgery for JFS has favourable clinical outcomes with a high rate of long-term tumour control and low complication rates.

Transcervical Endoscopic Esophageal Mobilization: An Approach to Transhiatal Esophagectomy

BackgroundTranscervical endoscopic esophageal mobilization (TEEM) is an approach to transhiatal esophagectomy that aims to minimize blood loss and decrease the operative time commonly associated with traditional transhiatal technique. MethodsA retrospective chart review was conducted on patients who underwent TEEM esophagectomy between 2009 and 2020. Baseline characteristics, perioperative outcomes, and postoperative complications were recorded. To report survival, a Kaplan-Meier survival plot was developed using SAS software (SAS Institute). ResultsA total of 241 patients underwent TEEM esophagectomy. The mean operative time was 185.1 ± 59.3 minutes, blood loss was 251.4 ± 212.3 mL, the number lymph nodes dissected was 13.6 ± 6.2, and the length of stay was 11.9 ± 8.5 days. In the postoperative setting, 68 (28.2%) patients experienced hoarseness, 62 (25.7%) had postoperative atrial fibrillation, 30 (12.4%) had an anastomotic leak, and 12 (4.6%) experienced chylothorax. The overall 30- and 90-day mortality rates were 2.1% (5 of 241) and 4.6% (11 of 241), respectively. The median overall survival was 2.36 years, with 60% 3-year survival and 40% 5-year survival. ConclusionsTEEM esophagectomy is a safe approach with acceptable postoperative morbidity and mortality and shorter operative times compared with historical norms.

492. OUTCOMES OF ESOPHAGECTOMY IN THE ELDERLY- IS IT WORTH THE EFFORT?

Abstract Background Esophageal cancer is the sixth most common cancer in India and most patients are diagnosed at locally or loco-regionally advanced stages. Multimodal management offers the best chance of cure, with surgery being the cornerstone. With improved life expectancy, elderly patients with esophageal cancer are being referred for surgery more frequently. Although recent studies have shown encouraging outcomes, increased post-operative complications are common. The aim of our study was to evaluate morbidity and survival in patients above 70 years undergoing curative surgery for esophageal cancer from 2011 to 2021 at our centre. Methods Of 2291 patients undergoing esophagectomy, 122 were above 70 years, ten were inoperable. Mean age was 73.3 years (70-84 years), with 78% males and 83% squamous cell carcinoma, most common location being lower-third (63.6%). Of the 110 patients, 80 (72.7%) received neoadjuvant treatment, 68(61.8%) were ASA grade II or more. McKneown’s approach was common, utilized in 55%, of which minimally invasive in 53%, with Ivor- Lewis, left thoraco-abdominal and transhiatal approaches in the rest. Mean blood loss was 350 ml, with mean operative time of 270 minutes and circumferential positivity rate of 12.7%. Results The mean ICU stay was 1 day, with the mean hospital stay being 13 days. Almost half (49%) had Clavien-Dindo grade III or higher morbidity, with pulmonary complications seen in 27%. Anastomotic leakage was seen in 20/110 (18%), with only 2 patients needing an intervention. 30-day mortality was 8.2%. Recurrences were seen in 21 patients, anastomotic and regional recurrences in 6, distant in 6, regional with distant in 9. The median recurrence free survival was 26 months with 3-year RFS of 43.7%. With a median follow-up of 25 months, median overall survival was 30 months and 3-year OS was 45.3%. Conclusion Despite higher post-operative morbidity and mortality, elderly patients have reasonable recurrence free and overall survival outcomes with curative surgery. With continuing refinements in prehabilitation, operative techniques, wider adoption of minimally invasive surgery, intra-operative management and post-operative care, early post-operative outcomes are likely to improve further. Elderly patients with resectable esophageal cancer should not be denied surgery.

