International journal of surgery最新文献

Background: Many studies have compared lip-splitting mandibulotomy (LSM) and lip-mandible preservation (LMP) techniques in oral and oropharyngeal cancer (OOPC) patients with inconsistent conclusions. Evidence-based recommendations for the optimal surgical approach for treating OOPC are lacking.

Methods: The Cochrane Library, Pubmed, Embase, Web of Science, WAN-FANG, CQVIP, and China National Knowledge Infrastructure were systematically searched to identify studies that compared LSM versus LMP for OOPC. An additional search of the gray literature was performed using Google Scholar, OpenGrey and ProQuest Dissertations & Theses Global. Survival rate, recurrence rate, surgical margin, perioperative outcomes, postoperative complications and functional status were assessed. The standard mean difference (SMD) and odds ratio (OR) with a 95% CI were pooled using fixed-effect or random-effect models.

Results: Four randomized controlled trials, five case-control studies, and twenty cohort studies including a total of 2622 patients were identified. The LSM approach significantly increased postoperative complications such as mandibular osteomyelitis/osteoradionecrosis (OR = 4.57; 95% CI = 1.20-17.39; P = 0.026), fistula (OR = 1.5; 95% CI = 1.05-2.15; P = 0.027), and flap infection (OR = 2.96; 95% CI = 1.49-5.87; P = 0.002), while LMP improved facial appearance (SMD = -0.65; 95% CI = -1.05 to -0.25; P = 0.002). Meta-analyses showed no significant difference in survival rate (OR = 1.07; 95% CI = 0.83-1.38; P = 0.59), total recurrence (OR = 1.15; 95% CI = 0.87-1.52; P = 0.325), local recurrence (OR = 1.39; 95% CI = 0.88-2.19; P = 0.163), operation duration (SMD = 0.19; 95% CI = -0.75 to 1.13; P = 0.688), length of hospital stay (SMD = 0.48; 95% CI = -0.27 to 1.22; P = 0.208), volume of blood loss (SMD = 0.43; 95% CI = -0.17 to 1.03; P = 0.156), surgical margin (OR = 1.01; 95% CI = 0.72-1.41; P = 0.947), hematoma/seroma (OR = 1.01; 95% CI = 0.46-2.25; P = 0.972), wound infection (OR = 1.28; 95% CI = 0.92-1.79; P = 0.145), swallowing (SMD = -0.33; 95% CI = -0.91 to 0.24; P = 0.428) and speech (SMD = -0.14; 95% CI = -0.44 to 0.17; P = 0.381) between the LSM and LMP groups.

Conclusion: These findings suggest that LMP may be a safe and efficient alternative to LSM for treating OOPC patients with decreased mandibular osteomyelitis/osteoradionecrosis, fistula, flap infection, and a better aesthetic outcome.

Background: With the clinical integration of sugammadex, a selective relaxant-binding agent, the approach to reversing neuromuscular blockade is revolutionized. Despite its efficacy, sugammadex's adverse reactions range from mild symptoms to severe cases, including anaphylaxis and coagulopathy. Assessing the nature of these reactions using the Food and Drug Administration's Adverse Event Reporting System (FAERS) database is vital for safe anesthetic practice. This study aimed to analyze and categorize the adverse drug events (ADEs) related to sugammadex reported in the FAERS database and evaluate the potential safety signals since its market entry.

Materials and methods: This systematic analysis study extracted and filtered FAERS data pertinent to sugammadex from its introduction in 2008 to the last quarter of 2023 and employed standardized MedDRA terminologies for ADE re-encoding. The Reporting Odds Ratio (ROR) method analyzed ADE signal strength, identifying significant cardiovascular, allergic, and neurological signals.

Results: From 1505 patient reports totaling 3562 ADEs, prominent adverse reaction signals were detected for respiratory and cardiovascular systems and severe allergic and neurological effects. Specific signals, including laryngospasm, bronchospasm, and Disseminated Intravascular Coagulation (DIC), among others, were highlighted and necessitated urgent clinical attention.

Conclusions: Sugammadex is associated with a spectrum of adverse reactions, some of which demand increased clinical surveillance, particularly in older and pediatric populations. The significance of allergic reactions, airway spasms, and coagulation events indicates the need for precise risk assessment and vigilant monitoring during clinical use.

