Simultaneous Resection Research Articles

Colorectal cancer liver metastases: increased incidence of local hepatic septic complications following simultaneous resections

Colorectal cancer liver metastases: increased incidence of local hepatic septic complications following simultaneous resections

Simultaneous Resection for Colorectal and Liver Metastases, new equipment and personalized medicine.

Nowadays we perform synchronous colorectal cancer resection along with synchronous liver metastases. We investigated whether colon resection first is safer than liver resection first and if simultaneous surgeries are in general safe. Patients and Methods: Twenty patients were included in our multicenter study. In our study patients had simultaneous laparoscopic resection of primary colorectal cancer and liver metastases. The patients included were divided into two groups based on their first surgery. Group A had colon resection first (n = 10) and group B had liver resection first (n = 10). All adverse effects and outcomes were compared after the first day of hospitalization. Results: The only difference between the two groups was the operative blood loss. It was observed to be less in group B. Conclusion: In our study we did not observe any significant difference regarding the order of the operation.

Minimally invasive simultaneous colorectal and liver resection for synchronous colorectal liver metastasis – short-term outcomes

Minimally invasive simultaneous colorectal and liver resection for synchronous colorectal liver metastasis – short-term outcomes

WITHDRAWN: Characterization of mutational landscape reveals influencing factors for therapeutic response and prognosis of colorectal cancer patients with synchronous liver metastases underwent simultaneous resection of primary and metastatic lesions

BackgroundPatients with stage IV colorectal cancer (CRC) with liver metastasis represent a specific group that can be treated with surgery. However, the influence of genomic alterations on the therapeutic response and prognosis was not clear in CRC patients underwent simultaneous surgery of primary and metastatic lesions. MethodsFifty-two patients underwent simultaneous surgery on primary and metastatic lesions were retrospectively recruited. The mutational landscape of primary lesion was established by whole-exome sequencing(WES). Non-parametric test, Fisher's exact test, multivariate analyses, Kaplan-Meier analyses were performed to identify risk factors for response and prognosis, and a Nomogram model was established. Analyses were performed and figures were plotted using the Graphpad PRISM 5.0 and the R software. ResultsSeveral top mutated genes were identified from the mutational landscape of primary lesions, including APC, TP53, KRAS and TTN, and many co-mutations, mutually exclusive mutations and aberrant functions or pathways were revealed. KRAS(P = 0.047) and TTN(P < 0.001) exhibited significant differences in tumor mutational burden(TMB) between mutant and wild-type groups. TP53(P = 0.045), MUC12(P = 0.012) and CEL(P = 0.032) mutational status significantly stratified the patient therapeutic response, in which MUT12 was an independent risk factor(P = 0.02). CRC location(P = 0.014), patient therapeutic response(P < 0.001), and the mutational status of ANKRD20A4(P = 0.006), EVC(P = 0.05), FHOD3(P = 0.05), MYO15A(P = 0.008) and POTEE(P < 0.001) showed significant stratification on patient prognosis, in which cancer location, response to therapy and ANKRD20A4 and EVC mutational status were independent risk factors. These factors were used to establish a Nomogram model to predict the individual patient prognosis. Internal and external validation verified the effectiveness of the model. ConclusionsIndependent risk factors including cancer location, response to therapy and ANKRD20A4 and EVC mutational status were identified and were used in the establishment of a Nomogram model for patient prognosis prediction.

Simultaneous laparoscopic liver metastasectomy and intersphincteric resection for neuroendocrine tumor of the rectum by natural orifice specimen extraction surgery.

Neuroendocrine tumors (NET) are relatively uncommon rectal neoplasms, and the liver is the most common site of distant metastasis. Simultaneous liver and colorectal resections by minimally invasive surgery and natural orifice specimen extraction are gaining popularity, reducing morbidity. We describe a case of rectal NET with liver metastasis operated simultaneously by laparoscopy with both specimens extracted via the anal canal. Transanal or transvaginal natural orifice specimen extraction surgery for suitable cases is underutilized and only isolated case reports for simultaneous resections exist.