438. TECHNIQUE OF COMPLETELY ROBOTIC MCKEOWN (3-HOLE) ESOPHAGECTOMY WITH INTRA-CORPOREAL GASTRIC CONDUIT CREATION, AND CERVICAL ESOPHAGO-GASTRIC ANASTOMOSIS FOR MID-ESOPHAGEAL ADENOCARCINOMA

Abstract Background Esophageal cancer is the 7th leading cause of cancer deaths, with an estimated total case of 22,370 in both males and females in 2024. Adenocarcinoma and squamous cell carcinoma account for over 90% of histology at diagnosis. The incidence of adenocarcinoma continues to rise due to the rising incidence and prevalence of obesity, gastro-esophageal reflux disease and Barrett's esophagus. Multi-modality treatment is currently the standard of care for locally advanced disease. This consists of neoadjuvant concurrent chemotherapy and radiation therapy, followed by esophagectomy. Minimally invasive approaches to esophagectomy are associated with decreased post-operative morbidities and overall satisfactory outcomes. While the Ivor Lewis esophagectomy with intra-thoracic anastomosis is the most common surgical approach to resection of distal esophageal and gastroesophageal (GE) junction tumors, the McKeown (3-hole) esophagectomy with cervical esophago-gastric anastomosis is best suited for tumors located in the proximal and mid-esophagus. Methods We describe our technique of robotic McKeown (3-hole) esophagectomy for mid-esophageal adenocarcinoma after neoadjuvant concurrent chemo-radiation therapy for clinical stage uT3N0M0 tumor. The thoracic esophagus is completely mobilized from the esophageal hiatus of the diaphragm up to the thoracic inlet via a right thoracoscopic approach, with harvesting of the regional lymph nodes together with the specimen. The left neck incision is made along the anterior border of the sternocleidomastoid muscle and the inferior belly of the omohyoid muscle is transected. The cervical esophagus is then completely mobilized into the wound and secured using a Penrose drain. Using a laparoscopic approach, the entire stomach is mobilized with division of the left gastric vessels but careful preservation of the right gastro-epiploic arcade while transecting the greater omentum and the short gastric vessels. An intra-corporeal creation of the gastric conduit then follows. The gastric conduit, secured to the proximal stomach at the resection staple line, is subsequently tunneled via the esophageal hiatus and through the mediastinum to exit at the left neck incision by applying traction on the cervical esophagus. The specimen is separated from the conduit, and the cervical esophagus is transected at the desired location for the anastomosis. A stapled end-to-side but functional end-to-end esophago-gastric anastomosis (Orringer's technique) is then created. Results A completely robotic technique of McKeown (3-hole) esophagectomy without the need to exteriorize the stomach to fashion the gastric conduit via a (mini)laparotomy is successfully accomplished in the majority of our patients with proximal or mid-esophageal tumors. An uneventful postoperative recovery was made. Fluoroscopic esophagram on post-operative day 5 did not demonstrate leakage from the anastomotic site. Gastric conduit emptying was satisfactory despite the lack of a routine gastric drainage procedure or injection of botulinum toxin into the pyloric ring. Conclusion Robotic-assisted thoracoscopic esophageal mobilization combined with laparoscopic completely intra-corporeal fashioning of gastric conduit with cervical esophago-gastric anastomosis is a technically feasible minimally invasive approach to performing McKeown esophagectomy with satisfactory post-operative outcomes and conduit functioning. https://www.dropbox.com/scl/fi/gzc1vzdzhzqn7niz95b8t/Robotic-McKeown-Esophagectomy-Video-3.mp4?rlkey=c4ja7s1aob10ah6ps500z7y29&dl=0

Early post-operative outcome of pre-pectoral implant-based immediate total breast reconstruction with Polyglactin 910 (Vicryl™) mesh – low cost solution for a low-middle income country

