Surgical Treatment Research Articles

Is tranexamic acid appropriate for all patients undergoing high-risk surgery?

Tranexamic acid (TXA), an antifibrinolytic agent, reduces surgical bleeding in a variety of procedures, such as cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery. However, there are surgical interventions for which its use is not yet widespread, and some caution persists because of concerns regarding thrombotic risk. The purpose of this review is to analyze the most recent evidence in various subgroups of surgical specialties and the association of TXA with thrombotic events and other side effects (e.g. seizures). Recent clinical trials and meta-analyses have shown that the efficacy and safety vary according to the clinical context, timing of administration, and dose. Some reports found that TXA reduces major bleeding by 25% without a significant increase in thrombotic events. Wider use of TXA has the potential to improve surgical safety, avoid unnecessary blood use, and save healthcare funds.

FP2.11 - Management of Acute Sigmoid Volvulus – a 10-year retrospective review

Abstract Aims This study aims to review the management and outcomes of acute sigmoid volvulus within our Trust. Methods This was a retrospective study conducted at our NHS Trust. All adult patients presenting with SV between January 2012 and January 2022 were included. Data was collected from electronic patient records. Admission data included management (conservative only, CM, emergency surgery, ES, or planned surgery, PS), episode number, and 30-day mortality. Surgical data included ASA grade, complication rates, and bowel continuity rates. Results 219 patients (54.8% male, median age 72yrs) presented with acute SV. 87.2% patients were managed conservatively at index presentation, 44% of whom experienced recurrent SV. 27.4% patients received surgical management during follow-up (18.3% ES, 9.1% PS), none of whom experienced recurrence following surgery. The rate of ES increased linearly with total number of episodes, from 11% at index presentation to 25% at ≥5 episodes. 30-day mortality was 13.4% in the CM group, 15% in the ES group, and 0% in the PS group. Post-operative complication rate was 42.5% in the ES group and 5% in the PS group. Bowel continuity was achieved in 22.5% of ES patients and 60% of PS patients. Discussion Conservative management of SV was associated with a significant recurrence rate in our cohort. Repeat admissions were associated with an increasing incidence of ES, which was associated with worse outcomes compared with PS. We recommend all patients are considered for planned surgical intervention at index presentation to reduce recurrence and minimise the rate of emergency intervention.

131I]6ß-Iodomethyl-19-norcholesterol SPECT/CT for the Lateralization of Mineralocorticoid Overproduction in Primary Aldosteronism.

In 42 consecutive patients with confirmed primary aldosteronism, molecular imaging has been performed. After dexamethasone suppression of the non-affected adrenal tissue, 37 MBq [131I]6ß-iodomethyl-19-norcholesterol was injected i.v., and SPECT/CT images were taken 7 days later. Based on the visual evaluation of the images by two nuclear medicine specialists, patients with one-sided tracer accumulation underwent adrenalectomy. To identify a SPECT/CT parameter that best characterizes the side difference, the maximum counts and the mean counts of spherical VOIs were analyzed. Of the 42 patients, 24 had one-sided aldosterone overproduction by SPECT/CT. After surgical removal of the involved adrenal, all 24 patients with SPECT/CT-identified unilateral aldosteronism achieved biochemical cure, defined as a normalized potassium level combined with an aldosterone-to-renin ratio ≤ 30. To identify the best measurable parameter of SPECT/CT side difference, the mean counts and maximum counts of a series of spherical VOIs of different diameters were analyzed. The ratio of the mean counts of 3 cm spherical VOIs of the right and left adrenal regions (lateralization index) was the best discriminator; a ratio of ≥1.29 was characteristic of one-sided disease, without overlap between the one-sided and two-sided patient groups. [131I]6ß-iodomethyl-19-norcholesterol SPECT/CT with a count-based image interpretation and side-ratio calculation may be an equipollent non-invasive substitute for adrenal venous sampling in the lateralization of mineralocorticoid overproduction. It reliably identifies unilateral disease and facilitates patients' selection for surgical intervention. If confirmed by others, this functional imaging may replace AVS when lateralization is required for management decisions in primary aldosteronism.

EP431 - It's all in the NEWS: Can Early Warning Scores help identify severe post-operative complications in Medical Tourism patients?

