American journal of surgery最新文献

Total Neoadjuvant Therapy (TNT) is a promising strategy for treating locally advanced rectal cancer (LARC) and has started to replace the traditional neoadjuvant chemoradiotherapy (CRT). This review combines findings from pivotal studies that helped TNT to integrate into clinical practice. It emphasizes the efficacy of TNT in improving the disease-free and metastasis-free survival, pathologic complete response and, according to recent studies, a potential improvement in overall survival when compared to standard CRT. In addition, the review analyzes increased organ preservation by TNT and explores the trend towards personalized medicine with the use of TNT. Additionally, it investigates the possibility of excluding radiotherapy in some subgroups. Future directions include integration of immunotherapy, use of TNT in early-stage disease and determining optimal components of TNT, such as type of chemotherapy and type of radiotherapy.

Background: Mechanically ventilated critically ill patients often develop pleural effusions, which may impact lung compliance and expansion. This systematic review explores the management of pleural effusion in the critically ill population.

Methods: A comprehensive literature search was performed. Quality of evidence rating and recommendation development utilized Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

Results: The full search retrieved 11,965 articles for screening, of which 28 studies ultimately met inclusion criteria. There were 15 cohort studies assessing oxygenation outcome and 17 cohort studies assessing pneumothorax outcome. Patients with drainage (n ​= ​418) had a pooled mean increase in PaO2/FiO2 ratio of 53 (P ​< ​0.00001, 95 ​% CI: 43-64, I² ​= ​0 ​%) compared to pre-drainage/no-drainage (n ​= ​432). In patients with drainage, the combined incidence of pneumothorax was 124/5995 (2.1 ​%).

Conclusion: In mechanically ventilated critically ill adult patients with pleural effusion and hypoxia, we conditionally recommend drainage of pleural effusion to improve oxygenation. P:F ratio <200 and pleural effusion volume estimate >500 ​mL are conditions in which drainage would have most benefit.

Introduction: This study discusses a tertiary trauma center's experience involving traumatic pancreatic injuries, focusing on identification, management, and complications, aiming to provide a valuable contribution to the literature on pancreatic trauma management.

Methods: We conducted a five year (2019-2023) retrospective analysis utilizing trauma registry data to identified pancreatic injuries in tier 1 and 2 activations. Pancreatic Organ Injury Scaling (OIS) and overall injury severity (ISS) was assessed using AAST scoring. Data was stratified by mechanism, management, associated injuries, and outcomes.

Results: Thirty-one patients suffering firearm (48.4 ​%), stabbing (16.1 ​%), or blunt injuries (35.5 ​%) were investigated. Firearms correlated with diaphragm (P ​= ​0.047), stomach (P ​= ​0.001) and intrabdominal injury count (P = 0.0042). Robust trends were found between OIS, ISS, complication, mortality and many alike.

Conclusion: In penetrating injury, increasing ISS and number of intrabdominal injuries should heighten pancreatic trauma suspicion and lower the threshold for surgical exploration, particularly when involving the diaphragm, stomach, transverse colon or spleen.

Background: Nearly a billion people worldwide risk Financial Catastrophe (FC) due to Out-of-Pocket (OOP) health expenditures. With Low-and-Middle-Income Countries (LMICs) disproportionately impacted, and the global burden of colorectal cancer (CRC) expected to increase 60 ​% by 2030, Nigeria is of interest. This study aims to evaluate the cost of treating CRC at Nigeria's first private cancer center.

Methods: The center's cancer registry was queried for CRC diagnosed between 2013 and 2023. Two research assistants in Lagos abstracted treatment costs (adjusted to 2023 USD), demographics and clinical characteristics. FC was defined as OOP >20 ​% of Nigeria's 2023 per-capita GDP ($467).

Results: 92 patients (colon (n ​= ​70), rectum (n ​= ​22), 66 ​% stage 4) were included. Average chemotherapy cost $7,678, procedure cost $1157. Average total cost for multi-therapy, $34,983. All treated patients risked FC. The greatest cost-contributors were chemotherapy (30 ​%) and other drugs (21 ​%). Procedures cost 3 ​%.

Conclusion: CRC treatment increases the risk of FC for nearly all patients. Risk-protection through insurance or financial navigation may be of benefit, and future studies should investigate the impact of these interventions on FC risk.

Background: Obesity is a known risk factor for thromboembolic complications in trauma patients. The aim of our study is to evaluate the prevalence of thrombotic complications in obese geriatric patients.

Methods: We performed a retrospective analysis of TQIP (2017-2019). A total of 119,906 patients≥65 years who sustained severe trauma were included. Primary outcomes were thrombotic complications including stroke/cerebrovascular accidents (CVA), myocardial infarction (MI), deep vein thrombosis (DVT) and pulmonary embolism (PE). Outcomes were compared between patients with obesity (BMI≥30 ​kg∖m²) and overweight (25 ​kg∖m²≤BMI<30 ​kg∖m²) and normal weight (19 ​kg∖m²≤BMI<25 ​kg∖m²) patients.

