Resection For Benign Pathology Research Articles

Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes?

Textbook outcome (TO) is an objective, composite measure of clinical outcomes in surgery. TO in liver surgery has been used in previous international studies to define and compare performance across centres. This study aimed to review TO rates following liver resection at a single institution. The secondary aim was to use a CuSum analysis to evaluate monitoring of performance quality over time for colorectal cancer liver metastases (CRCLM). All patients undergoing liver resection for benign and malignant causes from Christchurch Hospital hepatobiliary unit between 2005 and 2022 were included. Textbook outcomes measures were the absence of; intraoperative incidents, Clavien-Dindo >3 complication, 90 day re-admission, 90 day mortality, R1 resection, and post-operative bile leak/liver failure. Sequential CuSum analysis was performed to review achievement of TO in liver resections for colorectal cancer liver metastases (CRCLM). Four hundred and seventy-eight patients were included in this study, 54 had resection for benign pathology, 290 for CRCLM and 134 for other malignancies. TO was achieved in 74% of cases overall, with rates for benign, CRCLM and other malignancy being 82%, 73% and 74% respectively (P = 0.405). CuSum analysis documented a deterioration in performance after patient 60, with return to baseline by end of study period. TO for liver resection in a medium sized centre in New Zealand are comparable to published rates. It is possible to use process control techniques like CuSum with the binary result of TO to monitor performance, providing opportunity for continuous improvement in surgical units.

Immediate free flap reconstruction following the resection of benign jaw lesions: A 15-year perspective

ObjectivesTo report on outcomes of immediate free flap reconstruction following the resection of extensive benign jaw lesions. MethodsThis is a retrospective study on all patients who required free flap reconstruction after the ablation of benign jaw lesions and who were operated on by the Oral and Maxillofacial Surgery department in a tertiary care centre in Hong Kong from 2004 to 2019. The primary outcome assessed is flap success. The secondary outcomes assessed are recipient site, donor site and other complications, number of days on nasogastric tube and dental rehabilitation. Results45 patients were treated. Primary ameloblastoma was treated in 26 patients and recurrent ameloblastoma in five patients. 41 out of 45 cases were successful. The most common complication was local infection, experienced by 11.1 % of patients. On average, each patient spent 8.8 days on nasogastric tube feeding post-operatively. There was a significant difference in the number of days the patient was kept on nasogastric tube between the group which experienced recipient site complications and the group which did not (p = 0.0218). Dental rehabilitation with implants or dentures was possible in two-thirds of the patients. ConclusionImmediate free flap reconstruction is feasible for the reconstructing defects resulting from the resection of benign pathology, demonstrating high success and the option of dental rehabilitation. Age is not a significant factor in post-operative complications. Preventing recipient site complications may promote earlier resumption of oral feeding.