Postoperative morbidity after simultaneous versus staged resection of synchronous colorectal liver metastases: Impact of hepatic tumor burden

BackgroundWe sought to characterize the risk of postoperative complications relative to the surgical approach and overall synchronous colorectal liver metastases tumor burden score. MethodsPatients with synchronous colorectal liver metastases who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. Propensity score matching was employed to control for heterogeneity between the 2 groups. A virtual twins analysis was performed to identify potential subgroups of patients who might benefit more from staged versus simultaneous resection. ResultsAmong 976 patients who underwent liver resection for synchronous colorectal liver metastases, 589 patients (60.3%) had a staged approach, whereas 387 (39.7%) patients underwent simultaneous resection of the primary tumor and synchronous colorectal liver metastases. After propensity score matching, 295 patients who underwent each surgical approach were analyzed. Overall, the incidence of postoperative complications was 34.1% (n = 201). Among patients with high tumor burden scores, the surgical approach was associated with a higher incidence of postoperative complications; in contrast, among patients with low or medium tumor burden scores, the likelihood of complications did not differ based on the surgical approach. Virtual twins analysis demonstrated that preoperative tumor burden score was important to identify which subgroup of patients benefited most from staged versus simultaneous resection. Simultaneous resection was associated with better outcomes among patients with a tumor burden score <9 and a node-negative right-sided primary tumor; in contrast, staged resection was associated with better outcomes among patients with node-positive left-sided primary tumors and higher tumor burden score. ConclusionAmong patients with high tumor burden scores, simultaneous resection of the primary tumor and liver metastases was associated with an increased incidence of postoperative complications.

Comparing the Diagnostic Accuracy of Ultrasonography, CT, MRI, and PET/CT in Cervical Lymph Node Metastasis of Oral Squamous Cell Carcinoma.

(1) Background: In oral cancer staging, ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and 2-deoxy-2-[fluorine-18]fluoro-D-glucose (FDG) with positron emission tomography/computed tomography (PET/CT) are routinely used in clinical practice. The present study is a retrospective examination of the diagnostic accuracy of cervical lymph node metastasis using US, CT, MRI, and PET/CT, with histopathological diagnosis as a reference, to compare the different diagnostic imaging modalities. (2) Methods: The participants included 16 patients with oral squamous cell carcinoma who underwent US-, CT-, MRI-, and PET/CT-based preoperative diagnostic imaging and simultaneous primary lesion resection and neck dissection, including 82 level regions and 424 lymph nodes. We compared the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of each imaging modality based on the imaging results and the pathology results of metastasis. (3) Results: Of the four diagnostic imaging modalities, PET/CT exhibited the highest sensitivity but the lowest specificity and accuracy. US, CT, and MRI had high specificities. Comparing each level region and lymph node showed that differences were observed in PET/CT. (4) Conclusions: PET/CT to diagnose lymph node metastasis requires a comprehensive evaluation because it produces more false positives than other diagnostic imaging modalities. Using US, CT, and MRI, which have excellent spatial resolution, improves diagnostic accuracy at the lymph node level.

Combined hepatic resection and ablation for high burden of colorectal liver metastases demonstrates safety and durable survival

BackgroundHepatic resection (HR) and thermal ablation of Colorectal Liver Metastases (CRLM) have each individually demonstrated safety and survival benefit. We sought to provide our experience with the combination of HR + ablation within one operation for patients with multiple CRLM. MethodsReview of a single institution database of patients who underwent HR + ablation between 2010 and 2019. Results161 patients were identified who underwent HR + ablation for isolated CRLM (mean age: 59, male 63.4%). 125 (77.6%) patients had bilobar disease and 92 (57.1%) patients had ≥5 tumors. 28 (17.4%) patients experienced minor (grade 1 or 2) complications while 20 (12.4%) had grade 3–5 complications. Patients who underwent simultaneous colon resection with HR + ablation had a higher complication rate (22 of 47, 46.8%) than those undergoing HR + ablation only (26 of 114, 22.8%, p = 0.002). Median and 5-year OS for all patients undergoing HR + ablation was 38.2 months and 33.2%, respectively. 5-year hepatic recurrence free survival was 23.5%. Patients with 5 or more tumors demonstrated no difference in median survival compared to those with fewer than 5 tumors (37.0 months vs 38.4 months, p = 0.326). ConclusionsIn this population of CRLM patients with a relatively high burden of disease, HR + ablation demonstrated an acceptable safety profile as well as durable long-term survival.

