Rate Of Major Postoperative Complications Research Articles

Atrial fibrillation in patients with coronary heart disease: current state of the problem

Atrial fibrillation is one of the most common types of cardiac arrhythmia observed in clinical practice. Despite advances in the diagnosis and treatment, atrial fibrillation remains one of the leading causes of cardiovascular mortality and morbidity. In addition, atrial fibrillation is quite often combined with other pathologies of the cardiovascular system and is a marker of an unfavorable outcome. Several previous studies have demonstrated reduced survival in patients with coronary artery disease and atrial fibrillation who have not undergone surgery for arrhythmia. According to other data, the presence of preoperative atrial fibrillation among patients undergoing isolated coronary artery bypass grafting was associated with significantly higher rates of major postoperative complications. Nowadays, no one doubts the fact that atrial fibrillation during a coronary artery bypass surgery is a risk factor for increased hospital mortality, postoperative morbidity and leads to a decrease in the long-term survival. The studies confirm the necessity of surgical ablation for atrial fibrillation during coronary revascularization to reduce both short-term and long-term postoperative mortality and late complications.

Simultaneous resection for synchronous colorectal cancer liver metastases: A feasibility clinical trial.

We tested the feasibility of a simultaneous resection clinical trial in patients with synchronous colorectal cancer liver metastases to obtain the necessary information to plan a randomized trial. Multicenter feasibility single-arm trial enrolling patients with synchronous colorectal cancer liver metastases eligible for simultaneous resection. Prespecified criteria for feasibility were: proportion of eligible patients enrolled ≥66%, andthe proportion of enrolled patients who completed simultaneous resection ≥75%. The prespecified 90-day major postoperative complication rate was 30%. Of 61 eligible patients from February 2017 to August 2019, 41 were enrolled (67%; 95% confidence interval [CI], 55%-78%), 32 underwent simultaneous resection (78%; 95% CI, 63%-88%). Four patients were not enrolled due to the surgeon's preference, three were due to the complexity of resection (right hepatectomy and low anterior resection). Intraoperative complications during liver resection (n = 4) and progression of disease (n = 4) were the main reasons for not undergoing simultaneous resection. The 90-day incidence of major complications was 41% (95% CI, 16%-58%) and the 90-day postoperative mortality was 6% (95% CI, 1.7%-20%). According to prespecified criteria, enrolling patients with synchronous colorectal cancer liver metastases to a trial of simultaneous resection is feasible; however, it is associated with higher than anticipated 90-day postoperative complications.

Abdominal Panniculectomy: An Analysis of Outcomes in 238 Consecutive Patients over 10 Years.

Background:Panniculectomy is a commonly performed body contouring procedure to address skin laxity and its related complications. This study aimed to assess clinical outcomes of abdominal panniculectomy and identify predictors of complications at a tertiary academic healthcare center.Methods:A retrospective review of patients who underwent panniculectomy between January 2010 and January 2020 at our institution was performed. Exclusion criteria were a history of prior panniculectomy or abdominoplasty. Patient characteristics and clinical outcomes were collected. Univariate and multivariable analyses were performed to assess the risk factors of complications.Results:The mean age in the included 238 patients was 51.7 ± 12.7 years, and the mean body mass index (BMI) at the time of panniculectomy was 33 ± 7.5 kg/m2. Median resection weight was 2.7 kg (range: 0.15–14.6) and median length of hospital stay was 2 days (range: 0–24). Mean follow-up time was 50 ± 37 months. The rate of major complications was 22.3%. Revision surgery was performed in 3.4% of the cases. Multivariable analyses demonstrated that increase in BMI (P = 0.007) and active smoking (P = 0.026) were significantly associated with increased odds of major complication, and increase in BMI (P = 0.0004), history of venous thromboembolism (P = 0.034) and having a concomitant ventral hernia repair (P = 0.0044) were significantly associated with having a length of hospital stay of 3 days or more.Conclusions:Panniculectomy is generally safe to perform, with major postoperative complication rate of 22.3% in our series. Increase in BMI and active smoking were significantly associated with having a major complication. Higher BMI, concomitant hernia repair, and a history of venous thromboembolism were associated with length of hospital stay of 3 days or more.

