Length Of Resection Research Articles

P0677 Population-Based Analysis of 30-Day Postoperative Course in Crohn’s Disease Patients Undergoing Primary Bowel Resection

Abstract Background Despite a growing array of medical treatment options, resection rates for Crohn’s disease (CD) have decreased over time, while re-resection rates have remained stable at approximately one-third in historical cohorts. This study aimed to assess 30-day postoperative outcomes and complication rates following primary bowel resection in CD patients. Methods This study encompassed all CD patients undergoing primary resection in Eastern Denmark from 2010 to 2020 (46% of the Danish population, n=2,730,000). Clinical characteristics, surgical procedures, and complications (Clavien-Dindo classification and Rahbari score) were collected 30 days postoperatively (Figure 1). We used nonparametric statistics (median, interquartile range (IQR), percentages) and assessed complication risk with chi-square tests and multivariate logistic regression. Results Primary resection was performed on 631 CD patients due to disease activity. The median age at resection was 35 years (IQR: 25-49) with disease duration of 2 years (IQR: 0-7), and 227 (36%) were smokers. A total of 76 patients (12%) underwent acute resection (<24 hours), while 380 (60%) underwent elective procedures, 349 (55%) had laparoscopic surgery, 479 (76%) received a primary anastomosis (PA), and 94 (15%) were re-admitted. In total, 164 patients (26%) experienced complications within 30 days. Twenty-two (3%) had a Rahbari score of grade C, and two (0.3%) had grade B, and none had grade A. The Clavien-Dindo classification showed grade I: 22 (3%), grade II: 42 (7%), grade III: 95 (15%), grade IV: 4 (0.6%), and only one death (0.2%). Active steroid use (OR 2.26, 95% CI: 1.47–3.45, p<0.001), open surgery (OR 1.60, 95% CI: 1.10–2.34, p=0.015), and resection length >10 cm (OR 2.82, 95% CI: 0.532–51.9, p=0.325) were associated with higher odds, while primary anastomosis reduced risk (OR 0.42, 95% CI: 0.281–0.633, p<0.001). Never received IBD medication (OR 0.76, 95% CI: 0.42–1.30, p=0.336) or being on therapeutic doses of biologics (OR 1.31, 95% CI: 0.87–1.96, p=0.191) was not significantly associated with the risk of 30-day complications, nor were symptom burden (HBI) or smoking status (p=0.670 and 0.250). Conclusion CD patients are often diagnosed and primary resected young, facing significant risks within 30 days postoperatively: 15% were readmitted, and one-fourth experienced complications requiring treatment. the Risk of complications was increased by open surgery, resection length >10 cm, and preoperative corticosteroid use, while primary anastomosis reduced the risk. Receiving biologic therapy did not increase the risk of complications.

P0294 Functional outcomes after primary ileocecal resection for Crohn’s disease

Abstract Background Ileocecal resection (ICR) is a common procedure in Crohn’s disease (CD). Increasing evidence suggests ICR may be considered a first-line treatment for localized ileal CD to maintain long-term remission, rather than starting biologics. However, removal of the ileocecal valve affects bowel transit and disabling symptoms may arise. The aim of our study was to prospectively assess the impact of primary ICR on daily digestive symptoms in CD patients. Methods We included patients who underwent primary ICR at Saint-Antoine Hospital between January 2017 and December 2022. Patients were assessed after a morphological evaluation (endoscopy or MRI) performed between 5 months and 1 year post-ICR. Digestive symptoms were prospectively and systematically collected using a dedicated database. The primary endpoint was the prevalence of a composite outcome, defined as at least 4 soft or liquid stools per day and/or a fecal urgency with inability to delay defecation for more than 15 minutes, and/or moderate to severe daily abdominal pain. Secondary endpoints included other digestive symptoms. Multiple logistic regression analysis was performed to assess predictive factors for the primary outcome. Results One hundred nine patients were included. Indications for ICR were fistulizing disease (n=61, 56%) and stenosis (n=41, 37.6%). Only 7 patients (6.4%) had surgery for uncomplicated inflammatory disease. Thirty-five patients (32.1%) had morphological recurrence, defined as i2b, i3, i4 score, deep ulcers, stenosis, or fistulas on MRI. The primary endpoint was met by 24 patients (22%), with 21.1% having at least 3 liquid stools per day. Diarrhea (soft to liquid stools daily) was observed in 56.9%, fecal urgency in 22.9%, and abdominal pain in 32.1% (Figure 1). The primary endpoint prevalence was 17.6% in patients without morphological recurrence and 31.4% in those with recurrence (p=0.17) (Table 1). Multivariate analysis showed that age >40 years at surgery (OR=3.58 [95%CI 1.06-12.8] p=0.04), disease duration >2 years (OR=5.67 [95%CI 1.69-23.0] p=0.008), sepsis (fever >38.3°C within 7 days before surgery) (OR=8.06 [95%CI 1.68-44.2] p=0.01), and small bowel resection length >40 cm (OR=9.50 [95%CI 2.35-45.8] p=0.003) were associated with poorer digestive quality of life as defined by the primary composite endpoint. Conclusion The prevalence of digestive symptoms after primary ICR for CD is notable, regardless of disease recurrence. Advanced age, long disease duration, sepsis at surgery, and resection length were associated with disabling digestive symptoms. These results suggest that ICR leads to frequent and disabling digestive symptoms for many patients, which should be considered when proposing ICR.