Abstract Introduction Complications following surgical procedures abroad are regularly reported in news media. Often stories indicate delayed presentation to local medical services, possibly due to lack of good safety netting advice. Within the NHS, National Early Warning Score (NEWS) is used to identify those at risk of deterioration. This study aimed to determine if NEWS were associated with severity of post-operative complications. Methods A retrospective study was performed between January 2022-December 2023 at a DGH close to Gatwick Airport. The study included all emergency patients with complications following operations performed outside of UK. Data collected via electronic patient records included demographics, treatment and length of stay (LOS). Outcomes were analysed in two subgroups: NEWS 0 & NEWS ≥1. Results A total of 36 patients (mean age 40 years) were included in the study. NEWS at presentation ranged from 0-10. 25 (70%) patients had NEWS ≥1. In 100%, tachycardia (HR >90) was the abnormal parameter. NEWS ≥1 group demonstrated greater severity of complications (32% Clavien-Dindo Classification >3a vs 9%), increased rate of surgical intervention (36% vs 9%) and increased mean LOS (5.73 days vs 2.36 days). Relative Risk for severe complication was 3.96 in the NEWS ≥1 group. Conclusion Post-operative complications after surgery abroad are a significant risk to patients and a burden for local NHS services. Early presentation may lead to reduction in complex intervention and LOS. Promoting NEWS to patients going abroad for surgery may lead to improved outcomes. Advising patients to monitor their pulse after surgery is a simple message for health promotion.

WP2.13 - Local Audit based on MAGIC study to improve abscess management at Royal Devon University Healthcare Trust

Abstract Aim To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&E). Methods Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&E during September – December 2022. We collected data on patient demographics, clinical characteristics and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice. Results 31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics. Conclusion Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.

EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.

FP2.8 - Emergency CRC Resections: A single centre cohort Study

Abstract Aims According to NBOCA, 20% of cases of CRC’s are emergencies, associated with high rates of post-operative morbidity and death (11.3 % within 90 days, NBOCA annual report 2023). Emergency CRC commonly presents as obstruction and perforation, less commonly with other constitutional symptoms. Aim of study is to assess surgical outcomes in emergency malignant CRC resections. Methods Cohort study carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative surgical outcomes were analysed in all emergency CRC resections. All elective CRC resections were recruited as controls. Results Em CRC (n = 365) Elective CRC (n = 1349) Mann Whitney U test (p value) Age(yrs) 70.0 70.5 NS Sex(M:F) 193 : 172 764 : 585 NS ASA(median) 3 2 < 0.0001 BMI(kg/m2) 25.7 26.7 < 0.0005 Op time(mins) 134.1 186.1 < 0.0001 LOS(days) 11 7 < 0.0001 Complications (n) Leaks 7 59 NS Ileus 68 207 NS HAP 53 132 NS Anaemia (Tx) 8 47 NS Wound infections 41 115 NS Collections 29 67 NS Sepsis 31 55 NS Mortality (n) 30 day 32 26 NS 60 day 46 38 < 0.01 90 day 54 44 < 0.005 TNM stage (n) 0 10 16 1 20 351 2 107 456 3 158 446 4 45 52 Survival rates 1st year 71.1 92.3 5th year 48.3 77.1 10th year 41.1 68.5 Logrank p < 0.05 15th year 39.5 65.1 Conclusions Emergency CRC patients had a worse pre-operative functional limitation (ASA 3), prolonged hospitalization, greater 90-day mortality rate, thus poorer survival. Despite national bowel cancer screening initiatives, emergency CRC presentations remain a challenge. Our study supports prompt diagnosis and early surgical intervention.