Predicting infected pancreatic necrosis based on influential factors among the most common types of acute pancreatitis: a retrospective cohort study

Biliary and hypertriglyceridemic acute pancreatitis (BAP and HTGAP) are two of the leading etiologies in China. Infected pancreatic necrosis (IPN) is a particular and noticeable condition in the late stage of these diseases; however, the influential correlated factors on IPN and how to predict IPN are unclear. In this retrospective study, 1,116 patients whose diagnosis was BAP or HTGAP met the inclusion criteria among 1,746 enrolled cases. Clinical characteristics were carefully recorded for further investigation of the factors influencing IPN. During a 6-month follow-up, we analyzed bacterial spectra and postoperative indicators related to minimally invasive necrosectomy. Gallstones and hypertriglyceridemia were the most prevalent causes (52.6% vs. 11.3%). The participants with HTGAP were younger (40 vs. 52 years, P<0.001), had a higher rate of severe acute pancreatitis (SAP) (51.8% vs. 32.0%, P<0.001), and had a higher prevalence of multiple organ dysfunction syndrome (MODS) (26.4% vs. 19.0%, P=0.020) than BAP patients. More IPN cases were noted in the BAP group than in the HTGAP group [20.2% vs. 13.7%; odds ratio (OR): 1.598, 95% confidence interval (CI): 1.027 to 2.451; P=0.034]. Etiologies, C-reactive protein (CRP) levels, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and MODS were the factors influencing IPN. The bacterial spectra and the rates of major postoperative complications were not significantly different. Patients with BAP more frequently developed IPN. Etiology was independently related to the occurrence of IPN. The APACHE II score, MODS, etiology, and CRP contributed to predicting IPN occurrence. Management of IPN substantially improved the prognosis.

SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival

Abstract Aims The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival. Methods This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival. Results There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (&amp;gt;3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival. Conclusions ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.

Risk factors for surgical complications after anatomic lung resections in the era of VATS and ERAS.

BackgroundThe aim of this study was to identify risk factors for surgical complications after anatomic lung resections in the era of video‐assisted thoracic surgery (VATS) and enhanced recovery after surgery (ERAS).MethodsA retrospective analysis of all consecutive adult patients who underwent elective anatomic lung resections between January and December 2020 at our institution was performed.ResultsEighty patients (40 VATS, 40 thoracotomy) were included. The 30‐day mortality rate was 1.3%. The overall rate of major postoperative complications was 18.8%. Most major complications occurred in patients who underwent open surgery (complication rate 32.5%, share of total complications 86.7%). Major morbidity after VATS resection was rare (complication rate 2.5%, share of total complications 13.3%). In univariable analysis, thoracotomy (p = 0.003), impaired preoperative lung function (p = 0.003), complex surgery (p = 0.004) and sleeve resection (p = 0.037) were associated with adverse outcomes. In multivariable analysis, thoracotomy (p = 0.044) and impaired preoperative lung function (p = 0.028) were the only independent risk factors for major postoperative morbidity.ConclusionThoracotomy was associated with a 10‐fold increased risk for postoperative complications compared with minimally invasive surgery and was an independent risk factor for surgical complications. In the era of VATS and ERAS, the fact that thoracotomy is performed may be a reliable parameter to identify patients at risk for postoperative complications.

Impact of Mitomycin-C-Induced Neutropenia after Hyperthermic Intraperitoneal Chemotherapy with Cytoreductive Surgery in Colorectal Cancer Patients with Peritoneal Carcinomatosis

BackgroundMitomycin-C (MMC) is the most commonly used chemotherapeutic agent for hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery (CRS). However, MMC has a side effect of myelosuppression. This study aimed to evaluate the clinical manifestations and impact of MMC-induced neutropenia after CRS and HIPEC in colorectal cancer patients.MethodsA total of 124 colorectal cancer patients who underwent CRS with HIPEC between March 2015 and January 2019 were evaluated. Patients with malignancies of non-colorectal origin, hospital stay longer than 60 days, peritoneal cancer index > 30, and complete cytoreduction score > 2 were excluded. MMC 35 mg/m2 was administered for 90 min at 41–43 °C. The patients were divided into three groups: no neutropenia, mild neutropenia (grade 1–2), and severe neutropenia (grade 3–4).ResultsIn total, mild and severe neutropenia occurred in 30 (24.2%) and 48 (38.7%) patients, respectively. Age and body surface area were significantly different among the neutropenia groups. Severe neutropenia developed significantly earlier than mild neutropenia (6.9 days vs. 10.4 days, p < 0.001) and also lasted significantly longer (4.6 days vs. 2.5 days, p = 0.005). The rate of major postoperative complications was significantly higher in the severe neutropenia group than in the no and mild neutropenia groups (8.3% vs. 6.7% vs. 6.5%, p = 0.015)ConclusionsSevere neutropenia starts earlier and lasts longer than mild neutropenia after CRS and HIPEC using an MMC triple method. The higher rate of major postoperative complications in patients with severe neutropenia highlights the importance of postoperative management during the neutropenia period.

