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Annals of Surgery
Journal Prestige (SJR): 4.361
Citation Impact (citeScore): 5
Number of Followers: 90  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0003-4932 - ISSN (Online) 1528-1140
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • Patient, Surgeon, and Health Care Worker Safety during the COVID-19
           Pandemic

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      Authors: Hölscher; Arnulf H.
      Abstract: imageNo abstract available
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Discovery and Innovation in Surgery: Chance and Necessity

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      Authors: Bismuth; Henri
      Abstract: No abstract available
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Incisional Surgical Site Infections After Mass and Layered Closure of
           Upper Abdominal Transverse Incisions: First Results of a Randomized
           Controlled Trial

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      Authors: Grat; Michal; Morawski, Marcin; Krasnodebski, Maciej; Borkowski, Jan; Krawczyk, Piotr; Grat, Karolina; Stypulkowski, Jan; Maczkowski, Bartosz; Figiel, Wojciech; Lewandowski, Zbigniew; Kobryn, Konrad; Patkowski, Waldemar; Krawczyk, Marek; Wróblewski, Tadeusz; Otto, Wlodzimierz; Paluszkiewicz, Rafal; Zieniewicz, Krzysztof
      Abstract: imageObjective: To compare the early results of mass and layered closure of upper abdominal transverse incisions.Summary of Background Data: Contrary to midline incisions, data on closure of transverse abdominal incisions are lacking.Methods: This is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisional-SSI) was the primary end-point. Secondary end-points comprised suture-to-wound length ratio (SWLR), closure duration, and fascial dehiscence (clinicatrials.gov NCT03561727).Results: A total of 268 patients were randomized to either mass (n=134) or layered (n=134) closure. Incisional-SSIs occurred in 24 (17.9%) and 8 (6.0%) patients after mass and layered closure, respectively (P =0.004), with crude odds ratio (OR) of 0.29 [95% confidence interval (95% CI) 0.13–0.67; P =0.004]. Layered technique was independently associated with fewer incisional-SSIs (OR: 0.29; 95% CI 0.12–0.69; P =0.005). The number needed to treat, absolute, and relative risk reduction for layered technique in reducing incisional-SSIs were 8.4 patients, 11.9%, and 66.5%, respectively. Dehiscence occurred in one (0.8%) patient after layered closure and in two (1.5%) patients after mass closure (P>0.999). Median SWLR were 8.1 and 5.6 (P
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Open Preperitoneal Inguinal Hernia Repair, TREPP Versus TIPP in a
           Randomized Clinical Trial

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      Authors: Bökkerink; Willem J. V.; Koning, Giel G.; Vriens, Patrick W. H. E.; Mollen, Roland M. H. G.; Harker, Mitchell J. R.; Noordhof, Robin K.; Akkersdijk, Willem L.; van Laarhoven, Cees J. H. M.
      Abstract: imageObjective: The aim of this study was to compare chronic postoperative inguinal pain (CPIP) in patients with an inguinal hernia after the TransREctus Sheath PrePeritoneal (TREPP) and the TransInguinal PrePeritoneal Technique (TIPP).Background: The preperitoneal mesh position for inguinal hernia repair showed beneficial results regarding CPIP with low recurrence rates. Two open preperitoneal techniques, TREPP and TIPP, were compared in a randomized clinical trial with the hypothesis of fewer patients with CPIP after TREPP due to complete avoidance of nerve contact.Methods: Adult patients with a primary unilateral inguinal hernia were randomized to either TREPP or TIPP in four hospitals. Before the trial's start the study protocol was ethically approved and published. Outcomes included CPIP after 1 year (primary outcome) and recurrence rates, adverse events, and health-related quality of life (secondary outcomes). Follow-up was performed at 2 weeks, 6 months, and 1 year.Results: Baseline characteristics were comparable in both groups. Pain was less often present after TREPP at 2 weeks and 6 months, but CPIP at rest at 1 year was comparable: 1.9% after TREPP vs 1.4% after TIPP, P = 0.535). The overall recurrence rate was higher in the TREPP group, 8.9% vs 4.6%, P = 0.022). Corrected for a learning curve for TREPP, no significant difference could be assessed (TREPP 5.7% and TIPP 4.8%, P = 0.591).Conclusion: Both the TREPP and TIPP technique resulted in a low incidence of CPIP after 1-year follow-up. The TREPP method can be considered a solid method for inguinal hernia repair if expertise is present. The learning curve of the TREPP techniques needs further evaluation.Trial Registration: ISRCTN18591339
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Hypothermic Oxygenated Machine Perfusion Reduces Early Allograft Injury
           and Improves Post-transplant Outcomes in Extended Criteria Donation Liver
           Transplantation From Donation After Brain Death: Results From a
           Multicenter Randomized Controlled Trial (HOPE ECD-DBD)

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      Authors: Czigany; Zoltan; Pratschke, Johann; Fronek, Jirí; Guba, Markus; Schöning, Wenzel; Raptis, Dimitri Aristotle; Andrassy, Joachim; Kramer, Matthijs; Strnad, Pavel; Tolba, Rene Hany; Liu, Wenjia; Keller, Theresa; Miller, Hannah; Pavicevic, Sandra; Uluk, Deniz; Kocik, Matej; Lurje, Isabella; Trautwein, Christian; Mehrabi, Arianeb; Popescu, Irinel; Vondran, Florian Wolfgang Rudolf; Ju, Cynthia; Tacke, Frank; Neumann, Ulf Peter; Lurje, Georg
      Abstract: imageObjective: The aim of this study was to evaluate peak serum alanine aminotransferase (ALT) and postoperative clinical outcomes after hypothermic oxygenated machine perfusion (HOPE) versus static cold storage (SCS) in extended criteria donation (ECD) liver transplantation (LT) from donation after brain death (DBD).Background: HOPE might improve outcomes in LT, particularly in high-risk settings such as ECD organs after DBD, but this hypothesis has not yet been tested in a randomized controlled clinical trial (RCT).Methods: Between September 2017 and September 2020, 46 patients undergoing ECD-DBD LT from four centers were randomly assigned to HOPE (n = 23) or SCS (n = 23). Peak-ALT levels within 7 days following LT constituted the primary endpoint. Secondary endpoints included incidence of postoperative complications [Clavien-Dindo classification (CD), Comprehensive Complication Index (CCI)], length of intensive care- (ICU) and hospital-stay, and incidence of early allograft dysfunction (EAD).Results: Demographics were equally distributed between both groups [donor age: 72 (IQR: 59–78) years, recipient age: 62 (IQR: 55–65) years, labMELD: 15 (IQR: 9–25), 38 male and 8 female recipients]. HOPE resulted in a 47% decrease in serum peak ALT [418 (IQR: 221–828) vs 796 (IQR: 477–1195) IU/L, P = 0.030], a significant reduction in 90-day complications [44% vs 74% CD grade ≥3, P = 0.036; 32 (IQR: 12–56) vs 52 (IQR: 35–98) CCI, P = 0.021], and shorter ICU- and hospital-stays [5 (IQR: 4–8) vs 8 (IQR: 5–18) days, P = 0.045; 20 (IQR: 16–27) vs 36 (IQR: 23–62) days, P = 0.002] compared to SCS. A trend toward reduced EAD was observed for HOPE (17% vs 35%; P = 0.314).Conclusion: This multicenter RCT demonstrates that HOPE, in comparison to SCS, significantly reduces early allograft injury and improves post-transplant outcomes in ECD-DBD liver transplantation.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Neoadjuvant Therapy for Resectable Pancreatic Cancer: A New Standard of
           Care. Pooled Data From 3 Randomized Controlled Trials

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      Authors: Birrer; Dominique L.; Golcher, Henriette; Casadei, Riccardo; Haile, Sarah R.; Fritsch, Ralph; Hussung, Saskia; Brunner, Thomas B.; Fietkau, Rainer; Meyer, Thomas; Grützmann, Robert; Merkel, Susanne; Ricci, Claudio; Ingaldi, Carlo; Di Marco, Mariacristina; Guido, Alessandra; Serra, Carla; Minni, Francesco; Pestalozzi, Bernhard; Petrowsky, Henrik; DeOliveira, Michelle; Bechstein, Wolf O.; Bruns, Christiane J.; Oberkofler, Christian E.; Puhan, Milo; Lesurtel, Mickaël; Heinrich, Stefan; Clavien, Pierre-Alain
      Abstract: imageObjective: The aim of this study was to pool data from randomized controlled trials (RCT) limited to resectable pancreatic ductal adenocarcinoma (PDAC) to determine whether a neoadjuvant therapy impacts on disease-free survival (DFS) and surgical outcome.Summary Background Data: Few underpowered studies have suggested benefits from neoadjuvant chemo (± radiation) for strictly resectable PDAC without offering conclusive recommendations.Methods: Three RCTs were identified comparing neoadjuvant chemo (± radio) therapy vs. upfront surgery followed by adjuvant therapy in all cases. Data were pooled targeting DFS as primary endpoint, whereas overall survival (OS), postoperative morbidity, and mortality were investigated as secondary endpoints. Survival endpoints DFS and OS were compared using Cox proportional hazards regression with study-specific baseline hazards.Results: A total of 130 patients were randomized (56 in the neoadjuvant and 74 in the control group). DFS was significantly longer in the neoadjuvant treatment group compared to surgery only [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.4–0.9] (P = 0.01). Furthermore, DFS for the subgroup of R0 resections was similarly longer in the neoadjuvant treated group (HR 0.6, 95% CI 0.35–0.9, P = 0.045). Although postoperative complications (Comprehensive Complication Index, CCI®) occurred less frequently (P = 0.008), patients after neoadjuvant therapy experienced a higher toxicity, but without negative impact on oncological or surgical outcome parameters.Conclusion: Neoadjuvant therapy can be offered as an acceptable standard of care for patients with purely resectable PDAC. Future research with the advances of precision oncology should now focus on the definition of the optimal regimen.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing
           Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection:
           An International Multicenter Analysis

