Shorter Postoperative Hospital Research Articles

Comparison of watershed analysis with indocyanine green fluorescence staining and modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy.

The increasing utilization of computed tomography (CT) scans has significantly elevated the detection rate of pulmonary nodules. Pulmonary segmentectomy has become the preferred surgical technique for peripheral non-small cell lung cancer (NSCLC) measuring 2 cm or smaller. Various methods for identifying the intersegmental planes (ISPs) are currently employed. This study aims to compare the short-term clinical safety and efficacy of the watershed analysis with indocyanine green (ICG) fluorescence staining to the modified inflation-deflation method in single-port thoracoscopic complex pulmonary segmentectomy. This retrospective study was conducted on patients who underwent single-port thoracoscopic complex pulmonary segmentectomy at The First Affiliated Hospital of Soochow University between January 2023 and December 2023. One cohort received treatment with the watershed analysis with ICG fluorescence staining, while the other cohort was treated with the modified inflation-deflation method. The study evaluated intraoperative and postoperative conditions, as well as the short-term impact on postoperative pulmonary function in both groups. The watershed analysis with ICG fluorescence staining group demonstrated less operating time (P<0.001), shorter ISPs visualization time (P<0.001), and reduced intraoperative blood loss (P<0.001). Postoperatively, 8 patients (16%) in this group experienced air leakage, compared to 20 patients (39%) in the modified inflation-deflation method group, indicating significant differences between the groups (P=0.009). Additionally, the watershed analysis with ICG fluorescence staining group had shorter postoperative drainage tube duration (P<0.001), shorter postoperative hospitalization (P<0.001), and less postoperative pleural effusion volume (P<0.001). There was no disparity observed in pulmonary function decline at three months after the surgery between the two cohorts. The watershed analysis with ICG fluorescence staining is associated with less operating time, fewer postoperative complications, and a lower risk of postoperative air leakage in complex pulmonary segmentectomy. The impact on pulmonary function was comparable to the traditional method. These findings suggest that the watershed analysis with ICG fluorescence staining is a more promising, safe, and effective approach for complex pulmonary segmentectomy.

Comparative Analyses of the Outcomes Between Lobectomies and Trisegmentectomies/Lingulectomies in the Surgical Management of Clinical Stage I Left Upper Lobe Non-small Cell Lung Cancer.

Lobectomies are the standard surgical intervention for lung cancer; however, recently, surgeons have considered segmentectomies for smaller tumors, with their potential for favorable survival outcomes while preserving lung function. The surgical outcomes of trisegmentectomies/lingulectomies and lobectomies for clinical stage I left upper lobe (LUL) non-small cell lung cancers (NSCLCs) remain undetermined. Thus, our study aimed to assess the differences between the short-term surgical and long-term survival outcomes in patients with clinical stage I LUL NSCLC who underwent trisegmentectomies/lingulectomies and those who underwent lobectomies. Between 2011 and 2021, we retrospectively reviewed the data of 377 patients with clinical stage I NSCLC who had undergone LUL lobectomies or trisegmentectomies/lingulectomies. Patients were categorized into two subcohorts according to tumor size, i.e. 0-2 and 2-4 cm. To ensure preoperative demographic comparability, 1:1 propensity-score matching (PSM) was performed. This study focused on the 2-4cm subcohort. Post-PSM, patients who underwent trisegmentectomies/lingulectomies had quicker operations and shorter postoperative hospital and intensive care unit lengths of stay than those who underwent lobectomies. Post-PSM, no statistically significant differences in progression-free survival (PFS) or overall survival (OS) were observed between the segmentectomy and lobectomy groups in both the0-2 and 2-4cm subcohorts. The multivariate analysis revealed that different surgical methods were not statistically significant factors for either PFS or OS. Trisegmentectomies/lingulectomies are a feasible option for clinical stage I NSCLC, with better perioperative outcomes and similar survival rates when compared with LUL lobectomies.