Background: Bariatric and metabolic surgery tourism (BMT) is becoming an increasingly popular route to treatment for patients living with obesity. Recent reports have highlighted that some patients travelling abroad for bariatric surgery have received inadequate care, fraudulent care, and, tragically, some cases have resulted in death. This study aimed to define consensus in Europe regarding safe practices concerning BMT.

Materials and methods: IFSO-EC, EASO and ECPO initiated a task force to delineate safe practices in BMT. Two expert European panels were convened, one comprised of healthcare professionals (identified from EASO and IFSO-EC) and the other of patient representatives (identified from ECPO). The study utilized a modified Delphi consensus methodology, and 135 questions were administered. Surveys were conducted anonymously online, and consensus was defined as 70% agreement. Themes analyzed regarding BMT included regulation, pre-operative evaluation, operative care, post-operative care, advertising and online information.

Results: One hundred and nineteen healthcare professionals and 88 patient representatives participated from 26 countries. The healthcare professional panel included 66 bariatric surgeons, 28 endocrinologists, 18 dietitians, three nurses, two psychologists, one general practitioner and one gastroenterologist. Three questionnaire rounds were conducted for the healthcare professional panel, and two were performed for the patient representative panel. Consensus recommendations were given across all themes relevant to BMT. These included evaluating and managing psychological health, sleep apnea, cardiovascular disease, liver health and dietetic assessment. The recommendations covered the requirements for regulatory standards, including surgeon accreditation and procedural volume. They also included recommendations regarding patient education, standardized operative care, online information provision, and follow-up.

Conclusions: Through collaboration with healthcare professionals and patients living with obesity, we provide European recommendations regarding safe practices concerning BMT. Further evaluation is required regarding outcomes following BMT. These data, alongside the Delphi consensus recommendations, will inform BMT clinical guideline development.

Background: Local anesthetics as a part of intraarticular therapies (IATs) are widely used for treating knee osteoarthritis (KOA). Whether the substitution of liposomal bupivacaine (LB) for lidocaine is safe and effective in reducing the incidence of injection-emergent adverse events (AEs) after IATs remains unclear.

Methods: We recruited outpatients who had a clinical diagnosis of KOA and decided to receive IATs from November 2023 to April 2024. The type of IATs (glucocorticoids, platelet-rich plasma, and hyaluronic acid) for each participant was decided by the preference of patients after consulting with his or her treating physicians. Using lidocaine or LB as local anesthetics was determined by enrollment timing due to considerations of safety. The primary outcome was injection-emergent AEs after IATs. Secondary outcome measures included the Visual Analog Scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score.

Results: In this study, 123 and 103 patients, respectively, received lidocaine and LB according to their enrollment date. Compared with lidocaine, using LB yielded a reduced incidence of AEs in the overall 2 weeks (LB vs. lidocaine, 30.1% vs. 45.5%, P = 0.018) and week 1 (LB vs. lidocaine, 23.3% vs. 39.8%, P = 0.008). After adjusting for sex, baseline body mass index, age, baseline WOMAC pain subscale score, and K-L grade, the substitution of LB for lidocaine was significantly associated with the reduced incidence of AEs in 2 weeks (OR, 0.484; 95% CI, 0.274-0.853; P = 0.012). In the initial 3 days, the LB groups reported better outcomes in terms of VAS pain score (change from baseline of VAS pain, LB vs. lidocaine, day 1 -8.3 ± 8.9 vs. -1.9 ± 9.3, P < 0.001; day 2 -20.6 ± 16.1 vs. -13.7 ± 19.4, P = 0.005; day 3 -22.3 ± 18.5 vs. -16.3 ± 19.3, P = 0.020). The changes from the baseline of the WOMAC pain subscale at day 14 were similar between the two groups (LB vs. lidocaine, -32.2 ± 11.7 vs. -29.4 ± 11.3, P = 0.073).

Conclusion: With the substitution of LB for lidocaine, patients might have reported reduced incidence of AEs, mainly derived from the superiority in week 1. The substitution of LB for lidocaine was safe in different scenarios of IATs, and future randomized clinical trials were warranted by the current study.