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      Authors: Machairas; Nikolaos; Raptis, Dimitri A; Velázquez, Patricia Sánchez; Sauvanet, Alain; Rueda de Leon, Alexandra; Oba, Atsushi; Koerkamp, Bas Groot; Lovasik, Brendan; Chan, Carlos; Yeo, Charles J.; Bassi, Claudio; Ferrone, Cristina R.; Kooby, David; Moskal, David; Tamburrino, Domenico; Yoon, Dong-Sup; Barroso, Eduardo; de Santibañes, Eduardo; Kauffmann, Emanuele F.; Vigia, Emanuel; Robin, Fabien; Casciani, Fabio; Burdío, Fernando; Belfiori, Giulio; Malleo, Giuseppe; Lavu, Harish; Hartog, Hermien; Hwang, Ho-Kyoung; Han, Ho-Seong; Marques, Hugo P.; Poves, Ignasi; Domínguez-Rosado, Ismael; Park, Joon-Seong; Lillemoe, Keith D.; Roberts, Keith; Sulpice, Laurent; Besselink, Marc G.; Abuawwad, Mahmoud; Del Chiaro, Marco; de Santibañes, Martin; Falconi, Massimo; D'Silva, Mizelle; Silva, Michael; Hilal, Mohammed Abu; Qadan, Motaz; Sell, Naomi M.; Beghdadi, Nassiba; Napoli, Niccolò; Busch, Olivier R. C.; Mazza, Oscar; Muiesan, Paolo; Müller, Philip C.; Ravikumar, Reena; Schulick, Richard; Powell-Brett, Sarah; Abbas, Syed Hussain; Mackay, Tara M.; Stoop, Thomas F.; Gallagher, Tom K.; Boggi, Ugo; van Eijck, Casper; Clavien, Pierre-Alain; Conlon, Kevin C. P.; Fusai, Giuseppe Kito
      Abstract: imageObjective: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers.Summary of Background Data: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients.Methods: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018.Results: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Survival Benefit Associated With Resection of Locally Advanced Pancreatic
           Cancer After Upfront FOLFIRINOX Versus FOLFIRINOX Only: Multicenter
           Propensity Score-matched Analysis

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      Authors: Brada; Lilly J. H.; Daamen, Lois A.; Magermans, Lisa G.; Walma, Marieke S.; Latifi, Diba; van Dam, Ronald M.; de Hingh, Ignace H.; Liem, Mike S. L.; de Meijer, Vincent E.; Patijn, Gijs A.; Festen, Sebastiaan; Stommel, Martijn W. J.; Bosscha, Koop; Polée, Marco B.; Nio, Yung C.; Wessels, Frank J.; de Vries, Jan J. J.; van Lienden, Krijn P.; Bruijnen, Rutger C.; Busch, Olivier R.; Koerkamp, Bas Groot; van Eijck, Casper; Molenaar, Quintus I.; Wilmink, Hanneke J. W.; van Santvoort, Hjalmar C.; Besselink, Marc G.; for the Dutch Pancreatic Cancer Group
      Abstract: imageObjective: This study compared median OS after resection of LAPC after upfront FOLFIRINOX versus a propensity-score matched cohort of LAPC patients treated with FOLFIRINOX-only (ie, without resection).Background: Because the introduction of FOLFIRINOX chemotherapy, increased resection rates in LAPC patients have been reported, with improved OS. Some studies have also reported promising OS with FOLFIRINOX-only treatment in LAPC. Multicenter studies assessing the survival benefit associated with resection of LAPC versus patients treated with FOLFIRINOX-only are lacking.Methods: Patients with non-progressive LAPC after 4 cycles of FOLFIRINOX treatment, both with and without resection, were included from a prospective multicenter cohort in 16 centers (April 2015–December 2019). Cox regression analysis identified predictors for OS. One-to-one propensity score matching (PSM) was used to obtain a matched cohort of patients with and without resection. These patients were compared for OS.Results: Overall, 293 patients with LAPC were included, of whom 89 underwent a resection. Resection was associated with improved OS (24 vs 15 months, P < 0.01), as compared to patients without resection. Before PSM, resection, Charlson Comorbidity Index, and Response Evaluation Criteria in Solid Tumors (RECIST) response were predictors for OS. After PSM, resection remained associated with improved OS [Hazard Ratio (HR) 0.344, 95% confidence interval (0.222–0.534), P < 0.01], with an OS of 24 versus 15 months, as compared to patients without resection. Resection of LAPC was associated with improved 3-year OS (31% vs 11%, P < 0.01).Conclusions: Resection of LAPC after FOLFIRINOX was associated with increased OS and 3-year survival, as compared to propensity-score matched patients treated with FOLFIRINOX-only.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Improving Outcome of Superior Mediastinal Lymph Node Dissection During
           Esophagectomy: A Novel Approach Combining Continuous and Intermittent
           Recurrent Laryngeal Nerve Monitoring

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      Authors: Wong; Ian Y. H.; Zhang, Rui Qi; Tsang, Raymond K. Y.; Kwok, Jeanette Y. Y.; Wong, Claudia L. Y.; Chan, Desmond K. K.; Chan, Fion S. Y.; Law, Simon Y. K.
      Abstract: imageObjective: This study aimed at demonstrating the effects and learning curve of utilizing combined intermittent and continuous recurrent laryngeal nerve (RLN) monitoring for lymphadenectomy during esophagectomy.Background: RLN lymphadenectomy is oncologically important but is technically demanding. Vocal cord (VC) palsy as a result from RLN injury, carries significant morbidities.Methods: This is a retrospective study of consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent transthoracic esophagectomy from 2010 to 2020. Combined nerve monitoring (CNM) included: CNM which involved a periodic stimulating left vagal electrode and intermittent nerve monitoring which utilized a stimulating probe to identify the RLNs. The integrity of the RLNs was assessed both intermittently and continuously. This technique was introduced in 2014. Patients were divided into “before CNM” and “CNM” groups. The primary outcome was the difference in number of RLN lymph nodes harvested and VC palsy rate. Learning curves were demonstrated by cumulative sum (CUSUM) analysis.Results: Two hundred and fifty-five patients were included with 157 patients in “CNM” group. The mean number of RLN lymph nodes harvested was significantly higher (4.31 vs 0.45, P < 0.0001) for the “CNM” group. VC palsy rates were significantly lower (17.8% vs 32.7%, P = 0.007). There was an initial increase in VC palsy rate, peaked at around 46 cases. The increase in lymph nodes harvested above the mean plateaued at around 96 cases.Conclusions: CNM helped improve bilateral RLN lymphadenectomy. Lymph node harvesting was increased with reduction of VC palsy after a learning curve.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Presentation, Treatment, and Prognosis of Esophageal Carcinoma in a
           Nationwide Comparison of Sweden and the Netherlands

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      Authors: Kalff; Marianne C.; Gottlieb-Vedi, Eivind; Verhoeven, Rob H. A.; van Laarhoven, Hanneke W. M.; Lagergren, Jesper; Gisbertz, Suzanne S.; Markar, Sheraz R.; van Berge Henegouwen, Mark I.
      Abstract: imageObjective: This population-based study aimed to compare presentation, treatment allocation and survival of potentially curable esophageal cancer patients between Sweden and the Netherlands.Summary of Background data: Identification of inter-country differences in treatment allocation and survival may be used for targeted esophageal cancer care improvement.Methods: Nationwide datasets were acquired from a Swedish cohort study and the Netherlands Cancer Registry. Patients with potentially curable (cT1-T4a/Tx, cN0/+, cM0/x) esophageal adenocarcinoma or squamous cell carcinoma (SCC) diagnosed in 2011–2015 were included. Multivariable logistic regression provided odds ratios (OR) for treatment allocation, and multivariable Cox model provided hazard ratios (HR) for overall survival, all with 95% confidence intervals (CI), adjusted for age, sex, year, tumor sub-location and stage.Results: Among 1980 Swedish and 7829 Dutch esophageal cancer patients, Swedish patients were older (71 vs 69 years, P
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity After Minimally
           Invasive Ivor Lewis Esophagectomy: Including a Novel Grading System for
           Postoperative Endoscopic Assessment of GI-Anastomoses

