Minerva Surgery最新文献

Introduction: Pancreatic cancer resection in the elderly population represents a challenging problem. In addition, a chronological age for the "elderly" is lacking. The aim of the present review was to assess the safety and feasibility of major pancreatic tumor resection in elderly patients, considering different age cut-offs (≥70; ≥75 and ≥80 years old).

Evidence acquisition: A search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on the PubMmed/MEDLINE database. The population analyzed included elderly patients undergoing pancreatic resection for pancreatic cancer as compared with younger patients to evaluate morbidity, mortality, clinically relevant postoperative pancreatic fistula, delayed gastric emptying, post-pancreatectomy hemorrhage, length of stay, overall survival, and disease-free survival.

Evidence synthesis: The results of each study were reported using Risk Ratio (RR), Odds Ratio (OR) or Mean Difference and their P value. Twenty-four studies were included in the review for a total of 33,896 cases of which 25,937 (76.5%) were young people and 7378 (23.5%) were elderly people. The elderly age cut-off was mainly defined as ≥70 years old. Regarding the age cut-off ≥70 years old, the results comparing elderly patients (≥70 years) and younger patients (<70 years) were similar; for the age cut-offs ≥75 and ≥80 years old. Higher mortality and morbidity rates were found in the studies due to the fact that patients ≥75 and ≥80 years or older more frequently had major comorbidities than the younger patients.

Conclusions: This review showed that 1) elderly age cut-off has to be considered as ≥ 70 years old, and 2) age alone is not a contraindication for pancreatic cancer resection. However, elderly patients were frailer and more vulnerable than younger patients, and therefore required a careful preoperative assessment.

Background: Point-of-care ultrasound (POCUS) is increasingly utilized in clinical medicine, yet its role in assessing normal postoperative bowel function remains underexplored, particularly after laparoscopic colorectal surgeries.

Methods: A prospective cohort study of 20 laparoscopic bowel resection patients was conducted, utilizing small bowel POCUS before surgery and daily from postoperative day (POD) 1 to POD 4. Small bowel width and a Small Bowel Motility Index (SBMI) were recorded in each examination. Statistical analyses involved repeated measures ANOVA to evaluate motility and width changes over study days.

Results: The small bowel motility index displayed statistically significant differences across the study days before surgery up to POD4 (P<0.001). Pairwise comparisons revealed significant differences between pre-surgery (10.58±1.31) and POD1 (8.20±2.30) with a mean difference of 2.38 (P=0.009). Subsequent days demonstrated significant differences between POD1 and POD3 (9.78±1.51) and POD4 (10.30±2.05) with mean differences of -1.58 (P=0.049) and -2.10 (P=0.029) respectively. In contrast, small bowel width did not exhibit statistical significance during this follow-up period (P=0.112).

Conclusions: Our findings underscore the dynamic nature of small bowel motility, highlighting its potential as a crucial parameter for postoperative assessment. Further larger studies with vareity of patients are warranted to explore the broader applications of small bowel POCUS in postoperative care.

Introduction: Primary hyperparathyroidism (PHPT) is a common endocrine disease especially in postmenopausal women and in older adults, with elevated parathyroid hormone (PTH) levels by parathyroid glands. The main symptoms of PHPT are hypercalcemia, often associated with hypercalciuria, urolithiasis and bone demineralization that results in osteopenia or osteoporosis and increases overall fracture risk. Parathyroidectomy is today the only definitive treatment for patients to prevent worsening of symptoms. Minimally invasive targeted approach for parathyroidectomy can be offered to patients with well-localized disease, and combined with intraoperative PTH monitoring, the success rate reaches 95-97%; with short operative time, low complications rates and decreased hospital costs. To date, minimally invasive parathyroidectomy (MIP) can be performed under local anesthesia and most patients can be discharged on the same day of surgery or the following morning. The aim of this article is to summarize the current evidence of MIP under local anesthesia and its clinical outcomes to assess the effectiveness and safety of this procedure.