ThP6.10 - Overview of Necrotising Soft Tissue Infections' Risks and Outcomes

Abstract Introduction Necrotising Soft Tissue Infections (NSTI) are severe life-threatening conditions, which are increasing in incidence. Associated with high mortality and morbidity, NSTI’s are a significant burden to health care services globally. Identifying themes, risk factors and underlying causation is therefore of interest. Methods A retrospective data cohort study examining clinical data for all histologically confirmed NSTI cases in a single centre between 2012 to 2022 was conducted. Results 73 confirmed NSTI cases were identified. Patient co-morbidities included the following:CasesDiabetic34Smoker16Post-op12IVDU8Trauma7Immunosuppressed6Bowel Perf5Cancer5 68 patients underwent urgent surgical debridement, with an average of 3.59 (Range 1-11) further surgical interventions required. Patients spent an average of 8.24 days (Range 1-42 days) in ICU, with a hospital stay of 44.02 days. (Range 7-180 days) 6(8%) patients died (5 within first week of presentation). Defunctioning stomas were performed in 24 patients during the admission and 32 patients underwent reconstructive surgery after recovery from the acute phase. An array of causative organisms were identified with no clear delineating trends.NumberAnaerobes36Streptococcus35Staphylococcus20E Coli + Coliforms20Enterococcus15 Conclusion NSTIs continue to increase in incidence and prevalence. The old surgical adage ‘You will see one NSTI in your lifetime is no longer true. Associated morbidity and mortality is significant and a focus on early recognition and prevention is vital. Further larger data sets are required to delineate clear trends and associated risk factors that can effect meaningful health care policy change.

Rare forms of ectopic pregnancy, how not to miss the main thing. Clinical case of ovarian pregnancy, pregnancy in a rudimentary horn.

This article presents two cases of ectopic pregnancy, of different locations (ovaries and rudimentary horn), which had a life-threatening course. Despite modern high-quality diagnostics, which are widely available in our time, we see that making a diagnosis caused difficulties, since the final diagnosis was established and confirmed only intraoperatively. Based on this, we concluded that the clinical picture can become the leading one in making a diagnosis and choosing a doctor’s logical tactics. Such rare localizations, which cause difficulties in making a diagnosis, should not be overlooked. If an ectopic pregnancy is not detected in a timely manner and the risks are underestimated, then death may occur. Two clinical cases clearly demonstrate timely diagnosis, regardless of additional examination methods (Ultrasound of the pelvic organs, human chorionic gonadotropin) and an adequate choice of access and scope of surgical intervention. We should also not forget about the lack of awareness among women about this type of pathology. Often patients do not complain, do not remember the date of their last menstruation or do not monitor their menstrual cycle at all, and do not seek medical help in a timely manner. The combination of several factors at the same time can lead to a fatal development of events.

Clinical and biomechanical comparison of suture-external button versus interference screw associated with V-Y advancement or turndown flaps for flexor hallucis longus transfer in chronic Achilles tendon rupture.

Surgical treatment of chronic Achilles tendon rupture is a technically challenging procedure. We aimed to compare the clinical outcomes, range of motion, and strength of ankle plantar- and dorsiflexors between two techniques for fixation of flexor hallucis longus tendon to the calcaneus: interference screw and suture-external button. Twenty-five patients participated in this retrospective comparative study. All patients underwent short harvest FHL tendon transfer for chronic AT rupture were asked for a follow-up visit, at least one year following surgery. The outcomes were evaluated by visual analog scale (VAS), AOFAS ankle-hindfoot score, and VISA-A questionnaire. Ankle ROM with possible restriction in addition to isokinetic strength of ankle plantar- and dorsiflexors was assessed. No statistically significant difference was observed between the groups for pain (P = 0.81), AOFAS ankle-hindfoot scale (P = 0.97), and VISA-A (P = 0.44). Notably, more decrease in ankle dorsiflexion was seen in interference screw group in comparison with suture-external button group (4.4 ± 6.6 vs. 9.5 ± 6.1 degrees, P = 0.06). The difference of active dorsiflexion between operated and non-operated side in interference screw group was statistically significant (P = 0.02). Biotenodesis screw imposed more limb asymmetry in comparison with suture-external button technique. Fixation of transcalcaneal FHL tendon transfer for chronic AT either by interference screw or suture-external button has encouraging postoperative clinical results. Although ROM of the ankle joint reduced in both techniques, interference screw may result in more reduction in dorsiflexion of the ankle.

ThP2.12 - Evaluation of hand-assisted laparoscopic surgery of small intestine neuroendocrine tumors as an alternative surgical treatment for open surgery