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      Authors: Müller; Philip C.; Morell, Bernhard; Vetter, Diana; Raptis, Dimitri A.; Kapp, Joshua R.; Gubler, Christoph; Gutschow, Christian A.
      Abstract: imageObjective: Preemptive endoluminal vacuum therapy (pEVT) is a novel concept to reduce postoperative morbidity and has the potential to disrupt current treatment paradigms for patients undergoing esophagectomy.Summary of Background Data: Endoluminal vacuum therapy is an accepted treatment for AL after esophagectomy.Methods: Retrospective analysis of patients undergoing minimally invasive Ivor Lewis esophagectomy with pEVT between 11/2017 and 10/2020. The sponge was removed endoscopically after 4–6 days, and anastomosis and gastric conduit were assessed according to a novel endoscopic grading system. Further management was customized according to endoscopic appearance and clinical course. Endpoints were postoperative morbidity and AL rate, defined according to the Clavien-Dindo (CD) and International Esodata Study Group classifications.Results: PEVT was performed in 67 consecutive patients, 57 (85%) were high-risk patients with an ASA score>2, WHO/ECOG score>1, age>65 years, or BMI>29 kg/m2. Thirty patients experienced textbook outcome, and overall minor (≤CD IIIa) and major (≥CD IIIb) morbidity was 40.3% and 14.9% respectively. 30-day-mortality was 0%. Forty-nine patients (73%) had uneventful anastomotic healing after pEVT without further endoscopic treatment. The remaining 18 patients (27%) underwent prolonged EVT with uneventful anastomotic healing in 13 patients (19%), contained AL in 4 patients (6%), and 1 uncontained leakage (1.5%) in a case with proximal gastric conduit necrosis, resulting in an overall AL rate of 7.5%.Conclusions: PEVT is an innovative and safe procedure with a promising potential to reduce postoperative morbidity after minimally invasive Ivor Lewis esophagectomy and may be particularly valuable in highly comorbid cases.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Incidence and Risk Factors for Diaphragmatic Herniation Following
           Esophagectomy for Cancer

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      Authors: Hertault; Hugo; Gandon, Anne; Behal, Hélène; Legault, Gaëtan; Degisors, Sébastien; Martin, Louis; Messier, Marguerite; Noiret, Barbara; Vermersch, Mathilde; Nuytens, Frederiek; Eveno, Clarisse; Piessen, Guillaume
      Abstract: imageObjective: To evaluate the incidence and risk factors of diaphragmatic herniation following esophagectomy for cancer (DHEC), and assess the results of surgical repair.Summary Background data: The current incidence of DHEC is discussed with conflicting data regarding its treatment and natural course.Methods: Monocentric retrospective cohort study (2009–2018). From 902 patients, 719 patients with a complete follow-up of CT scans after transthoracic esophagectomy for cancer were reexamined to identify the occurrence of a DHEC. The incidence of DHEC was estimated using Kalbfleisch and Prentice method and risk factors of DHEC were studied using the Fine and Gray competitive risk regression model by treating death as a competing event. Survival was analyzed.Results: Five-year DHEC incidence was 10.3% [95% CI, 7.8%–13.2%] (n = 59), asymptomatic in 54.2% of cases. In the multivariable analysis, the risk factors for DHEC were: presence of hiatal hernia on preoperative CT scan (HR = 1.72 [1.01–2.94], P = 0.046), previous hiatus surgery (HR = 3.68 [1.61–8.45], P = 0.002), gastroesophageal junction tumor location (HR = 3.51 [1.91–6.45], P < 0.001), neoadjuvant chemoradiotherapy (HR = 4.27 [1.70–10.76], P < 0.001), and minimally invasive abdominal phase (HR = 2.98 [1.60–5.55], P < 0.001). A cure for DHEC was achieved in 55.9%. The postoperative mortality rate was nil, the overall morbidity rate was 12.1%, and the DHEC recurrence rate was 30.3%. Occurrence of DHEC was significantly associated with a lower hazard rate of death in a time-varying Cox's regression analysis (HR = 0.43[0.23–0.81], P = 0.010).Conclusions: The 5-year incidence of DHEC is 10.3% and is associated with a favorable prognosis. Surgical repair of symptomatic or progressive DHEC is associated with an acceptable morbidity. However, the optimal surgical repair technique remains to be determined in view of the large number of recurrences.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Surgical Management of Retrorectal Tumors: A French Multicentric
           Experience of 270 Consecutives Cases

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      Authors: Aubert; Mathilde; Mege, Diane; Parc, Yann; Rullier, Eric; Cotte, Eddy; Meurette, Guillaume; Zerbib, Philippe; Trilling, Bertrand; Lelong, Bernard; Sabbagh, Charles; Lakkis, Zaher; Ouaissi, Mehdi; Lebreton, Gil; Rouanet, Philippe; Manceau, Gilles; Tuech, Jean-Jacques; Piessen, Guillaume; Bresler, Laurent; Beyer-Berjot, Laura; Denost, Quentin; Lefèvre, Jérémie H; Panis, Yves; on behalf of the French Research Group of Rectal Cancer Surgery (GRECCAR
      Abstract: imageObjective: To report the largest multicentric experience on surgical management of retrorectal tumors (RRT).Background: Literature data on RRT is limited. There is no consensus concerning the best surgical approach for the management of RRT.Methods: Patients operated for RRT in 18 academic French centers were retrospectively included (2000–2019).Results: A total of 270 patients were included. Surgery was performed through abdominal (n = 72, 27%), bottom (n = 190, 70%), or combined approach (n = 8, 3%). Abdominal approach was laparoscopic in 53/72 (74%) and bottom approach was Kraske modified procedures in 169/190 (89%) patients. In laparoscopic abdominal group, tumors were more frequently symptomatic (37/53, 70% vs 88/169, 52%, P = 0.02), larger [mean diameter = 60.5 ± 24 (range, 13–107) vs 51 ± 26 (20–105) mm, P = 0.02] and located above S3 vertebra (n = 3/42, 7% vs 0%, P = 0.001) than those from Kraske modified group. Laparoscopy was associated with a higher risk of postoperative ileus (n = 4/53, 7.5% vs 0%, P = 0.002) and rectal fistula (n = 3/53, 6% vs 0%, P=0.01) but less wound abscess (n = 1/53, 2% vs 24/169, 14%, P = 0.02) than Kraske modified procedures. RRT was malignant in 8%. After a mean follow up of 27 ±39 (1–221) months, local recurrence was noted in 8% of the patients. After surgery, chronic pain was observed in 17% of the patients without significant difference between the 2 groups (15/74, 20% vs 3/30, 10%; P = 0.3).Conclusions: Both laparoscopic and Kraske modified approaches can be used for surgical treatment of RRT (according to their location and their size), with similar long-term results.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Diverting Enterostomy Improves Overall Survival of Patients With Severe
           Steroid-refractory Gastrointestinal Acute Graft-Versus-Host Disease

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      Authors: Khodr; Justine; Zerbib, Philippe; Rogosnitzky, Moshe; Magro, Leonardo; Truant, Stéphanie; Yakoub-Agha, Ibrahim; Duhamel, Alain; Seguy, David
      Abstract: imageObjective: The aim of this study was to evaluate the benefit of diverting enterostomy (DE) in patients with severe steroid-refractory (SR) gastrointestinal acute graft-versus-host-disease (GI-aGVHD) following allogeneic hematopoietic stem-cell transplantation (ASCT).Summary and Background Data: Severe GI-aGVHD refractory to the first-line steroid therapy is a rare but dramatic life-threatening complication. Second lines of immunosuppressors have limited effects and increase the risk of sepsis. Data suggest that limiting GI bacterial translocation by DE could restrain severe GI-aGVHD.Methods: From 2004 to 2018, we retrospectively reviewed all consecutive patients undergoing ASCT for hematologic malignancies who developed severe SR GI-aGVHD. We compared patients in whom a proximal DE was performed (Enterostomy group) with those not subjected to DE (Medical group). The primary endpoint was the 1-year overall survival (OS) measured from the onset of GI-aGVHD. Secondary endpoints were the 2-year OS and causes of death.Results: Of the 1295 patients who underwent ASCT, 51 patients with severe SR GI-aGVHD were analyzed (13 in Enterostomy group and 38 in Medical group). Characteristics of patients, transplantation modalities, and aGVHD severity were similar in both groups. The 1-year OS was better after DE (54% vs 5%, P = 0.0004). The 2-year OS was also better in “Enterostomy group” (31% vs 2.5%; P = 0.0015), with a trend to lower death by sepsis (30.8% vs 57.9%; P = 0.091).Conclusion: DE should be considered for severe GI-aGVHD as soon as resistance to the corticosteroid is identified.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Perihilar Cholangiocarcinoma – Novel Benchmark Values for Surgical and
           Oncological Outcomes From 24 Expert Centers