Minimally invasive versus open ileal ureter with ileocystoplasty: comparative outcomes and 5-year experience

PurposeTo present the experience of ileal ureter with ileocystoplasty (IUC), and compare the outcomes of IUC in minimally invasive procedures to open procedures.Patients and methodsFrom December 2017 to April 2023, twenty patients underwent IUC in open or minimally invasive (including laparoscopic and robotic) procedures. The baseline characteristics, perioperative data and follow-up outcomes were collected. Success was defined as relief of clinical symptoms, stable postoperative serum creatine and absence of radiographic obstruction. The perioperative and follow-up outcomes of open procedures and minimally invasive procedures were compared.ResultsThe etiology included pelvic irradiation (14/20), urinary tuberculosis (3/20) and surgical injury (3/20). Bilateral ureter strictures were repaired in 15 cases. The surgeries conducted consisted of open procedures in 9 patients and minimally invasive procedures in 11 patients. Compared to open procedures, minimally invasive surgeries had less median estimated blood loss (EBL) (100 ml vs. 300 min, p = 0.010) and shorter postoperative hospitalization (27 d vs. 13 d, p = 0.004). Two patients in the open group experienced grade 3 complications (sigmoid fistula and acute cholecystitis in one patient, and pulmonary embolism in another patient). Over a median follow-up period of 20.1 months, the median bladder functional capacity was 300 ml, with a 100% success rate of IUC.ConclusionIUC is feasible in both open and minimally invasive procedures, with acceptable complications and a high success rate. Minimally invasive procedures can have less EBL and shorter postoperative hospitalization than open procedure. However, prospective studies with larger groups and longer follow-up are needed.

Comparative Study between Gluteal Artery Perforator Flaps and Local Fasciocutaneous Flaps in Reconstruction of Gluteal Pressure Ulcers.

Gluteal pressure ulcers are a common problem, associated with great morbidity and cost, and their surgical treatment includes debridement with complete bursectomy, followed by soft tissue coverage. Gluteal artery perforator flaps and gluteal fasciocutaneous flaps are commonly preferred for reconstruction because they preserve the gluteal muscle, allowing for revision in recurrent cases. The aim of this study was to evaluate the differences between these two flaps in the reconstruction of gluteal pressure ulcers regarding operative time, postoperative hospital stay, postoperative complications, and recurrence. This prospective comparative study was conducted on 30 patients who presented with stage IV gluteal pressure ulcers. Patients were randomly allocated into two equal groups: each group consisted of 15 patients. Cases in group A were reconstructed using gluteal artery perforator flaps, and those in group B were reconstructed using local fasciocutaneous flaps. There was statistically significant long operative time and short postoperative hospital stay in gluteal artery perforator flaps when compared with local fasciocutaneous flaps. Also, the fasciocutaneous group reported a higher nonsignificant complication rate when compared with the gluteal perforator group. No recurrent cases were reported, and most patients had satisfactory outcomes in both groups. Both techniques are safe, reliable, and effective and can be considered as a first-line option in the reconstruction of gluteal pressure ulcers.

Comparisons of Percutaneous Ablation, Open or Laparoscopic Liver Resection for Barcelona Clinic Liver Cancer Stage 0-A Hepatocellular Carcinoma: A Concurrent Generalized Propensity Score Analysis.

Liver resection and ablation remain the most common therapeutic options for Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC), but there is a lack of evidence to show which is the most suitable therapy. This study aimed to make concurrent multi-arm comparisons of the short-term and long-term outcomes of percutaneous ablation (PA), open (OLR) or laparoscopic liver resection (LLR) for these patients. This was a retrospective observational cohort study. A series of generalized propensity score methods for multiple treatment groups were performed to concurrently compare the clinical outcomes of these three treatment options to balance potential confounders. Regression standardization was used to account for hazard of all-cause mortality and recurrence of intergroup differences. Of the 1778 patients included, 1237, 307 and 234 underwent OLR, LLR and PA, respectively. After overlap weighting, which was the optimal adjustment strategy, patients in the minimally invasive group (LLR and PA groups) had few postoperative complications and short postoperative hospital stays (both P < 0.001). The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate were significantly higher in the LLR group when compared with the OLR and PA groups (RFS: 55.6% vs 48.0% vs 30.2%, P < 0.001; OS: 89.1% vs 79.7% vs 84.0%, P = 0.020). Multivariable Cox analysis and regression standardization showed that LLR was an independent factor for better RFS when compared with OLR and PA. In subgroup analysis, the long-term outcomes of patients with BCLC stage A HCC were consistent with the whole population. In the observational study using various covariate adjustment analysis with excellent balance, LLR is not only minimally invasive, but also provides better RFS and equivalent OS for patients with BCLC stage 0-A HCC when compared with OLR and PA.