Association of Adipopenia at Preoperative PET/CT with Mortality in Stage I Non–Small Cell Lung Cancer

Background Body mass index (BMI) and sarcopenia status are well-established prognostic factors in patients with lung cancer. However, the relationship between the amount of adipose tissue and survival remains unclear. Purpose To investigate the association between baseline adipopenia and outcomes in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods Consecutive patients who underwent surgical resection for stage I NSCLC between 2011 and 2015 at a single tertiary care center were retrospectively identified. The primary outcome was the 5-year overall survival (OS) rate, and secondary outcomes were the 5-year disease-free survival (DFS) rate and the major postoperative complication rate. The abdominal total fat volume at the waist and the skeletal muscle area at the L3 level were obtained from preoperative PET/CT data and were normalized by the height squared to calculate the fat volume index (FVI) and skeletal muscle index. Adipopenia was defined as the sex-specific lowest quartile of the FVI for the study sample, and sarcopenia was determined using the skeletal muscle index reference value (men, <55 cm2/m2; women, <39 cm2/m2). The association between body composition and outcomes was evaluated using Cox regression analysis. Results A total of 440 patients (median age, 65 years [interquartile range, 58-72 years]; 243 men) were evaluated. Most underweight patients (<20 kg/m2) had adipopenia (97%, 36 of 37 patients), but overweight patients (25-30 kg/m2, n = 138) and obese patients (>30 kg/m2, n = 14) did not have adipopenia (3%, four of 152 patients). In the group with a normal BMI (20-25 kg/m2), 28% (70 of 251 patients) had adipopenia and 67% (168 of 251 patients) had sarcopenia. After adjusting for age, sex, smoking history, surgical procedure, stage, histologic type, BMI, and sarcopenia, adipopenia was associated with reduced 5-year OS (hazard ratio [HR] = 2.2; 95% CI: 1.1, 3.8; P = .02) and 5-year non-cancer-specific OS rates (HR = 3.2; 95% CI: 1.2, 8.7; P = .02). There was no association between adipopenia and postoperative complications (P = .45) or between adipopenia and the 5-year DFS rate (P = .18). Conclusion Baseline adipopenia was associated with a reduced 5-year overall survival rate in patients with early-stage non-small cell lung cancer and may indicate risk for non-cancer-related death. © RSNA, 2021 Online supplemental material is available for this article.

Sutureless Versus Rapid Deployment Aortic Valve Replacement: Results From a Multicenter Registry

BackgroundThis study compared clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless vs rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). MethodsWe examined 4695 patients who underwent isolated or combined SURD-AVR. The “sutureless” Perceval valve (LivaNova PLC, London, United Kingdom) was used in 3133 patients and the “rapid deployment” Intuity (Edwards Lifesciences, Irvine, CA) in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. ResultsPatients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross-clamp and cardiopulmonary bypass times. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared with those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. ConclusionsOur results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation.