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      Authors: Mueller; Matteo; Breuer, Eva; Mizuno, Takashi; Bartsch, Fabian; Ratti, Francesca; Benzing, Christian; Ammar-Khodja, Noémie; Sugiura, Teiichi; Takayashiki, Tsukasa; Hessheimer, Amelia; Kim, Hyung Sun; Ruzzenente, Andrea; Ahn, Keun Soo; Wong, Tiffany; Bednarsch, Jan; D'Silva, Mizelle; Koerkamp, Bas Groot; Jeddou, Heithem; López-López, Victor; de Ponthaud, Charles; Yonkus, Jennifer A.; Ismail, Warsan; Nooijen, Lynn E.; Hidalgo-Salinas, Camila; Kontis, Elissaios; Wagner, Kim C.; Gunasekaran, Ganesh; Higuchi, Ryota; Gleisner, Ana; Shwaartz, Chaya; Sapisochin, Gonzalo; Schulick, Richard D.; Yamamoto, Masakazu; Noji, Takehiro; Hirano, Satoshi; Schwartz, Myron; Oldhafer, Karl J.; Prachalias, Andreas; Fusai, Giuseppe K.; Erdmann, Joris I.; Line, Pål-Dag; Smoot, Rory L.; Soubrane, Olivier; Robles-Campos, Ricardo; Boudjema, Karim; Polak, Wojciech G.; Han, Ho-Seong; Neumann, Ulf P.; Lo, Chung-Mau; Kang, Koo Jeong; Guglielmi, Alfredo; Park, Joon Seong; Fondevila, Constantino; Ohtsuka, Masayuki; Uesaka, Katsuhiko; Adam, René; Pratschke, Johann; Aldrighetti, Luca; De Oliveira, Michelle L.; Gores, Gregory J.; Lang, Hauke; Nagino, Masato; Clavien, Pierre-Alain
      Abstract: imageObjective: The aim of this study was to define robust benchmark values for the surgical treatment of perihilar cholangiocarcinomas (PHC) to enable unbiased comparisons.Background: Despite ongoing efforts, postoperative mortality and morbidity remains high after complex liver surgery for PHC. Benchmark data of best achievable results in surgical PHC treatment are however still lacking.Methods: This study analyzed consecutive patients undergoing major liver surgery for PHC in 24 high-volume centers in 3 continents over the recent 5-year period (2014–2018) with a minimum follow-up of 1 year in each patient. Benchmark patients were those operated at high-volume centers (≥50 cases during the study period) without the need for vascular reconstruction due to tumor invasion, or the presence of significant co-morbidities such as severe obesity (body mass index ≥35), diabetes, or cardiovascular diseases. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers.Results: Seven hundred eight (39%) of a total of 1829 consecutive patients qualified as benchmark cases. Benchmark cut-offs included: R0 resection ≥57%, postoperative liver failure (International Study Group of Liver Surgery): ≤35%; in-hospital and 3-month mortality rates ≤8% and ≤13%, respectively; 3-month grade 3 complications and the CCI: ≤70% and ≤30.5, respectively; bile leak-rate: ≤47% and 5-year overall survival of ≥39.7%. Centers operating mostly on complex cases disclosed better outcome including lower post-operative liver failure rates (4% vs 13%; P = 0.002). Centers from Asia disclosed better outcomes.Conclusion: Surgery for PHC remains associated with high morbidity and mortality with now the availability of benchmark values covering 21 outcome parameters, which may serve as key references for comparison in any future analyses of individuals, group of patients or centers.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study):
           A Multicenter Cohort Study

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      Authors: Beugniez; César; Sauvanet, Alain; Sulpice, Laurent; Gaujoux, Sébastien; Turrini, Olivier; Truant, Stéphanie; Schwarz, Lilian; Piessen, Guillaume; Regimbeau, Jean Marc; Muscari, Fabrice; Adham, Mustapha; Pattou, François; Schneider, Lucil; Clement, Guillaume; Delpero, Jean-Robert; Pruvot, François-René; Mehdi, El Amrani; the French-ACHBT Working Group
      Abstract: imageObjectives: Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate.Background: Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved.Methods: All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death.Results: Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality.Conclusions: One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Half of Postoperative Deaths After Cytoreductive Surgery and Hyperthermic
           Intraperitoneal Chemotherapy Could be Preventable: A French Root Cause
           Analysis on 5562 Patients

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      Authors: Houlzé-Laroye; Constance; Glehen, Olivier; Sgarbura, Olivia; Gayat, Etienne; Sourrouille, Isabelle; Tuech, Jean-Jacques; Delhorme, Jean-Baptiste; Dumont, Frédéric; Ceribelli, Cécilia; Amroun, Koceila; Arvieux, Catherine; Moszkowicz, David; Pirro, Nicolas; Lefevre, Jérémie H.; Courvosier-Clement, Thomas; Paquette, Brice; Mariani, Pascale; Pezet, Denis; Sabbagh, Charles; Tessier, Williams; Celerier, Bertrand; Guilloit, Jean-Marc; Taibi, Abdelkader; Quenet, François; Bakrin, Naoual; Pocard, Marc; Goéré, Diane; Brigand, Cécile; Piessen, Guillaume; Eveno, Clarisse
      Abstract: imageObjective: To perform a retrospective root-cause analysis of postoperative death after CRS and HIPEC procedures.Background: The combination of CRS and HIPEC is an effective therapeutic strategy to treat peritoneal surface malignancies, however it is associated with significant postoperative mortality.Methods: All patients treated with a combination of CRS and HIPEC between January 2009 and December 2018 in 22 French centers and died in the hospital, were retrospectively analyzed. Perioperative data of the 101 patients were collected by a local senior surgeon with a sole junior surgeon. Three independent experts investigated the typical root cause of death and provided conclusions on whether postoperative death was preventable (PREV group) or not (NON-PREV group). A typical root cause of preventable postoperative death was classified on a cause-and-effect diagram.Results: Of the 5562 CRS+HIPEC procedures performed, 101 in-hospital deaths (1.8%) were identified, of which a total of 18 patients of 70 years old and above and 20 patients with ASA score of 3. Etiology of peritoneal disease was mainly colorectal. A total of 54 patients (53%) were classified in the PREV group and 47 patients (47%) in the NON-PREV group. The results of the study show that in the PREV group, WHO performance status 1-2 was more frequent and the Median Peritoneal Cancer Index was higher compared with those of the NON-PREV group. The cause of death in the PREV group was classified as: (i) preoperatively for debatable indication (59%), (ii) intraoperatively (30%) and (iii) postoperatively in 17 patients (31%). A multifactorial cause of death was found in 11 patients (20%).Conclusion: More than half of the postoperative deaths after combined CRS and HIPEC may be preventable, mainly by following guidelines regarding preoperative selection of the patients and adequate intraoperative decisions.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Predicting Intraoperative Difficulty of Open Liver Resections: The
           DIFF-scOR Study, An Analysis of 1393 Consecutive Hepatectomies From a
           French Multicenter Cohort

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      Authors: Pothet; Clara; Drumez, Élodie; Joosten, Alexandre; Genin, Michaël; Hobeika, Christian; Mabrut, Jean-Yves; Grégoire, Émilie; Régimbeau, Jean Marc; Bonal, Mathieu; Farges, Olivier; Vibert, Éric; Pruvot, François-René; Boleslawski, Emmanuel
      Abstract: imageObjective: The aim of this study was to build a predictive model of operative difficulty in open liver resections (LRs).Summary Background Data: Recent attempts at classifying open-LR have been focused on postoperative outcomes and were based on predefined anatomical schemes without taking into account other anatomical/technical factors.Methods: Four intraoperative variables were perceived by the authors as to reflect operative difficulty: operation and transection times, blood loss, and number of Pringle maneuvers. A hierarchical ascendant classification (HAC) was used to identify homogeneous groups of operative difficulty, based on these variables. Predefined technical/anatomical factors were then selected to build a multivariable logistic regression model (DIFF-scOR), to predict the probability of pertaining to the highest difficulty group. Its discrimination/calibration was assessed. Missing data were handled using multiple imputation.Results: HAC identified 2 clusters of operative difficulty. In the “Difficult LR” group (20.8% of the procedures), operation time (401 min vs 243 min), transection time (150 vs.63 minute), blood loss (900 vs 400 mL), and number of Pringle maneuvers (3 vs 1) were higher than in the “Standard LR” group. Determinants of operative difficulty were body weight, number and size of nodules, biliary drainage, anatomical or combined LR, transection planes between segments 2 and 4, 4, and 8 or 7 and 8, nonanatomical resections in segments 2, 7, or 8, caval resection, bilioentric anastomosis and number of specimens. The c-statistic of the DIFF-scOR was 0.822. By contrast, the discrimination of the DIFF-scOR to predict 90-day mortality and severe morbidity was poor (c-statistic: 0.616 and 0.634, respectively).Conclusion: The DIFF-scOR accurately predicts open-LR difficulty and may be used for various purposes in clinical practice and research.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • FLOT-regimen Chemotherapy and Transthoracic en bloc Resection for
           Esophageal and Junctional Adenocarcinoma

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      Authors: Donlon; Noel E.; Kammili, Anitha; Roopnarinesingh, Ryan; Davern, Maria; Power, Robert; King, Sinead; Chmelo, Jakub; Phillips, Alexander W.; Donohoe, Claire L.; Ravi, Narayanasamy; Lowery, Maeve; Mueller, Carmen L.; Cools-Lartigue, Jonathan; Ferri, Lorenzo E.; Reynolds, John V.
      Abstract: imageBackground and Aims: The FLOT4-AIO trial established the FLOT regimen as a compelling option for gastric, junctional and esophageal adenocarcinoma. Data on FLOT with en-bloc transthoracic esophagectomy (TTE) are limited. This study explored operative complications, tolerance, toxicity, physiological impact, and oncologic outcomes.Study design: An observational cohort study on consecutive patients at 3 tertiary centers undergoing FLOT and TTE. Toxicity, operative complications (per ECCG definitions), tumor regression grade (TRG), recurrences and survival were documented, as well as pre and post FLOT assessment of sarcopenia and pulmonary physiology.Results: 175 patients (cT2-4a, Nany) commenced treatment, 84% male, median age 65, 94% cT3/T4a, 73% cN+. 89% completed 4 preoperative cycles, and 35% all cycles. Grade 3/4 toxicities included neutropenia (12%), diarrhoea (13%), and infection (15%). Sarcopenia increased from 18% to 37% (P = 0.020), and diffusion capacity (DLCO) decreased by 8% (-34% + 25%; P < 0.010). On pathology, ypT3/4 was 59%, and ypN+54%, with 10% TRG 1, 14% TRG 2, and 76% TRG3-5, and R0 95%. 161 underwent TTE, with an in-hospital mortality of 0.6%, 24%-pneumonia, 11%-anastomotic leak, and Clavien Dindo ≥III in 27%. At a median follow up of 12 months (1-85), 33 relapsed, 8 (5%) locally, and 3yr survival was 60%.Conclusion: FLOT and en bloc TTE was safe, with no discernible impact on operative complications, with 24% having a major pathologic response. Caveats include a limited pathologic response in the majority, and negative impact on muscle mass and lung physiology, and low use of adjuvant cycles. These data may provide a real-world benchmark for this complex care pathway.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Defining Global Benchmarks in Elective Secondary Bariatric Surgery
           Comprising Conversional, Revisional, and Reversal Procedures