Abstract Aims Small intestinal neuroendocrine tumor (SI-NETs) is the most common malignancy of the small bowel. Curative treatment is exclusively operative and explorative laparotomy is still considered to be the standard procedure. The purpose of this retrospective cohort study was to assess the outcome of minimally invasive surgery in patients with SI-NETs, at our endocrine surgery unit in 2019, compared to the open approach. Methods Patients who underwent surgery for SI-NETs between 2013 and 2023 were included. Descriptive variables such as operative time, length of hospital stay, use of analgesia and radiciality were compared primarily between groups of patients operated before and after 2019 and secondarily between open and hand-port assisted laparoscopic surgery (HALS). Results Of 97 patients with SI-NET included in the study, 58 (59.8 %) had an open and 39 (40.2 %) minimal invasive surgery. While difference in the operative time, 121 min (91.3-150.3) vs 108 min (83-141), the length of hospital stay, 6 days (4-7) vs 5 days (4-8) and surgical radicality in patients with stage II-III, 79.3% vs 85%, (p-value 0.313) was not significant, 86.2% of patients with explorative laparotomy required epidural analgesia compared to 23.1% with HALS (p-value = <0.001). Conclusion Hand-port assisted laparoscopic surgery of SI-NETs was assessed to be a feasible approach without compromising radical resection and enhancing postoperative recovery with lower amount of required analgesia postoperatively.

The potential of autologous regulatory T cell (Treg) therapy to prevent Cardiac Allograft Vasculopathy (CAV) in paediatric heart transplant recipients

Paediatric heart transplant is an established treatment for end stage heart failure in children, however patients have to commit to lifelong medical surveillance and adhere to daily immunosuppressants to minimise the risk of rejection. Compliance with immunosuppressants can be burdensome with their toxic side effects and need for frequent blood monitoring especially in children. Though the incidence of early rejection episodes has significantly improved overtime, the long-term allograft health and survival is determined by Cardiac Allograft Vasculopathy (CAV) which affects a vast number of post-transplant patients. Once CAV has set in, there is no medical or surgical treatment to reverse it and graft survival is significantly compromised across all age groups. Current treatment strategies include novel immunosuppressant agents and drugs to lower blood lipid levels to address the underlying immunological pathophysiology and to manage traditional cardiac risk factors. Translational researchers are seeking novel immunological approaches that can lead to permanent acceptance of the allograft such as using regulatory T cell (Tregs) immunotherapy. Clinical trials in the setting of graft versus host disease, autoimmunity and kidney and liver transplantation using Tregs have shown the feasibility and safety of this strategy. This review will summarise current knowledge of the latest clinical therapies for CAV and pre-clinical evidence in support of Treg therapy for CAV. We will also discuss the different Treg sources and the considerations of translating this into a feasible immunotherapy in clinical practice in the paediatric population.

EP592 - A surgical case report of an epiploic hernia - A mobile right colon herniating through the foramen of Winslow

Abstract Introduction An Epiploic Hernia is an extremely rare type of abdominal hernia with <0.1 % incidence where the bowel or other intra-abdominal contents herniate through the Foramen of Winslow. A case of an Epiploic hernia in a middle-aged female is presented here. Presentation of case A woman in her 60s was admitted to a tertiary level hospital with severe right sided intermittent upper abdominal pain associated with nausea, bloating and constipation. The symptoms were thought to be due to biliary colic and managed conservatively. Since the symptoms persisted and a computed tomography scan of abdomen was organized. CT scan showed that the caecum was in the upper left quadrant. A laparoscopy was performed and demonstrated that her right colon was mobile herniating through the Foramen of Winslow into the lesser sac. The hernia was reduced, and the bowel was viable. The patient was discharged with no complications. Discussion There have been case reports of small bowel as the content of the hernia with lesser occurrences of caecum, ascending colon, transverse colon, gall bladder, omentum, or Meckel's diverticulum. A caecal herniation through the Foramen of Winslow is reported only with an incidence of 0.02 %. <10 % of these Epiploic hernias are diagnosed preoperatively making it a potentially life-threatening condition if not treated promptly due to high risk of bowel strangulation and mortality of up to 50 %. Conclusion A high index of suspicion is needed for the diagnosis of this internal hernia and radiological investigation is fundamental in making this diagnosis for allowing prompt surgical treatment.