BackgroundThe incidence of breast cancer in Pakistan has been rising with approximately one third of these patients requiring mastectomy. Among breast reconstruction treatment options, the use of Acellular Dermal Matrix (ADM) for pre-pectoral breast implant surgery has proven effective with improved cosmetic outcome. However, due to high cost it cannot be regularly implemented in a developing country like Pakistan. An alternative to ADM, Polyglactin 910 (Vicryl™, Ethicon) mesh has been introduced in pre-pectoral breast reconstructive surgery which has shown to be almost 10 times lower in cost. We set out to determine the frequency of early postoperative complications when using Polyglactin 910 mesh for pre-pectoral implant-based breast reconstruction surgery.MethodsA single centre, retrospective, chart review was conducted, and a total 28 women were included in the study. Thirty-two pre-pectoral implant-based mastectomies with Polyglactin 910 mesh were performed. Early post-operative outcomes (within 12 months of procedure) including duration of antibiotic use, post-operative infection, implant displacement, flap necrosis, seroma formation, wound dehiscence, hematoma formation, capsular contracture and reconstruction failure, were recorded.ResultsOnly 4 (12.5%) women experienced early post-operative morbidity. One patient developed a wound dehiscence, which eventually led to reconstruction failure and removal of the implant. Another patient had seroma formation and flap necrosis. None of the patients developed postoperative implant displacement, hematoma formation or capsular contracture in the early post-operative period.ConclusionThis study reveals that early post-operative outcomes with Polyglactin 910 mesh in breast reconstructive surgery are few, thus making it a cost effective, reliable, and safe treatment option, especially in developing countries like Pakistan.

Neoadjuvant 177Lu-DOTATATE for non-functioning pancreatic neuroendocrine tumours (NEOLUPANET): multicentre phase II study.

Resection of non-functioning pancreatic neuroendocrine tumours (NF-PanNETs) is curative in most patients. The potential benefits of neoadjuvant treatments have, however, never been explored. The primary aim of this study was to evaluate the safety of neoadjuvant 177Lu-labelled DOTA0-octreotate (177Lu-DOTATATE) followed by surgery in patients with NF-PanNETs. NEOLUPANET was a multicentre, single-arm, phase II trial of patients with sporadic, resectable or potentially resectable NF-PanNETs at high-risk of recurrence; those with positive 68Ga-labelled DOTA PET were eligible. All patients were candidates for neoadjuvant 177Lu-DOTATATE followed by surgery. A sample size of 30 patients was calculated to test postoperative complication rates against predefined cut-offs. The primary endpoint was safety, reflected by postoperative morbidity and mortality within 90 days. Secondary endpoints included rate of objective radiological response and quality of life. From March 2020 to February 2023, 31 patients were enrolled, of whom 26 completed 4 cycles of 177Lu-DOTATATE. A partial radiological response was observed in 18 of 31 patients, and 13 patients had stable disease. Disease progression was not observed. Twenty-four R0 resections and 4 R1 resections were performed in 29 patients who underwent surgery. One tumour was unresectable owing to vascular involvement. There was no postoperative death. Postoperative complications occurred in 21 of 29 patients. Severe complications were observed in seven patients. Quality of life remained stable after 177Lu-DOTATATE and decreased after surgery. Neoadjuvant treatment with 177Lu-DOTATATE is safe and effective for patients with NF-PanNETs.

Tracheostomy Avoidance in Flap Reconstruction of the Upper Aerodigestive Tract is Safe in Selected Patients.

