Minerva Surgery最新文献

Background: Palliative surgical management of advanced gastric cancer with gastric outlet obstruction remains controversial. While both palliative gastrectomy (PG) and gastrojejunostomy (PGJ) offer symptom relief, their impact on survival and postoperative outcomes is debated.

Methods: We conducted a retrospective cohort study of 70 patients with advanced gastric cancer and symptomatic gastric outlet obstruction, treated at a single tertiary center between 2017 and 2024. Patients underwent either PG or PGJ after being deemed unsuitable for endoscopic intervention. Clinical and surgical parameters, complications, nutritional support, and survival outcomes were analyzed.

Results: Of the 70 patients, 46 underwent PG and 24 underwent PGJ. Median survival was significantly longer in the PG group (344 vs. 117 days, P<0.001), and PG was an independent predictor of improved survival (HR 0.083, P<0.001). PG was associated with higher rates of anastomotic leaks and ICU admissions, while PGJ showed higher rates of delayed gastric emptying and need for post-discharge nutritional support (33.3% vs. 6.7%, P=0.009). Return to oral intake was more common after PG (95.7% vs. 79.2%, P=0.042). Postoperative chemotherapy significantly improved survival (HR=0.152, P=0.003).

Conclusions: PG offers a significant survival benefit over PGJ in selected patients with advanced gastric cancer, but at the cost of increased surgical morbidity. Careful patient selection based on disease extent, performance status, and likelihood of postoperative recovery is essential for optimizing outcomes.

Background: Acute cholecystitis (AC) is a common general surgical emergency. Older age is associated with higher incidence of gallstones and increasing severity of AC. Data on outcomes for older adults with AC remain sparse however.

Methods: All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, comorbidities, length of stay, clinical management, in-patient mortality, and readmissions. Patients were grouped into cohorts by age range.

Results: Overall, 20,886 admission episodes were identified, with a median age of 59 years (IQR 43-73) and 11,747 (56%) female patients; 3745 patients were in the 65-74 year group, 3239 in the 75-84 year, and 1478 in the over 85 year group. Older adults had more co-morbidities (Charlson Co-morbidity Index >3 in 440 (30%) of the over 85s, 689 (21%) of 75-84 years, 429 (11%) 65-74 years, and 421 (3%) under 65s (P<0.0001). In the over 85 years group, patients had the highest in-patient mortality rate (96 [6.5%]; P<0.0001), lowest rate of cholecystectomy (49 [3%]; P<0.0001), highest rate of percutaneous cholecystostomy use (140 [9%]; P<0.0001), and lowest rates of discharge to home (947 [64%]). Patients in the 65-74 year and 75-84 year groups also experienced poorer outcomes than those in the under 65 year group.

Conclusions: Increasing age is associated with worsening outcomes for patients with AC. For the oldest adults, AC is associated with significant risks of morbidity and potential loss of independence.

Background: Allogenic blood transfusion (ABT) is associated with postoperative complications and possibly early recurrence (ER). after oncologic surgery. We sought to investigate predictors and impact of ABT in cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: All patients who underwent CRS±HIPEC from June 2020 to January 2022 at a high-volume center were included. Patients were classified according to whether they had received a perioperative ABT during the entire hospitalization period. ER was defined as the time from complete resection to the first recurrence (local or distant) or death, whichever occurred first, within 2 years after surgery. Multivariate logistic regression and Cox analysis identified risk factors for ABT and ER, respectively.

Results: Of 168 patients, 56 (33.3%) required ABT (mean 2.4 [2.2] red blood cell units). Multivariate logistic analysis showed that hemoglobin levels 24-h before surgery (odds ratio [OR] 0.5; 95% confidence interval [CI]: 0.4 to 0.7), intraoperative fluid balance (OR 1.01; 95% CI: 1.01 to 1.02) and time of surgery (OR 1.1; 95% CI: 1.1 to 1.1) were independently associated with ABT. Multivariate Cox regression identified time of surgery (hazard ratio [HR] 1.01, 95% CI: 1.01 to 1.02) and previous systemic chemotherapy (HR 2.5, 95% CI: 1.3 to 4.8) as risk factors for ER, while ABT was not (P=0.078).

Conclusions: Lower preoperative hemoglobin levels, higher intraoperative fluid balance, and longer surgery time are risk factors for ABT. Longer operative time and previous systemic chemotherapy are associated with early recurrence.

Introduction: Amyand's hernia (AH) is a relatively rare type of inguinal hernia, characterized by the presence of the appendix inside the hernia sac. The aim of this study is to examine the role of prosthetic mesh in AH repair compared to the traditional suture repair techniques regarding safety, efficacy and various postoperative complications.

Evidence acquisition: A systematic review of MEDLINE via PubMed, Scopus and Google Scholar was performed, aligned with the PRISMA guidelines. All studies in English language reporting AH repair using mesh or suture techniques in adults including more than 5 patients were included.

Evidence synthesis: Twelve studies reported a total of 123 patients with AH, 58 of which were repaired using prosthetic mesh and 71 with traditional suture techniques. The overall presence of an inflamed appendix was 58.5%. Appendicitis was present in 12.7% of the mesh repair group compared to a 95.5% of the suture repair group. Surgical site infections (SSIs) were 3.4% of all complications in the mesh group compared to 6.8% in the suture repair group. Extended hospital stay of more than 10 days was observed in 12.7 in the mesh group compared to 7.3% of the suture repair group.

Conclusions: The most technically challenging cases with septic conditions are appropriate for suture repair only, while mesh repair is usually performed in AH cases without appendix inflammation and is more commonly used in conjunction with appendix reduction into the abdominal cavity rather than appendicectomy.