Efficiency of the Crile Procedure in the Removal of Thyroid Malignancies Invaded into the Internal Jugular Vein

Aim: This work aims to determine the effectiveness of the Crile procedure for optimizing the diagnosis and treatment of patients with locally advanced thyroid malignancies.&#x0D; Objects: The objects of the study were the results of treatment of patients with thyroid cancer using two techniques: Crile procedure and vein resection with sealing and preservation of blood flow.&#x0D; Materials and Methods: The research was carried out experimentally using Crile surgical intervention and vein resection with sealing and preservation of blood flow. The effectiveness of the treatment was assessed by observing the recurrence and mortality rates. The patient’s quality of life was assessed through the conversation and questionnaire survey.&#x0D; Results and Findings: It was found that Doppler ultrasonography of the main vessels in the neck helps to establish the internal jugular vein invasion, as well as its tumour thrombosis at the preoperative stage in clinical cases of suspected extrathyroidal extension of thyroid tumours in addition to radiological methods. A thyroid gland with a tumour invaded into the internal jugular vein must be radically removed with simultaneous resection of the affected part of the vein. We proved that the Crile procedure — resection of a vein with sealing of stumps and interruption of blood flow on one side of the neck — is a safe technique. It reduces the trauma and duration of the operation and reduces the likelihood of recurrence as it does not require further plastic surgery or vascular shunting with the restoration of blood flow. At the same time, bilateral interruption of blood flow in cases of resection of both internal jugular veins can lead to serious complications and requires a blood flow restoration operation from the side of the smaller tumour invasion.

Biomechanical Finite Element Analysis of Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach

Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states. A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions. Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process. Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal.

Feasibility of robotic multivisceral resections in colorectal cancer patients: a NSQIP-based study.

Multivisceral robotic surgery may be an alternative to sequential procedures in select patients with colorectal cancer who are diagnosed with synchronous lesions or in those who require additional procedures at the time of resection. The aim of this study was to assess utilization of the robot for multivisceral resections and compare the surgical outcomes of this approach to laparoscopic resections. Adult colorectal surgery patients who underwent a colectomy or proctectomy and a concurrent abdominal surgery procedure in the American College of Surgeons NSQIP database (2016-2021) were included. The primary outcomes were 30-day postoperative overall and serious morbidity. Factors associated with morbidity were assessed using a multivariable logistic regression. Of the 3875 patients who underwent simultaneous multivisceral resections, 397 (10.3%) underwent a robotic approach and 962 (24.8%) a laparoscopic approach. Gynecological procedures (38%) comprised the largest proportion of concurrent procedures followed by hepatic resections (18%). On unadjusted analysis, rates of overall morbidity (25.4% vs. 30.0%) and serious morbidity (12.1% vs 12.0%) did not differ between the robotic and laparoscopic approach groups, respectively. The rate of conversion to open was lower for the robotic compared to laparoscopic approach (9.3% vs. 28.8%, p < 0.001), and length of stay was shorter (4 vs. 5, p < 0.001). On adjusted analysis, there was no significant difference in overall (OR 0.87, 95% CI 0.65-1.16, p = 0.34) or serious morbidity (OR 1.12, 95% CI 0.75-1.65, p = 0.59) between the two approaches even after concurrent procedure risk stratification. Robotic multivisceral resections can be performed with acceptable overall and serious morbidity in selectpatients with colorectal cancer. Rates of conversion and length of stay may be decreased with a robotic approach, and future research is needed to determine the optimal operative approach in this patient population.