P1311 Mucosal Microbiome Signatures Associated with Postoperative Endoscopic Recurrence in Paediatric Crohn’s Disease

Abstract Background Following ileocecal resection (ICR) for Crohn’s disease (CD), recurrence is frequent even in the biologic era. Gut microbiota is involved in this setting and a few adult studies have suggested that bacterial recolonization after surgery may predict recurrence. Given the inherent risk of postoperative recurrence associated with age and disease duration, studies investigating the role of the gut microbiota in predicting relapse in children undergoing ICR appears critical. We aimed to identify changes in the mucosal microbiome associated with, and predictive of, endoscopic CD recurrence within the first year post-ICR in a paediatric population. Methods Microbiota composition (16S rDNA sequencing) was assessed from ileal and colonic mucosa at the time of ICR and later during endoscopic evaluation from above and below the surgical anastomosis in 33 patients (26 with paired samples) prospectively recruited at a tertiary care paediatric IBD center. Results The study included 33 children (mean age 16±2.7 years) undergoing ICR. At the time of ileo-colonoscopy, 9 (35%) patients had endoscopic recurrence (Rutgeerts’ score≥ i2). ICR strongly modified the gut mucosal microbiota composition with significant changes in β-diversity (R2= 0.03, PERMANOVA test, p=0.01). Bacterial recolonization post-ICR differed according to recurrence status (Figure 1). Post-operatively, recurrence was associated with an increase in Fusobacterium, Dialister genera and in members of the Lachnospiraceae family, and a decrease in Faecalibacterium, Lactobacillus genera and members of the Streptococcaceae family. Microbiota colonizing the neoterminal ileum and subanastomotic colon differed in children with recurrence and showed, compared to remission, elevated and reduced bacterial abundance of the Enterobacter (q=0.1) and Ruminococcaceae (q=0.05) families in colonic samples respectively while the ileal mucosa exhibited profound depletion in Faecalibacterium (q=0.01). Postoperative colonic mucosal relative abundance of Enterobacteriaceae (q=0.06) and Ruminococcaceae (q=0.06) correlated positively and negatively with length of intestinal resection. At the time of surgery, several bacterial taxa able to predict relapse were identified (Figure 2). Conclusion Predicting postoperative CD relapse remains challenging, although several clinical risk factors of recurrence have been identified. Our study demonstrates that bacterial recolonization following ICR might pave the way towards remission or recurrence. Our results highlight, for the first time in a paediatric population, target species that may help clinicians to better define patients at risk of relapse and allow precise modulations of the overall microbial ecosystem towards remission pattern.

P0233 Prevalence and characteristics of short bowel syndrome in Crohn's disease: a retrospective observational single centre study