Assess the impact of tracheostomy on postoperative morbidity and mortality and examine factors that predicted tracheostomy in head and neck flap patients. Retrospective cohort January 2017 to December 2021. Single tertiary center. Adult patients undergoing head and neck flap reconstruction were included, excluding cutaneous reconstruction, laryngectomy, or with tracheostomy present at surgery. Patients were routinely extubated immediately following surgery. Univariate and multivariable analyses examined associations between tracheostomy and postoperative outcomes and identified predictors of tracheostomy. We included 193 patients, 69 (35.8%) with tracheostomy and 124 (64.2%) without. Tracheostomy avoidance was associated with no difference in 30-day mortality (P = .531) and with decreased likelihood of 30-day complications (0.019), unplanned return to the operating room (0.021), and discharge to a facility (<0.001) and with 2.2 decrease in length of stay on multivariable analysis (confidence interval [CI]: 0.62-3.82, P = .007). Four patients (2.1%) required reactive tracheostomy with no resulting mortalities. Significant associations with tracheostomy on multivariable analysis included bilateral neck dissections (odds ratio [OR]: 3.13, CI 1.12-9.06, P = .030), number of resected mandibular subsites (OR: 2.65, CI: 1.50-5.67, P = .0023), specimen volume (OR: 1.87, CI: 1.29-2.71, P = .001), body mass index < 20 (OR: 3.80, CI: 1.24-11.64, P = .019), mandibulectomy (OR: 0.04, CI: 0.01-0.22, P < .001), forearm flap (OR: 0.15, CI: 0.05-0.41, P < .001), oral cavity site (OR: 0.21, CI: 0.06-0.73, P = .014), and age > 70 (OR: 0.33, CI: 0.14-0.81, P = .016). Tracheostomy avoidance is safe in properly selected patients undergoing head and neck flap reconstruction. Multiple factors predicted tracheostomy, which may guide patient selection at other centers.

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision &amp; repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Comparison of a risk calculator with frailty indices in patients undergoing lung cancer resection.

Perioperative risk stratification is an essential component of preoperative planning for cancer surgery. While frailty has gained attention for its utility in risk stratification, no studies have directly compared it to existing risk calculators. Therefore, the objective of this study was to compare the risk stratification of the American College of Surgeons Surgical Risk Calculator (ACS-SRC), the Revised Risk Analysis Index (RAI-rev), and the Modified Frailty Index (5-mFI). The primary outcomes were 30-day postoperative morbidity, 30-day postoperative mortality, unplanned readmission, unplanned reoperation, and discharge disposition other-than-home. Patients undergoing anatomic lung resection for primary, non-small cell lung cancer were identified within the American College of Surgeons National Quality Improvement Program (ACS NSQIP) database. The ACS-SRC, RAI-rev, and 5-mFI tools were used to predict adverse postoperative events. Tools were compared for discrimination in the primary outcomes. 9663 patients undergoing anatomic lung resection for cancer between 2012 and 2014 were included. The cohort was 53.1% female. Median age at diagnosis was 67 (interquartile range = 59-74) years. Cardiothoracic surgeons performed 89% and general surgeons performed 11.0% of the operations. Perioperative morbidity and mortality rates were 10.9% (n = 1048) and 1.6% (n = 158). Rates of 30-day postoperative unplanned readmission and reoperation were 7.5% (n = 725) and 4.8% (n = 468). The ACS-SRC had the highest discrimination for all measured outcomes, as measured by the area under the receiver operating curve (AUC) and corresponding confidence interval (95% confidence interval [CI]). This included perioperative mortality (AUC = 0.74, 95% CI = 0.71-0.78), compared to RAI-rev (AUC = 0.66, 95% CI = 0.62-0.69) and 5-mFI (AUC = 0.61, 95% CI = 0.57-0.65; p < 0.001). The RAI-rev and 5-mFI had similar discrimination for all measured outcomes. ACS-SRC was the perioperative risk stratification tool with the highest predictive discrimination for adverse, 30-day, postoperative events for patients with cancer treated with anatomic lung resection.

Effect of the BiZact™ Low-Temperature Dissecting Device on Intra- and Postoperative Morbidities Related to Tonsillectomy-A Systematic Review and Meta-Analysis.