Effectiveness of Surgical Treatment of Patients with Respiratory Tuberculosis Complicated with Chronic Pleural Empyema Depending on Spread of Intrapleural Pathological Alterations

INTRODUCTION: Chronic tuberculous pleural empyema (CTPE) is a severe form of tuberculous lesion characterized by a purulent-destructive process in the residual pleural cavity, gross irreversible morphofunctional specific alterations in the pleura forming within three-five months after appearance of clinical signs of pleurisy. Patients with respiratory tuberculosis (RT) complicated with pleural empyema, are the most severe contingent of patients in tuberculosis (TB) hospitals.&#x0D; AIM: To study effectiveness of surgical treatment of patients with RT complicated with CTPE depending on spread of pathological alterations in the parietal pleura.&#x0D; MATERIALS AND METHODS: The study included 65 patients (43 men, 66.2%, aged 2361 years; 22 women, 33.8%, aged 2665 years) with RT complicated with CTPE, who underwent surgical treatment in the volume of pleurectomy with decortication of lung. Patients were divided to 3 groups depending on spread of pathological alterations in the parietal pleura: group 1 (n = 40, 61.5%) with spread of CTPE not exceeding the surface area of one anatomical wall of the pleural cavity; group 2 (n = 15, 23.1%) with CTPE involving 23 anatomical walls of the pleural cavity; group 3 (n = 10, 15.4%) with CTPE involving all anatomical walls of the pleural cavity.&#x0D; RESULTS: The effectiveness of complex treatment of patients with RT complicated with CTPE was 92.3% (n = 60). In the period from 2014 to 2021, the rate of postoperative complications after pleurectomy with decortication of lung including simultaneous resection, was 12.3%, mortality rate 0% and postoperative recurrences of empyema 7.7%. Despite adequate postoperative conservative treatment, the achievement of clinical effect and the absence of postoperative recurrences were directly proportional to the spread of intrapleural alterations. The destructive widespread forms of PT with multiple and wide-range drug resistance of mycobacterium tuberculosis are more common among the patients with subtotal and total forms of CTPE.&#x0D; CONCLUSION: The obtained results evidence a high effectiveness of surgical treatment of the given category of patients irrespective of spread of pathological alterations in the pleura and lung.

Safety of early Hartmann reversal during adjuvant chemotherapy in colorectal cancer: a pilot study.

Most patients undergoing the Hartmann procedure for complicated colorectal cancer require chemotherapy because of their advanced status. Stoma created during the procedure is typically closed after the completion of postoperative chemotherapy. However, stomas can induce medical or surgical complications and disturb quality of life. This study aimed to evaluate the safety of Hartmann's reversal during postoperative chemotherapy. We conducted a retrospective review of electronic medical records. Between 2017 and 2021, 96 patients underwent Hartmann reversal for after colorectal cancer surgery. Among them, the number of patients who underwent Hartmann procedure with radical resection of complicated colorectal cancer and Hartmann reversal during adjuvant chemotherapy was 13. The clinical, surgical, and pathological characteristics of the patients were evaluated. Eight and five patients had obstructions and perforations, respectively. Two patients with synchronous liver metastases underwent simultaneous liver resection and reversal simultaneously. Five and eight patients received adjuvant chemotherapy with capecitabine and FOLFOX, respectively. The median interval between the Hartmann procedure and reversal was 3.31 months (2.69-5.59). The median operative time for Hartmann's reversal was 190 min (100-335). The median hospital stay was 10 days (7-21). Four patients (30.8%) developed postoperative complications, and the rate of 3 or higher grade according to the Clavien-Dindo classification within 90 days postoperatively was 0%. Except for 1 patient who refused continuation of chemotherapy, 12 patients completed the planned chemotherapy. Median total duration of adjuvant chemotherapy was 6.78 months (5.98-8.48). There was no mortality. Early Hartmann reversal during adjuvant chemotherapy is tolerable and safe in carefully selected patients. In particular, it can be used as a therapeutic option for patients with complicated colorectal cancer with synchronous resectable metastases.

Effects of chronic liver disease on the outcomes of simultaneous resection of colorectal cancer with synchronous liver metastases: a propensity score matching study.

