Minerva Surgery最新文献

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.

Introduction: At present, harvesting more lymph nodes is considered more conducive to the prognosis of colorectal cancer surgery. The recent development of enhanced surgical visualization has led to the wide employment of indocyanine green (ICG) to assist minimally invasive surgery. This systematic review aims to provide a wide and critical overview of the current state of the art of ICG lymphography during rectal surgery, by focusing on the most relevant literature on this topic.

Evidence acquisition: After validation and registration in the PROSPERO international prospective register of systematic reviews on the 5^th May 2024 (ID: CRD42024539426), 8 publications have been considered relevant for the research query and have been divided into two groups: lateral pelvic lymph node dissection (LPLND) and lateral pelvic sentinel lymph node biopsy (LPSLNB). A meta-analysis has not been performed due to the low statistical significance.

Evidence synthesis: ICG lymphography seems to improve the number of harvested lateral pelvic lymph nodes, to reduce intraoperative blood loss and hospital length of stay during LPLND. In LPSLNB the detection rate of lateral pelvic sentinel lymph nodes ranged from 91.3% to 92%.

Conclusions: ICG lymphography for fluorescence guidance for LLND is a feasible and safe technique, with promising application in terms of the number of harvested lymph nodes and post-operative outcomes improvement during rectal oncological surgery. As some of these benefits have been already suggested by the current literature, they need to be confirmed in larger and randomized clinical.

Introduction: Studies suggested that restrictive fluid therapy during major surgery could be associated with better post-operative outcomes. The albumin uses in the perioperative period has been the subject of numerous studies with a still controversial efficacy and safety profile. This study aimed to assess the efficacy and safety of perioperative albumin use during major non-cardiac surgery.

Evidence acquisition: This study was registered in PROSPERO (ID: CRD42022353278). We performed an electronic search of the relevant literature from 2000 until 2023. The primary endpoint was the incidence of moderate postoperative complications (defined by a Clavien-Dindo classification grade ≥2). Secondary endpoints were intraoperative fluid balance, intraoperative blood loss, postoperative wound infection and acute kidney injury (AKI).

Evidence synthesis: We identified four relevant studies involving 426 patients (213 patients in the albumin group versus 213 patients in the control group). The meta-analysis did not reveal any significant difference between both group regarding the incidence of postoperative moderate complications even after subgroup analyses based on intraoperative or postoperative albumin administration (OR=1.23, 95% CI 0.73, 2.08, P=0.44). No difference was found for intraoperative fluid balance (MD=-190.83, 95% CI -408.67, 27.02, P=0.09), intraoperative blood loss (MD=-27.54, 95% CI -225.55, 170.48, P=0.79) and postoperative wound infection (OR=1.91, 95% CI 0.98, 3.73, P=0.06). Moreover, albumin administration was not associated with a significant increase of AKI incidence (OR=2.02, 95% CI 0.90, 4.53, P=0.09).

Conclusions: Perioperative use of albumin during major non-cardiac surgery did not result in an increased incidence of moderate postoperative complications.