OUTCOME OF MINI GASTRIC BYPASS AFTER FAILED VERTICAL BAND GASTROPLASTY IN TREATMENT OF MORBID OBESE PATIENTS

Background: Bariatric surgery has long been introduced for weight control if conservative treatment failed and was widely accepted in the past decades. Compared with nonsurgical strategies, bariatric surgery proves more effectiveness for moderately to severely obese people to lose weight. Besides, bariatric surgery was demonstrated to induce significant and long-term remission of obesity related comorbidities.Aim of The Work: The aim of this study to review the outcome of Mini gastric bypass as a line of management of failed VBG operation in treatment of morbid obese patients as regard weight loos, intraoperative complications, postoperative complications and other comorbidities within one year follow up after operation.Patients and Methods: Our study includes thirty (30) morbidly obese patients who fulfilled the criteria for bariatric surgery with BMI >40 or >35 with associated co-morbidities with failure of previous restrictive operation (VBG). These patients were enrolled in a prospective study and had a retrospectively gathered outcome analysis at the department of surgery Ain-Shams University Hospitals. Our study was conducted in El-Demerdash hospital, Ain- Shams University. Thirty patients were selected and operated upon from June 2017 till June 2019 and followed up to June 2020.Results: In our study causes of revision in (30) patients: weight regain (10) patients severe GERD (9) patients, un satisfactory weight loss (8) patients, eating difficulties (3) patients. In our study The mean initial BMI for the patients was The preoperative BMI with mean ± SD: 42.9 ± 7.21 kg/m2, was higher than post-operative BMI at 3 months with mean ± SD value of 38.03± 5.62 kg/m2), than post-operative BMI at 6 months with mean ± SD value of 33.98 ± 4.58 kg/m2, than post-operative BMI at 12 months with mean ± SD value of 29.22 ± 3.60 kg/m2.Conclusion: Mini-gastric bypass offers major benefits with quite satisfactory results over most alternative procedures. Our data, which includes follow up of two years, indicates that mini gastric bypass is: An effective procedure for the treatment of failed restrictive procedure (VBG). Technically feasible. Safe operation with a low rate of major postoperative complications. Has a significant reduction in patient’s hospital stay. Helps in the achievement of a significant weight loss and improvement of obesity related metabolic co morbidities. Efficient in loosing excess weight and in maintaining the weight loss. so it is considered a promising revisional bariatric procedure operation for patients with failed prior open or laparoscopic VBG

MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY Ziv Savin, Aviv Kupershmidt, Snir Dekalo, Dorel Poulin, Ofer Yossepowitch, Alon Lazarovich, Barak Rosenzwieg, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, and Roy Mano Ziv SavinZiv Savin More articles by this author , Aviv KupershmidtAviv Kupershmidt More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Dorel PoulinDorel Poulin More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Alon LazarovichAlon Lazarovich More articles by this author , Barak RosenzwiegBarak Rosenzwieg More articles by this author , Reut ShasharReut Shashar More articles by this author , Azik HoffmanAzik Hoffman More articles by this author , Jonathan GalJonathan Gal More articles by this author , Miki HaiflerMiki Haifler More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Malnutrition Universal Screening Tool (MUST) integrates body mass index and unplanned weight loss to assess the nutritional status of patients, and was previously associated with adverse outcomes after gastrointestinal operations. The predictive role of MUST among patients undergoing radical cystectomy is unknown. METHODS: We conducted a multi-center retrospective analysis of 227 patients who underwent radical cystectomy for bladder cancer in 4 medical centers between 2015-2019. Patients were stratified according to the MUST score [MUST=0 (n=188) vs. MUST ≥1 (n=39)]. Baseline clinical, pathological and functional characteristics were compared between groups. Endpoints were 30-day postoperative morbidity, cancer-specific-survival (CSS) and overall survival (OS). Kaplan-Meier curves and cox regression analyses were used to evaluate survival and identify predictors of outcome. RESULTS: Median age of the study cohort was 69 years (IQR 63-74). Median duration of follow up was 23 months (IQR 14-35). Thirty-day major postoperative complication rate (Clavien-Dindo grade 3-5) was 17%. Estimated 2-year OS and CSS rates were 73% and 75%, respectively. Baseline characteristics were not different between the MUST groups. OS and CSS were significantly lower (p <0.001) in the malnourished group (MUST ≥1) with medians of 32 months (95%CI 20-44) and 33 months (95%CI 27-46), respectively, compared to the MUST=0 group (medians were not reached, Figure 1). There was no difference in post-operative complication rates between the groups. On multivariable analysis, MUST ≥1 was found to be an independent risk factor for overall-mortality (HR=2.4, 95%CI 1.4-4.2) and cancer-specific-death (HR=2.5, 95% CI 1.4-4.4). CONCLUSIONS: High MUST scores are associated with decreased survival in patients after radical cystectomy. Therefore, the MUST score may assist in perioperative evaluation and patient selection. Future studies should focus on whether improving the nutritional status of malnourished patients will result in improved ontological outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e762-e762 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin More articles by this author Aviv Kupershmidt More articles by this author Snir Dekalo More articles by this author Dorel Poulin More articles by this author Ofer Yossepowitch More articles by this author Alon Lazarovich More articles by this author Barak Rosenzwieg More articles by this author Reut Shashar More articles by this author Azik Hoffman More articles by this author Jonathan Gal More articles by this author Miki Haifler More articles by this author Roy Mano More articles by this author Expand All Advertisement Loading ...

Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique.

Transfeminine patients can experience significant gender dysphoria in vocal communication. Feminization laryngoplasty (FL) is a gender-affirming surgery developed to elevate speaking vocal range, as well as alter vocal resonance and laryngeal cosmesis. The purpose here was to appraise FL's long-term voice outcomes across a 17-year review period. Level III, retrospective study and description of technique. A single-institution transfeminine voice clinic. Voice data (speaking fundamental frequency [F0], lowest F0, highest F0, F0 range in both Hertz and semitones, and maximum phonation time [MPT]) were collected and assessed. Self-assessment of voice femininity and complications were documented. The 162 patients, all transfeminine women, had a mean age of 40 years with 36-month mean follow-up. There were significant increases in mean speaking F0 (Δ = 50 ± 30 Hz, Δ = 6 ± 3 semitones; P < .001) and mean change in lowest F0 (Δ = 58 ± 31 Hz, Δ = 8 ± 4 semitones; P < .001). There was no significant difference in mean change in highest F0 or MPT. There was significant improvement (Δ = 60% ± 39%; P < .001) in perceptual self-assessment of vocal femininity. There was a 1.2% rate of major postoperative complications requiring inpatient admission or operative intervention. There were no differences in vocal outcomes between those patients who had less than 1-year follow-up and those who had 5-year follow-up. FL in this cohort was a safe and effective technique for increasing mean speaking F0, mean lowest F0, and voice gender perception over a prolonged follow-up period. These findings add to the possible treatments aimed at addressing the morbid dysphoria related to voice and communication for our transfeminine patients.

Comparing Complication Rates After Elective Total Knee Arthroplasty Delivered Or Purchased By The VA.

The Department of Veterans Affairs (VA) both delivers health care in its own facilities and, increasingly, purchases care for veterans in the community. Policy makers, administrators, health care providers, and veterans frequently face decisions about which services should be delivered versus purchased by the VA. Comparisons of quality across settings are essential if veterans are to receive care that is consistently accessible, patient centered, effective, and safe. We compared risk-adjusted major postoperative complication rates for total knee arthroplasties that were delivered in VA facilities versus purchased from community providers. Overall, adjusted complication rates were significantly lower for arthroplasties delivered by the VA compared with those that were purchased. However, hospital-level comparisons revealed five locations where VA-purchased care outperformed VA-delivered care. As the amount of VA-purchased care continues to increase under the Veterans Access, Choice, and Accountability Act of 2014 and the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, these results support VA monitoring of overall and local comparative hospital performance to improve the quality of the care that the VA delivers while ensuring optimal outcomes in VA-purchased care.

P-118 Survival outcomes of adjuvant chemotherapy in stage IVA/B high-grade appendiceal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Despite the lack of supporting data, it is a common practice to use adjuvant chemotherapy (ACT) in high-grade appendiceal cancer patients with peritoneal metastases (stage IVA/B) after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). Low incidence precludes conducting randomized clinical trials; therefore, many oncologists extrapolate from node-positive colon cancer studies demonstrating benefits of ACT. We aimed to evaluate ACT efficacy after CRS/HIPEC in patients with stage IVA/B appendiceal cancer. A single-institution retrospective cohort study using a prospective database was conducted. Stage IVA/B high-grade appendiceal cancer patients who underwent CRS/HIPEC with CC-0/1/2 were included. Survival outcomes were compared between patients receiving ACT and those under observation. Subgroup analysis was performed based on histopathologic subtype, neoadjuvant chemotherapy (NACT), lymph node (LN) status, and peritoneal cancer index (PCI) ≥20. We identified 196 patients: 84 with ACT and 112 with no adjuvant chemotherapy (NoCT). There was no significant difference between groups in age, preoperative tumor markers, NACT frequency, PCI, as well as complete cytoreduction (CC-0/1) and postoperative major complication rates. ACT group had more patients with signet ring cell carcinoma (SRC) (51% vs 31%, p=0.022) and positive LN (56% vs 34%, p=0.002). ACT regimens included 5-FU/capecitabine in 11 (13%), FOLFOX in 53 (63%), FOLFIRI in 17 (20%), with/without bevacizumab. Regimens were unknown in 3 (4%) patients. Median number of cycles was 8 (IQR: 4-12) and median time between CRS/HIPEC and ACT was 12 (IQR: 8-15) weeks. Median follow-up was 68 months. Overall survival (OS) did not significantly differ between groups (54 months in ACT vs 66 in NoCT, p=0.894). Subgroup analysis showed no OS benefit of ACT compared to NoCT for patients with NACT (median OS: 40 vs 33 months, p=0.284) or without NACT (53 vs 82 months, p=0.457), with SRC (39 vs 33 months, p=0.389) or without SRC (54 vs 89 months, p=0.583), positive LNs (39 vs 33 months, p=0.894), or PCI ≥20 (39 vs 24 months, p=0.356), respectively. Additionally, ACT did not impact OS after adjusting for other factors in the multivariable Cox regression model. In our patient cohort, colorectal-type ACT did not improve OS in stage IVA/B appendiceal cancer treated with CRS/HIPEC, even when adjusting for confounding factors. This may be due to differences in tumor biology compared to colon cancer or the inability to detect differences in a small sample size. Data from prospective collaborative clinical trials are needed.