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      Authors: Gero; Daniel; Vannijvel, Marie; Okkema, Sietske; Deleus, Ellen; Lloyd, Aaron; Lo Menzo, Emanuele; Tadros, George; Raguz, Ivana; San Martin, Andres; Kraljevic, Marko; Mantziari, Styliani; Frey, Sebastien; Gensthaler, Lisa; Sammalkorpi, Henna; Garcia-Galocha, José Luis; Zapata, Amalia; Tatarian, Talar; Wiggins, Tom; Bardisi, Ekhlas; Goreux, Jean-Philippe; Seki, Yosuke; Vonlanthen, René; Widmer, Jeannette; Thalheimer, Andreas; Kasama, Kazunori; Himpens, Jacques; Hollyman, Marianne; Welbourn, Richard; Aggarwal, Rajesh; Beekley, Alec; Sepulveda, Matias; Torres, Antonio; Juuti, Anne; Salminen, Paulina; Prager, Gerhard; Iannelli, Antonio; Suter, Michel; Peterli, Ralph; Boza, Camilo; Rosenthal, Raul; Higa, Kelvin; Lannoo, Matthias; Hazebroek, Eric J.; Dillemans, Bruno; Clavien, Pierre-Alain; Puhan, Milo; Raptis, Dimitri A.; Bueter, Marco
      Abstract: imageObjective: To define “best possible” outcomes for secondary bariatric surgery (BS).Background: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS.Methods: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years.Results: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ± 10 years, 8.4 ± 5.3 years after primary BS, with a BMI 35.2 ± 7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1–3) 15.6% of benchmark patients required a reoperation.Conclusion: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Partial Versus Total Thyroidectomy: What Influences Most Surgeons’
           Decision' Analysis of a Nationwide Cohort of 375,810 Patients Over 10
           Years

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      Authors: Marciniak; Camille; Lenne, Xavier; Clément, Guillaume; Bruandet, Amélie; Lifante, Jean-Christophe; Sebag, Frédéric; Mirallié, Eric; Mathonnet, Muriel; Brunaud, Laurent; Donatini, Gianluca; Tresallet, Christophe; Ménégaux, Fabrice; Theis, Didier; Pattou, François; Caiazzo, Robert; on the behalf of AFCE Study Group
      Abstract: imageNational and international guidelines about thyroid surgery seem to be moving more and more towards less radical surgical procedures but everyday practice does not seem to always align with them. We describe for the first time the role of non-surgical parameters in the surgeon's choice for thyroid surgery.Objective: The ain of this study was to describe thyroid surgery and to identify the factors leading to either a total or a partial thyroidectomy regardless of the severity of the thyroid disease.Summary Background Data: National and international guidelines about thyroid surgery seem to be moving more and more toward less radical surgical procedures but everyday practice does not seem to always align with them.Methods: We based this nationwide retrospective cohort study on a national database that compiles discharge abstracts for every admission for thyroidectomy to French acute healthcare facilities (PMSI database 2010 to 2019).Results: In this study, 375,810 patients (male: 23%; age = 53 ± 15 years) had a thyroidectomy (partial: 28%) for cancer (17%), hyperthyroidism (16%), nonfunctioning goiter (64%), or other (3%). We noticed a global trend toward more partial thyroidectomy (P < 0.001) with a significant increase in the proportion of lobectomy in the post-ATA recommendations’ period (P < 0.001) as well as in the “French Levothyrox crisis” period, in which we saw an unexpected rise of adverse events notifications associated with the marketing of a new formula of Levothyrox (P < 0.001) amid widespread media coverage. In a multivariate analysis, we also identified that complete resection was more frequently performed in centers with a caseload>40/year [P < 0.001, odds ratio (OR) = 1.48], for obese patients (body mass index>30 kg/m2; P < 0.001, OR = 1.42), and according to the indication of surgery (OR benign = 1, OR cancer = 2.25, OR hyperthyroidism = 4.13).Conclusion: We describe for the first time the role of non-surgical parameters in the surgeon's choice for thyroid surgery.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Long-term Normothermic Machine Preservation of Partial Livers: First
           Experience With 21 Human Hemi-livers

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      Authors: Mueller; Matteo; Hefti, Max; Eshmuminov, Dilmurodjon; Schuler, Martin J.; Sousa Da Silva, Richard X.; Petrowsky, Henrik; De Oliveira, Michelle L.; Oberkofler, Christian E.; Hagedorn, Catherine; Mancina, Leandro; Weber, Achim; Burg, Brian; Tibbitt, Mark W.; Rudolf von Rohr, Philipp; Dutkowski, Philipp; Becker, Dustin; Bautista Borrego, Lucia; Clavien, Pierre-Alain
      Abstract: imageObjective: The aim of this study was to maintain long-term full function and viability of partial livers perfused ex situ for sufficient duration to enable ex situ treatment, repair, and regeneration.Background: Organ shortage remains the single most important factor limiting the success of transplantation. Autotransplantation in patients with nonresectable liver tumors is rarely feasible due to insufficient tumor-free remnant tissue. This limitation could be solved by the availability of long-term preservation of partial livers that enables functional regeneration and subsequent transplantation.Methods: Partial swine livers were perfused with autologous blood after being procured from healthy pigs following 70% in-vivo resection, leaving only the right lateral lobe. Partial human livers were recovered from patients undergoing anatomic right or left hepatectomies and perfused with a blood based perfusate together with various medical additives. Assessment of physiologic function during perfusion was based on markers of hepatocyte, cholangiocyte, vascular and immune compartments, as well as histology.Results: Following the development phase with partial swine livers, 21 partial human livers (14 right and 7 left hemi-livers) were perfused, eventually reaching the targeted perfusion duration of 1 week with the final protocol. These partial livers disclosed a stable perfusion with normal hepatic function including bile production (5–10 mL/h), lactate clearance, and maintenance of energy exhibited by normal of adenosine triphosphate (ATP) and glycogen levels, and preserved liver architecture for up to 1 week.Conclusion: This pioneering research presents the inaugural evidence for long-term machine perfusion of partial livers and provides a pathway for innovative and relevant clinical applications to increase the availability of organs and provide novel approaches in hepatic oncology.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Hepatocellular Adenoma Risk Factors of Hemorrhage: Size Is Not the Only
           Concern!: Single-center Retrospective Experience of 261 Patients

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      Authors: Julien; Céline; Le-Bail, Brigitte; Ouazzani Touhami, Kevin; Frulio, Nora; Blanc, Jean-Frédéric; Adam, Jean-Philippe; Laurent, Christophe; Balabaud, Charles; Bioulac-Sage, Paulette; Chiche, Laurence
      Abstract: imageObjective: Our aim was to determine independent risk factors of clinical bleeding of hepatocellular adenoma (HCA) to define a better management strategy.Summary Background Data: HCA is a rare benign liver tumor with severe complications: malignant transformation that is rare (5%–8%) and more often, hemorrhage (20%–27%). To date, only size> 5 cm and histological subtype (possibly sonic hedgehog) are associated with bleeding, but these criteria are not clearly established.Methods: We retrospectively collected data from a cohort of 268 patients with HCA managed in our tertiary center, from 1984 to 2020 and focused on clinical bleeding. Hemorrhage was considered severe when it required intensive care and moderate when bleeding symptoms required a hospitalization. We included 261 patients, of whom 130 (49.8%) had multiple HCAs or liver adenomatosis. All surgical specimen and liver biopsy were reviewed by an experienced liver pathologist and reclassified in the light of the current immunohistochemistry. Mean duration of follow-up was 93.3 months (range 1–363). We analyzed type, frequency, consequences of bleeding, and risk factors among clinical data and HCA characteristics.Results: Eighty-three HCA (31.8%) were hemorrhagic. There were 4 pregnant women with 1 newborn death. One patient died before treatment. Surgery was performed in 78 (94.0%) patients. Mortality was nil and severe complications occurred in 11.5%. Multivariate analysis identified size (OR 1.02 [1.01–1.02], P < 0.001), shHCA (OR 21.02 [5.05–87.52], P < 0.001), b-catenin mutation on exon 7/8 (OR 6.47 [1.78–23.55], P = 0.0046), chronic alcohol consumption (OR 9.16 [2.47–34.01], P < 0.001) as independent risk factors of clinical bleeding.Conclusions: This series, focused on the hemorrhagic risk of HCA, shows that size, but rather more molecular subtype is determinant in the natural history of HCA.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Impact of Permanent Post-thyroidectomy Hypoparathyroidism on
           Self-evaluation of Quality of Life and Voice: Results From the National
           QoL-Hypopara Study