Abstract Background Despite a wide range of treatment options for Crohn’s Disease (CD), over half of patients require bowel resection within five years of diagnosis, with one-third needing additional surgery. Even with conservative surgical techniques, these patients remain at risk of Short Bowel Syndrome (SBS), defined as a residual small bowel length of less than 200 cm, potentially leading to intestinal failure (IF), characterized by reduced absorption of macronutrients, water or electrolytes. The prevalence and risk factors for SBS in CD patients remain unclear. Available retrospective studies report an SBS prevalence in operated CD patients ranging from 3.3% to 5.9 %. Our study aimed at describing the prevalence and characteristics of SBS, IF and Intestinal Functional Deficiency (IFD), defined as the need of any chronic enteral supplementation of macro and/or micronutrients, in a cohort of CD patients. Methods We conducted a retrospective observational cohort study, including all adult patients with CD referred to the Gastroenterology Department at IRCCS San Gerardo dei Tintori (Monza - Italy) between September 2014 and April 2022. Data were collected through the Electronic Medical Records. Results 456 CD patients were included with a mean age of 52 years (±18 SD). 221 (48.5%) patients underwent bowel surgery with a median resection length of 63 cm (IQR 60.75); the ileocecal valve was preserved in 49 (22.1%) patients. Four patients (1.8% of operated CD patients) developed SBS, after two to four surgeries over a median follow-up of 18 (IQR 15) years. Of these, three presented with type 2 SBS (jejuno-colonic anastomosis) and one with type 1 SBS (jejunostomy). Three patients had ileocolonic disease and one ileal disease, upper disease was present in three. Two SBS patients had stricturing disease, and the remaining two a penetrating phenotype. Perianal involvement was present in two patients. Only one patient (0.5%) developed permanent IF. On the other hand, 110 (49.7%) of operated patients presented post-surgical IFD: 109 (99.1%) received vitamins, 7 (6.4%) proteo-caloric, and 3 (2.7%) electrolytes supplements. These patients had a higher median age (62 vs 51.5 years, p=0.001), longer small bowel resections (60 vs 20 cm, p<0.0001) and more frequent ileocecal valve resections (91.8% vs 63.9%, p<0.0001) than patients without deficiency. Conclusion SBS and IF are rare conditions in CD patients following surgical bowel resection, prevalence is lower than previously reported. Whereas IFD affects about half of resected CD patients, highlighting the importance of prevention, early diagnosis and treatment of nutritional deficit.

Measure Subtrochanteric Osteotomy in Unilateral Crowe-IV Dysplasia-Surgical Technique.

Determining the optimal osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip undergoing subtrochanteric osteotomy remains challenging due to the significant variability in pelvic and spinal alignment. Incorrect osteotomy length, compounded by pelvic or spinal tilt, can adversely affect postoperative gait and long-term outcomes. Therefore, this study could introduce a method to calculate the osteotomy length for patients with unilateral Crowe-IV developmental dysplasia of the hip, correcting spinal and pelvic tilt, and improving patient gait. This is a retrospective study that included 28 patients with unilateral Crowe-IV developmental dysplasia of the hip collected from June 2019 to June 2020, who underwent total hip arthroplasty with measured subtrochanteric osteotomy technique. The average follow-up period was 4.3 years (last follow-up). Harris scores, pelvic tilt angles represented by iliac obliquity angle (IO) and sacral obliquity angle (SO), and postoperative complications were recorded. Statistical analysis was performed using independent sample t-tests for normally distributed data and the Mann-Whitney U test for non-normally distributed data. Postoperatively, pelvic tilt angles improved significantly. The comparison of preoperative and postoperative 3-month IO angles (8.77° ± 3.31° vs. 5.28° ± 2.29°, p = 0.00), and postoperative 3-month and last follow-up (5.28° ± 2.29° vs. 2.88° ± 1.39°, p = 0.00) showed statistically significant differences. Similarly, the comparison of preoperative and postoperative 3-month SO angles (9.56° ± 3.1° vs. 5.81° ± 2.78°, p = 0.00), and postoperative 3-month and last follow-up (5.81 °± 2.78° vs. 3.59° ± 1.72°, p = 0.00) showed statistically significant differences. Harris scores significantly improved from preoperative to 1-year postoperative (47.35 ± 12.32 vs. 80.5 ± 7.81, p = 0.00), and from 1-year postoperative to last follow-up (80.5 ± 7.81 vs. 90.78 ± 2.86, p = 0.00) with statistical significance. There were no significant differences in adverse event rates between the two groups. Total hip arthroplasty combined with measurement subtrochanteric osteotomy technique improves pelvic tilt and Harris scores in Crowe-IV developmental dysplasia patients. This technique may serve as a guideline for determining resection length.

Minimum resection length to ensure a pathologically negative distal margin and a larger remnant stomach for esophagogastric junction cancer.