A COMPARATIVE STUDY OF SCLEROTHERAPY AND HEMORRHOIDECTOMY IN SECOND-DEGREE HEMORRHOIDS

Objective: The objective is to compare the post-operative complications and outcome of sclerotherapy and hemorrhoidectomy in second-degree hemorrhoids. Methods: A hospital-based prospective comparative study on 100 cases diagnosed to have second-degree hemorrhoids attending emergency or outdoor was taken between December 2021 and November 2022 at the department of Surgery, S.P. Medical College and P.B.M Hospital, Bikaner. Cases were divided into 2 groups SCL group (sclerotherapy group) and H group (hemorrhoidectomy group). Results: The mean age in H group was 38.56±7.8 years whereas 39.08±8.2 years in SCL group. (p&gt;0.05) and both groups were sociodemographically comparable. The mean duration of hospital stay in H group was 1.5±0.4 days whereas 0.9±0.3 day in SCL group (p&lt;0.05). In H group, maximum 96.00% had complaints of pain and 30% had bleeding whereas in SCL maximum of 66.00% had complaints of bleeding and 38% had constipation. In H group, maximum 74% were cured whereas 96% in the group SCL (p=0.005*). Conclusion: The findings of the study conclude that of the two surgical procedures employed in the study to treat hemorrhoids sclerotherapy was found to had less complications, early ambulation, short post-operative hospital stay, and cost-effective.

Renal cell carcinoma outcomes in end-stage renal disease: A 40-year study from two Japanese institutions.

The objective of the study was to analyze the outcomes of patients with renal cell carcinoma (RCC) arising in end-stage renal disease (ESRD) over a 40-year span. We retrospectively evaluated data of patients with ESRD-RCC diagnosed between 1979 and 2020 at two institutions. We assessed changes in stage, surgical approaches, and cancer-specific survival (CSS) following nephrectomy according to era between ESRD-RCC and sporadic RCC. Furthermore, perioperative outcomes in patients with ESRD-RCC were compared between laparoscopic and open surgery. Patients with ESRD-RCC (n = 549) were diagnosed at an earlier stage (p = 0.0276), and the ratio of laparoscopic nephrectomy was increased (p < 0.0001) according to eras. Since 2000 (i.e., after implementation of laparoscopic nephrectomy), patients with ESRD-RCC (n = 305) had significantly shorter CSS (p = 0.0063) after nephrectomy than sporadic RCC (n = 2732). After adjustment by multivariate analysis and propensity score matching, ESRD status was independently associated with shorter CSS (p = 0.0055 and p = 0.0473, respectively). Improved CSS in sporadic RCC (p < 0.0001), but not ESRD-RCC (p = 0.904), according to era contributed to this difference. Laparoscopic nephrectomy showed favorable outcomes, including shorter surgery time, lower estimated bleeding volumes, transfusion rates, and readmission rates, and shorter postoperative hospitalization than open nephrectomy (p < 0.05). Advances in diagnostic and treatment modalities potentially enable early diagnosis and minimally invasive surgery for patients with ESRD-RCC. As ESRD-RCC may not present indolently, careful post-operative monitoring is needed.

Evaluation of Outcomes of Percutaneous Endoscopic Discectomy in the Treatment of Patients with Lumbar Degenerative Disc Herniation

Background Lumbar discectomy is one of the most common operations performed worldwide for lumbarrelated symptoms. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness. Aim and objectives The aim of this study was to analyze the safety and efficacy of percutaneous endoscopic discectomy in the treatment of lumbar degenerative disc herniation for adult patients. Subjects and methods A systematic review was conducted, including adult patients (&amp;gt; 18 years and less than 80 years old) with surgical treatment of lumbar radiculopathy secondary to degenerative herniated discs. Results results revealed that mean preoperative VAS was 6.05 which improved post operation to 1.35. Mean preoperative ODI score was 56.5 which decreased to 14.2 post operation, and SF-36 physical was used by four studies and mean preoperative score was 42.07 which increased to 76.2 post operation. SF-36 mental score used by three studies with mean preoperative score was 41.08 which increased post operation to 65.5. Conclusion PELD appears to be an effective intervention for LDH, as it has a small amount of intraoperative blood loss, short postoperative hospital stay, and good clinical and functional outcomes. It needs more training, as it has a long learning curve.

Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias.

The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45-65 years) and a median ejection fraction of 58.5% (IQR, 56.2%-60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. The median hospital stay after surgery was 2 days (IQR, 2-3 days). The median surgical time for BCSD was 113 minutes (IQR, 104-126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5-28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.

Robotic Hysterectomy with Ureter Identification and Uterine Artery Ligation for Benign Gynecological Conditions: An Early-Year Single-Center Experience.