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      Authors: Frey; Samuel; Figueres, Lucile; Pattou, François; Le Bras, Maëlle; Caillard, Cécile; Mathonnet, Muriel; Hamy, Antoine; Brunaud, Laurent; Lifante, Jean-Christophe; Trésallet, Christophe; Sebag, Frédéric; Menegaux, Fabrice; Blanchard, Claire; Leroy, Maxime; Mirallié, Eric; The Qol-Hypopara Study Group
      Abstract: imageObjective: The aim of this study was to compare the quality of life (mental health) and voice in patients with or without permanent hypoparathyroidism after total thyroidectomy.Summary Background Data: Permanent hypoparathyroidism is an underestimated complication of thyroid surgery owing to suppression of parathormone secretion. Few studies have evaluated the consequences of hypoparathyroidism on quality of life and none has studied its effects on voice.Methods: The QoL-hypopara study (ClinicalTrial.gov NCT04053647) was a national observational study. Adult thyroidectomized patients were included between January and June 2020. A serum parathormone level 6 months after surgery defined permanent hypoparathyroidism. Patients answered the MOS-36-item short-form health (SF-36), the Voice Handicap Index (VHI) surveys, and a list of questions regarding their symptoms.Results: A total of 141 patients were included, 45 with permanent hypoparathyroidism. The median period between thyroid surgery and the questionnaire was 6 (Q1-Q3 4–11) and 4 (4–5) years in hypoparathyroid patients and controls respectively. Hypoparathyroid patients presented a reduced median mental score ratio (SF-36) [0.88 (Q1–Q3 0.63–1.01) vs 1.04 (0.82–1.13), P = 0.003] and a lower voice quality (incidence rate ratio for total VHI 1.83-fold higher, P < 0.001). In multivariable analysis, hypoparathyroidism [−0.17 (95% confidence interval −0.28 to −0.07), P = 0.002], but not age, female sex, thyroid cancer, or abnormal TSH level, was associated with the reduced mental score ratio. Myalgia, joint pain, paresthesia, tetany, anxiety attack, and exhaustion were the most common symptoms among hypoparathyroid patients (>50%).Conclusions: Hypoparathyroid patients present significantly impaired quality of life, lower voice quality, and frequent symptoms. These results reinforce the importance of preventing this complication.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • The Impact of Cold Ischaemia Time on Outcomes of Living Donor Kidney
           Transplantation in the UK Living Kidney Sharing Scheme

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      Authors: van de Laar; Stijn C.; Robb, Matthew L.; Hogg, Rachel; Burnapp, Lisa; Papalois, Vassilios E.; Dor, Frank J. M. F.
      Abstract: imageObjective: To assess the impact of CIT on living donor kidney transplantation (LDKT) outcomes in the UKLKSS versus outside the scheme.Background: LDKT provides the best treatment option for end-stage kidney disease patients. end-stage kidney disease patients with an incompatible living donor still have an opportunity to be transplanted through Kidney Exchange Programmes (KEP). In KEPs where kidneys travel rather than donors, cold ischaemia time (CIT) can be prolonged.Methods: Data from all UK adult LDKT between 2007 and 2018 were analysed.Results: 9969 LDKT were performed during this period, of which 1396 (14%) were transplanted through the UKLKSS, which we refer to as KEP. Median CIT was significantly different for KEP versus non-KEP (339 versus 182 minutes, P < 0.001). KEP LDKT had a higher incidence of delayed graft function (DGF) (2.91% versus 5.73%, P < 0.0001), lower 1-year (estimated Glomerular Filtration Rate (eGFR) 57.90 versus 55.25 ml/min, P = 0.04) and 5-year graft function (eGFR 55.62 versus 53.09 ml/min, P = 0.01) compared to the non-KEP group, but 1- and 5-year graft survival were similar. Within KEP, a prolonged CIT was associated with more DGF (3.47% versus 1.95%, P = 0.03), and lower graft function at 1 and 5-years (eGFR = 55 vs 50 ml/min, P = 0.02), but had no impact on graft survival.Conclusion: Whilst CIT was longer in KEP, associated with more DGF and lower graft function, excellent 5-year graft survival similar to non-KEP was found.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Outcomes of Esophagogastric Cancer Surgery During Eight Years of Surgical
           Auditing by the Dutch Upper Gastrointestinal Cancer Audit (DUCA)

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      Authors: Voeten; Daan M.; Busweiler, Linde A. D.; van der Werf, Leonie R.; Wijnhoven, Bas P. L.; Verhoeven, Rob H. A.; van Sandick, Johanna W.; van Hillegersberg, Richard; van Berge Henegouwen, Mark I.; on behalf of the Dutch Upper Gastrointestinal Cancer Audit (DUCA Group
      Abstract: imageObjective: To evaluate changes in treatment and outcomes of esophagogastric cancer surgery after introduction of the DUCA. In addition, the presence of risk-averse behavior was assessed.Summary of Background Data: Clinical auditing is seen as an important quality improvement tool; however, its long-term efficacy remains largely unknown. In addition, critics claim that enhancements result from risk-averse behavior rather than positive effects of auditing.Methods: DUCA data were used from registration start (1-1-2011) until 31-12-2018. Trends in patient, tumor, hospital and treatment characteristics were univariably assessed. Trends in short-term outcomes were investigated using multilevel multivariable logistic regression. Presence of risk aversion was described by the corrected proportion of patients undergoing surgery, using data from the Netherlands Cancer Registry. To evaluate the impact of centralization on time trends identified, the association between hospital volume and outcomes was investigated.Results: This study included 6172 patients with esophageal and 3,690 with gastric cancer who underwent surgery. Pathological outcomes (lymph node yield, radicality) improved and futile surgery decreased over the years. In-hospital/30-day mortality decreased for esophagectomy (4.2% to 2.5%) and for gastrectomy (7.1% to 4.3%). Reinterventions, (minor) complications and readmissions increased. Risk aversion appeared absent. Between 2011-2018, annual median hospital volumes increased from 38 to 53 for esophagectomy and from 14 to 29 for gastrectomy. Higher hospital volumes were associated with several improved outcomes measures.Conclusions: During 8 years of auditing, outcomes improved, with no signs of risk-averse behavior. These improvements occurred in parallel with centralization. Feedback on postoperative complications remains the focus of the DUCA.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Liver Venous Deprivation or Associating Liver Partition and Portal Vein
           Ligation for Staged Hepatectomy': A Retrospective Multicentric Study

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      Authors: Chebaro; Alexandre; Buc, Emmanuel; Durin, Thibault; Chiche, Laurence; Brustia, Raffaele; Didier, Alexandre; Pruvot, François-René; Kitano, Yuki; Muscari, Fabrice; Lecolle, Katia; Sulpice, Laurent; Sonmez, Ercin; Bougard, Marie; El Amrani, Mehdi; Sommacale, Daniele; Maulat, Charlotte; Ayav, Ahmet; Adam, René; Laurent, Christophe; Truant, Stéphanie
      Abstract: imageObjective: To compare 2 techniques of remnant liver hypertrophy in candidates for extended hepatectomy: radiological simultaneous portal vein embolization and hepatic vein embolization (HVE); namely LVD, and ALPPS.Background: Recent advances in chemotherapy and surgical techniques have widened indications for extended hepatectomy, before which remnant liver augmentation is mandatory. ALPPS and LVD typically show higher hypertrophy rates than portal vein embolization, but their respective places in patient management remain unclear.Methods: All consecutive ALPPS and LVD procedures performed in 8 French centers between 2011 and 2020 were included. The main endpoint was the successful resection rate (resection rate without 90-day mortality) analyzed according to an intention-to-treat principle. Secondary endpoints were hypertrophy rates, intra and postoperative outcomes.Results: Among 209 patients, 124 had LVD 37 [13,1015] days before surgery, whereas 85 underwent ALPPS with an inter-stages period of 10 [6, 69] days. ALPPS was mostly-performed for colorectal liver metastases (CRLM), LVD for CRLM and perihilar cholangiocarcinoma. Hypertrophy was faster for ALPPS. Successful resection rates were 72.6% for LVD ± rescue ALPPS (n = 6) versus 90.6% for ALPPS (P < 0.001). Operative duration, blood losses and length-of-stay were lower for LVD, whereas 90-day major complications and mortality were comparable. Results were globally unchanged for CRLM patients, or after excluding the early 2 years of experience (learning-curve effect).Conclusions: This study is the first 1 comparing LVD versus ALPPS in the largest cohort so far. Despite its retrospective design, it yields original results that may serve as the basis for a prospective study.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • A Game of Adaptability: Reflecting on the Highlights and Challenges of
           Applying for Surgical Residency During the COVID-19 Pandemic

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      Authors: Kubi; Boateng; Keiler, James; Douglas, Anthony II
      Abstract: Virtual recruitment of candidates applying into General Surgery residency during the COVID-19 pandemic presented a number of benefits and challenges. Notable benefits for candidates included financial and resource cost savings, the ability to conduct multiple interviews within short time frame, and the ability to meet more faculty members on virtual interview day. Challenges included technological difficulties, difficulty assessing culture and authenticity of in-program relationships, zoom fatigue, and inability to form relationships with co-applicants. After assessing our experiences with these benefits and challenges, the authors recommend that future recruitment cycles maintain virtual interview days with optional, nonevaluative open house days for revisit and second look opportunities.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Surgical Residents at the Forefront of the COVID-19 Pandemic: Perspectives
           on Redeployment

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      Authors: Samuel; Nardin
      Abstract: The COVID-19 pandemic has led many of us to re-evaluate our approaches to disaster management, reflect on our experiences, and be reminded of the strong resolve for our work. This article details a resident's perspective on redeployment of surgical residents to the COVID-19 frontline setting, using the example of the COVID-19 intensive care unit. Redeployment during a pandemic brings the unique opportunity to collaborate with colleagues on the frontlines and learn alongside one another about the evolving management of this disease. During this ongoing pandemic, it is incumbent upon us as clinicians to work together in a multidisciplinary manner and reflect on ways this pandemic impacts the delivery of patient care.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Demise of “Hilar En Bloc Resection by No-touch Technique” as Surgery
           for Perihilar Cholangiocarcinoma: Dissociation Between Theory and Practice
           