Given the rising prevalence of chronic liver disease (CLD), it is increasingly important to understand its impact on surgical outcomes. Our aim was to evaluate the impact of CLD on short-term outcomes in patients with colorectal cancer and synchronous liver metastases undergoing simultaneous surgery. We retrospectively reviewed patients with colorectal cancer and liver metastases who underwent simultaneous resection between January 2013 and June 2022. Patients were divided into the CLD and non-CLD groups. Data regarding short-term surgical outcomes were compared between the two groups. A total of 187 patients were included. After propensity score matching, there were 42 patients in each group, and the basic characteristics of the two groups were similar. Patients with CLD had a significantly greater incidence of postoperative complications (47.6% vs. 26.2%; P = 0.042). The operation times of the CLD and non-CLD groups were similar (297 vs. 307.5 min, P = 0.537), and the blood loss was comparable between the two groups (250 vs. 155 ml, P = 0.066). No significant differences were observed between the two groups in pneumonia (P > 0.999), urinary infection rate (P > 0.999), ileus rate (P = 0.474), wound infection rates (P > 0.999), abdominal infection rate (P = 0.533), anastomotic leakage rate (P > 0.999), digestive hemorrhage rate (P > 0.999), bile leakage rate (P > 0.999), hepatic hemorrhage rate (P > 0.999), reoperation rate (P > 0.999), intensive care rate (P > 0.999), or severe liver failure (P > 0.999). There were no deaths in the two groups. CLD significantly prolonged the length of hospital stay (P = 0.011). CLD is an important factor affecting postoperative complications in patients with colorectal cancer liver metastases undergoing simultaneous surgery. Considering the large number of patients with CLD in China, more attention and medical care should be provided to patients with CLD who require simultaneous resection of colorectal cancer with synchronous liver metastases.

832 Analysis of Surgical Outcomes and Survival Benefit of Simultaneous Resection of the Primary Colonic Tumour and Liver Metastasis – Experience of a UK Tertiary Centre Between 2013-2022

Abstract Introduction 22% of patients with colorectal cancer present with synchronous metastases. Traditionally, surgical management for these patients is performed separately although increasingly these are being done as simultaneous resections as supported by NICE, UK. Large-scale data to support this is limited and heterogeneous. Aim We aimed to analyse the experience of simultaneous resection at a UK tertiary centre with attention to surgical, oncological outcomes, and survival benefits. Method A prospective database between 2013-2022 was analysed, and clinical data were collared. Statistics performed using R. Results Ninety-six simultaneous resections were reviewed. 71% were left-sided including rectal and 29% were right-sided, while 69% and 31% of patients underwent minor and major liver resections respectively. The majority of cases were performed as open (77%), laparoscopic (16%), or converted to open (6.5%). 30-day mortality was 1% and morbidity rate was 55.4% (Clavien Dindo III 39.2%, IV 4%). Stoma formation rate was 34%. To date, 62% had recurrent disease, 55% received further chemotherapy and 29% had further resections. Median time to recurrence was 31.2 weeks. Median total survival was 34 months. Left-sided and minor liver resections tended towards improved survival, but this was non-significant; survival was significantly improved for those patients diagnosed via the bowel cancer screening program (BSCP). Conclusions Simultaneous resection of colorectal cancer and liver metastases is safe with low mortality and an acceptable morbidity rate. Overall survival of 34 months is promising with further analysis required into oncological strategies and improving uptake of the BSCP.

486. FOR SYNCHRONOUS ESOPHAGEAL CARCINOMA AND PULMONARY LESION: IS IT APPROPRIATE TO PERFORM COMBINED RESECTION?

Abstract Background Reports on esophageal cancer with concurrent lung lesion cases are rare and mostly individual cases. Furthermore, the safety and feasibility of combined resection for patients with synchronous pulmonary lesions and esophageal cancer had always been a controversial topic. In the current study, we retrospectively analyzed the clinical data of patients who underwent simultaneous surgical resection for esophageal cancer with concurrent lung lesions, and explored their clinical characteristics, treatment outcomes, especially postoperative complications and prognosis. Method Patients who underwent esophagectomy between February 2009 and December 2022 were retrospectively reviewed at our center, and those with combined lung resection at the same setting were matched in a 1:1 propensity score matched (PSM) ratio to esophagectomy-alone patients. The main postoperative complications (including pneumonia, anastomotic leakage, pleural effusion, and other complications) and overall survival were compared. Results Of the 7152 esophagectomies, 222 cases of combined resection for synchronous pulmonary lesion (including 105 pneumatoceles, 71 benign nodules, and 46 malignant nodules) were eligible, and 1:1 ratio PSM esophagectomy-alone patients were matched. Wedge resection was the most frequent procedures (181, 81.5%). No significant differences were found in the incidence of postoperative complication between combined resection and esophagectomy-alone: pneumonia (21.2% vs. 20.7%), anastomotic leakage (7.2% vs. 6.3%), pleural effusion (15.3% vs. 13.1%). Moreover, different type of pulmonary lesions and extent of pulmonary resection also unaffected the incidence of postoperative complications. Survival analysis showed no significant difference for combined surgery or esophagectomy-alone. Conclusion In this large sample size study, combined resection dose not elevate the incidence of postoperative complications and weaken the overall survival for patients with synchronous esophageal carcinoma and pulmonary lesion. Therefore, for patients with clinically diagnosed esophageal cancer combined with lung lesions requiring surgery, the risk of concurrent resection may be acceptable.