Background and Objectives: We investigated the effects of using a BiZact™ device for tonsillectomy on operating time, intraoperative blood loss, postoperative bleeding rate, and pain through a meta-analysis of the relevant literature. Materials and Methods: We reviewed studies retrieved from the databases of PubMed, SCOPUS, Google Scholar, Embase, Web of Science, and Cochrane up to March 2024. The results were analyzed following PRISMA guidelines. Six studies that compared the outcomes of patients receiving perioperative BiZact™ tonsillectomy with those in control groups (cold steel dissection or bipolar tonsillectomy) were included for this analysis of the outcomes, which included intraoperative bleeding and time, postoperative pain, and frequency of postoperative bleeding. Results: The operative time (SMD -11.5985, 95%CI [-20.3326; -2.8644], I2 = 99.5%) in the treatment group was significantly reduced compared to the control group. However, BiZact™ showed no significant efficacy in reducing intraoperative bleeding when compared with the control group (SMD -0.0480, 95%CI [-1.8200; 1.7240], I2 = 98.6%). Postoperative pain on day 1 (SMD -0.0885, 95%CI [-0.4368; 0.2598], I2 = 98.9%), day 3 (SMD -0.2118, 95%CI [-0.6110; 0.1873], I2 = 99.5%), and later than day 7 (SMD 0.0924, 95%CI [-0.2491; 0.4338], I2 = 98.6%) in the treatment group was not significantly reduced relative to the control group. When compared to the control group, BiZact™ did not reduce the incidence of secondary postoperative bleeding control in the operation room (OR 0.5711, 95%CI [0.2476; 1.3173], I2 = 32.1%), primary bleeding (OR 0.4514, 95%CI [0.0568; 3.5894], I2 = 0.0%), or all postoperative bleeding events (OR 0.8117, 95%CI [0.5796; 1.1368], I2 = 26.3%). Conclusions: This study demonstrated that using the BiZact™ device for tonsillectomy significantly decreased the operative time but could not effectively reduce intraoperative bleeding or postoperative pain and bleeding.

Efficacy of Enzotein in post-operative recovery and morbidity reduction in acute necrotizing pancreatitis: a case report

Efficacy of Enzotein in post-operative recovery and morbidity reduction in acute necrotizing pancreatitis: a case report

High-exchange ULTrafiltration to enhance recovery after paediatric cardiac surgery (ULTRA): study protocol for a Canadian double-blinded randomised controlled trial

IntroductionSurgical repair is the standard of care for most infants and children with congenital heart disease. Cardiopulmonary bypass (CPB) is required to facilitate these operations but elicits a systemic inflammatory...

Risk evaluation and recipient selection in adult liver transplantation: A mixed-methods survey

Background: Liver transplant (LT) is the definitive treatment for end-stage liver disease. Limited resources and important post-operative implications for recipients compel judicious risk stratification and patient selection. However, little is known about the factors influencing physicians’ assessment regarding patient selection for LT and risk evaluation. Methods: We conducted a mixed-methods, cross-sectional survey involving Canadian hepatologists, anesthesiologists, LT surgeons, and French anesthesiologists. The survey contained quantitative questions and a vignette-based qualitative substudy about risk assessment and patient selection for LT. Descriptive statistics and qualitative content analyses were used. Results: We obtained answers from 129 physicians, and 63 participated in the qualitative substudy. We observed considerable variability in risk assessment prior to LT and identified many factors perceived to increase the risk of complications. Clinicians reported that the acceptable incidence of at least 1 severe post-operative complication for a LT program was 20% (95% CI: 20-30%). They identified the presence of any comorbidity as increasing the risk of different post-operative complications, especially acute kidney injury and cardiovascular complications. Frailty and functional disorders, severity of the liver disease, renal failure and cardiovascular comorbidities prior to LT emerged as important risk factors for post-operative morbidity. Most respondents were willing to pursue LT in patients with grade III acute-on-chronic liver failure but were less often willing to do so when faced with the uncertainty of a clinical example. Conclusions: Clinicians had a heterogeneous appraisal of the post-operative risk of complications following LT, as well as factors considered in risk assessment.