Ensuring a pathologically negative distal margin (DM) and preserving a larger remnant stomach is important for proximal gastrectomy (PG) in patients with esophagogastric junction (EGJ) cancer. However, the minimum DM length for ensuring negative margins has not been identified. We enrolled patients undergoing PG or total gastrectomy for EGJ cancer. A parameter ΔDM, representing the pathological extension distally beyond the gross tumor boundary, was evaluated. The maximum ΔDM, which indicates the minimum length ensuring a pathologically negative DM, was determined in all patients. Subgroup analyses were performed according to factors associated with ΔDM > 10mm. The possible incidences of pathologically positive DM based on gross DM length were also calculated. Among 253 eligible patients, the maximum ΔDM was 55mm. Growth and pathological types were significantly associated with ΔDM > 10mm. In subgroup analyses, the maximum ΔDM was 30/20/55mm for the superficial/expansive/infiltrative growth types, and 55/40mm for the differentiated/undifferentiated types. In the infiltrative growth type alone, the maximum ΔDM remained 55/40mm for the differentiated/undifferentiated types. However, even if the gross DM length was reduced to 30mm, the possible incidence of pathologically positive DM only increased to 2.6% in the infiltrative differentiated type. We recommend a minimum DM length of 30/20/55mm for the superficial/expansive/ infiltrative growth types. Specifically in the infiltrative growth type, we alternatively recommend 30/40mm for the differentiated/undifferentiated types, with a mandatory intraoperative frozen section analysis. Mini-abstract This study proposes a distal margin length for safe resection of esophagogastric junction cancer, ensuring pathologically negative margins while preserving a larger remnant stomach, based on growth and pathological types.

Metatarsal Aneurysmal Bone Cysts Treated With En Bloc Resection and Reconstruction With Fibular Allograft.

Treatment of Primary metatarsal aneurysmal bone cyst (ABC) with curettage and bone grafting unfortunately has a high recurrence rate, particularly in short tubular bones. This study presents a 16-year experience treating ABCs in the bones of the foot at an orthopaedic oncology referral center. Treatment involved en bloc resection and reconstruction of the defect with fibular allograft in all cases. Retrospectively collected data were used to document the outcomes. This retrospective review includes patients with primary metatarsal ABC treated en bloc resection at a single center between 2004 and 2020. Information on the diagnosis, treatment, complications, and outcomes was collected from our database for all eligible patients. Radiologic healing was used as our primary outcome measure. The patient's function was assessed using the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score. The study included 19 subjects (11 women, 8 men) with a mean age of 18 years (SD 11-35). The average resected length was 4.24 cm (3-6 cm). The mean follow-up time was 79.26 months (28-160 months). The mean TESS score and MSTS were 94.52 and 28.42, respectively. The average healing time was 10.2 weeks. No patient had local recurrence. Arthrodesis was performed in 3 patients because of joint involvement. Repeat surgery was performed for 2 patients, debridement for one because of infection and bone graft for another because of nonunion. One patient had experienced an allograft fracture. Based on the Enneking classification, our experience has shown that a reasonable surgical approach for primary active and invasive metatarsal ABC is en bloc resection and reconstruction with fibula allograft. This method has a low risk of recurrence and does not result in significant functional impairment.

Risk Factors of Reoperation in Patients with Intestinal Behçet's Disease Treated by Initial Bowel Resection.

Background/Objectives: Intestinal Behçet's disease (iBD) often requires surgical intervention, with a significant proportion of patients needing reoperation. This study aimed to investigate the risk factors associated with reoperation in patients with iBD who underwent initial bowel resection and to evaluate the perioperative and long-term outcomes in these patients. Methods: This was a retrospective case-control study analyzing patients who underwent their initial bowel resection due to iBD between 2005-2021 at a tertiary referral hospital. Reoperation was considered a surgery due to postoperative complications (within 30 days of the initial surgery) or disease progression. Results: A total of 81 patients were included. The median follow-up duration was 107.1 months, during which 26 patients (32%) underwent reoperation. Multivariable analysis showed that the presence of hematological disorders (hazards ratio [HR], 9.13; 95% confidence interval [CI], 3.79-22.02, p < 0.001), higher c-reactive protein (CRP) levels before the initial surgery (HR, 1.01; 95% CI, 1.01-1.02, p < 0.001), and a shorter specimen resection length (HR, 0.96; 95% CI, 0.93-0.99, p = 0.011) were risk factors for reoperation. Patients who underwent reoperation had higher rates of postoperative complications (69.2% vs. 43.6%, p = 0.031), required longer antibiotic use (12 vs. 7 days, p = 0.012), and had extended hospital stays (18 vs. 9 days, p = 0.011). They also had worse 5-year survival rates than those who did not undergo reoperation (83.5% vs. 98.4%, p = 0.012). Conclusions: Concurrent hematological disorders, high preoperative CRP levels, and short specimen resection were associated with an increased risk of reoperation in patients with iBD who underwent their initial bowel resections. They also had worse perioperative and long-term outcomes.