Background: Researchers have long been interested in the potential relationship between osteoarthritis (OA), falls, and fractures; however, the evidence supporting this relationship has been conflicting. This study aimed to investigate the association between osteoarthritis and future fracture events.

Materials and methods: This study was designed as a prospective cohort study. We recruited a total of 440 476 individuals from the UK Biobank to investigate the impact of OA on the incidence of fracture. Among the total population, there were 54 581 participants diagnosed with OA. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results: A total of 26 083 fracture events were documented over a median follow-up period of 13.5 years. After multivariable adjustment, participants with osteoarthritis had an HR (95% CI) of 1.11 (1.08, 1.15) for future fracture events compared to participants without osteoarthritis ( P  < 0.0001). Falls explained 16.34% of the association between osteoarthritis and fracture events and 14.15% of the association between knee osteoarthritis and fracture events. The association was not substantially altered across the series of sensitivity analyses.

Conclusion: Osteoarthritis was associated with a greater risk of future fracture events. This finding highlights the importance of preventing future fracture events in people with osteoarthritis.

Background: Esophageal squamous cell carcinoma (ESCC) poses a substantial healthcare challenge, particularly in areas such as East Asia. The pathologic nodal (pN) stage of ESCC remains a controversial factor. Accurately predicting overall survival (OS) after esophagectomy is crucial for treatment planning and improving treatment outcomes.

Method: An analysis was conducted using data from Esophageal Cancer Case Management Database of Sichuan Cancer Hospital and Institute, spanning from January 2010 to December 2017. Our study aimed to examine the clinicopathological characteristics, lymph node resection at individual stations, and treatment details of patients with ESCC who underwent esophagectomy. In addition, a novel nodal stage (N stage) was based on the number of lymph node metastasis (LNM) stations, and a prediction model for OS was devised using the pN stage and the newly proposed N stage.

Results: After analyzing 49 indicators through univariate and multifactorial analyses, 25 of the most significant factors affecting OS after esophagectomy were identified. Further analysis using least absolute shrinkage and selection operator regression revealed six key factors. Models were developed based on the pN stage and the newly introduced N stage. Evaluation of the area under the curve indicated that Model 2 exhibited slightly superior clinical utility compared to Model 1.

Conclusions: Our study demonstrates that the newly introduced N stage, based on the number of LNM stations, exhibits comparable performance to the current American Joint Committee on Cancer/Union for International Cancer Control pN system, with a slight advantageous edge.

Background: We aimed to assess the efficacy and feasibility of applying patient-reported outcome (PRO) based symptom management in the early postoperative period after breast cancer surgery.

Materials and methods: Before surgery, patients diagnosed with breast cancer who met the inclusion criteria were randomly assigned in a 1:1 ratio to receive either postoperative PRO-based symptom management or usual care. All patients completed the MD Anderson Symptom Inventory-Chinese version (MDASI-C) via the electronic PRO system preoperatively, on a daily basis postoperatively, and twice weekly after discharge, for a duration up to 2 weeks. In the PRO-based care group, in addition to receiving usual care, patients whose symptoms reported by completing MDASI-C with a score of ≥4 will be managed symptomatically by the attending surgeon. Patients in the usual care group received routine care and their MDASI-C scores were unknown to their attending surgeon. The primary outcome was the MDASI-C score of patients at the time of discharge. Analyses were conducted in accordance with the established protocol.

Results: Of the 134 participants, 67 were randomly assigned to each group. At discharge, the total score of MDASI-C scale was significantly higher in the usual care group comapred to the PRO-based care group (median [interquartile range], 22 [19] vs. 35 [36]; P = 0.002). The score of FACT-B scale (adjusted mean difference, 0.39; 95% confidence interval, 0.11-1.06; P = 0.009) was significantly lower in the usual care group than in the PRO-based care group during the 14 days after surgery. In the PRO-based care group, 87.2% of patients found the PRO-based symptom management approach helpful in their early postoperative recovery.

Conclusion: The implementation of a PRO-based symptom management system within 2 weeks after breast cancer surgery effectively alleviates symptom burden and improves quality of life compared to usual care.