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      Authors: Nagino; Masato; Clavien, Pierre-Alain
      Abstract: No abstract available
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Comparative Propensity Matched Outcomes in Severe COVID-19 Respiratory
           Failure—Extracorporeal Membrane Oxygenation or Maximum Ventilation Alone
           

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      Authors: Mustafa; Asif K.; Joshi, Devang J.; Alexander, Philip J.; Tabachnick, Deborah R.; Cross, Chadrick A.; Jweied, Eias E.; Mody, Nitesh S.; Huh, Marc H.; Fasih, Subia; Pappas, Pat S.; Tatooles, Antone J.
      Abstract: imageObjective: Does extracorporeal membrane oxygenation (ECMO) improve outcomes in ECMO-eligible patients with COVID-19 respiratory failure compared to maximum ventilation alone (MVA)?Summary Background Data: ECMO is beneficial in severe cases of respiratory failure when mechanical ventilation is inadequate. Outcomes for ECMO-eligible COVID-19 patients on MVA have not been reported. Consequently, a direct comparison between COVID-19 patients on ECMO and those on MVA has not been established.Methods: A total of 3406 COVID-19 patients treated at two major medical centers in Chicago were studied. One hundred ninety-five required maximum ventilatory support, and met ECMO eligibility criteria. Eighty ECMO patients were propensity matched to an equal number of MVA patients using detailed demographic, physiological, and comorbidity data. Primary outcome was survival and disposition at discharge.Results: Seventy-one percent of patients were decannulated from ECMO. Mechanical ventilation was discontinued in 75% ECMO and 16% MVA patients. Twenty-five percent of patients in the ECMO arm expired, 21% while on ECMO, compared with 74% in the MVA cohort. Mortality was significantly lower across all age and BMI groups in the ECMO arm. Sixty-eight percent ECMO and 26% MVA patients were discharged from the hospital. Fewer ECMO patients required long-term rehabilitation. Major complications such as septic shock, ventilator associated pneumonia, inotropic requirements, acute liver and kidney injuries are less frequent among ECMO patients.Conclusions: ECMO-eligible patients with severe COVID-19 respiratory failure demonstrate a 3-fold improvement in survival with ECMO. They are also in a better physical state at discharge and have lower overall complication rates. As such, strong consideration should be given for ECMO when mechanical ventilatory support alone becomes insufficient in treating COVID-19 respiratory failure.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • An Experimental Simulation of Heat Effects on Cognition and Workload of
           Surgical Team Members

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      Authors: Ward; Mary K.; Yam, Cheryl M. H.; Palejwala, Zehra; Wallman, Karen; Taggart, Sarah M.; Wood, Fiona M.; Parker, Sharon K.
      Abstract: imageObjective: To isolate heat exposure as a cause of cognitive impairment and increased subjective workload in burns surgical teams.Summary of Background Data: Raising ambient temperature of the operating room can improve burns patient outcomes, but risks increased cognitive impairment and workload of surgical team members. Prior research indicates ambient heat exposure depletes physiological and cognitive resources, but these findings have not been studied in the context of burns surgical teams.Methods: Seventeen surgical team members completed 2 surgery simulations of similar complexities in a hot and in a normothermic operating room. During each simulation, participants completed multiple cognitive tests to assess cognitive functioning and the SURG-TLX to self-assess workload. Order effects, core body temperature changes due to menstruation, and circadian rhythms were controlled for in the experimental design. Descriptive statistics, correlations, and mixed ANOVAs were performed to assess relationships between ambient heat exposure with cognitive functioning and perceived workload.Results: Heat had a main effect on executive functioning and verbal reasoning. Duration of heat exposure (heat ∗ time) increased response times and negatively impacted executive functioning, spatial planning, and mental rotation. Perceived workload was higher in the hot condition.Conclusions: We provide causal evidence that over time, heat exposure impairs cognitive speed and accuracy, and increases subjective workload. We recommend building on this study to drive best-practices for acute burns surgery and design work to enable burns teams to maintain their cognitive stamina, lower their workload, and improve outcomes for patients and surgeons.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Surgeon Perspectives on Benefits and Downsides of Overlapping Surgery:
           In-depth, Qualitative Interviews

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      Authors: Perez; Andrew W.; Brelsford, Kathleen M.; Diehl, Carolyn J.; Langerman, Alexander J.
      Abstract: imageObjective: The aim of the study was to characterize surgeon perspectives regarding the benefits and downsides of conducting overlapping surgery.Background: Although surgeons are key stakeholders in current discussions surrounding overlapping surgery, little has been published regarding their opinions on the practice. Further characterization of surgeon perspectives is needed to guide future studies and policy development regarding overlapping surgery.Methods: Study information was sent to all members of 3 professional surgical societies. Interested individuals were eligible to participate if they identified as attending surgeons in an academic setting who work with trainees. Purposive selection was used to diversify surgeons interviewed across multiple dimensions, including subspecialty and opinion regarding appropriateness of overlapping surgery. In-depth, qualitative interviews were conducted with participants regarding their opinions on overlapping surgery.Results: The 51 surgeons interviewed identified a wide array of potential benefits and disadvantages of overlapping surgery, some of which have not previously been measured, including downsides to surgeon wellness and patient experience, less surgeon control over procedures, and difficulty in scheduling cases. Interviewees often disagreed as to whether overlapping surgery negatively or positively affects each dimension discussed, particularly regarding the impact on resident training.Conclusions: The utilization of the novel perspectives presented here will allow for targeted assessment of physician perspectives in future quantitative studies and increase the likelihood that variables measured encompass the range of factors that surgeons find meaningful and relevant. Priority areas of future research should include examining effects of overlapping surgery on surgical training and surgeon wellness.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • The Association Between Preoperative Opioid Exposure and Prolonged
           Postoperative Use

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      Authors: Katzman; Charles; Harker, Emily C.; Ahmed, Rizwan; Keilin, Charles A.; Vu, Joceline V.; Cron, David C.; Gunaseelan, Vidhya; Lai, Yen-Ling; Brummett, Chad M.; Englesbe, Michael J.; Waljee, Jennifer F.
      Abstract: imageObjective: To determine the effect of nonchronic, periodic preoperative opioid use on prolonged opioid fills after surgery.Background: Nonchronic, periodic opioid use is common, but its effect on prolonged postoperative opioid fills is not well understood. We hypothesize greater periodic opioid use before surgery is correlated with persistent postoperative use.Methods: We used a national private insurance claims database, Optum's de-identifed Clinformatics Data Mart Database, to identify adults undergoing general, gynecologic, and urologic surgical procedures between 2008 and 2015 (N = 191,043). We described patterns of opioid fills based on dose, recency, duration, and continuity to categorize preoperative opioid exposure. Patients with chronic use were excluded. Our primary outcome was persistent postoperative use, defined as filling an opioid prescription between 91- and 180-days post-discharge. The association between preoperative opioid use and persistent use was determined using multivariable logistic regression, controlling for clinical covariates.Results: In the year before surgery, 41% of patients had nonchronic, periodic opioid fills. Compared with other risk factors, patterns of preoperative fills were most strongly correlated with persistent postoperative opioid use. Patients with recent intermittent use were significantly more likely to have prolonged fills after surgery compared with opioid-naïve patients [minimal use: odds ratio (OR): 2.0, 95% confidence interval (CI) 1.89–2.03; remote intermittent: OR 4.7, 95% CI 4.46–4.93; recent intermittent: OR 12.2, 95% CI 11.49–12.90].Conclusions: Patients with nonchronic, periodic opioid use before surgery are vulnerable to persistent postoperative opioid use. Identifying opioid use before surgery is a critical opportunity to optimize care after surgery.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Repair, Reconstruct, or Divert: Fate of the Perforated Esophagus

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      Authors: Tang; Andrew; Ahmad, Usman; Raja, Siva; Siddiqui, Hafiz U.; Sinopoli, Jillian N.; O’Dell, Alexander; Pande, Amol; Blackstone, Eugene H.; Murthy, Sudish C.
      Abstract: imageObjectives: The aim of this study was to determine differences in esophageal perforation populations undergoing different advanced interventions for perforated esophagus and identify predictors of treatment outcomes.Summary Background Data: Contained esophageal perforation can often be managed expectantly, but uncontained perforation is uniformly fatal without invasive intervention. Treatment options for the latter range from simple endoscopic control through advanced intervention. Clinical presentation varies greatly and directs which intervention is most appropriate.Methods: From 1996 to 2017, 335 patients were treated for esophageal perforation, and 166 for advanced interventions: 74 primary repair with tissue flap (repair), 26 esophagectomy and gastric pull-up (resection), and 66 esophagectomy and immediate diversion with planned delayed reconstruction (resection-diversion). Patient characteristics, clinical presentation, operative outcomes, and survival were abstracted. Pittsburgh Severity Scores (PSS) were retrospectively calculated. Random survival forest analysis was performed for 90-day mortality and competing risks for reconstruction after resection-diversion.Results: Repair and resection patients had lower PSS than resection-diversion patients (3 vs 3 vs 6, respectively). Ninety-day mortality for repair, resection, and resection-diversion was 11% vs 7.7% vs 23%, and 5-year survival was 71% vs 63% vs 47%. Risk of death after resection-diversion was highest within 1 year, but 52% of patients had reconstruction of the upper alimentary tract within 2 years.Conclusions: Several advanced interventions exist for critically ill patients with uncontained esophageal perforation. Repair and organ preservation are always preferred; however, patients at extremes of illness might best be treated with resection-diversion, with the understanding that the competing risk of death may preclude eventual reconstruction.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Genomewide Expression Profiling Identifies a Novel miRNA-based Signature
           for the Detection of Peritoneal Metastasis in Patients With Gastric Cancer
           