EP289 - Laparoscopic Management of Cholecystocoloic Fistula as a Day Surgery Case – A Case Report

Abstract Introduction Cholecystocoloic fistula (CF) is a rare sequelae of biliary stone disease with a 2% prevalence, previously it was considered a contraindication for laparoscopic management. Preoperative diagnosis can be very challenging, the pathognomonic triad of Pneumobilia, chronic diarrhoea, and vitamin K malabsorption should raise a high index of suspicion but is not always present, furthermore, preoperative imaging (EUS, ERCP, and Barium enema) help in the diagnosis, however, those are not routine practice in investigating typical biliary colic presentation. Case presentation We report a Cholecystocoloic fistula diagnosed intraoperatively and successfully managed with a laparoscopic approach. A 63-year-old male with a background of hemiplegia and aphasia followed a surgical treatment for intracranial haemorrhage 12 years ago. He presented with recurrent attacks of acute calculus cholecystitis investigated by US and CT scans, and both have failed to detect CF. During his previous admission, he was managed conservatively and added to the elective laparoscopic cholecystectomy list. His surgery was challenging, Intraoperative findings revealed a gallbladder adherent to the surrounding omentum and transverse colon, with a fistulous communication of the gallbladder fundus to the transverse colon, the fistula was divided, and the colonic opening was sutured. The surgery was uneventful and he was discharged home after 18 hours with no postoperative complications. Conclusion A high index of suspicion should be raised for Cholecystocoloic fistula diagnosis intraoperatively, especially with a history of long-term recurrent cholecystitis even in the absence of usual presentation and imaging. Moreover, a laparoscopic approach is possible and successful in experienced hands.

Medial patellar luxation induces cartilage erosion in dogs: a retrospective study of prevalence and risk factors.

To explain the relationship between cartilage erosion and medial patellar luxation (MPL) and to identify risk factors in dogs. A retrospective review was conducted on 90 dogs (103 stifles) surgically treated for MPL between January 2006 and March 2024. Data collected included signalment, side of operated stifle, patellar luxation grade, symptom duration, and lameness score. Cartilage erosion was evaluated for extent and location on the patella and femoral trochlea. Statistical analyses were conducted to identify risk factors. The prevalence of cartilage erosion of the patella and femoral trochlea was 47.6% (49/103) and 54.4% (56/103), respectively, increasing with a higher grade of patellar luxation. Lesions were most prevalent in the distolateral patella and proximomedial trochlea, with generalized lesions more prevalent in grade IV. The extent of both lesions was significantly associated with age, patellar luxation grade, and symptom duration, while body weight significantly correlated only with the cartilage erosion of the patella. No significant correlation was observed with sex, side of operated stifle, or lameness score. Many patients with MPL exhibited cartilage erosion in the patellofemoral joint, likely due to biomechanical mechanisms. Surgery can be indicated for patients with MPL, as it may prevent cartilage erosion while improving patellofemoral alignment and gait. When selecting surgical candidates, it is important to consider risk factors, such as patellar luxation grade, body weight, age, and symptom duration. Early surgical treatment is recommended, especially for dogs with higher body weight and higher grade of MPL, to prevent cartilage erosion and secondary osteoarthritis.

WP5.14 - Cost of conservative management of acute appendicitis: a cohort study

Abstract Aims Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy & lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management. Methods Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography & outcomes were evaluated for non surgical management. Appendicectomy (acute & interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services. Results Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 <0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 <0.0001 CRP(mg/L) 76.3 66.3 3.4 <0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 <0.0001 Complicated 74 332 3 <0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 <0.0001 IP AB(days) 2 2 0 <0.0001 Post-op AB(days) 7 0 0 <0.0001 App HPA(mm) Length 66.6 55.7 <0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 <0.0001 Conclusions Appendicitis grading clinically & radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs & workload.

EP484 - Triple negative male breast cancer: a case report

Abstract Background Male breast cancer (MBC) is a rare malignancy, may present at advanced disease stage. Triple negative breast cancer (TNBC) known to have the poorest prognosis of all other histological types of breast cancer. This paper presents a case of 71 years old gentleman diagnosed with TNBC. Materials and Methods A 71 years old male patient, presented with a right breast lump. Clinically he had a skin dent and a palpable 3cm lump underneath in the right breast axillary tail. Mammogram and breast US showed suspicious lesion in right breast axillary tail in addition to a suspicious lymph node in right axilla. Imaging guided core biopsies were taken from the breast and axillary abnormalities. The histology revealed grade1 invasive ductal carcinoma NST, ER 0, PR 0 and HER 2 negative. The Breast-Multidisciplinary Team meeting advised for mastectomy and axillary clearance, this has been performed. Result The postoperative Pathomorphology report revealed 23 mm triple negative invasive ductal carcinoma NST, grade 1with Ki67 10%, T2N1M0. The postoperative MDT recommended annual surveillance with mammogram for 5 years. Conclusions MBC is uncommon entity, accounting for < 1% of all breast cancer diagnosed in both genders and the MTNBC still is rarer, and mastectomy is the mainstay of surgical treatment in addition to chemotherapy and radiotherapy , however the later doesn’t affect the cause-specific survival rate.