Evidence acquisition: We searched PubMed, Embase, Cochrane and Web of Science databases from their date of inception until 30^th May 2024. Inclusion criteria consisted in articles from any country written in English reporting MIP under local anesthesia related clinical outcomes in humans. RCTs, quasi-RCTs, cross-sectional studies, retrospective and prospective cohort studies, case-control studies were included.

Evidence synthesis: We identified 23 eligible studies that included 2470 adults (mostly female asymptomatic) with PHPT; follow-up duration varied from six months to 24 months. All studies were screened for assessments of quality based on Newcastle-Ottawa Scale and the risk of bias based on ROBIN-I of the included studies. The operative time, number of conversions to general anesthesia, hospital stay and complications was respectively: 43.86 minutes, with 114 conversions to general anesthesia, mean hospitalization time was 16.83±8.62 hours and complications reported in 71 patients. Previously of surgery, the abnormal parathyroid gland is localized using multiplexed ion beam imaging (MIBI) plus ultrasound (US) in 12 studies, only MIBI in three studies, thallium-technetium scan plus US in three studies, single-photon-emission computed tomography (SPECT) plus US in one study and a combination of MIBI, US, SPECT, CT and magnet resonance in one study. The mean preoperative value of PTH and serum calcium was 277.44 pg/mL and 11.49 mg/dL respectively; while the mean postoperative value of PTH and serum calcium was 46.18 pg/mL and 9.11 mg/dL respectively. At the definitive histology the most of pathology is adenoma with 542 cases reported, followed by hyperplasia with 35 cases and only 20 cases of carcinoma.

Conclusions: Focused

In the past, patients who underwent thoracic surgery were advised to rest, recover, and save energy, avoiding engaging in tiring physical activity. Postoperative rest-centered management of patients following anatomical resection can cause pulmonary and cardiovascular complications. Inability to cough, not deep breathing, dysfunctional diaphragm, pain and lying down cause lung atelectasis, pneumonia, and respiratory failure. Early postoperative mobilization's effects on mental or physical recovery and morbidity rate are unclear. Although advanced technological developments, thoracotomy is still the main incision for thoracic surgery. Lung resection and thoracotomy reduce the quality of patients' daily ambulatory activities. The exercise was shown to have anti-inflammatory effects. Anxiety, fear, and pain activate the same brain regions. Postoperative early mobilization could reduce anxiety and help to reduce the intensity of pain. Many different procedures that stop bed rest, start mobilization, and the walking distance or number of steps during postoperative the first mobilization are applied in the departments of thoracic surgery. How many meters the patient can walk and how many steps he/she needs to take are variable. Protocols to facilitate and enforce early mobilization would be beneficial. Early mobilization can reduce the rate of postoperative complications and length of hospital. Early mobilization as soon as possible within the first 24 h is supported as safe and acceptable in literature.

Background: The detection of indeterminate pulmonary nodules (IPN) at diagnosis of colorectal cancer (CRC) has increased. However, there is limited information on predictive factors for its progression (pPF) to pulmonary metastases (PM). This study aims to identify these pPF to select appropriate management strategies.

Methods: Single-center observational retrospective study including patients who underwent elective surgery for first non-metastatic CRC episode (January 2016- June 2019) with IPN at diagnosis. Patients were divided into those who developed PM in the same location as previous IPN (LM group) and those who did not (FM group).

Results: One hundred twenty-one patients were included; 4.9% developed PM in the same location as previous IPN. Univariate analysis revealed a significant difference in IPN size between groups with 8 (5, 10) mm in LM versus 3 (1, 5) mm in FM (P=0.006). ROC curve showed a size of ≥5 mm as the best cutoff point to predict IPN progression. Multivariate analysis identified size ≥5mm as the only independent pPF (OR 11.9, 95%CI 1.3-105.8, P=0.026). The median time to diagnose PM in LM group was 13.8(SD 5.2) months.

Conclusions: We recommend a closer follow-up for patients with CRC and IPN ≥5 mm at diagnosis so they will have a higher risk of developing PM.