Ejso最新文献

Background: The optimal oesophagogastric anastomosis technique for oesophageal cancer surgery remains unclear. The aim of this study was to perform a network meta-analysis (NMA) of randomised clinical trials (RCTs) to compare oesophagogastric anastomosis techniques for oesophageal cancer surgery.

Methods: A systematic review and NMA were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines-NMA extension. Statistical analyses were performed using R and Shiny.

Results: Overall, 16 RCTs were included (14 provided data eligible for NMA). These included 2520 patients and 4 different anastomosis techniques: 1055 (41.9 %) patients underwent circular stapled (CS), 1232 (48.9 %) underwent handsewn (HS), 100 (3.9 %) underwent triangulated stapled (TS) and 133 (5.3 %) underwent linear stapled (LS). Fourteen studies reported on open surgery, while one reported on both open and minimally invasive techniques. At NMA, no significant difference was observed regarding anastomotic leak rates among all techniques, while HS significantly reduced anastomotic leaks following cervical technique (odds ratio (OR): 0.32, 95 % confidence interval (CI): 0.13-0.78). Moreover, HS (OR: 0.58, 95 % CI: 0.38-0.90) and LS (OR: 0.21, 95%CI: 0.06-0.71) significantly reduced anastomotic stricture rates, while LS significantly reduced anastomotic strictures following intrathoracic anastomotic technique (OR: 0.17, 95%CI: 0.06-0.90).

Conclusion: HS reduced anastomotic leaks following cervical anastomoses, while HS and LS reduced overall anastomotic strictures (with LS significantly reducing strictures following intrathoracic anastomoses). Importantly, institutional and surgeon expertise should be considered prior to adopting these results into contemporary practice for open oesphagectomy, with a call for the harmonisation of trials to align with contemporary, minimally invasive approaches.

Approximately 1.5 million women suffer from gynecological malignancies every year. Around 60 % of these cancers are classified as rare in the European population. Because of their rarity, the management of these tumors requires specific approaches by the cancer community and national health systems. Effective international collaborations in the area of gynecological cancer are underway, thanks to various initiatives such as GYNOCARE and other Collaboration in Science and Technology (COST) Actions. This special issue of EJSO collects expert opinions on the ongoing research and treatment options in various types of gynecological malignancy.

Introduction: Endoscopy-assisted breast surgery is gaining popularity in the treatment of breast cancer owing to its minimally access nature. However, its application in Mainland China varies significantly across regions. We aimed to evaluate the current practices and challenges of endoscopy-assisted breast surgery in Mainland China using a nationwide cross-sectional survey.

Material and methods: In 2022, we conducted a comprehensive questionnaire survey across Mainland China regarding the clinical practices of breast surgery in 215 hospitals, 198 responded fully before September 2024 and included for analysis. Data on hospital characteristics, types of EABS performed, agreements on indications and contraindications, complications, and surgeon preferences were collected and analyzed.

Results: Of 198 hospitals with complete responses in the endoscopy-assisted breast surgery section, 93 (47.0 %) could perform endoscopy-assisted breast surgery, and 7 (3.5 %) could perform robot-assisted breast surgeries. Hospitals performing endoscopy-assisted breast surgery had more developed breast surgery departments, higher numbers of inpatient beds, and a greater patient population. The median annual number of endoscopy-assisted breast surgery procedures per hospital was 55, with significant variability. Common procedures included endoscopy-assisted breast-conserving surgery and lumpectomy (15.5 % and 30.7 %, respectively). Breast reconstructions constituted 15.5 %. The most commonly reported complications were seroma formation and bleeding. Despite these complications, endoscopy-assisted breast surgery was considered safe and effective, with positive aesthetic and functional outcomes.

Conclusions: To the best of our knowledge, this is the largest cross-sectional study on endoscopy-assisted breast surgery-related clinical practices in China, highlighting regional disparities and the need for standardized training and procedures.

Introduction: The pre-treatment waiting interval of gastric cancer patients receiving neoadjuvant chemotherapy (nCT) followed by gastrectomy includes pre-nCT (diagnosis to nCT) and preoperative (diagnosis to surgery) waiting intervals. This study aimed to investigate the impact of these two distinct intervals on short-term postoperative outcomes.

Methods: Patients (cT1-4aN0-3M0) who underwent nCT plus gastrectomy were included using the Dutch national DUCA-database. Multivariate logistic regression was used to determine the impact of the two waiting intervals upon short-term postoperative outcomes: pre-nCT waiting intervals (≤5, 5-8 and 8-12 weeks) and preoperative waiting intervals (≤17, 17-22, and >22 weeks).

Results: Between 2010 and 2021, 1242 patients were included. Compared to the pre-nCT waiting interval ≤5 weeks, the longer intervals (5-8 and 8-12 weeks) were not associated with worse 30-day mortality (p-value = 0.707; p-value = 0.900), overall complications (p-value = 0.733; p-value = 0.453), pulmonary complications (p-value = 0.250; p-value = 0.238), gastrointestinal complications (p-value = 0.396; p-value = 0.992), re-interventions (p-value = 0.407; p-value = 0.072) and 30-day readmission (p-value = 0.992; p-value = 0.664). Compared to the preoperative waiting interval ≤17 weeks, the longer intervals (17-22 and > 22 weeks) were also not associated with worse 30-day mortality (p-value = 0.926; p-value = 0.732), overall complications (p-value = 0.286; p-value = 0.510), pulmonary complications (p-value = 0.912; p-value = 0.351), gastrointestinal complications (p-value = 0.765; p-value = 0.882), re-interventions (p-value = 0.617; p-value = 0.800) and 30-day readmission (p-value = 0.592; p-value = 0.782).

