Surgical Practice最新文献

{"title":"Neoadjuvant chemotherapy versus upfront surgery for resectable colorectal liver metastases: A systemic review and meta-analysis","authors":"Pipit Burasakarn MD, PhD,&nbsp;Sermsak Hongjinda MD,&nbsp;Pusit Fuengfoo MD,&nbsp;Anuparp Thienhiran MD","doi":"10.1111/1744-1633.12662","DOIUrl":"10.1111/1744-1633.12662","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>The following electronic databases were searched for systematic literature: PubMed, Cochrane Library and Google Scholar. Studies fulfilling the following criteria were included in the analysis: compared neoadjuvant chemotherapy and upfront surgery; included patients with resectable metastases at the time of presentation; reported the long-term results, including overall survival (OS) and disease-free survival (DFS); and identified early adverse postoperative events, including 30-day mortality and overall postoperative complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over 24 studies with 8700 patients were analysed. Patients were divided into the neoadjuvant chemotherapy group (<i>n</i> = 3490, 40.1%) and the upfront surgery group (<i>n</i> = 5172, 59.4%). The meta-analysis showed no statistically significant difference in terms of overall morbidities [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.84-1.67] and mortality (OR 1.48, 95% CI 0.75-2.92) between the neoadjuvant chemotherapy and upfront surgery groups. However, the meta-analysis showed a favourable OS in the upfront surgery group (OR 1.21, 95% CI 1.06-1.38) and favourable DFS in the upfront surgery group (OR 1.71, 95% CI 1.38-2.12), including the subgroups of 1-, 3-, 5-year DFS (OR 1.38, 95% CI 1.06-1.8; OR 2.06, 95% CI 1.35-3.14 and OR 1.65, 95% CI 1.18-2.29, respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"28 1","pages":"16-26"},"PeriodicalIF":0.8,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135875324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infrahyoid flap—a good substitute for free flaps in oral reconstruction during the COVID-19 pandemic","authors":"Tam-Lin Chow FRCS (Edin), FHKAM (Surgery),&nbsp;Siu-Chung Fung FCDSHK (OMS), FHKAM (Dental Surgery),&nbsp;Calvin K. P. Tsui FRCS (Edin), FHKAM (Surgery),&nbsp;Jeren Jin Mun Lim FRCS (Edin), FHKAM (Surgery)","doi":"10.1111/1744-1633.12660","DOIUrl":"10.1111/1744-1633.12660","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>During the coronavirus disease 2019 (COVID-19) pandemic, experts have recommended simplifying the process of reconstruction following the extirpation of head and neck cancer by favouring the use of pedicled flaps over free flaps. This approach reduces the duration of the operation and mitigates the risk of free flap failure, which can be exacerbated by the hypercoagulopathy state seen in infected patients. We aim to contribute our experience with the pedicled infrahyoid flap, a procedure not previously reported in Hong Kong.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study including patients who underwent infrahyoid flap reconstruction following resection of oral cavity cancer. Data for a total of nine patients were retrospectively retrieved from the hospital's computerised systems, and these patients were evaluated for demographic information, clinicopathologic parameters as well as oral function and reconstruction outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the nine infrahyoid flaps used, eight were myocutaneous flaps and one was a muscle flap. The dimensions of the flap skin ranged from 24.0 to 46.72 cm². All of the flaps, with the exception of one case that experienced epidermolysis of the flap skin, exhibited complete survival. Fortunately, the epidermolysis healed without complications, such as the development of an orocutaneous fistula. The average time required for flap harvesting was approximately 1 hour. All nine patients were able to resume oral feeding and achieved satisfactory speech outcomes. Seven of these patients survived without any tumour recurrence, but unfortunately, two patients died due to lung metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The infrahyoid flap proves to be a viable alternative to free flaps for the repair of medium-sized oral defects, especially in compromised patients and during the COVID-19 pandemic.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"221-225"},"PeriodicalIF":0.8,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135131733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The enhanced recovery after surgery program in elderly patients over 75 years of age undergoing elective colorectal cancer surgery","authors":"Dorothy Sze Wing Hung,&nbsp;Colin Wai Ho Chu,&nbsp;Kam Hung Kwok","doi":"10.1111/1744-1633.12661","DOIUrl":"10.1111/1744-1633.12661","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The enhanced recovery after surgery (ERAS) program has been well established for patients undergoing colorectal surgery. However, there has been a lack of studies on its use for elderly patients. Our unit implemented the ERAS program in September 2018. The aim of this study is to evaluate the outcome of the ERAS program in patients over 75 years who are undergoing colorectal surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>In this retrospective study, we compared all patients aged 75 and above who were admitted to Queen Elizabeth Hospital for elective colorectal cancer surgery before the implementation of the ERAS program (1 January 2016 to 31 August 2018) with those treated after its implementation (1 April 2019 to March 2022). The primary end point was the