Terms Of Postoperative Mortality Research Articles

Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: a retrospective cohort study.

To compare predictive significance of sarcopenia and clinical frailty scale (CFS) in terms of postoperative mortality in patients undergoing emergency laparotomy METHODS: In compliance with STROCSS statement standards, a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and CFS were compared using the receiver operating characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs. 0.70, P<0.0001), in-hospital mortality (AUC: 0.79 vs. 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs. 0.67, P=0.0009) compared with CFS. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality [coefficient: 4.333, OR: 76.16 (95% CI 37.06-156.52), P<0.0001] but not the CFS [coefficient: 0.096, OR: 1.10 (95% CI 0.88-1.38), P=0.4047]. Sarcopenia is a stronger predictor of postoperative mortality compared with CFS in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.

Peri-operative score for elderly patients with resectable hepatocellular carcinoma.

Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality. To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score. A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm. Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles. This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.

NELA 1 Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: A retrospective cohort study

Abstract Aims To compare predictive significance of sarcopenia and clinical frailty scale in terms of postoperative mortality in patients undergoing emergency laparotomy. Methods In compliance with STROCSS statement standards a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and clinical frailty scale were compared using the Receiver Operating Characteristic (ROC) curve analysis and multivariable binary logistic regression analysis. Results A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs 0.70, P&amp;lt;0.0001), in-hospital mortality (AUC: 0.79 vs 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs 0.67, P=0.0009) compared with clinical frailty scale. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality (coefficient: 4.22119, P&amp;lt;0.0001) but did not identify clinical frailty score as independent predictor (coefficient: 0.066311, P=0.5544). Conclusions Sarcopenia is a stronger predictor of postoperative mortality compared with clinical frailty score in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery.

Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy. A video vignette is presented showing the details of an emergent laparoscopic right colectomy as performed to treat a 59-year-old woman who presented with clinical signs of peritonitis, and radiologic findings suggestive of acute right-colon diverticulitis complicated by perforation of the hepatic flexure and periduodenal abscess. We also aimed to evaluate the relative outcomes of laparoscopic versus conventional surgery by meta-analyzing the currently available comparative evidence on the argument. A total of 2848 patients were included in the analysis, of which 979 patients received minimally invasive surgery and 1869 had conventional surgery. Laparoscopic surgery had a longer operating time and resulted in an abbreviated hospital stay. Overall, patients receiving laparoscopy had significantly lower morbidity than those whose surgery was undertaken by laparotomy, while there was no statistically significant difference in terms of postoperative mortality. According to the existing literature, minimally invasive surgery improves the postoperative outcomes of patients receiving surgery for right-sided colonic diverticulitis.

Comparison of risk of complication between neuraxial anaesthesia and general anaesthesia for hip fracture surgery: a systematic review and meta analysis.

Controversy remains over the choice of anaesthetic technique for patients undergoing surgery for hip fracture. To compare the risk of complication of neuraxial anaesthesia with general anaesthesia in patients undergoing hip fracture surgery. This systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and was registered at PROSPERO(CRD42022337384). The study included eligible randomised controlled trials published before February 2022. Data synthesis was performed to compare the differences between general and neuraxial anaesthesia. Meta-regression analysis was performed to investigate the influence of the publication year. Subgroup analysis was performed based on patient age and anaesthetic technique used. GRADE assessment was performed to assess the quality of each outcome. Twenty randomised controlled trials and 4802 patients were included. Data synthesis revealed significant higher risk of acute kidney injury in the general anaesthesia group(P=0.01). There were no significant differences between the two techniques in postoperative short-term mortality (P=0.34), delirium (P=0.40), postoperative nausea and vomiting (P=0.40), cardiac infarction (P=0.31), acute heart failure (P=0.34) and pulmonary embolism (P=0.24) and pneumonia(P=0.15). Subgroup analysis based on patient age and use of sedative medication did not reveal any significant differences. Meta-regression analysis of the publication year versus each adverse event revealed no statistically significant differences. A significantly higher risk of postoperative acute kidney injury was found in patients receiving general anaesthesia. This study revealed no significant differences in terms of postoperative mortality and other complications between general and neuraxial anaesthesia. The results were consistent across the age groups.