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Gastric Cancer Peritoneal Metastases: Results from the Lithuanian PIPAC Program.

Peritoneal metastases (PM) of gastric cancer (GC) are considered a terminal condition, with reported median survival ranging from 2 to 9 months. Standard treatment typically involves systemic chemotherapy alone or combined with targeted therapy or immunotherapy, though efficacy is limited. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel technique for treating GC PM, although it remains an experimental treatment under investigation. This study aimed to summarize the outcomes of GC PM treatment with PIPAC from the Lithuanian PIPAC program. All patients who underwent PIPAC for GC PM at Vilnius University Hospital Santaros Klinikos between 2015 and 2022 were included in this retrospective study. The safety of PIPAC was assessed by postoperative complications according to the Clavien-Dindo classification. Efficacy was evaluated based on the peritoneal carcinomatosis index (PCI), ascites dynamics throughout the treatment, and long-term outcomes. In total, 32 patients underwent 71 PIPAC procedures. Intraoperative and postoperative morbidity related to PIPAC occurred after three (4.2%) procedures. Following PIPAC, there was a tendency towards a decrease in median PCI from 10 (Q1 3; Q3 13) to 7 (Q1 2; Q3 12), p = 0.75, and a decrease in median ascites volume from 1300 mL (Q1 500; Q3 3600) at the first PIPAC to 700 mL (Q1 250; Q3 4750) at the last PIPAC, p = 0.56; however, these differences were not statistically significant. The median overall survival after PM diagnosis was 12.5 months (95% CI 10-17), and the median survival after the first PIPAC procedure was 5 months (95% CI 4-10). PIPAC is a safe and feasible treatment option for GC PM; however, well-designed prospective studies are needed to fully assess its efficacy.

Preoperative risk-factors for secondary spontaneous pneumothorax surgery in Japan: a nationwide database study.

We aimed to identify preoperative risk factors for secondary spontaneous pneumothorax surgery. The National Clinical Database of Japan, with six annual datasets from 2014 to 2019, was used. All patients who underwent surgery for secondary spontaneous pneumothorax were included, excluding those < 15years old and those with incomplete data. The effects of preoperative risk factors were analyzed for operative mortality (mortality during hospitalization or within 30days, regardless of hospitalization status), 30-day mortality, and postoperative respiratory morbidities. Of the 18,309 patients enrolled in the study, operative mortality, 30-day mortality, and postoperative respiratory morbidities were observed in 654 (3.6%), 343 (1.9%), and 2258 (12.3%) patients, respectively. Increasing age, male sex, body mass index < 18.5 or > 30, performance status > 2, emergent surgery, interstitial pneumonia, and diabetes in preoperative co-morbidity, tumors, and other diseases in underlying lung disease were significant risk factors for operative mortality. Those for 30-day mortality included autoimmune disease instead of male sex and diabetes, while those for postoperative respiratory morbidities included lymphangiomyomatosis instead of a body mass index > 30. We identified many preoperative risk factors for operative mortality, 30-day mortality, and postoperative respiratory morbidities in secondary spontaneous pneumothorax surgery. These findings will assist in selecting appropriate surgical candidates.

Impact of Multi-Institutional Enhanced Recovery after Surgery Protocol Implementation on Elective Colorectal Surgery Outcomes