post-operative length of stay. The secondary end points were wound infection, retention of urine, pneumonia, deep vein thrombosis, pulmonary embolism, use of total parenteral nutrition, acute coronary syndrome, blood transfusion, reoperation, in-hospital mortality, unplanned readmission within 28 days and Clinical Fragility Score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 258 patients were included. The median length of stay was 8.4 days in the pre-ERAS group vs 6.8 days in the ERAS group. In-patient death (1.4% in the pre-ERAS group vs 0.9% in the ERAS group) and readmission rate (7.7% in the pre-ERAS group vs 12.2% in the ERAS group) were similar between the two groups. About 31.5% of patients in the pre-ERAS group had higher Clinical Fragility Scale post-operatively as compared with 7.8% in the ERAS group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The ERAS program shortened the length of hospital stay by 1.6 days, and patients had lower Clinical Fragility Scale post-operatively. Adverse events were not increased. The ERAS program can be safely applied to elderly patients with colorectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"226-231"},"PeriodicalIF":0.8,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135804730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute appendicitis during the fifth wave of the COVID-19 pandemic in a local cluster: A retrospective cohort study","authors":"M. P. Luk,&nbsp;T. W. Hung,&nbsp;L. M. Yu,&nbsp;M. Y. Kan,&nbsp;C. H. Lau","doi":"10.1111/1744-1633.12651","DOIUrl":"10.1111/1744-1633.12651","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Acute appendicitis is a common surgical emergency. This study aims to determine whether there are any delays in patients attending the emergency department, potentially leading to an increase in the rates of complicated appendicitis and post-operative complications during the fifth wave of the coronavirus disease 2019 (COVID-19) pandemic in a local cluster in Hong Kong.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we analysed 138 patients diagnosed with acute appendicitis during the fifth wave of the COVID-19 pandemic and pre-COVID-19 period. The main study parameters were the duration between the onset of symptoms and attendance to the accident and emergency department, severity of appendicitis, post-operative complication(s), operation time and total hospital length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no delay in presentation between the two groups of patients. The rates of complicated appendicitis and post-operative complications were comparable between the two groups. There was a significantly shorter length of stay for patients with acute appendicitis patients during the fifth wave of the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The perspective of the general public towards the COVID-19 pandemic is changing. Increased understanding of the COVID-19 infection and availability of antiviral medications against COVID-19 could be useful to eliminate patient's anxiety when attending medical care in public hospitals.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"216-220"},"PeriodicalIF":0.8,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82831932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generative artificial intelligence and surgeons","authors":"Paul B. S. Lai","doi":"10.1111/1744-1633.12648","DOIUrl":"https://doi.org/10.1111/1744-1633.12648","url":null,"abstract":"ChatGPT (Chat Generative Pre-trained Transformer) is regarded as the prime mover of the digital revolution. The first version called GPT-1 was released in 2018 and in just a couple of years, the more recent versions have shown the platform to be exponentially powerful. Outside the medical world, the use of generative artificial intelligence (AI) tools is increasingly common in marketing and sales, product and service development, and service operations. AI is also increasingly used in medicine and the application of AI in actual clinical services such as the interpretation of plain chest X-rays or certain pathology settings has opened up new possibilities as well as controversies within the medical profession. Some individuals who have tried ChatGPT consider it to be a slightly more advanced version of a ‘chatbot’, and they have noticed instances where it provides incorrect information or answers. However, a recent cross-sectional study has shown that a chatbot can generate better quality and more empathetic responses to patient questions than real physicians answering questions in an online forum. This editorial is not going to discuss the technical aspects of using ChatGPT or how to write ‘prompts’ that would enhance the ability of ChatGPT to generate something more desirable. Rather, I would like to raise a few possibilities where generative AI could help with surgical training.","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"128-130"},"PeriodicalIF":0.8,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50152874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Practice May 2023 CME for Fellows","authors":"","doi":"10.1111/1744-1633.12644","DOIUrl":"https://doi.org/10.1111/1744-1633.12644","url":null,"abstract":"Questions True False 1. Clinical presentation for pulmonary embolism includes: A. Desaturation ☑ ☐ B. Hypertension ☐ ☑ C. Bradycardia ☐ ☑ D. Chest pain ☑ ☐ E. Haemoptysis ☑ ☐ 2. Risk factors for post-operative pulmonary embolism includes: A. Young age ☐ ☑ B. Malignancy ☑ ☐ C. Post-operative infection ☑ ☐ D. Diabetics ☐ ☑ E. Smoking ☐ ☑ 3. Concerning post-operative pulmonary