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients

Outcomes of Patients with Anastomotic Leakage After Transhiatal, McKeown or Ivor Lewis Esophagectomy: A Nationwide Cohort Study

BackgroundAnastomotic leakage has a great impact on clinical outcomes after esophagectomy. It has never been studied whether anastomotic leakage is of equal severity between different types of esophagectomy (i.e., transhiatal, McKeown and Ivor Lewis) in terms of postoperative mortality and morbidity.MethodsAll esophageal cancer patients with anastomotic leakage after transhiatal, McKeown or Ivor Lewis esophagectomy between 2011 and 2019 were selected from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) registry. The primary outcome was 30-day/in-hospital mortality. Secondary outcomes included postoperative complications, re-operation and ICU readmission rate.ResultsData from 1030 patients with anastomotic leakage after transhiatal (n=287), McKeown (n=397) and Ivor Lewis esophagectomy (n=346) were evaluated. The 30-day/in-hospital mortality rate was 4.5% in patients with leakage after transhiatal esophagectomy, 8.1% after McKeown and 8.1% after Ivor Lewis esophagectomy (P=0.139). After correction for confounders, leakage after transhiatal resection was associated with lower mortality (OR 0.152–0.699, P=0.004), but mortality after McKeown and Ivor Lewis esophagectomy was similar. Re-operation rate was 24.0% after transhiatal, 40.6% after McKeown and 41.3% after Ivor Lewis esophagectomy (P<0.001). ICU readmission rate was 24.0% after transhiatal, 37.8% after McKeown and 43.4% after Ivor Lewis esophagectomy (P<0.001).ConclusionThis study in patients with anastomotic leakage confirms a strong association between severity of clinical consequences and different types of esophagectomy. It supports the hypothesis that cervical leakage is generally less severe than intrathoracic leakage. The clinical impact of anastomotic leakage should be taken into account, in addition to its incidence, when different types of esophagectomy are compared by clinicians or researchers.

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients - A Retrospective, Propensity-Score Matched Study.

PurposeTo compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty.MethodsPatients ≥65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan–Meier method.ResultsThree hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level.ConclusionPNB was related to lower 30- and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.

Improved Overall Survival of Colorectal Cancer under Multidisciplinary Team: A Meta-Analysis.

Purpose The purpose of the current meta-analysis was to evaluate whether multidisciplinary team improved overall survival of colorectal cancer. Methods PubMed, EMBASE, and Cochrane Library database were searched from inception to October 25, 2020. The hazard ratio (HR) and 95% confidence (CI) of overall survival (OS) were calculated. Results A total of 11 studies with 30814 patients were included in this meta-analysis. After pooling the HRs, the MDT group was associated with better OS compared with the non-MDT group (HR = 0.81, 95% CI 0.69-0.94, p = 0.005). In subgroup analysis of stage IV colorectal cancer, the MDT group was associated with better OS as well (HR = 0.73, 95% CI 0.59-0.90, p = 0.004). However, in terms of postoperative mortality, no significant difference was found between MDT and non-MDT groups (OR = 0.84, 95% CI 0.44-1.61, p = 0.60). Conclusion MDT could improve OS of colorectal cancer patients.

Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)

IntroductionIn recent years, minimally invasive distal pancreatectomy (MIDP) has been used with increasing frequency to accelerate patient recovery. Distal pancreatectomy has an overall morbidity rate of 30%–40%. The known advantages...

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review.

ObjectiveTo investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases.MethodsA comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision.ResultsEight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes.ConclusionHybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

Predictive value of lower extremity color doppler ultrasonography before knee arthroplasty on a postoperative cardiovascular event

BackgroundThe study intended to determine the presence of lower limb arterial calcification (LLAC) in lower extremity color Doppler ultrasonography (CDUS) before primary total knee arthroplasty (TKA) and its relation with cardiovascular events (CVE) during knee arthroplasty and the postoperative period, as well as to investigate its effect on surgical risk estimation. MethodsWe designed this study as a retrospective cohort study. The study comprised 467 patients who met the inclusion criteria and had surgery for a primary gonarthrosis diagnosis between January 2005 and December 2015 were included. In the study group, patients with arterial calcification in the lower extremity CDUS were included; however, those reported not to have it were included in the control group. The research data were obtained from preoperative anesthesia records and patient medical records. Results72% of the sample had preoperative cardiovascular comorbidity. There was no difference between the groups in terms of comorbidities, except for congestive heart failure (CHF) and peripheral artery disease (PAD). The groups did not differ in terms of ASA scores, either. Both pre- and post-operative CVEs, i.e., ischemic heart disease, dysrhythmia, and CHF, were statistically high in the study group. In terms of postoperative mortality, there was no statistical difference between the groups. ConclusionThe study demonstrates that the presence of LLAC in CDUS is associated with increased risk of perioperative cardiovascular events (CVEs). Ultrasonographic detection of LLAC may give some idea the surgeon about the requirement for additional preoperative cardiac examinations.