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      Authors: Shimura; Tadanobu; Toden, Shusuke; Kandimalla, Raju; Toiyama, Yuji; Okugawa, Yoshinaga; Kanda, Mitsuro; Baba, Hideo; Kodera, Yasuhiro; Kusunoki, Masato; Goel, Ajay
      Abstract: imageObjective: This study aimed to conduct a genomewide transcriptomic profiling to develop a microRNA (miRNA)-based signature for the identification of peritoneal metastasis (PM) in patients with gastric cancer (GC).Summary Background Data: Even though PM in patients with GC has long been recognized to associate with poor prognosis, currently there is lack of availability of molecular biomarkers for its robust diagnosis.Methods: We performed a systematic biomarker discovery by analyzing miRNA expression profiles in primary tumors from GC patients with and without PM, and subsequently validated the expression of candidate miRNA biomarkers in 3 independent clinical cohorts of 354 patients with advanced GC.Results: Five miRNAs (miR-30a-5p, -134-5p, -337-3p, -659-3p, and -3917) were identified during the initial discovery phase; three of which (miR-30a-5p, -659-3p, and -3917) were significantly overexpressed in the primary tumors from PM-positive patients in the testing cohort (P = 0.002, 0.04, and 0.007, respectively), and distinguished patients with versus without peritoneal metastasis with the value of area under the curve (AUC) of 0.82. Furthermore, high expression of these miRNAs also associated with poor prognosis (hazard ratio = 2.18, P = 0.04). The efficacy of the combination miRNA signature was subsequently validated in an independent validation cohort (AUC = 0.74). Finally, our miRNA signature when combined together with the macroscopic Borrmann's type score offered a much superior diagnostic in all 3 cohorts (AUC = 0.87, 0.76, and 0.79, respectively).Conclusions: We have established an miRNA-based signature that have a potential to identify peritoneal metastasis in GC patients.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute
           Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label,
           Noninferiority Trial

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      Authors: Mora-López; Laura; Ruiz-Edo, Neus; Estrada-Ferrer, Oscar; Piñana-Campón, Maria Luisa; Labró-Ciurans, Meritxell; Escuder-Perez, Jordi; Sales-Mallafré, Ricard; Rebasa-Cladera, Pere; Navarro-Soto, Salvador; Serra-Aracil, Xavier; for the DINAMO-study Group
      Abstract: imageObjective: Mild AD can be treated safely and effectively on an outpatient basis without antibiotics.Summary of Background Data: In recent years, it has shown no benefit of antibiotics in the treatment of uncomplicated AD in hospitalized patients. Also, outpatient treatment of uncomplicated AD has been shown to be safe and effective.Methods: A Prospective, multicentre, open-label, noninferiority, randomized controlled trial, in 15 hospitals of patients consulting the emergency department with symptoms compatible with AD.The Participants were patients with mild AD diagnosed by Computed Tomography meeting the inclusion criteria were randomly assigned to control arm (ATB-Group): classical treatment (875/125 mg/8 h amoxicillin/clavulanic acid apart from anti-inflammatory and symptomatic treatment) or experimental arm (Non-ATB-Group): experimental treatment (antiinflammatory and symptomatic treatment). Clinical controls were performed at 2, 7, 30, and 90 days.The primary endpoint was hospital admission. Secondary endpoints included number of emergency department revisits, pain control and emergency surgery in the different arms.Results: Four hundred and eighty patients meeting the inclusion criteria were randomly assigned to Non-ATB-Group (n = 242) or ATB-Group (n = 238). Hospitalization rates were: ATB-Group 14/238 (5.8%) and Non-ATB-Group 8/242 (3.3%) [mean difference 2.58%, 95% confidence interval (CI) 6.32 to -1.17], confirming noninferiority margin. Revisits: ATB-Group 16/238 (6.7%) and Non-ATB-Group 17/242 (7%) (mean difference -0.3, 95% CI 4.22 to -4.83). Poor pain control at 2 days follow up: ATB-Group 13/230 (5.7%), Non-ATB-Group 5/221 (2.3%) (mean difference 3.39, 95% CI 6.96 to -0.18).Conclusions: Nonantibiotic outpatient treatment of mild AD is safe and effective and is not inferior to current standard treatment.Trial registration: ClinicalTrials.gov (NCT02785549); EU Clinical Trials Register (2016-001596-75)
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Fighting Inertia: Why are we Continuing to Treat Acute Uncomplicated
           Diverticulitis With Antibiotics'

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      Authors: Hawkins; Alexander T.
      Abstract: No abstract available
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Analysis of Nonbattle Deaths Among U.S. Service Members in the Deployed
           Environment

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      Authors: Le; Tuan D.; Gurney, Jennifer M.; Akers, Kevin S.; Chung, Kevin K.; Singh, Karan P.; Wang, Heuy-Ching; Stackle, Mark E.; Pusateri, Anthony E.
      Abstract: imageObjective: Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention.Background: Injuries in combat are categorized as battle (result of hostile action) or nonbattle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had nonbattle injuries and emphasized prevention. NBD have not yet been characterized.Methods: U.S. military casualty data for Iraq and Afghanistan from 2001 to 2014 were obtained from the Defense Casualty Analysis System (DCAS) and the Department of Defense Trauma Registry (DoDTR). Two databases were used because DoDTR does not capture prehospital deaths, while DCAS does not contain clinical details. Nonbattle injuries and NBD were identified, etiologies classified, and NBD trends were assessed using a weighted moving average and time-series analysis with autoregressive integrated moving average. Future NBD rates were forecast.Results: DCAS recorded 59,799 casualties; 21.0% (n = 1431) of all deaths (n = 6745) were NBD. DoDTR recorded 29,958 casualties; 11.5% (n = 206) of all deaths (n = 1788) were NBD. After early fluctuations, NBD rates for both Iraq and Afghanistan stabilized at approximately 21%. Leading causes of NBD were gunshot wounds and vehicle accidents, accounting for 66%. Approximately 25% was self-inflicted. A 24% NBD rate was forecasted from 2015 through 2025.Conclusions: Approximately 1 in 5 deaths were NBD. The majority were potentially preventable, including a significant proportion of self-inflicted injuries. A single comprehensive data repository would facilitate future mortality monitoring and performance improvement. These data may assist military leaders with implementing targeted safety strategies.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Association Between Hospital Volume and Failure to Rescue After Open or
           Endovascular Repair of Intact Abdominal Aortic Aneurysms in the VASCUNET
           and International Consortium of Vascular Registries

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      Authors: D’Oria; Mario; Scali, Salvatore; Mao, Jialin; Szeberin, Zoltán; Thomson, Ian; Beiles, Barry; Stone, David; Sedrakyan, Art; Eldrup, Nikolaj; Venermo, Maarit; Cassar, Kevin; Altreuther, Martin; Boyle, Jonathan R.; Behrendt, Christian-Alexander; Beck, Adam W.; Mani, Kevin
      Abstract: imageObjective: To investigate the association between hospital volume and failure to rescue (FtR), after open repair (OAR), and endovascular repair (EVAR) of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries.Summary of Background Data: FtR (ie, in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death.Methods: Using data from 8 vascular registries, complication and mortality rates after intact AAA repair were examined (n = 60,273; EVAR-43,668; OAR-16,605). A restricted analysis using pooled data from 4 countries (Australia, Hungary, New Zealand, and USA) reporting data on all postoperative complications (bleeding, stroke, cardiac, respiratory, renal, colonic ischemia) was performed to identify risk-adjusted association between hospital volume and FtR.Results: The most frequently reported complications were cardiac (EVAR-3.0%, OAR-8.9%) and respiratory (EVAR-1.0%, OAR-5.7%). In adjusted analysis, 4.3% of EVARs and 18.5% of OARs had at least 1 complication. The overall FtR rate was 10.3% after EVAR and 15.7% after OAR. Subjects treated in the highest volume centers (Q4) had 46% and 80% lower odds of FtR after EVAR (OR = 0.54; 95% CI = 0.34–0.87; P = 0.04) and OAR (OR = 0.22; 95% CI = 0.11–0.44; P < 0.001) when compared to lowest volume centers (Q1), respectively. Colonic ischemia had the highest risk of FtR for both procedures (adjusted predicted risks, EVAR: 27%, 95% CI 14%–45%; OAR: 30%, 95% CI 17%–46%).Conclusions: In this multi-national dataset, FtR rate after intact AAA repair with EVAR and OAR is significantly associated with hospital volume. Hospitals in the top volume quartiles achieve the lowest mortality after a complication has occurred.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
  • Reciprocal Learning Between Military and Civilian Surgeons: Past and
           Future Paths for Medical Innovation

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      Authors: Agarwal; Divyansh; Barker, Clyde F.; Naji, Ali; Schwab, C. William
      Abstract: imageNumerous surgical advances have resulted from exchanges between military and civilian surgeons. As part of the U.S. National Library of Medicine Michael E. DeBakey Fellowship in the History of Medicine, we conducted archival research to shed light on the lessons that civilian surgery has learned from the military system and vice-versa. Several historical case studies highlight the need for immersive programs where surgeons from the military and civilian sectors can gain exposure to the techniques, expertise, and institutional knowledge the other domain provides. Our findings demonstrate the benefits and promise of structured programs to promote reciprocal learning between military and civilian surgery.
      PubDate: Mon, 01 Nov 2021 00:00:00 GMT-
       
 
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