Clinical Surgical Oncology最新文献

Objective

The use of cefazolin (CEZ) is recommended as a preoperative prophylactic antibiotic, but other antibiotics may be used for various reasons. We adopted a fluoroquinolone (levofloxacin; LVFX) as a preoperative prophylactic antibiotic because of reduced supply of CEZ worldwide, while the efficacy of LVFX in preventing infectious complications including surgical site infection (SSI), empyema, and pneumonia has not been fully investigated.

Methods

The medical records of 260 patients who underwent primary lung cancer resection between April 2018 and July 2020 were retrospectively reviewed. Eighty-nine patients before May 2019 were intravenously received a single dose of CEZ with additional administration every 3 ​h during surgery (the CEZ group) and 171 patients after that date were orally received a preoperative single dose of LVFX (the LVFX group). The efficacy of preventing infectious complications was compared between two groups. The propensity score matching (PSM) method was also applied to minimize selection bias.

Results

Infectious complications were observed in 3.1% (8/260) of patients, with no significant difference between the LVFX group (2.9%) and the CEZ group (3.4%) regardless of subtypes such as SSI and empyema. After PSM, 77 patients each were matched from the two groups, and there was also no significant difference in the incidence of infectious complications (the LVFX group; 2.6% vs. the CEZ group; 3.9%).

Conclusion

LVFX has comparable efficacy to CEZ for preventing infectious complications, and may be an alternative to preoperative antibiotics for patients with primary lung cancer who underwent pulmonary resection.

Background

Currently, no published studies have compared the short-term and long-term outcomes of robotic-assisted and open surgery for elderly patients (aged 65 years or older) with sigmoid colon and rectal cancer in China. Hence, our study was conducted to assess whether robotic-assisted surgery is superior to traditional approaches.

Methods

A total of 208 patients who received either open resection (n ​= ​93) or robotic-assisted resection (n ​= ​115) between October 2010 and October 2014 were included in the study. We compared clinical characteristic variables and patient demographics between the two approaches and assessed short- and long-term outcomes.

Results

Patient characteristics were not significantly different between the groups. First flatus postoperative days (P ​< .001), less time to liquid diet (P ​= ​.004), and shorter postoperative hospital stay (P ​= ​.046) were found in the robotic-assisted surgery group. The operation time was also more in the robotic-assisted surgery group (P ​= ​.03). The 3-year overall survival rate was 83.0% in the robotic-assisted surgery group and 78.0% in the open surgery group (P ​= ​.938). The 3-year disease free survival rate was 76.0% and 72.0% in the robotic-assisted surgery and open surgery groups, respectively (P ​= ​.817). No significant difference was found in the overall survival and disease-free survival between the two approaches.

Conclusions

Robotic-assisted surgery is safe and feasible for elderly patients with sigmoid colon and rectal cancer and is associated with more operation time and faster recovery as compared to open surgery. No significant differences were found in 3-year survival outcomes between the two groups.

Background

Although low molecular weight heparin (LMWH) is recommended to prevent venous thromboembolism (VTE) in patients with gastric cancer, it's difficult for surgeons to choose appropriate time to start anti-coagulation because of the risk of surgical field bleeding after radical gastrectomy. We compared the risk of VTE and bleeding between patients receiving LMWH within and beyond 48 ​h after surgery.

Methods

The medical records of consecutive cases receiving radical gastrectomy from November 1st, 2017 to October 31st, 2018 in Zhongshan Hospital Gastric Cancer Center were carefully reviewed. Patients receiving LMWH within and beyond 48 ​h after surgery were regarded as Early Group (EG) and Delayed Group (DG), respectively. Incidence of VTE and bleeding complications were compared and risk factors of bleeding were evaluated.

Results

Six hundred and sixty-five cases were enrolled, including 465 in EG and 200 in DG. No significant differences of clinicopathological or operative features were observed except for fewer combined resection (DG: 5.0%, EG: 1.9%, P ​= ​0.030) and shorter surgery duration (DG: 194min, EG: 168min, P ​< ​0.001). No patients suffered from deep venous thrombosis or pulmonary embolism in our study. However, postoperative bleeding rate was higher in EG (DG: 1.5%, EG: 7.5%, P ​= ​0.002). Multivariate analysis suggested that EG was the independent risk factor of bleeding (OR: 3.744, 1.13–12.36, P ​= ​0.030).

Conclusion

Use of LMWH 48 ​h after radical gastrectomy maybe a good choice for clinical surgeons to reduce postoperative bleeding rate without increasing VTE risk in gastric cancer patients.

Background and objectives

Multivisceral resection (MVR) is advocated by some high-volume sarcoma centers. The objective of this study was to investigate the therapeutic effect of MVR in primary retroperitoneal sarcoma (RPS) with tumor burden less than 10 ​cm.

Methods

A retrospective analysis of patients with primary RPS who underwent radical surgical resection from 2009 to 2021 with lesions smaller than the size of a baseball (10 ​cm) was carried out. The incidence of postoperative morbidity and postoperative local recurrence-free survival rate of the MVR group and the non-MVR group were compared by propensity score-matching analysis.

Results

A total of 319 patients with primary RPS underwent surgical resection, of which 95 patients (29.8%) had a tumor burden less than 10 ​cm, with 24 patients (25.3%) involved in the MVR group and 71 patients (74.7%) in the non-MVR group. After matching, the two groups showed no statistical difference at baseline, while the MVR group reported more postoperative complications (P ​= ​0.008) and a longer median postoperative hospital stay (P ​= ​0.002). In terms of local recurrence-free survival, there were no statistical difference between the two groups (P ​= ​0.269).

Conclusions

Primary RPS patients with tumors smaller than baseball may not benefit from aggressive surgical strategy.

Lung cancer remains the most common malignant tumor worldwide, accounting for the majority of cancer-related deaths. The main treatment for lung cancer is surgery. For patients with lung cancer who undergo surgical treatment, the current hospitalization time is short, and postoperative complications and the readmission and mortality rates are significantly higher. Therefore, to allow patients to better recover and monitor changes in their health conditions, remote monitoring might be a suitable approach. Several studies have shown that remote monitoring at home could be highly valuable in a wide range of surgical patients, and the application is practically feasible. Compared to traditional follow-up methods, the new technology can enable to understand the changes in patients’ conditions more comprehensively and relay the information instantly to the physicians and researchers. Hence, it is necessary to promote the application of this technology in patients with lung cancer surgery for improved outcomes in long-term follow-up.