Results: A total number of 30,356 (26.8 ​%) patients were obese. All clotting complications (stroke/CVA, MI, DVT and PE) were significantly more frequent among obese patients (p ​< ​0.001for all). Multivariate logistic regression showed that obese patients had significantly increased odds of stroke/CVA (OR ​= ​1.207), MI (OR ​= ​1.301), DVT (OR ​= ​1.311) and PE (OR ​= ​1.241) (p ​< ​0.001 for all).

Conclusion: Obese geriatric patients who sustain severe traumatic injuries are at increased risk of thromboembolic complications compared to non-obese patients.

Level of evidence: Level III retrospective study.

Background: Capnography has shown to be an invaluable tool in assessing trauma victims in different setups. To elucidate this, we conducted this meta-analysis to evaluate the utility of end-tidal CO₂ (ETCO₂) and the arterial CO₂ -ETCO₂ gap (PaCO₂-ETCO₂) measurements on predictiveness for mortality in trauma patients.

Methods: A systematic literature search was performed (01/1990-06/2023). The inclusion criteria included adult trauma patients, with mention of mortality. The primary outcome was evaluating the reliability of ETCO₂ in predicting mortality.

Results: Seventeen studies were included, with total of 3445 patients. Mean age was 39.08-year, 22.3 ​% female. Overall mortality was 25.6 ​%, mostly retrospective studies. Mean ETCO₂ in survivors was 31.45 ​mmHg, and 24.75 ​mmHg in deceased patients, (p ​= ​0.0128). Mean PaCO₂-ETCO₂ gap in survivors was 6.8 ​mmHg, and 15.0 ​mmHg in deceased patients, (p ​< ​0.001). Using receiver operator characteristic curve analysis, ETCO₂ of 30.2 ​mmHg with high sensitivity to predict mortality.

Conclusion: Low ETCO₂ or a wide PaCO₂-ETCO₂ gap were significantly correlated with poor outcomes in trauma patients. This easily obtained value can help predict those who need more aggressive treatments.

Background: Colorectal anastomotic devices have been used for nearly a century, with stapled anastomoses being the most common despite leak rates up to 20 ​%. This review aimed to evaluate newer alternative devices.

Method: A systematic review and meta-analysis of publications from the last decade were conducted, focusing on devices forming colorectal anastomoses, excluding those facilitating sutured or stapled anastomoses or designed to prevent leaks. Data from MEDLINE, Embase, Cochrane, and ClinicalTrials.gov were analysed.

Results: Eighteen studies (7 human, 10 animal, 1 ex-vivo) involving 955 anastomoses were included. Compression mechanisms were the most common. The pooled complication rate in human studies was 9.7 ​% (95 ​% CI: 4.3-15.2 ​%) with significant heterogeneity (I2 ​= ​81.7 ​%). The leak rate after compression anastomoses was 3.3 ​% (95 ​% CI: 1.9-4.7 ​%) with no heterogeneity (I2 ​= ​0 ​%). A novel device with transanal catheters allowed intraoperative and postoperative assessment.

Conclusions: Outcomes are comparable to existing methods, with new technologies offering promising advancements.

Background: Ostomates suffer from multiple comorbidities and social stigma, which can be especially debilitating in young patients. TikTok has become a popular platform for this population to establish a community and gain resources. This study aims to characterize intestinal ostomy videos on TikTok.

Methods: The top 50 videos for search terms "ileostomy," "colostomy," "ostomy," and "stoma" were queried on TikTok. Information was compiled regarding the videos' creators, content type, overall sentiment, and viewer engagement.

Results: A total of 113 videos amongst 38 creators garnered 52,021,700 likes and 370,983 comments. Most videos focused on education (45.5%) and personal stories (22.7%). Creators were predominantly young females (82.0%), with minimal input from healthcare professionals (3% of videos). Sixty-nine (61%) of videos had responses with further questions.

Conclusions: Our study reveals a gap between interest and availability of professional educational material regarding intestinal ostomies. Addressing this deficiency may improve patient acceptance, bystander understanding, and its negative stigma.

Background: Over 100 countries do not have a local cardiac surgeon, whereas capacity, coverage, or cultural constrains may limit access to cardiac surgical care in-country. This scoping review aims to summarize the current literature of patients seeking cardiac surgical care abroad and determine research gaps for this understudied aspect of global surgical care.

Methods: A scoping review was conducted on patients seeking cardiac surgery outside of their home country using MEDLINE, EMBASE, CINAHL, SCOPUS, WHO Global Index Medicus, and PubMed databases. Relevant articles were descriptively and quantitatively summarized.

Results: Out of a total of 49 articles and 6351 patients, the most common procedures were coronary artery bypass grafts & valve procedures (N ​= ​3948; 62 ​%) and congenital heart disease repairs (N ​= ​2049; 32 ​%). The most prevalent countries of origin were Japan, Nigeria, and the United Arab Emirates. The United States, France, and the United Kingdom were the most common destination countries. Most patients (N ​= ​1483; 23 ​%) sought care abroad due to limited therapeutic options in the home country. Funding sources stemmed comparably from government funding, non-governmental organization funding, and out-of-pocket payments.

Conclusions: The extent of and reasons for individuals traveling abroad for cardiac surgery are poorly described. Localizing cardiac care, while requiring significant resources, may lead to substantial cost savings and improved access to care. Until then, improving access to international travel for cardiac surgery remains an important strategy.