A novel piglet model of esophageal stricture following variable segmental esophageal resection and re-anastomosis.

Esophageal strictures following esophageal atresia repair are a source of significant morbidity. To test new therapeutic approaches, we designed a piglet model of esophageal stricture by resecting variable lengths of esophagus with subsequent re-anastomosis. This study describes the model and validates its physiologic impact by blinded analysis of the weight gains of the piglets. A total of 24 two-week old Pietrain piglets had esophageal resections performed, ranging from 0 to 5 cm, with the goal of inducing postoperative esophageal strictures. Postoperative body-weights were evaluated by repeated analysis of variance followed by pairwise group-comparisons based on estimated marginal means. In addition, body weight was modeled by linear-mixed model regression. Different resection lengths were compared. The esophagi were evaluated postmortem for stricture. Of 24 operated piglets, 23 reached the endpoint, and 90% developed an esophageal stricture that was radiologically visible in a contrast study, as well as appreciable macroscopically in the necropsy. We found differences in pre- and postoperative body weights for all piglets (F (1, 18) = 298.54, p < 0.001), but no differences between resection lengths (F (4, 18) = 0.36, p = 0.837). Our model of postoperative esophageal stricture offers the opportunity to investigate potential treatments for strictures associated with esophageal atresia, since it reliably induces strictures and results in minimal loss of animals. The similar body weight gain in all groups indicates that stricture is mainly the result of esophageal resection and re-anastomosis, regardless of the length of the resected segment.

Wrist fusion with ulnar translocation for aggressive giant cell tumour of distal end radius: Short-term functional and clinico-radiological outcomes

BackgroundThe distal end radius (DER) is the third most common site of a giant cell tumour (GCT) in bone. GCT is a locally aggressive benign tumour with metastatic potential. The main goals in the management of GCT of DER are the complete removal of the tumours, the prevention of recurrence, and the restoration of the functional wrist. PurposeThis case series reports the clinical and functional outcome of en bloc tumour resection, ulnar translocation and wrist arthrodesis in patients with high-grade GCT of DER. MethodsSixteen patients with Campanacci grade II & III GCT of distal end radius who underwent the procedure between 2009 and 2018 and had a follow-up of 2 years were included. Patients with distant metastasis, chronic severe systemic illness, operated previously, and follow-up dropouts were excluded from the study. The patient's demographic profile and tumour characteristics were collected at the initial visit. Grip strength, modified MAYO wrist score, and VAS score for wrist pain were collected preoperatively and at 1-year and 2-year follow-ups. ResultsThe study included predominantly females (13 vs 3). The mean age was 31.5 ± 8 years with a symptom duration of 6.5 ± 3.1 months (range 3–14). The mean resection length was 8.31 ± 1.5 cm (range 6–12). The mean Ulnoradial and ulnocarpal union time was 22.7 ± 8.0 and 17.5 ± 2.3 weeks, respectively. The mean modified Mayo Wrist score was 20.63 ± 9.4, 48.7 ± 5.6 and 60.6 ± 4.0 at preop, 1 year and 2 years follow-up. The mean MSTS score was 22.68 ± 1.8 (range 19–26). Two patients had ulnoradial nonunion. ConclusionWrist arthrodesis by ulnar translocation and plate fixation is a viable option in the management of GCT of distal end radius. The short-term clinical and functional outcomes are favourable for restoring adequate wrist function.

Allograft-prosthesis composite after proximal femur bone tumor resection in pediatric age: Is it effective in preserving bone stock?