embolism: A. It has a low mortality rate. ☐ ☑ B. It is a relatively uncommon post-operative complication. ☑ ☐ C. The diagnosis of post-operative pulmonary embolism might be underestimated. ☑ ☐ D. Patients with post-operative pulmonary embolism might be asymptomatic. ☑ ☐ E. Over-treating pulmonary embolism in asymptomatic patients might lead to adverse health consequences including increasing bleeding risk after anticoagulation ☑ ☐","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"197-198"},"PeriodicalIF":0.8,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50152875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Best Original Paper Award","authors":"","doi":"10.1111/1744-1633.12645","DOIUrl":"https://doi.org/10.1111/1744-1633.12645","url":null,"abstract":"Dr Lysander Hin CHAU (Co-authors: Dr Tsui-lin NG, Dr Chi-fai KAN, Dr Chi-hang YEE, Dr Lok-hei LEUNG, Dr Kwok-leung HO, Dr Hing-shing SO, Dr Sau-kwan CHU) from Department of surgery, Urology Division, Tuen Mun Hospital, Tuen Mun, Hong Kong, for their work titled “Radical prostatectomy for prostate cancer: Hong Kong status in the era of Surgical Outcomes Monitoring and Improvement Programme”. The manuscript was published in Volume 26, Issue 2, May 2022, Pages 108–114.","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"127"},"PeriodicalIF":0.8,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50152873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Practice August 2023 CME for Fellows","authors":"","doi":"10.1111/1744-1633.12647","DOIUrl":"https://doi.org/10.1111/1744-1633.12647","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 3","pages":"199-200"},"PeriodicalIF":0.8,"publicationDate":"2023-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50154497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic distal splenopancreatectomy","authors":"Andrea González De Godos,&nbsp;Pablo Marcos Santos,&nbsp;Pilar Pinto Fuentes,&nbsp;David Pacheco Sánchez","doi":"10.1111/1744-1633.12650","DOIUrl":"10.1111/1744-1633.12650","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The use of minimally invasive approaches for pancreaticobiliary surgery has recently gained wider acceptance. Surgical arms with unparalleled flexibility, manual dexterity, 3D imaging and tremor elimination have increased anatomical access and decreased the difficulty of surgery. We describe a case of mucinous cystadenoma treated with robotic distal splenopancreatectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>A 72-year-old woman presented with anorexia, nausea, constipation and weight loss of 9 kg in 3 months. Imaging and histological studies indicated it likely to be a mucinous cystadenoma of the body–tail of the pancreas. Robotic distal splenopancreatectomy was performed with intraoperative identification and splenic artery ligation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The patient made an uneventful recovery and was discharged on postoperative day 7. A pathology study confirmed mucinous cystadenoma with focal low-grade epithelial dysplasia and clear margins.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Robotic distal pancreatectomy is a safe and feasible approach in appropriately selected patients. Although the procedural cost is higher with the robotic approach, some argue that this is balanced by the shorter overall length of stay, thus making robotic distal pancreatectomy a cost-effective option.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"248-249"},"PeriodicalIF":0.8,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73286516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A short report regarding an economic and anatomy-based simulated skin model","authors":"Billy Ho Hung Cheung,&nbsp;Valerie Wai Yee Ho,&nbsp;Kent-Man Chu","doi":"10.1111/1744-1633.12649","DOIUrl":"10.1111/1744-1633.12649","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Conventionally, the Objective Structured Clinical Examination (OSCE) requires the recruitment of patients with appropriate physical signs, which became impossible during the fifth wave of the local COVID-19 pandemic. To host the final OSCE without any actual patients, our department developed a skin model from readily available materials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>One of the final-year surgical OSCE stations focused on the identification and management of benign subcutaneous lesions, including sebaceous cysts (also called epidermal inclusion cysts) and lipomas.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> The design</h3>\u0000 \u0000 <p>The model starts with a low-cost skin model from Limbs &amp; Things (cost: US $6.9–10/piece). The sebaceous cyst model involved dissection of the superficial ‘skin’ flap. The lesion was re-created using gel held by a plastic wall created by a glove fingertip sealed off by silk sutures. Additional modifications were made to the lipoma model to differentiate these two types of lesions. The pass rate in this station was similar to that of actual patients. Assessment of the models by experienced surgeons showed that they were easy to differentiate and suitable for teaching and assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This anatomy-based, low-cost skin model is easily reproducible and might serve as a good adjunct for clinical year teaching and assessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"244-247"},"PeriodicalIF":0.8,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1744-1633.12649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76162638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}