S0708 The Postoperative Outcomes of Patients With Inflammatory Bowel Disease Undergoing Liver Transplant: A Nationwide Analysis

INTRODUCTION: Due to the shared liver etiologies and metabolic risk factors, patients with IBD develop end-stage liver disease that require liver transplant therapy (LT). It is therefore important to assess the effect of IBD on the postoperative outcomes in patients undergoing LT. METHODS: Patients who underwent LT were selected from the 2011–2017 National Inpatient Sample and were stratified by the presence of IBD (a combination of Crohn's disease and ulcerative colitis). The endpoints included mortality, length of stay, hospitalization costs, and postoperative outcomes. RESULTS: Of the 8063 cases of LT identified from the database, 277 cases had IBD. Compared to the IBD-absent cohort, the IBD cohort was younger (47.1 vs 52.3y P < 0.01) and more likely to be White or Native American (White 80.9 vs 66.4, Black 12.3 vs 9.75, Hispanic 3.25 vs 14, Asian or Pacific islander 0.72 vs 4.03, Native American 0.72 vs 0.62, Other 2.17 vs 5.15% P < 0.01). No difference was found in gender distribution (female 33.6 vs 36.2% P = 0.41). There was no difference between cohorts in terms of postoperative mortality (2.89 vs 3.67% P = 0.6, OR 0.78 95% CI 0.38–1.59), as well as LOS (19.8 vs 21.7d P = 0.86) and hospitalization costs ($486,525 vs $53,7283 P = 0.21). However, the IBD cohort had higher incidences of bowel obstruction (9.03 vs 5.12% P < 0.01, OR 1.84 95% CI 1.20–2.80), wound complications (3.97 vs 1.43% P < 0.01, OR 2.86 95% CI 1.52–5.38), and postoperative infection (3.61 vs 1.79% P = 0.047, OR 2.06 95% CI 1.07–3.96). However, there was no difference between cohorts in the incidence of postoperative bleeding (12.3 vs 13.8% P = 0.53, OR 0.88 95% CI 0.61–1.26) and bowel perforation (0.72 vs 0.48% P = 0.39, OR 1.52 95% CI 0.18–5.96). In a multivariate analysis using separate endpoints, the IBD cohort was associated with wound complication (P = 0.01, aOR 2.33 95% CI 1.12–4.40) despite controlling for age, gender, race, postoperative complications, liver-related covariates, and IBD-related intestinal events. CONCLUSION: The presence of IBD is not associated with increased hospital mortality in patients undergoing LT. However, since these patients have an increased risk of wound complications following LT, they require early postoperative wound assessment and multidisciplinary management of wound complications.Figure 1.: Multivariate model: inflammatory bowel disease is associated with increased postoperative wound complication in patients undergoing liver transplant therapy.

Occlusion of the Main Pancreatic Duct as a Method to Avoid a Pancreatojejunal Anastomosis: Metabolic Consequences

Introduction: The poor prognosis seen after the Whipple procedure greatly depends on leaks from pancreatic-duo­denal anastomosis. Objective: To evaluate ligation of the pancreatic duct without reconstruction of the gastrointestinal tract continuity to prevent pancreatic postoperative fistula occurrence and to reduce surgical time. Methods: An experimental study was carried out on New Zealand adult rabbits who underwent pancreatic duct ligation without pancreatic-duodenal anastomosis. Pancreatic enzyme was administered orally to one operated group; another group of animals was operated on and monitored without enzyme replacement. Results: The groups were compared, and variations in weight and metabolic profiles were assessed. No significant differences were found between both operated groups in terms of postoperative mortality or reoperations. Discussion/Conclusion: The morbidity associated with pancreatic duct ligation is low, the procedure is well tolerated, and endocrine insufficiency does not seem to be a problem in the animal model.

The Results of Cardiac Surgery in Terms of Patient Blood Management in Our Hospital.

Clinic of Anaesthesiology and Reanimation, Türkiye Yüksek İhtisas Training and Research Hospital, beginning in 2014, the patient blood management (PBM) protocol is individualised based on patients' comorbidities, and the threshold for transfusion is 7 g dL-1 of haemoglobin for patients without comorbidities and 8-9 g dL-1 for patients with comorbidities. In this study, our aim was to compare patient outcomes, requirement for transfusion and the cost of transfusion between two different periods with and without PBM protocol. 229 and 283 patients who underwent open-heart surgery using cardiopulmonary bypass during the first 4 months of 2012 and the first 4 months of 2017, respectively, were included in this retrospective, cross-sectional study. There were no differences between the groups in preoperative data. Blood and blood product usage was observed to be significantly lower at the time of the PBM protocol. The use of packed red blood cells decreased from 2 units to 0and that of fresh frozen plasma decreased from 2 units to 0. In terms of postoperative mortality, there were no differences between the groups. According to the results of this study, the transfusion of unnecessary blood and blood products was reduced and the cost decreased with PBM protocol. Blood product usage did not affect 30-day mortality. It will be possible to achieve more valuable results if more patients are assessed, PBM protocol is implemented and postoperative results are evaluated in detail.