P-117 Survival outcomes following systemic chemotherapy in stage IVA/B high-grade mucinous appendiceal cancer after unsuccessful cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

The appropriate management of patients with unresectable mucinous appendiceal cancer (MAC) with peritoneal spread (Stage IVA/B) after a failed attempt at cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is unclear. Systemic chemotherapy (SCT) may be an option; however, data regarding its effectiveness in stage IVA/B MAC is controversial. This study aimed to assess outcomes after SCT in patients with unresectable peritoneal metastases from high-grade MAC. A single-center retrospective cohort study was conducted using a prospective CRS/HIPEC database. Stage IVA/B high-grade MAC patients deemed surgical candidates, but had an aborted CRS/HIPEC or underwent only palliative HIPEC were included. Overall survival (OS) was compared between patients with postoperative SCT and those without. Among 80 identified patients, 20 received SCT and 60 did not (NoCT). There was no difference between groups in age (p=0.314), sex (p=0.796), proportion of newly diagnosed patients (p=0.893), histopathologic subtype (p=0.108), preoperative chemotherapy (p=0.962), preoperative tumor markers (CA 19-9, CA 125, CEA), and postoperative major complication rates (p=0.358). Both groups had extensive residual disease (median peritoneal cancer index: 39 vs 39, p=0.956). SCT regimens included: 5-FU/capecitabine in 25% (n=5), FOLFOX in 30% (n=6), FOLFIRI in 30% (n=6), FOLFIRINOX in 5% (n=1) with/without bevacizumab. Regimens were unknown in 10% (n=2). Median number of cycles was 12 (IQR: 6-15) and median time between the procedure and SCT was 7 (IQR: 5-10) weeks. Median follow-up was 65 months. Median OS was significantly higher in the SCT group (26 months; 95%CI: 10.8-41.5) versus NoCT group (10 months; 95%CI: 7.3-12.7) (p < 0.0001), with hazard ratio 0.30 (95%CI: 0.16-0.57, p < 0.0001). Systemic chemotherapy improves overall survival in high-grade MAC patients with unresectable peritoneal metastases who were deemed surgical candidates, but underwent an unsuccessful CRS/HIPEC attempt. Further prospective studies with a larger sample size are required to identify patient subgroups who benefit the most from SCT.

Does liver cirrhosis affect the surgical outcome of primary colorectal cancer surgery? A meta-analysis

PurposeThe purpose of this meta-analysis was to evaluate the effect of liver cirrhosis (LC) on the short-term and long-term surgical outcomes of colorectal cancer (CRC).MethodsThe PubMed, Embase, and Cochrane Library databases were searched from inception to March 23, 2021. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of enrolled studies, and RevMan 5.3 was used for data analysis in this meta-analysis. The registration ID of this current meta-analysis on PROSPERO is CRD42021238042.ResultsIn total, five studies with 2485 patients were included in this meta-analysis. For the baseline information, no significant differences in age, sex, tumor location, or tumor T staging were noted. Regarding short-term outcomes, the cirrhotic group had more major complications (OR=5.15, 95% CI=1.62 to 16.37, p=0.005), a higher re-operation rate (OR=2.04, 95% CI=1.07 to 3.88, p=0.03), and a higher short-term mortality rate (OR=2.85, 95% CI=1.93 to 4.20, p<0.00001) than the non-cirrhotic group. However, no significant differences in minor complications (OR=1.54, 95% CI=0.78 to 3.02, p=0.21) or the rate of intensive care unit (ICU) admission (OR=0.76, 95% CI=0.10 to 5.99, p=0.80) were noted between the two groups. Moreover, the non-cirrhotic group exhibited a longer survival time than the cirrhotic group (HR=2.96, 95% CI=2.28 to 3.85, p<0.00001).ConclusionPreexisting LC was associated with an increased postoperative major complication rate, a higher rate of re-operation, a higher short-term mortality rate, and poor overall survival following CRC surgery.