Background: Enhanced Recovery After Surgery (ERAS) protocols aim to improve surgical patient outcomes, although their effectiveness may vary. This study assessed the impact of multi-institutional ERAS implementation on postoperative morbidity in patients undergoing elective colorectal surgery. Methods: We conducted a multicenter retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. We analyzed patient outcomes before (2012-2014) and after (2015-2020) ERAS implementation across four hospitals. Multivariable logistic regression was used to determine the impact of ERAS program on certain outcomes. Results: A total of 8,930 cases were analyzed: 3,573 in the pre-ERAS and 5,357 in the ERAS cohort. The ERAS cohort demonstrated significant reductions in superficial surgical site infection (SSI) (7.5% vs 2.5%, p&lt;0.001), deep SSI (0.6% vs 0.2%, p=0.016), urinary tract infection (3.3% vs 1.5%, p&lt;0.001), pulmonary embolism (0.7% vs 0.4%, p=0.022), deep vein thrombosis (1.4% vs 0.9%, p=0.020), sepsis (3.0% vs. 2.1%, p=0.006), and other complications. Median length of stay decreased from 5 to 4 days (p&lt;0.001), and 30-day readmission rate dropped from 11.3% to 9.8% (p=0.022). Overall, ERAS implementation was associated with a 35% decrease in the odds of all 30-day complications (OR 0.65, 95%CI: 0.59-0.73). There was no effect on 30-day (p=0.962) or overall mortality rates (p=0.732). Conclusion: A standardized ERAS protocol, used across multiple institutions, significantly improves elective colorectal surgery outcomes, reducing complications, length of hospital stay, and readmissions. These findings support the broader implementation of ERAS to enhance patient care and reduce healthcare costs.

Outcomes after open posterior component separation via transversus abdominis release (TAR) for incisional hernia repair. A systematic review and meta-analysis.

Given its potential advantages, open Transversus Abdominis Release (oTAR) has been proposed as a durable solution for complex AWR. However, its applicability in different scenarios remains uncertain. We aimed to analyze the current available evidence and determine surgical outcomes after oTAR. We performed a systematic electronic search on oTAR in PubMed/Medline, Embase, and Cochrane Central Register of Controlled Trials databases. Postoperative morbidity and recurrence rates were included as primary endpoints and Quality of life (QoL) was included as secondary endpoint. A random-effect model was used to generate a pooled proportion with 95% confidence interval (CI) between all studies. A total of 22 studies with 4,910 patients undergoing oTAR were included for analysis. Mean hernia defect and mesh area were 394 (140-622) cm2 and 1065 (557-2206) cm2, respectively. Mean follow-up was 19.7 (1-32) months. The weighted pooled proportion of recurrence, overall morbidity, surgical site occurrences (SSO), surgical site infection (SSI), surgical site occurrences requiring procedural intervention (SSOPI), major morbidity and mortality were: 6% (95% CI, 3-10%), 34% (95% CI, 26-43%), 22% (95% CI, 16-29%), 11% (95% CI, 8-16%), 4% (95% CI, 3-7%), 6% (95% CI, 4-10%) and 1% (95% CI, 1-2%), respectively. A significant improvement in QoL after oTAR was reported among studies. Open TAR is an effective technique for complex ventral hernias as it is associated with low recurrence rate and a significant improvement in QoL. However, the relatively high morbidity rates observed emphasize the necessity of further patients' selection and optimization to improve outcomes.

Benefits of jejunostomy feeding in patients who underwent gastrectomy for cancer treatment.

Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy. To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer. Between 2003 and 2017, all patients undergoing gastrectomy for cancer treatment were included retrospectively. A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared. Of the 172 patients included, 60 received jejunostomy. Preoperatively, the two groups were comparable with respect to the nutritional parameters studied (body mass index, albumin, etc.). In the postoperative period, the J + group lost less weight and albumin: 5.74 ± 8.4 vs 9.86 ± 7.5 kg (P = 0.07) and 7.2 ± 5.6 vs 14.7 ± 12.7 g/L (P = 0.16), respectively. Overall morbidity was 25% in the J + group and 36.6% in the J - group (P = 0.12). The J + group had fewer respiratory, infectious, and grade 3 complications: 0% vs 5.4% (P = 0.09), 1.2% vs 9.3% (P = 0.03), and 0% vs 4.7% (P = 0.05), respectively. The 30-day mortality was 6.7% in the J + group and 6.3% in the J - group (P = 0.91). Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity. A prospective study could confirm our results.