Simultaneous thulium laser resection of the prostate and transperineal prostate biopsy in clinically diagnosed metastatic prostate cancer with bladder outlet obstruction.

Metastatic prostate cancer (mPCa) patients complicated with bladder outlet obstruction (BOO) are often referred to a urologist. Androgen deprivation therapy (ADT) combined with indwelling catheter usually be the initial management.To retrospectively analysis the safety and efficacy of simultaneous thulium laser resection of the prostate (TmLRP) and transperineal prostate biopsy in metastatic prostate cancer with bladder outlet obstruction.From January 2016 to December 2021, 67 clinically diagnosed mPCa with BOO patients were included in this study. All patients were preoperatively assessed with international prostate symptom score (IPSS), QoL, serum prostate-specific antigen (PSA), prostate volume evaluation by transrectal ultrasound, postvoid residual urine volume (PVR), and maximum flow rate (Qmax). Preoperative and perioperative parameters at 1-, 3-, and 6-month follow-up were also evaluated. All complications were recorded.Simultaneous TmLRP and transperineal prostate biopsy had obvious advantages for clinically diagnosed mPCa patients with BOO, including short overall operation time (52 ± 23.3min), little hemoglobin decrease (0.6 ± 0.7g/l), and short hospital stay (average 3.8days). In addition, simultaneous TmLRP and transperineal prostate biopsy also brought them significant improvement on IPSS, QoL score, Qmax, and PVR volume (P < 0.001) at 1-, 3-, and 6-month follow-up after operation compared to preoperative parameters. Complications were in a low incidence.Simultaneous TmLRP and transperineal prostate biopsy is a bloodless operation with immediate effect and little perioperative complication. Importantly, it is a promising technology in the diagnosis and treatment of clinically diagnosed mPCa patients with BOO.

Evaluation of the ACS-NSQIP Surgical Risk Calculator in Patients with Hepatic Metastases from Colorectal Cancer Undergoing Liver Resection

BackgroundThe American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC) has been designed to predict morbidity and mortality and help stratify surgical patients. This study evaluates the performance of the SRC for patients undergoing surgery for colorectal liver metastases (CRLM). MethodsSRC was retrospectively computed for patients undergoing liver or simultaneous colon and liver surgery for colorectal cancer (CRC) in two high tertiary referral centres from 2011 to 2020. C-statistics and Brier score were calculated as a mean of discrimination and calibration respectively, for both group and for every level of surgeon adjustment score (SAS) for liver resections in case of simultaneous liver-colon surgery. An AUC ≥ 0.7 shows acceptable discrimination; a Brier score next to 0 means the prediction tool has good calibration. ResultsFour hundred ten patients were included, 153 underwent simultaneous resection, and 257 underwent liver-only resections. For simultaneous surgery, the ACS-NSQIP SRC showed good calibration and discrimination only for cardiac complication (AUC = 0.720, 0.740, and 0.702 for liver resection unadjusted, SAS-2, and SAS-3 respectively; 0.714 for colon resection; and Brier score = 0.04 in every case). For liver-only surgery, it only showed good calibration for cardiac complications (Brier score = 0.03). The SRC underestimated the incidence of overall complications, pneumonia, cardiac complications, and the length of hospital stay. ConclusionsACS-NSQIP SRC showed good predicting capabilities only for 1 out of 5 evaluated outcomes; therefore, it is not a reliable tool for patients undergoing liver surgery for CRLM, both in the simultaneous and staged resections.