The use and application of robotic systems with a high-definition, three-dimensional vision system and advanced EndoWrist technology have become widespread. We sought to share our clinical experience with ureter identification and preventive uterine artery ligation in robotic hysterectomy. The records of patients undergoing robotic hysterectomy between May 2014 and December 2015, including patient preoperative characteristics, operative time, and postoperative outcomes, were analyzed. We evaluated the feasibility and safety of using early ureteral identification and preventive uterine artery ligation in robotic hysterectomy in patients with benign gynecological conditions. Overall, 49 patients diagnosed with benign gynecological conditions were evaluated. The mean age of the patients and mean uterine weight were 46.2 ± 5.3 years and 348.7 ± 311.8 g, respectively. Robotic hysterectomy achieved satisfactory results, including a short postoperative hospital stay (2.7 ± 0.8 days), low conversion rate (n = 0), and low complication rate (n = 1; 2%). The average estimated blood loss was 109 ± 107.2 mL. Our results suggest that robotic hysterectomy using early ureteral identification and preventive uterine artery ligation is feasible and safe in patients with benign gynecological conditions.

Revolutionizing radical prostatectomy - a comparative study of traditional and modern automated surgical techniques

Introduction and purpose:&#x0D; Prostate cancer is a common malignancy seen worldwide and second most common cancer among Polish men as well as globally. The symptoms of prostate cancer depend on severity of the cancer. Prostate cancer diagnosis is typically established through physical examination- digital rectal examination (DRE), PSA (prostate specific antigen) testing and confirmed by histopathological examination. The choice of treatment method depends on many factors: disease severity, risk assessment (based on PSA, TNM and Gleason score), age of the patient and expected survival time. Treatment include surgery, hormone therapy, radiation therapy or chemotherapy. In some cases, the combination of methods can be used to achieve better outcomes. &#x0D; One of available treatment option is radical prostatectomy which includes open radical prostatectomy (ORP), laparoscopic and laparoscopic robot assisted radical prostatectomy (RARP). We aimed at presenting various outcomes comparing open radical prostatectomy and robot assisted radical prostatectomy.&#x0D; State of knowledge: &#x0D; In order to carry out the review of the topic we began to collect information and comprehensive research in PubMed database. The analysis focused on the treatment of prostate cancer especially radical prostatectomy methods, the course of surgical procedure, postoperative care, oncological results, intraoperative and postoperative complications.&#x0D; Conclusion:&#x0D; ORP and RARP ae two surgical procedures used in prostate cancer treatment. Both of them involve removal of the prostate gland but also have a multiplicity of differences. RARP is safe and less invasive alternative to ORP with shorter postoperative hospitalization. However, ORP is known for no necessity for expensive specialized equipment such as Da Vinci or Versius robot surgery system and shorter operative time.

Hernia Surgical Treatment; Multi-options and Paucity of Statistical Conformation for the Preferred Surgical Option

Background: Hernia is a common pathology in the globe and reported more frequently, particularly, inguinal hernia. Aims: To identify the surgery of choice for the treatment of hernias by evaluating the required postoperative hospitalization time, as no other complications have been reported according to data from Mordovian Republic hospital. Material and Methods: A retrospective cohort study involved 790 patients for the period 2017-2022 treated surgically for various types of hernia; inguinal hernia, umbilical hernia, spontaneously reduced strangulated post-operative ventral hernia, incarcerated post-operative ventral hernia, and hernia of the Lina Alba. The T-test was used for statistical analysis, and a one-way ANOVA test and Pearson correlation test were conducted using the Statistica program. Results: The hospitalization period after Liechtenstein surgery is statistically less than Postemsky surgery (mean 6.88 days, 7.43 days, respectively, t value -2.29593, p&lt;0.02) and laparoscopic surgery (mean 6.88 days, 8.19072 days, respectively, t value 4,206817, p&lt;0,000031). At the same time, laparoscopic surgery has a shorter post-operative hospitalization than Postemsky surgery (t value -2.19326, p&lt;0.02). According to the surgical approach, the patient’s post-operative hospitalization days differ (mean days: min. days; max. days, 7.50192: 0.00; 30.00). According to Postemsky (M ± m; 7.43262, ±0.167012), according to Martynov (M ± m; 8.37500, ±0.113440), according to Liechtenstein (M ± m; 6.88153, ±0.146845), according to Mayo (M ± m; 7.51282, ±0.280156), according to Bassini (M ± m; 8.77778, ± 2.379179), laparoscopically (M ± m; 8.19072, ± 0.268434), according to Sapezhko (M ± m; 8.25000, ± 1.380074), and another type of surgery (M ± m; 11.40000, ± 2.501999). Women (mean 8.525114 days) were hospitalized longer than men (mean 7.065371 days), t value 5.871044, p&lt; 0.001. A statistically significant correlation has been found between age and postoperative hospitalization time (Pearson Rank Order Correlations r=0.215561, p &lt;0.05). Conclusion: The study shows that the Lichtenstein surgery is the surgery of choice in terms of hospitalization time after the surgery. Straight association between sex and age with postoperative hospitalization days.