The purpose of the study was to answer the following questions. What was functional results of pediatric patients receiving a short stem allograft-prosthesis composite of the proximal femur? What was complication rate and revision-free implant survival? Was it possible to preserve the bone stock of the proximal femur in pediatric patients? We reviewed 10 pediatric patients treated with proximal femur resection for a primary bone tumor and reconstruction with short stem allograft-prosthesis composite, with at least 24 months follow-up. The median age was 9 years (4-13) at surgery. The mean resection length was 15 cm (6-29). In six cases, fixation was performed with a short plate positioned under the great trochanter while in four cases a long plate extended over the great trochanter was employed. Nine complications that required surgical revision were assessed in six patients (one wound dehiscence, two nonunions, two fractures, one acetabular wear, three hypometria), while allograft-prosthesis composite removal was required in three patients. The revision-free survival was 57% (95% confidence interval 33%-100%) at 5 and 10 years. The graft removal-free survival was 75% (95% confidence interval 50%-100%) at 5 and 10 years. The mean Musculo-Skeletal Tumor Society Score was 28 (20-30). Allograft-prosthesis composites with short stem and compression plate represents an effective reconstructive option after proximal femur resection for primary bone tumors in growing patients, preserving bone stock. The use of a compression plate extended over the greater trochanter seemed to reduce failure rate.

Induced membrane technique for malignant bone tumours of the humerus.

The aim of this study was to report on mid- to long-term results following large humeral tumoral resection and reconstruction with the induced-membrane technique in skeletally immature patients suffering from primary malignant bone tumours. A retrospective analysis identified all children who underwent the two stages of a humeral reconstruction using the induced-membrane technique for primary malignant humerus tumours between 2002 and 2020. Functional assessment was conducted by an independent observer using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper limb. Radiological assessment was performed by two independent observers and the healing index was calculated (i.e., months/cm). Eight adolescents (5 osteosarcomas and 3 Ewing sarcoma), with a mean age of 14.2 years (SD = 2.7), were included. The mean length of the bone resection was 17.4cm (SD = 3.8), and the mean delay of the resection and reconstruction stages was 9.4 months (SD = 4). The mean follow-up was 6.6 years (SD = 4.3). The mean MSTS score was 77.4% and the global average healing index was 1.04 months/cm (SD = 2.2). Four complications (i.e., prominence device, fracture, aseptic pseudarthrosis, radial palsy) and one local recurrence were observed in four patients, requiring four unplanned surgical procedures in three patients. One patient died fourteen years after the initial treatment due to a lung recurrence. The induced-membrane technique is an effective and safe alternative for reconstructing large humeral bone defects after tumour resection in adolescents. Although this is a two-stage technique, it gives good functional results comparable to other strategies found in the literature. IV.

Indications and Long-Term Outcomes of Intercalary Reconstruction Techniques for Diaphyseal Bone Tumors

Objective: Intercalary reconstruction after resection of diaphyseal bone tumors allows for adjacent-joint preservation; however, despite implant advancements they continue to experience high failure rates. Free fibular autograft (FFA), allograft interposition, and metallic endoprostheses are used, but there is no consensus on optimal construct. Methods: We conducted an IRB-approved retrospective review of patients who underwent intercalary reconstruction for oncologic indications at a single institution (1999 to 2022). Inclusion criteria included intercalary reconstruction with FFA, allograft, or endoprosthesis for oncologic indications and with minimum follow-up of 3 months. Primary outcome was implant survival. Secondary outcomes included complication type, rate, and timing, resection length, distance from articular surface, and failure modes. Results: Thirty-five patients met inclusion criteria, 23 men and 12 women. Reconstructive options included: FFA (N=8), endoprosthesis (N=16), and allograft (N=11). Average follow-up was 3.9 years. Average patient age was 41.8 years; FFA patients were younger than endoprosthesis patients (P=0.0002). FFAs were closer to the articular surface than endoprostheses (P=0.0003). Overall implant survival was 36.6% at 21 years; median survival was 2.04 years. Overall complication rate was 65.7%, with no difference between groups. Ten patients (28.5%) ultimately ended with a joint-sacrificing operation. Conclusions: This study supports the existing literature’s reported high rate of complication and implant failure of intercalary reconstructions. Salvage options are available, including those for secondary joint-sparing operations; however, they often result in a joint-sacrificing endoprosthesis limiting function and longevity. With patients having improved life expectancy for both metastatic and primary bone tumors, implant optimization is critical.

Proximal Fibulectomy for Giant Cell Tumours: What Works!