Comparison Between Salvage Liver Transplantation and Repeat Liver Resection for Recurrent Hepatocellular Carcinoma: A Systematic Review and Meta-analysis

IntroductionRepeat liver resection (RLR) has been adopted by surgeons as the first-line treatment in the case of intrahepatic recurrence of hepatocellular carcinoma (HCC), whereas salvage liver transplantation (SLT) is considered a second-line option. The aim of our study was to evaluate the results of SLT and RLR for HCC. MethodsWe searched for articles published up to December 1, 2017, in the PubMed database that compared SLT with RLR for HCC. We extracted data about patient and tumor characteristics, operative and postoperative outcomes, and survival and performed a meta-analysis. ResultsPatients who underwent SLT had somewhat larger liver lesions (mean difference: 0.73 cm, 95% confidence interval [CI]: 0.29–1.18, P = .001; I2: 0%, P = .82). Moreover, salvage liver transplantation resulted in higher blood loss, longer operating time, longer hospital stay, and higher postoperative morbidity (risk ratio [RR]: 2.45, 95% CI: 1.6–3.75, P < .0001; I2: 0%, P = .58) than RLR, whereas there was no significant difference in terms of postoperative mortality (RR: 6.48, 95% CI: 0.51–82.54, P = .15; I2: 61%, P = .08). On the other hand, SLT led to longer disease-free survival (DFS) than RLR (HR: 0.42, 95% CI: 0.25–0.7, P = .0009; I2: 63%, P = .03), but there was no significant difference in regard to overall survival (OS) (HR: 0.82, 95% CI: 0.55–1.23, P = .34; I2: 0%, P = .62). ConclusionsSLT seems to be inferior to RLR regarding operative and postoperative results but presents a significant advantage in terms of DFS over RLR.

Does Induction Therapy Increase Anastomotic Complications in Bronchial Sleeve Resections?

Sleeve lobectomy represents a safe and effective treatment for central NSCLC to avoid the risks of pneumonectomy. Induction therapy (IT) may be indicated in advanced stages; however, the effect of IT on bronchial anastomoses remains uncertain. The purpose of the study was to evaluate the impact of IT on the complications of the anastomoses. Between 2000 and 2012, 159 consecutive patients were submitted to sleeve lobectomy for NSCLC at our Institution. We retrospectively compared the results of patients who underwent IT before operation with those who received upfront surgery. In the study period, 49 (30.8%) patients received IT (37 chemotherapy, 1 radiotherapy and 11 chemo-radiotherapy) and 110 (69.2%) patients were directly submitted to surgery (S). The two groups were comparable for sex, age, comorbidities, ASA score, pulmonary function, side, type of procedure and histology. Pathological stage was statistically higher for IT group (p = 0.001). No differences between IT and S groups were observed in terms of post-operative mortality (2% vs 0%, p = NS), morbidity (45% vs 38%, p = NS), including early (6% vs 9%, p = NS) and long-term (16% vs 14%, p = NS) bronchial complication rates. Patients undergoing induction mediastinal radiotherapy, however, are at higher risk of bronchial complications. In our experience, the use of induction chemotherapy did not significantly increase mortality and morbidity rates, in particular, neither for early nor for late anastomotic complications. We, therefore, conclude that sleeve lobectomy after induction chemotherapy is safe and reliable procedure for the treatment of locally advanced NSCLC.