Comparison of laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver: meta-analysis

Aim. To analyze studies focused on comparing laparoscopic and open simultaneous surgeries for synchronous metastases of colorectal cancer in the liver.Materials and methods. The electronic databases PubMed, Web of Science, Scopus, Embase, Cochrane Library were searched for the studies focused on the comparison of open and laparoscopic simultaneous surgeries for synchronous metastatic liver lesions, dated till October 20, 2020. Keywords: simultaneous resections, colorectal cancer, liver metastases, simultaneous laparoscopic.Results. Meta-analysis contains the results of 1211 simultaneous surgeries for simultaneous metastases of colorectal cancer in the liver: 450 laparoscopic and 761 open surgeries. Laparoscopic surgery was characterized with lower blood loss [weighted mean difference (WMD) = -131.77, 95% CI: -232.54 to -31.00, p = 0.01], a shorter postoperative hospitalization [WMD = -2.87, 95% CI: -3.41 to -2. 33, p &lt; 0.00001], early first bowel movement [WMD = -0.99, 95% CI: -1.40 to -0.58, p &lt; 0.0001], early initiation of enteral feeding [WMD = -1.20, 95% CI: -2.06 to -0.33, p = 0.007]), lower incidence of postoperative complications [OR = 0.60, 95% CI: 0.46–0.80, p = 0.0004]. A statistically significant advantage of laparoscopic access was established in overall [OR = 0.80, 95% CI: 0.64–0.99, p = 0.04] and recurrence-free survival [OR = 0.73, 95% CI: 0.60–0.89, p = 0.002].Conclusion. Perioperative and distant oncologic outcomes demonstrate safety and efficacy of laparoscopic simultaneous interventions for synchronous metastases of colorectal cancer in comparison with open interventions.

Feasibility and Surgical Effect of Annulus Sparing in Consecutive Patients with Tetralogy of Fallot: A Retrospective Cohort Study

Objective: Annulus-sparing (AS) repair for tetralogy of Fallot (TOF) with a dysplastic pulmonary valve annulus (PVA) is a challenging procedure and is controversial. This study aimed to assess the feasibility and surgical effect of AS repair versus transannular patch enlargement (TAPE) repair, especially in individuals with dysplastic pulmonary valves. Methods: This retrospective cohort study included 375 pediatric patients with a primary diagnosis of TOF in the Center for Pediatric Cardiac Surgery of Fuwai hospital from January 2014 to June 2017. Among them, 60 consecutive and nonselective patients underwent 1-stage repair of TOF with aggressive PVA-preserving strategies performed by a single surgeon were enrolled in AS cohort. In AS cohort, patients were divided into AS, PVA z-score ≥−2 group (33 patients) and AS, PVA z-score &lt;−2 group (27 patients). During the same period, 315 patients underwent TAPE repair by other surgeons were enrolled as TAPE cohort, of these, 87 patients with PVA z-score ≥−2 were excluded. From the 228 patients in the TAPE group, 27 cases were selected as TAPE, PVA z-score &lt;−2 group according to the propensity score and 1:1 ratio with AS, PVA z-score &lt;−2 group. The primary outcome was a composite of reintervention, significant pulmonary regurgitation, and significant annular peak gradient (APG). Kaplan-Meier curve was plotted to show the survival rate of severe pulmonary regurgitation. Results: One death occurred after the TAPE operation in TAPE group, and 1 patient in the AS z ≥−2 group needed reintervention with a balloon. After a median follow-up of (30.3 ± 11.6) months, compared with AS z ≥−2 group, there was no difference in the technical performance score for severe pulmonary stenosis (APGs &gt; 20 mmHg) in the AS z &lt;−2 group. Compared with TAPE, AS repair was often accompanied by a postoperative APGs over 20 mmHg (P = 0.001). More patients underwent TAPE suffered from moderate or severe pulmonary regurgitation than those who received AS repair (20 (74.1%) vs. 7 (26.0%), P &lt; 0.001). AS repair was associated with a shorter duration of mechanical ventilation (20 vs. 29 hours, P = 0.039), faster discharge from the intensive care unit (2.0 vs. 4.0 days, P = 0.022) and shorter postoperative hospitalization (8.0 vs. 11.0 days, P = 0.008) compared with TAPE. Conclusions: APG demonstrated an upward trend in the TAPE group and a downtrend in the AS group after discharge from hospital. AS repair had an acceptable surgical effect in TOF patients, even in those with a dysplastic PVA. A higher APG remained upon hospital discharge in dysplastic patients with AS, but a downward trend was observed over time.

