To compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastases.
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.
Over 24 studies with 8700 patients were analysed. Patients were divided into the neoadjuvant chemotherapy group (n = 3490, 40.1%) and the upfront surgery group (n = 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).
Neoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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