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Introductionhow best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resection. Methodswe reviewed the iCral prospectively maintained database to compare the relative risk of AL of patients undergoing colorectal resection for cancer to that of patients receiving simultaneous liver and colorectal resection for cancer with isolated hepatic metastases. The incidence of AL was the primary outcome of the analysis. Perioperative details and postoperative complications were also appraised. Resultsout of a total of 996 patients who underwent colorectal resection for cancer, 206 receiving isolated colorectal resection were compared with a matched group of 53 patients undergoing simultaneous liver and colorectal resection. Combined surgery had greater operative time and resulted in longer postoperative hospitalization compared to colorectal resection alone. The proportion of overall morbidity following combined resection was significantly higher than after isolated colorectal resection (56.6% vs. 37.9%, p = 0.021). Overall, the two groups of patients did not differ neither on the rate of major postoperative complications, nor in terms of AL (9.4% vs. 6.3%, p = 0.381). At specific multivariate analysis, the duration of surgery was the only risk factor independently associated with the likelihood of AL. Conclusionscombining hepatic with colorectal resection for the treatment of synchronous liver metastasis from colorectal cancer does not increase significantly the incidence of AL.

Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB.

The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m2) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients. Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted. The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m2. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%). SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.

Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score-Matched Study and Meta-Analysis.

Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

Increasing severity of anemia is associated with poorer 30-day outcomes for total shoulder arthroplasty.

BackgroundTotal shoulder arthroplasty (TSA) has increased in utilization over the past several decades. Anemia is a common preoperative condition among patients undergoing TSA and has been associated with poorer outcomes in other surgical procedures. To the best of our knowledge, no study has analyzed the association between anemia severity and TSA outcomes. Therefore, the purpose of this study is to determine the effects that increasing severity of anemia may have on the postoperative outcomes in patients receiving primary TSA.MethodsA retrospective analysis was performed using the American College of Surgeons National Surgery Quality Improvement Project database from the years 2015 to 2018. Current Procedure Terminology code 23472 was used to identify all primary TSA procedures recorded during this time frame. Patients with greater than 38% preoperative hematocrit (HCT) were classified as having normal HCT levels. Patients with HCT values between 33% and 38% were classified as having mild anemia. All patients with less than 33% HCT were classified as having moderate/severe anemia. Patient demographic information, preoperative risk factors, and postoperative outcomes were compared among the 3 cohorts. A multivariate logistic regression including demographic factors and comorbidities was performed to determine whether increasing severity of anemia is independently associated with poorer postoperative outcomes.ResultsOf the 15,185 patients included in this study, 11,404 had normal HCT levels, 2962 patients were mildly anemic, and 819 patients had moderate to severe anemia. With increasing severity of anemia, there was an increased average hospital length of stay (1.6 vs. 2.1 vs. 3.0 days, P < .001), rate of readmissions (2.3% vs. 4.8% vs. 7.0%, P < .001), and rate of all reoperations (1.1% vs. 1.8% vs. 3.1%, P < .001). There was a statistically significant increase in both minor (1.9% vs. 2.7% vs. 4.4%, P < .001) and major (1.2% vs. 2.4% vs. 4.3%, P < .001) postoperative complication rates as well. Multivariate analysis identified anemia as an independent predictor of readmissions, reoperations, minor complications, and major complications.ConclusionWe found increasing severity of anemia to be associated with progressively worse 30-day postoperative outcomes. This is consistent with the outcomes found for increasing severity of anemia in patients receiving other total joint procedures. Using preoperative HCT levels may be a useful tool for predicting the risk of postoperative complications in patients undergoing TSA. This information could be used to further optimize patient selection for primary TSA.