Comparison of Safety and Outcomes between Endoscopic and Surgical Resections of Intermediate-Risk Primary Gastric Gastrointestinal Stromal Tumors

Background and Aims: The objective of this study was to compare the safety and efficacy of endoscopic resection with surgical resection in the treatment of intermediate-risk gastric gastrointestinal stromal tumors (GISTs) and to further evaluate whether imatinib adjuvant treatment is necessary for resected intermediate-risk gastric GIST by ER. Methods: We retrospectively studied 128 cases for intermediate-risk gastric GISTs that were distributed in endoscopic (n = 33) and surgical groups (n = 95) at our center between December 2009 to July 2020. We statistically compared the clinical features, pathological reports, perioperative data, and long-term follow-up outcomes. Results: Compared with the surgery group, the endoscopy group was associated with smaller tumor size (2.4 ± 1.0 vs. 6.0 ± 1.7 cm, p < 0.001), shorter operating time (67.3 ± 36.5 vs. 145.9 ± 74.8 min, p < 0.001), fewer incidence of short-term postoperative complications (3% vs. 32.6%, p = 0.002). Shorter postoperative hospital days (4.5 ± 1.4 vs. 8.5 ± 2.4 days, p < 0.001), shorter gastric functional recovery time (p < 0.001), and a lower overall medical cost of hospitalization (p < 0.001) was detected in the endoscopy group. During the median 44.5 months follow-up period, there were no cases of recurrence, metastasis, and death in the endoscopy group. Among 128 patients, 68 accepted adjuvant therapy with imatinib after resection. It was observed that the OS of the adjuvant treatment group with imatinib was lower than that of the group without imatinib (p = 0.033). Conclusion: Endoscopic resection for intermediate-risk gastric GIST is a feasible and safe method, and there is no significant benefit for patients with intermediate-risk gastric GIST to accept imatinib adjuvant treatment after ER.

Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery: A matched-pair analysis.

The indications of minimally invasive surgery (MIS) for T4 colorectal cancer are controversial because the advantages of MIS are unclear. Therefore, we compared overall survival (OS) and recurrence-free survival (RFS) as the primary endpoint, and short-term outcome, alteration in perioperative laboratory data, and the interval of postoperative chemotherapy from operation as secondary endpoints, between MIS and open surgery (OPEN) using a matched-pair analysis. We explored the advantages of MIS for T4 colorectal cancer.In this retrospective single-institution study, we included 125 patients with clinical T4 colorectal cancer who underwent curative-intent surgery of the primary tumor between October 2010 and September 2019. Conversion cases were excluded. MIS patients were matched to OPEN patients (ratio of 1:2) according to tumor location, clinical T stage, and preoperative treatment.We identified 25 and 50 patients who underwent OPEN and MIS, respectively, including 31 with distant metastasis. Both groups had similar background characteristics. The rate of major morbidities (Clavien-Dindo grade > III) was comparable between the 2 groups (P = .597), and there was no mortality in either group. MIS tended to result in shorter postoperative hospitalization than OPEN (P = .073). Perioperative alterations in laboratory data revealed that MIS suppressed surgical invasiveness better compared to OPEN. Postoperative chemotherapy, especially for patients with distant metastasis who underwent primary tumor resection, tended to be started earlier in the MIS group than in the OPEN group (P = .075). OS and RFS were comparable between the 2 groups (P = .996 and .870, respectively). In the multivariate analyses, MIS was not a significant prognostic factor for poor OS and RFS.MIS was surgically safe and showed similar oncological outcomes to OPEN—with the potential of reduced invasiveness and enhanced recovery from surgery. Therefore, patients undergoing MIS might receive subsequent postoperative treatments earlier.