Conclusion: A longer pre-nCT or preoperative waiting interval is not associated with worse short-term postoperative outcomes in Western gastric cancer patients undergoing nCT plus gastrectomy.

Introduction: Approximately 70 % of ovarian cancer patients present at diagnosis with advanced disease(AOC) and impaired clinical conditions, making them not ideal surgical candidates. We aimed to investigate whether neoadjuvant chemotherapy(NACT) can modify pre-operative characteristics of patients at high risk(HR) of perioperative complications, as defined in the Mayo Clinic Algorithm. We also compared their morbidity and survival outcomes with comparable HR women undergoing primary surgery (PCS).

Methods: We retrospectively collected FIGO stage III and greater AOC patients undergoing either NACT-interval cytoreductive surgery(HR-NACT) or PCS from 01/2013 to 12/2022. HR features included: Albumin <3.5 g/dL or age≥80 years or age 75-79 and at least one among: ECOG PS > 1, stage IV disease, or complex surgery likely (more than hysterectomy, salpingo-oophorectomy and omentectomy).

Results: 400 patients were included. Among them, 298 met the criteria for the HR-NACT group; 203(68.1 %) underwent ICS after 3-4 cycles whislt 95(31.9 %) completed 6 NACT cycles. We reported an improvement in clinical variables in women undergoing 3-4 cycles of NACT: raise of ECOG = 0 rate(53.3 % vs 81.8 %; p < 0.001) and median albumin serum levels(3.0 g/dl vs 4.0 g/dl; p < 0.001). We identified 102 comparable HR-PCS patients. No difference in intraoperative complications was detected, while a difference was found in severe post-operative complications, favoring patients treated with both 3-4(5.4 % vs 18.6 % p = 0.0003) and 6 NACT cycles(7.8 % vs 18.6 %, p = 0.053). No difference in both DFS and OS was reported.

Conclusions: We offer a rationale to combine non interventional pre-habilitation procedure with short term chemotherapy cycles, aiming to improve pre-operative conditions of selected HR patients.

Importance: Breast cancer is the most prevalent cancer among women globally, and Singapore is no exception. Surgical intervention, especially mastectomy, is a cornerstone of breast cancer treatment. While conventional mastectomy (CM) has been the gold standard, robotic mastectomy (RM) has emerged as a promising alternative due to its minimally invasive nature. However, its cost-effectiveness remains uncertain, especially in resource-constrained settings like Singapore.

Objective: To determine whether robotic mastectomy is cost-effective compared to conventional mastectomy in Singapore from a healthcare system perspective, using quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) as outcome measures.

Design setting and participants: This cost-utility analysis used a Markov model to simulate long-term health outcomes and costs associated with RM and CM over a 10-year horizon. Data on surgical costs, quality of life, survival rates, and complication probabilities were drawn from published literature and clinical expert opinion. The analysis was conducted from a Singaporean healthcare perspective, applying a 3 % annual discount rate to account for time preferences.

Interventions: Robotic mastectomy and conventional mastectomy were compared in terms of their associated costs and health outcomes. RM utilized the da Vinci robotic surgical system, while CM was performed via traditional surgical techniques.

Main outcomes and measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) (cost per QALY gained), with QALYs as the measure of effectiveness. Sensitivity analyses (including probabilistic sensitivity analysis (PSA)) assessed the robustness of results to variations in model parameters.

Results: The base-case analysis showed that RM incurred higher upfront costs but resulted in higher long-term QALY gains compared to CM. The ICER for RM was estimated at SGD 30,000 per QALY, below Singapore's willingness-to-pay (WTP) threshold of SGD 65,000 per QALY. Probabilistic sensitivity analysis (PSA) demonstrated that RM remained cost-effective in 85 % of simulations at the WTP threshold. The Cost-Effectiveness Frontier (CEF) analysis confirmed that RM offered better value as the WTP threshold increased.

Conclusion and relevance: Robotic mastectomy is cost-effective in the long term in Singapore, primarily due to fewer complications, faster recovery, and improved quality of life. These findings are relevant for healthcare policymakers seeking to optimize breast cancer treatment in resource-limited settings.

Surgery, especially if minimally invasive, still plays a role in the diagnosis of suspect lymphoproliferative lesions in challenging locations such as the retroperitoneum. Fluorescence guidance may help in such cases facilitating the visualization of highly vascularized lesions. Our recent experience with a 71-year-old woman with retroperitoneal lymphadenopathy and suspected lymphoma supports this hypothesis. A solution of indocyanine green (ICG) intravenously administered at the induction of anesthesia helped identify and dissect the lymphadenopathy. Histology confirmed follicular B cell lymphoma. This case supports the growing role of ICG fluorescence in guiding minimally invasive surgeries for lymphoproliferative diseases, offering a potential alternative to more complex preoperative and intraoperative ICG administration techniques.