Minimally invasive approach for double and triple valve surgery

Background: Although benefitsof minimally invasive cardiac surgery have been described when compared with astandard approach through a median sternotomy, few experience and data exist inthe setting of double and triple valve surgery, whose annual incidence is 3% to25% of all valve surgery. We describe our experience with minimally invasivemultiple valve surgery through a right minithoracotomy. Methods: All patients scheduled for aminithoracotomy approach underwent a preoperative evaluation, includingcomputed tomography scan and epiaortic and femoral vessels ultrasound. Mitraland tricuspid valve disease is treated through a right minithoracotomy performedthrough a 4–5 cm lateral skin incision at the level of the fourth intercostalspace. In case of mitro-aortic or triple valve disease, the procedure iscarried out through a 5–7 cm incision in the 3rd intercostal space at 2–4 cmfrom the sternal edge. A femoral platform is generally used for cardiopulmonarybypass estabilishment, but, in selected patients, a central aortic cannulationcould be also performed to allow an antegrade perfusion. Results: We have started our minimally invasiveprogram in 2003. Gaining experience with the minithoracotomy, all patients witha concomitant mitral and tricuspid valve disease were treated with this kind ofapproach. In 1,604 patients undergoing minimally invasive mitral valve surgeryover a 10-year period, concomitant tricuspid valve repair was performed in 234patients (14.6 %), with good early and long-term outocomes. The next step,especially after the introduction of sutureless aortic prostheses, wasrepresented by the minimally invasive treatment of mitro-aortic and triplevalve disease. Sixty-nine patients underwent concomitant mitral and aorticvalve surgery through a right minithoracotomy, and a triple valve surgery wasperformed 12 (17.4%) of them. Good results were obtained in terms ofpostoperative mortality and morbidity. Conclusions: Double and triplevalve surgery through a right minithoracotomy is a feasible approach in thissubgroup of high-risk patients.

IP071. Comparison of Fenestrated Endovascular and Open Surgical Repair for Suprarenal and Type IV Thoracoabdominal Aortic Aneurysms∗

The aim of this monocentric retrospective study was to compare outcomes of fenestrated endovascular aneurysm repair (FEVAR) and open surgical repair (OR) of suprarenal abdominal aortic aneurysms and type IV thoracoabdominal aneurysms (TAAAs). Consecutive patients undergoing elective FEVAR and OR of suprarenal and type IV TAAAs between January 2012 and November 2015 were included. Choice between FEVAR and OR was based on anatomic criteria and the patient’s comorbidities. In the OR group, an extracorporeal circulation was systematically used to provide oxygenated isothermic blood to the renal and the visceral arteries during aortic clamping. During the study period, 26 patients underwent FEVAR and 26 underwent OR. Patients in the FEVAR group were significantly older (FEVAR, 74 ± 8 years; OR, 67 ± 8 years; P < .001) and had a lower preoperative glomerular filtration rate (FEVAR, 63 [47-81] mL/min/1.73 m2; OR, 77 [64-87] mL/min/1.73 m2; P = .049). Univariate analysis showed no difference in terms of 30-day mortality (FEVAR and OR groups, 2/26 [7.7%]). Moderate to severe complication rates were 54% (14/26) in the FEVAR group and 65% (17/26; P = .4) in the OR group. Permanent paraplegia occurred in one (4%) FEVAR patient and two (8%) OR patients. In the FEVAR group, two (8%) patients required permanent dialysis. In the OR group, four (15%) patients required transient dialysis. The mean follow-up time was 37 ± 20 months after FEVAR and 35 ± 18 months after OR. At 24 months, the actuarial survival rate was significantly higher in the OR group (FEVAR group, 62%; OR group, 92%; log-rank test, P = .03), and estimated freedom from reintervention rates (FEVAR vs OR group, 64% vs 64%; log-rank test, P = .63) were not significantly different between both groups. In this study, no significant difference in terms of postoperative mortality, complication, and reintervention rates could be identified between FEVAR and OR for suprarenal and type IV TAAAs. OR provided good midterm results.

Comparison between open and laparoscopic gastrectomy for gastric cancer: A monocentric retrospective study from a western country

The majority of laparoscopic gastrectomy (LG) reports arise from Asia and the benefit of this approach in western countries remains unclear. The objective of this study was to compare the postoperative outcomes between LG and open gastrectomy (OG) for gastric cancer in a western center. Between 2005 and 2015, all consecutive patients with gastric cancer who underwent either LG or OG were enrolled. Postoperative morbimortality was evaluated according to Dindo-Clavien classification. Over 164patients, 60 had LG and 104OG with a mean age of 62 and 65years, respectively. Total gastrectomy represented 58% of LG and 54% of OG (P=0.749). Operative time was not different in the two groups (160.8 vs. 174.2min, P=0.780) so as intraoperative blood loss (111 vs. 173mL, P=0.057). The rate of severe complications (including postoperative bleeding) was significantly higher in the LG group (40% vs. 23%, P=0.012) so as reoperation rate (27% vs. 6%, P<0.001). There was no statistical difference in terms of postoperative mortality (0 vs. 3%, P=0.252) or length of hospital stay (20 vs. 16days, P=0.116). Laparoscopic gastrectomy for the treatment of gastric cancer in western countries appears to be feasible but with a higher rate of severe complications compared to open gastrectomy.