Surgical treatment of anomalous origin of the left pulmonary artery from the descending aorta in a teenager: a case report

Anomalous origin of one pulmonary artery (AOPA) is a rare congenital heart disease whose symptoms often occur in infancy, and patients have little chance of surviving into adulthood without timely treatments. AOPA is more frequent in infants and toddlers rather than in adults, and it accounts for only 0.12% of all congenital heart disease cases. In all AOPA cases, the right pulmonary artery from the ascending aorta remains common. This study reported a case with anomalous origin of the left pulmonary artery (AOLPA) from the descending aorta in a teenager who underwent double-incision surgery of median sternotomy and left lateral thoracotomies with favorable outcomes.

FP4.4 - Everything is not always as it seems – Discordance between cross-sectional imaging and pathology. A case report

Abstract Cross-sectional imaging of colonic pathology is usually correlated with other investigations such as optical colonoscopy (OC) prior to surgical treatment. In situations such as acute inflammation, this is not possible and surgery is undertaken based on cross-sectional imaging without histopathological confirmation. This case reports describes a 78-year-old female who presented with progressive shortness of breath associated with fatigue and unintentional weight loss. Initial bloods demonstrated a normocytic anaemia (Hb 105g/L, MCV 86fl), raised D-dimer (3460ng/mL) and raised C-reactive protein (133mg/L) with normal white cell count (8.6 x109/L). An unprepared computed tomography (CT) of the abdomen and pelvis revealed extensive bowel thickening in the caecum with radiological appearances consistent with a primary caecal malignancy. Preoperative colonoscopy was not performed as suspicion of perforation on CT imaging precluded the use of mechanical bowel preparation. Preoperative optimisation of the patient was commenced and an elective right hemicolectomy performed. The patient had an uneventful post-operative recovery. Results on histopathology inspection revealed chronic xanthogranulomatous inflammation but no macroscopic or microscopic evidence of dysplasia or malignancy. There continues to be an emerging role for the use of CT imaging, especially CT colonography, in the investigation and diagnosis of CRC. However, difficulty in distinguishing between malignant and non-malignant inflammation on CT endorses the quintessential place of OC with biopsy as the definitive investigation of CRC, especially if suspicion of CRC on unprepared CT. Xanthogranulomatous inflammation should be considered by clinicians, radiologists and pathologists as a differential diagnosis when CRC is suspected clinically and radiologically, without biopsy confirmation.

Comparison of survivals between sublobar resection and lobar resection for patients with clinical stage I non-small cell lung cancer and interstitial lung disease: a propensity score matching analysis.

Patients with early-stage lung cancer and interstitial lung disease have a poorer prognosis than those without interstitial lung disease. This study aimed to compare the long-term outcomes of lobar and sublobar resections in these patients. We retrospectively analyzed 138 consecutive patients with clinical stage I non-small cell lung cancer and interstitial lung disease who underwent surgical treatment at two institutions between January 2010 and December 2020. Propensity score matching analysis was performed to adjust for baseline characteristics. Thirty-six patients underwent sublobar resection and 102 underwent lobar resection. The median follow-up was 45.7 months. In all patients, 5-year overall survival (OS) rates were 33.2% and 73.2%, and 5-year recurrence-free survival (RFS) rates were 24.2% and 60.1% in the sublobar and lobar resection groups, respectively (p < 0.01, <0.01). Death due to lung cancer and locoregional recurrence were significantly more frequent in the sublobar resection group than in the lobar resection group (p = 0.034, <0.01, respectively). On propensity score matching analysis, the 5-year OS rates of the 19 matched pairs were 46.3% and 73.2%, and the RFS rates were 31.6% and 67.6% in the sublobar and lobar resection groups, respectively (p = 0.036, <0.01). The Cox proportional hazards model demonstrated a significant association between lobar resection and improved survival (p = 0.047). The patients in the lobar resection group had better survival rates than those in the sublobar resection group. In terms of long-term prognosis, deliberately limited surgery may not be necessary for patients who tolerate lobectomy.