One-Stage Flexible Ureteroscopy during Single-Tract Percutaneous Nephrolithotomy in the Treatment of Parallel Calyceal Stones

Introduction: The aim of this study was to compare the clinical safety and efficiency between one-stage flexible ureteroscopy (FURS) during single-tract percutaneous nephrolithotomy (PCNL) and multi-tract PCNL in the treatment of parallel calyceal stones. Methods: One hundred and twenty-five patients who had calyceal stones parallel to puncture channel from March 2017 to January 2021 were enrolled and assigned into two groups. Seventy cases received the treatment of FURS combined with single-tract PCNL under the oblique supine position (the Combined group), and 55 cases had multi-tract PCNL procedure under the prone position (the Multi-tract group). Demographic characteristics, clinical information, and surgical outcomes were analyzed. Results: Demographic variables and stone characteristics did not show statistical difference between the two groups. Compared with the Multi-tract group, there were longer operation time (p = 0.021), shorter postoperative hospitalization days (p = 0.003), smaller postoperative hemoglobin drop (p = 0.002), less incidence of moderate and severe postoperative pain (p = 0.001), and postoperative perirenal hematoma (p = 0.012) in the Combined group. No significant difference was found in the stone-free rate (SFR) and postoperative fever between the two groups (p = 0.880 and p = 0.324). More patients needed postoperative intervening embolization in the Multi-tract group (p = 0.048). Discussion/Conclusions: For most patients with parallel calyceal stones, one-stage FURS combined with single-tract PCNL procedure was a safer procedure for the reduction of complications and could achieve a comparative SFR compared to the multi-tract PCNL.

Comparison of transvaginal mesh surgery and robot-assisted sacrocolpopexy for pelvic organ prolapse

BackgroundPelvic organ prolapse (POP) is greatly affecting the quality of life (QOL) of women. There are some surgical techniques for POP repair, for example, transvaginal mesh surgery (TVM), laparoscopic sacrocolpopexy (LSC), and robot-assisted sacrocolpopexy (RSC). In the United States and Europe, the number of TVM has rapidly decreased since 2011 due to complications and safety concerns and has shifted to LSC/RSC. In Japan, RSC has increased after the insurance coverage of RSC in 2020. Therefore, we compared the surgical outcomes of TVM and RSC in POP surgery.MethodsWe retrospectively collected POP surgery underwent TVM or RSC at our hospital and compared the operative time, blood loss, postoperative hospital stay, postoperative complications, and preoperative and postoperative stress urinary incontinence (SUI) of two groups. Preoperative and postoperative SUI were classified into 3 groups: “improved preoperative SUI”, “persistent preoperative SUI” and “de novo SUI”, which occurred for the first time in patients with no preoperative SUI, and compared incidence rate. The Mann–Whitney U test and Fisher’s exact test were used to compare the two groups, and P < 0.05 was considered statistically significant.ResultsFrom August 2011 to July 2021, 76 POP surgery was performed and they were classified into two groups: TVM group (n = 39) and RSC group (n = 37). There was no difference in patient age and BMI between the TVM and RSC groups. The median of operative time was 78.0 vs. 111.0 min (p = 0.06), blood loss was 20.0 ml vs. 5.0 ml (p < 0.05), and postoperative hospital stay was 4.0 days vs. 3.0 days (p < 0.05), with less blood loss and shorter postoperative hospital stay in the RSC group. There was no difference in postoperative complications between the TVM and RSC groups (17.9% vs. 16.2%, p = 1.00). De novo SUI was 25.6% vs. 5.4% (p < 0.05) in the TVM and RSC groups, of which 23.1% vs. 5.4% (p < 0.05) occurred within 3 months of surgery.ConclusionRSC is more beneficial and less invasive for patients with pelvic organ prolapse than TVM. In addition, de novo SUI as postoperative complication of RSC was lower than of TVM.

Does temporary ileostomy via specimen extraction site affect the short outcomes and complications after laparoscopic low anterior resection in rectal cancer patients? A propensity score matching analysis

PurposeThe purpose of the current study was to compare the outcomes of temporary stoma through the specimen extraction site (SSES) and stoma through a new site (SNS) after laparoscopic low anterior resection.MethodsThe rectal cancer patients who underwent laparoscopic low anterior resection plus temporary ileostomy were recruited in a single clinical database from Jun 2013 to Jun 2020. The SSES group and the SNS group were compared using propensity score matching (PSM) analysis.ResultsA total of 257 rectal cancer patients were included in this study, there were 162 patients in the SSES group and 95 patients in the SNS group. After 1:1 ratio PSM, there was no difference in baseline information (p > 0.05). The SSES group had smaller intraoperative blood loss (p = 0.016 < 0.05), shorter operation time (p < 0.01) and shorter post-operative hospital stay (p = 0.021 < 0.05) than the SNS group before PSM. However, the SSES group shorter operation time (p = 0.006 < 0.05) than the SNS group after PSM, moreover, there was no significant difference in stoma-related complications (p > 0.05). In the multivariate analysis, longer operation time was an independent factor (p = 0.019 < 0.05, OR = 1.006, 95% CI = 1.001–1.011) for the stoma-related complications.ConclusionBased on the current evidence, the SSES group had smaller intraoperative blood loss, shorter operation time and shorter post-operative hospital stay before PSM, and shorter operation time after PSM. Therefore, SSES might be superior than SNS after laparoscopic low anterior resection for rectal cancer patients.