Giant cell tumor of bone (GCTB) is the most common primary tumor of proximal fibula. Because of its close proximity to vascular structures, common peroneal nerve (CPN) and attachment of lateral collateral ligament (LCL), proximal fibulectomy poses unique challenges. We analyzed oncological and functional outcome of patients who underwent proximal fibulectomy for GCTB of proximal fibula. Between January 2006 and December 2020, 23 patients underwent proximal fibulectomy for GCTB of proximal fibula, four were recurrent tumors. Mean resection length was 9cm (5 to 15cm). The LCL and biceps tendon were not reconstructed in 22 cases. The common peroneal nerve was sacrificed in seven patients including three recurrent cases. Functional status was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system. There were two vascular complications and one infection. With 4 patients lost to follow up, mean follow up was 90months (12 to 197). No patient had local or distant recurrence. Mean MSTS score was 26 (21 to 30). Eleven of 23 patients (48%) had loss of common peroneal nerve function with poorer functional outcome. No patient had symptoms suggestive of knee instability. Proximal fibulectomy is oncologically safe. Reconstruction of the LCL attachment is not mandatory and patients do not have symptomatic knee instability. Functional outcomes are compromised after sacrifice of common peroneal nerve and may be potentially improved with tendon transfers at index surgery.

Prophylactic endoscopic vacuum therapy for stricture prevention following wide-field endoscopic submucosal dissection of superficial esophageal cancer

Background and aimsEsophageal stricture (ES) is a severe adverse event following wide-field endoscopic submucosal dissection (ESD) of superficial esophageal carcinoma. This study evaluated the efficacy and safety of combining endoscopic vacuum therapy (EVT) and budesonide orodispersible tablet (BOT) in preventing post-ESD strictures. MethodsThis prospective case series included patients with superficial esophageal squamous cell carcinoma and adenocarcinoma who had wide-field ESD (≥75% circumference, resection length ≥50 mm). After ESD, EVT was applied immediately, followed by 8 weeks of BOT. The main outcome measurement was the incidence of post-ESD stricture. ResultsEleven patients underwent ESD. Of these, 81.8% had 75-99% circumference resected, and 18.2% had a circumferential resection. EVT remained in situ for a mean of 3.5 days. No esophageal strictures were observed by the final follow-up. There were no major adverse events related to EVT or BOT. ConclusionsThe prophylactic combination of EVT and BOT is a novel and promising strategy for reducing post-ESD strictures.

Prediction modeling of postoperative pulmonary complications following lung resection based on random forest algorithm.

Postoperative pulmonary complications (PPCs) are a significant concern following lung resection due to prolonged hospital stays and increased morbidity and mortality among patients. This study aims to develop and validate a risk prediction model for PPCs after lung resection using the random forest (RF) algorithm to enhance early detection and intervention. Data from 180 patients who underwent lung resections at the Third Affiliated Hospital of the Naval Medical University between September 2022 and February 2024 were retrospectively analyzed. The patients were randomly allocated into a training set and a test set in an 8:2 ratio. An RF model was constructed using Python, with feature importance ranked based on the mean Gini index. The predictive performance of the model was evaluated through analyses of the receiver operating characteristic curve, calibration curve, and decision curve. Among the 180 patients included, 47 (26.1%) developed PPCs. The top 5 predictive factors identified by the RF model were blood loss, maximal length of resection, number of lymph nodes removed, forced expiratory volume in the first second as a percentage of predicted value, and age. The receiver operating characteristic curve and calibration curve analyses demonstrated favorable discrimination and calibration capabilities of the model, while decision curve analysis indicated its clinical applicability. The RF algorithm is effective in predicting PPCs following lung resection and holds promise for clinical application.

The Utility of Preoperative Phenylephrine Testing in Müller Muscle Conjunctival Resection Surgery for Involutional Ptosis.

Phenylephrine testing prior to Müller muscle conjunctival resection has traditionally been used to predict postoperative outcomes. The purpose of this study is to determine if preoperative phenylephrine testing impacts postoperative changes in eyelid position. In this multicenter cross-sectional cohort study, 270 eyelids of participants with involutional ptosis and levator function >12 mm who underwent Müller muscle conjunctival resection were divided into 2 comparison groups. Participants who had preoperative phenylephrine testing served as the control group and those who did not were the study group. The primary outcome measure was postoperative marginal reflex distance from the upper eyelid margin (marginal reflex distance 1 [MRD1]) at the latest follow-up visit. Secondary outcomes included change in MRD1, reoperation rate, and predictive capacity of preoperative phenylephrine testing. Of the 270 eyelids that underwent Müller muscle conjunctival resection, 116 eyelids served as controls and 154 were in the study group. Mean age of participants was 62.6 years. Levator function, resection length, preoperative MRD1, change in MRD1, and latest postoperative MRD1 measures when compared in the control and study groups demonstrated no significance (p > 0.05) via 2-tailed t-test. Postoperative MRD1 was correctly predicted within 1 mm for 60.2% of eyelids that underwent preoperative phenylephrine testing. Preoperative phenylephrine testing does not significantly predict postoperative eyelid elevation following Müller muscle conjunctival resection. Surgeons may thereby reassess the utility of preoperative phenylephrine testing given the lack of influence on surgical outcomes.

