Minerva Surgery最新文献

Introduction: The aim of this systematic review was to compare minimally invasive procedures versus excision and wound closure for the treatment of pilonidal disease (PD) in terms of perioperative outcomes.

Evidence acquisition: Search was performed in PubMed, Embase and Web of Science, founding 581 articles.

Evidence synthesis: Six articles published between 2018 and 2023, including 595 patients were included in the present systematic review. All of these studies presented endoscopic pilonidal sinus treatment (EPSIT) as the minimally invasive surgical technique for the treatment of pilonidal disease, while no articles meeting the inclusion and exclusion criteria addressed video-assisted ablation of pilonidal sinus. One hundred eighty-two patients (30.6%) underwent EPSIT (Group A), whereas 413 (69.4%) underwent excision and wound closure (Group B). Patients in Group A experienced shorter operative times (42.1±16 minutes) and hospital stay (0.5±0.3 days) in comparison to Groups B (59.3±19 minutes and 2.4±1 days, respectively). Group A had lower complication rate (12.5%) compared to Group B (35.2%) and recurrence rate (17.9% versus 14.8%). Wound dehiscence rate was 12.8% in Group B. Mean time to complete healing was longer in Group A than Group B (47.9±26.1 days and 39.1±22.3 days, respectively).

Conclusions: EPSIT requires approximately 9 additional days to fully heal, but it avoids the risk of wound dehiscence, and had fewer complications, along with a shorter hospital stay, compared to those treated with excision and wound closure. The choice of treatment should be personalized, considering the individual needs and specific risk factors for wound dehiscence.

Background: Venous ulcers are chronic open skin sores, difficult to heal, caused by bad microcirculation in patients with chronic venous insufficiency (CVI) and sustained venous hypertension. In this pilot supplement registry study, the efficacy and safety of oral Centellicum^® (Centella Asiatica standardized extract, Horphag Research) 675 mg/day for 3 months as part of the management of venous ulcerations were evaluated.

Methods: Study endpoints considered measuring the changes in the area of the ulceration and microcirculatory parameters in patients with CVI.

Results: 160 subjects with venous ulcers and CVI completed the study: 80 in the Centellicum^® group, supplemented with 675 mg Centellicum^® per day in addition to the best management treatment (BM) and 80 in the control group with only the BM. The control and treatment groups were comparable for age and sex distribution. Skin resting flux is generally abnormally increased at the peri malleolar region in CVI patients and around ulcerations. Both groups exhibited improvements in microcirculation, skin resting flux (RF) measured with Laser Doppler flowmetry (LDF), transcutaneous PO2 and PCO2. However, the supplementation proved to be more effective than the best management only (P<0.05). After 90 days, the supplement group exhibited a significantly lower number of ulcerations and average ulcer area compared to the control group (P<0.05). In the Centellicum^® group, the ulcer area decreased from 2.34±0.3 cm² to 0.33±0.5 cm², whereas in the control group, it only decreased from 2.4±0.5 cm² to 1.61±0.7 cm². The difference between the two management groups was statistically significant (P<0.021). The rate of completely closed ulcers was 96.2% in the Centellicum^® group, significantly higher than the 83.7% healing rate observed in in the control group. Notably, after just one month, 65% (52/80) of ulcers in the Centellicum^® group had completely healed, compared to only 18.75% (15/80) in the control group. Ulcer closure was the most critical clinical outcome observed.

Conclusions: In venous ulcerations, Centellicum^® supplementation in combination with ulcer management, improved microcirculation parameters and ulcer healing rate. Most of the treatments were done at home by the patients or by their tutors. This study indicates a potential role of Centellicum^® in venous ulcers and CVI and suggests the need to plan larger and more prolonged healing studies.

Background: The role of 25-hydroxy vitamin D (25(OH)D) in predicting surgical complications has been increasingly studied in various fields, with limited research on its impact in colorectal surgery. This study aimed to assess the predictive value of preoperative vitamin D levels for postoperative complications and compare it with albumin levels, a known nutritional marker. The secondary objective was to identify cutoff values for both markers to identify at-risk patients for targeted nutritional interventions.

Methods: This single-center, retrospective study included patients undergoing colorectal surgery between June 2023 and August 2024. Preoperative 25(OH)D, albumin, and other nutritional markers (blood glucose, folate, vitamin B12) were measured during a nutritional assessment one month before surgery. These markers were analyzed in relation to postoperative complications.

Results: Lower preoperative levels of both 25(OH)D and albumin were significantly associated with postoperative complications (P=0.039 and P=0.012, respectively). Univariate analysis identified ASA score, folate, 25(OH)D, and albumin as predictors, with multivariate analysis confirming albumin (P=0.044) as significant, while 25(OH)D showed a trend (P=0.086). Optimal cutoff values were 14.4 ng/mL for 25(OH)D and 3.6 g/dL for albumin.

Conclusions: Lower 25(OH)D and albumin levels were associated with postoperative complications. Preoperative nutritional assessment is critical for identifying high-risk patients and implementing corrective interventions.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancer, with a 5-year survival of 8-10%. Approximately 50% of cases present with metastases at time of diagnosis, with the liver representing the most common site. International guidelines recommend palliative chemotherapy for metastatic disease, yet several studies report prolonged survival after surgery or locoregional therapy in selected patients with both synchronous and metachronous liver metastases (LM).