Comparison of the Efficacy and Complications of Soft Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of Urinary Calculi: A Systematic Review and Meta-analysis.

Objective To systematically evaluate the efficacy and complications of soft ureteroscopic lithotripsy (SUL) and percutaneous nephrolithotomy (PCNL) in the treatment of urinary calculi and to provide evidence-proof medicine basis for the popularization and application of flexible ureteroscopic lithotripsy. Methods PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network Database (CNKI), China VIP Database, Wanfang Database, and China Biomedical Literature Database (CBM) were searched for randomized controlled trials (RCT) related to soft ureteroscopic lithotripsy and percutaneous nephrolithotomy in the treatment of urinary calculi from Jan. 2010 to Mar. 2022. The bias risk of each included literature was assessed according to the standard of Cochrane manual 5.1.0. The collected data were meta-analyzed by RevMan 5.4 statistical software. Results Ultimately, 6 RCT (a total of 794 samples) were included for meta-analysis. Heterogeneity test results of stone clearance rate were chi2 = 2.44, df = 5, P = 0.79 > 0.05, and I2 = 0%, indicating none obvious heterogeneity among the included research data. The test of WMD was Z = 2.11 (P = 0.03). It could be considered that compared with PCNL in the treatment of urinary calculi, SUL had a higher stone clearance rate in patients with urolithiasis. Secondly, heterogeneity test of operation time was chi2 = 184.95, df = 5, P < 0.00001, and I2 = 97%. The results of heterogeneity test of intraoperative blood loss displayed chi2 = 645.47, df = 5, P < 0.00001, and I2 = 99%. Then, heterogeneity test results of postoperative hospital stay existed chi2 = 57.37, df = 5, P < 0.00001, and I2 = 91% with an obvious heterogeneity. According to the results of this analysis, it could be considered that compared with PCNL in the treatment of urolithiasis, the operation time of SUL in the treatment of urolithiasis was longer, but the amount of intraoperative bleeding and postoperative hospital stay was significantly reduced. The results of heterogeneity of stress index level NE showed as chi2 = 0.32, df = 2, P = 0.85 > 0.05, and I2 = 0%, and COR was chi2 = 1.09, df = 1, P = 0.30 > 0.05, and I2 = 8%. It showed that there was no obvious heterogeneity. The heterogeneity of ACTH was chi2 = 390.36, df = 2, P < 0.00001, and I2 = 99%, suggesting obvious heterogeneity. The test of combined effect dose WMD was Z = 21.90, 4.50, and 15.42, (P < 0.00001). It could be considered that there was a statistical difference in the WMD of stress response between patients with urinary calculi treated by soft ureteroscope and percutaneous nephrolithotomy, indicating that the stress response of patients with urinary calculi treated with SUL is less than that of PCNL. For the heterogeneity test of serum creatinine level, NE showed chi2 = 0.78, df = 2, P = 0.68 > 0.05, and I2 = 0% without obvious heterogeneity, and the combined effect dose WMD is analyzed by random effect model. The test of combined effect dose WMD was Z = 4.22 (P < 0.00001). It can be considered that the improvement of serum creatinine level in patients with urolithiasis treated with SUL was better than that of PCNL. The results of heterogeneity test on the safety of operation are as follows: chi2 = 13.76, df = 5, P = 0.02, and I2 = 64%, indicating obvious heterogeneity among the included research data. The combined effect dose of WMD was Z = 5.53 (P < 0.00001). This could be considered that soft ureteroscopic lithotripsy had higher safety and less postoperative complications than percutaneous nephrolithotomy in the treatment of urinary calculi. An inverted funnel chart was used to analyze the publication bias of the study with stone clearance rate as the outcome index. The results showed that the figure was not completely symmetrical and the Egger's test showed that the figure was P = 0.0005 < 0.001. It was suggested that there may be a certain degree of publication bias. Conclusion PCNL and SUL can achieve higher stone clearance rate in the treatment of renal calculi. However, SUL has the advantages of less intraoperative bleeding, short stress reaction and postoperative hospital stay, less damage to renal function, and low incidence of complications, which is beneficial to the rapid recovery of patients after operation. More studies with higher methodological quality and longer intervention time are needed to further verify.