The Utility of 4D-CT Imaging in Primary Hyperparathyroidism Management in a Low-Volume Center.

Background: Ultrasonography (US) and the 99mTc-sestamibi parathyroid scan (SPS) may have suboptimal accuracy when detecting the localization of enlarged parathyroid gland(s) (PTG). Therefore, the more accurate four-dimensional computed tomography scan (4D-CT) has been employed for PTG imaging. Currently, there is a paucity of data evaluating the utility of 4D-CT in low caseload settings. Aim and Objectives: To evaluate the impact of PTG imaging, using 4D-CT in conjunction with its intraoperatively displayed results, on the outcomes of surgical PTX. Materials and Methods: A single-center retrospective analysis of surgically treated patients with pHPT from 01/2010 to 01/2021 was conducted. An evaluation of the impact of the preoperative imaging modalities on the results of surgical treatment was carried out. Results: During the study period, 290 PTX were performed; 45 cases were excluded due to surgery for secondary, tertiary or recurrent HPT, or due to the use of alternative imaging techniques. The remaining 245 patients were included in the study. US was carried out for PTG imaging in 236 (96.3%), SPS in 93 (38.0%), and 4D-CT in 52 patients (21.2%). The use of 4D-CT was associated with a significantly higher rate of successful localization of enlarged PTG (49 cases, 94.2%) compared to US and SPS (74 cases, 31.4%, and 54 cases, 58.1%, respectively). We distinguished between three groups of patients based on preoperative imaging: (1) PTG lateralization via US or SPS in 106 (43.3%) cases; (2) precise localization of PTG via 4D-CT in 49 (20.0%) patients; and (3) in 90 cases (36.7%), PTG imaging failed to localize an enlarged gland. The group of 4D-CT localization had significantly shorter operative time, lower rate of simultaneous thyroid resections, as well as lower rate of removal of ≥2 PTG, compared to the other groups. The 4D-CT imaging was also associated with the lowest perioperative morbidity and with the lowest median PTH in the one month follow-up; however, compared to the other groups, these differences were statistically not significant. The implementation of 4D-CT (since 01/2018) was associated with a decrease in the need for redo surgery (from 11.5% to 7.3%) and significantly increased the annual case load of PTX at our institution (from 15.3 to 41.0) compared to the period before 4D-CT diagnostics. Conclusions: 4D-CT imaging enabled to precisely locate almost 95% of enlarged PTG in patients with pHPT. Accurate localization and intraoperatively displayed imaging results are useful guides for surgeons to make PTX a faster and safer procedure in a low-volume center.

Simultaneous resection of colorectal cancer and synchronous colorectal liver metastases: A risk stratified analysis of the NSQIP database.

Over 25% of patients diagnosed with colorectal cancer (CRC) will develop colorectal liver metastases (CRLM). Controversy exists over the surgical management of these patients. This study aims to investigate the safety of a simultaneous surgical approach by stratifying patients based on procedure risk and operative approach. Using ACS-NSQIP (2016-2020), patients with CRC who underwent isolated colorectal, isolated hepatic, or simultaneous resections were identified. Colorectal and hepatic procedures were stratified by morbidity risk (high vs. low) and operative approach (open vs. minimally invasive). Thirty-day overall morbidity was compared between risk matched isolated and simultaneous resection groups. A total of 65 417 patients were identified, with 1550 (2.4%) undergoing simultaneous resections. A total of 1207 (77.9%) underwent a low-risk colorectal and low-risk liver resection. On multivariate analysis, there was no significant difference in overall morbidity between patients who had a simultaneous open high-risk colorectal/low-risk hepatic procedure compared to patients who had an isolated open high-risk colorectal procedure (odds ratio: 1.19; 95% confidence interval: 0.94-1.50; p = 0.148). All other combinations of simultaneous procedures had statistically significant higher rates of morbidity than the isolated group. Simultaneous resection of colorectal and synchronous CRLM is associated with an increased risk of morbidity in most circumstances in a risk stratified analysis, although rates of readmission and reoperation were not increased. Minimally invasive surgical approaches may significantly mitigate this morbidity.