Evidence acquisition: Despite the numerous attempts to define selection criteria of patients with LM from PDAC who would benefit most from surgery, evidence is contradictory. This article aims to describe underlying principles of paradigm shift in multimodal management of hepatic oligometastatic PDAC, providing a summary of the published series with respect to morbidity, mortality and survival outcomes.

Evidence synthesis: Upfront resection of both primary tumor and synchronous LM should be avoided, since it does not imply prolonged survival compared to that of patients with liver oligometastatic PDAC candidate to chemotherapy. Resection or radiofrequency ablation of metachronous liver lesions can be an option in case of small metastases amenable of minor resection. Management of liver oligometastatic PDAC after neoadjuvant therapy can be performed in case of good response to chemotherapy after accurate restaging. Yet, duration of neoadjuvant therapy or entity of biological response are some issue still undefined in this setting.

Conclusions: Ongoing trial may overcome limitations of retrospective studies, as well as molecular biology can help to better understand tumor behavior and tailor the surgical approach on cancer genetic signature.

Introduction: Surgical site infections (SSI) represent a global health challenge, particularly in colorectal surgery, when rates can reach up to 20%. The role of mechanical bowel preparation (MBP) is still debated. A systematic review is proposed to evaluate MBP effectiveness in reducing SSI and complications after colorectal surgery.

Evidence acquisition: This systematic review and meta-analysis was conducted following the PRISMA guidelines. Only randomized studies comparing two or more methods for preventing infectious complications in patients undergoing colorectal surgery were included. The primary endpoint was the occurrence of SSIs, while secondary endpoints included anastomotic leak (AL) and intra-abdominal septic complications (IASC) other than AL.

Evidence synthesis: Eighteen studies met the inclusion criteria, including a total of 6,302 patients in the analysis. The meta-analysis showed similar SSI rates between the MBP and no-treatment groups (OR 1.015, 95% CI 0.855-1.206, I²=22.33%, P=0.863) as well as between the MBP and enema groups (OR 1.100, 95% CI 0.616-1.965, I²=35.96%, P=0.748). The risk of anastomotic leak (AL) was also similar when comparing no treatment to MBP (OR 0.904, 95% CI 0.661-1.237, I²=0%, P=0.528), and MBP to enema (OR 0.727, 95% CI 0.286-1.845, I²=25.98%, P=0.502). IASC rates were lower with MBP compared to no treatment (OR 0.526, 95% CI 0.326-0.848, I²=3.50%, P=0.008).

Conclusions: This meta-analysis found no significant reduction in SSI or AL rates with MBP alone compared to no preparation or enema use. However, MBP significantly lowered IASC. Further research is warranted to evaluate the effectiveness of MBP combined with antibiotics in reducing postoperative complications.

Breast and ovarian cancer account for millions of new cancer diagnoses worldwide annually. An individual's risk of breast and/or ovarian cancer is the result of a complex interplay between non-modifiable and modifiable factors. This review provides a comprehensive map of the current state of our understanding of breast and ovarian cancer risk as conducted through a literature review utilizing PubMed and Cochrane review as primary databases and the selection process prioritized year of publication for up-to-date research and journal impact factor as criteria of research credibility. We review non-modifiable risk factors, such as genetic variations, age, sex assigned at birth, and reproductive history as well as how advances in genetic mapping have led to increased insight in pathogenic germline variants. Additionally, we discuss modifiable factors such as lifestyle and environmental exposures which allow the opportunity for intervention to reduce risk. Contemporary high risk screening tools, including understanding their strengths and weaknesses, are discussed and how they can lend to the determination of eligibility for preventive measures, including risk-reducing operations. The unique challenges of under-represented groups, such as non-Hispanic Black women, transgender/nonbinary/and gender-diverse individuals, and Asian and Pacific Islander populations are reviewed in the context of breast and ovarian cancer risk. Future research on improving risk assessment tools and identifying genomic variants will yield improved personalized healthcare solutions.

Background: Natural orifice specimen extraction (NOSE) via the anus or vagina is an alternative to conventional transabdominal extraction. We aimed to evaluate the safety and outcomes of NOSE following colorectal surgery in obese Asian patients.

Methods: We performed a retrospective cohort study of patients who underwent laparoscopic colorectal resection with NOSE for non-metastatic cancer or benign disease between February 2021 to October 2023. Clinical T4 or N2 disease on preoperative imaging were excluded from NOSE. Patient characteristics and perioperative outcomes were compared between patients with Body Mass Index (BMI) <25 kg/m² versus BMI ≥25 kg/m².

Results: Forty-nine consecutive patients underwent elective colorectal surgery with attempted NOSE over the 33-month study period. Forty patients (81.6%) had resection for a diagnosis of colorectal cancer. Twenty-seven (55.1%) patients had BMI<25 kg/m² and 22 (44.9%) had BMI≥25 kg/m², with a median BMI of 22.1 kg/m² and 27.8 kg/m² in the lower and higher BMI cohorts respectively. Patient gender, albumin level, operative indication, and type of surgery performed were comparable. There were no statistical differences in the NOSE conduit used, operative duration, blood loss, postoperative gastrointestinal recovery time, and complication rates. Median postoperative length of stay was 3 days in either group. Two patients (9.1%) failed NOSE in the high BMI cohort. There were no open conversions. Amongst patients with colorectal cancer, distribution of pT and pN stages, total lymph node harvest, and tumour diameter were similar.

Conclusions: Colorectal NOSE surgery amongst selected obese Asian patients results in similar perioperative outcomes and postoperative morbidity rates compared to non-obese patients.