Essential updates 2022-2023: Surgical and adjuvant therapies for locally advanced colorectal cancer.

Pivotal articles that had been published between 2022 and 2023 on surgical and perioperative adjuvant treatments for locally advanced colorectal cancer (CRC) were reviewed. This review focuses on new evidence in the following areas: optimization of surgical procedures for colon cancer, including the optimal length of bowel resection and use of the no-touch isolation technique; minimally invasive surgery for rectal cancer, such as laparoscopic transanal total mesorectal excision and robotic surgery; neoadjuvant treatments for rectal cancer, including total neoadjuvant therapy; neoadjuvant chemotherapy for colon cancer; and postoperative adjuvant chemotherapy for Stage II and III colon cancer. Although the current understanding may not enable perfect decision-making for patients and medical professionals, ongoing advancements are expected to result in more effective personalized treatment plans, ultimately improving the prognosis and quality of life of patients.

The MRE11-RAD50-NBS1 complex both starts and extends DNA end resection in mouse meiosis.

Nucleolytic resection of DNA ends is critical for homologous recombination, but its mechanism is not fully understood, particularly in mammalian meiosis. Here we examine roles of the conserved MRN complex (MRE11, RAD50, and NBS1) through genome-wide analysis of meiotic resection in mice with various MRN mutations, including several that cause chromosomal instability in humans. Meiotic DSBs form at elevated levels but remain unresected if Mre11 is conditionally deleted, thus MRN is required for both resection initiation and regulation of DSB numbers. Resection lengths are reduced to varying degrees in MRN hypomorphs or if MRE11 nuclease activity is attenuated in a conditional nuclease-dead Mre11 model. These findings unexpectedly establish that MRN is needed for longer-range extension of resection, not just resection initiation. Finally, resection defects are additively worsened by combining MRN and Exo1 mutations, and mice that are unable to initiate resection or have greatly curtailed resection lengths experience catastrophic spermatogenic failure. Our results elucidate multiple functions of MRN in meiotic recombination, uncover unanticipated relationships between short- and long-range resection, and establish the importance of resection for mammalian meiosis.

COVID-19 Related Tracheal Stenosis Requiring Tracheal Resection: A Case Series.

To characterize the preoperative and intraoperative findings of symptomatic tracheal stenosis associated with COVID-19 related respiratory failure requiring tracheal resection. We performed a retrospective review identifying all patients with a history of tracheal stenosis secondary to COVID-19 related respiratory failure who subsequently received a tracheal resection at our institution between January 2020 and June 2023. Clinical, radiological, pathological, and surgical characteristics were recorded to describe and characterize pre-operative and intraoperative findings associated with tracheal stenosis in the setting of a previous COVID-19 infection. We retrospectively reviewed 11 patients with COVID-19 related tracheal stenosis that required open tracheal or cricotracheal resection. The mean age was 54.1. Patients were hospitalized for a mean of 49.5 days related to COVID-19 complications. Tracheotomy was completed in 10 patients (90.9%) during their initial hospitalization with COVID-19 related respiratory failure. Patients were intubated a mean of 18.6 days prior to tracheotomy completion. Ten patients (90.9%) underwent endoscopic operative interventions for their tracheal stenosis prior to open resection. Intraoperatively, the mean stenosis length was 3.33 cm. The mean tracheal resection length was 3.96 cm. Patients were hospitalized for a mean of 8.27 days post operatively with no significant post operative complications. Symptomatic tracheal stenosis in the setting of prolonged intubation due to COVID-19 is an under-described etiology. This is one of the largest single institution retrospective reviews that identifies 11 patients with prolonged intubation who developed symptomatic tracheal stenosis refractory to conservative management and ultimately requiring tracheal resection.