Annals of surgery最新文献

Objective: To determine the uptake of robotic-assisted bariatric surgery and evaluate its safety compared to the laparoscopic approach.

Summary background data: Use of the robotic-assisted platform for bariatric surgery is increasing, however its comparative safety relative to the laparoscopic approach is unclear.

Methods: This retrospective cohort study included adult patients in a national Medicare claims database who underwent bariatric surgery from January 1, 2012 to December 31, 2020. Instrumental variables analysis was used to assess risk-adjusted outcomes at 90 days, and 1, 3, 5, and 7 years after surgery.

Results: 121,521 patients (mean [SD] age 56.9 [11.7] years; 91,136 [75.0%] female) underwent bariatric surgery during the study period, of whom 74,993 (61.7%) underwent sleeve gastrectomy and 46,528 (38.3%) underwent gastric bypass. Use of robotic-assisted sleeve gastrectomy increased by 250%, from 5.1% to 17.9%, and use of robotic-assisted gastric bypass increased by 361%, from 4.2% to 19.3%. There were no significant differences in 90-day outcomes between the two approaches. At 7 years, there were no significant differences in the adjusted hazard ratio (aHR) of complications, hospitalization, emergency department use, reintervention, or revision between the two approaches. However, compared to the laparoscopic approach, the robotic-assisted approach was associated with a higher 7-year aHR of reoperation for both procedures (sleeve gastrectomy aHR 1.51 [95% CI 1.06-1.97]; gastric bypass aHR 1.58 [95% CI 1.12-2.03]).

Conclusions: In this national cohort, use of robotic-assisted bariatric surgery more than tripled over the last decade, and short- and long-term outcomes were largely equivalent.

Background and aim: Transplantation of livers from donation after circulatory death (DCD) donors is associated with an increased risk of nonanastomotic biliary strictures (NAS). Dual hypothermic oxygenated machine perfusion (DHOPE) of donor livers before transplantation has been shown to reduce the incidence of symptomatic NAS and acute cellular rejection (ACR) within 6 months, but long-term results are unknown. The aim of this study was to assess the 5-year incidence of NAS and ACR in the DHOPE-DCD Trial (ClinicalTrials.gov number NCT02584283).

Methods: Between January 2016 and July 2019 recipients of DCD livers in 6 European centers were randomly assigned to receive that liver either after DHOPE (machine perfusion group) or after conventional static cold storage (control group). Primary endpoint was the incidence of NAS at 5-year follow-up. Secondary endpoints included ACR, graft, and patient survival.

Results: A total of 78 patients were included in the machine perfusion group and 78 patients in the control group. After 5 years of follow-up, the incidence of NAS was significantly lower in the machine perfusion group, compared with control group: 14% versus 26% (hazard ratio: 0.47, 95% CI: 0.23-0.99; P=0.048). In patients with immune-mediated disease, who are at increased risk of ACR, the rate of ACR was significantly lower in the machine perfusion group: 0% versus 32% (P=0.036).

Conclusions: The short-term benefits of DHOPE in DCD liver transplantation persist up to 5-year post-transplant, with significant reductions in incidence of NAS, and ACR in high-risk patients, compared with conventional static cold storage.

Objective: This randomized controlled trial (RCT) compared the impact of high-intensity interval training (HIIT) versus standard care (SC) on preoperative cardiopulmonary fitness in patients before esophageal or lung cancer surgery.

Background: Exercise prehabilitation aims to optimise preoperative condition and attenuate postoperative risks. Although intuitive, defining the optimal training parameters to impact physiologically before surgery with attendant clinical benefit remains challenging.

Methods: Utilising a parallel, 2-armed RCT design, n=79 participants [(mean age (SD): 64 (9.3) years, 67% males] scheduled for curative resection for lung (50.6%) or esophageal (49.6%) cancer with ≥2-weeks preoperative lead-in, were recruited and randomised to HIIT (n=41) or SC (n=38). HIIT was completed on an electronically braked cycle ergometer consisting of 30 minutes of 15-second intervals at 100% peak power output alternating with 15-second active recovery for 5 days/week. The SC arm was offered moderate-intensity exercises 2 to 3 days/week. The primary outcome was peak oxygen consumption (VO 2 peak), measured by cardiopulmonary exercise testing. Secondary outcomes included lower limb strength and physical functioning.

Results: Baseline cardiopulmonary fitness was predominantly very poor [n=75 (95%)]. Adjusting for baseline in a linear model, VO 2 peak increased significantly ( P =0.05) in the HIIT group versus SC (6.6% between-group difference). HIIT increased VO 2 peak from 18.7 (5.0) to 21.7 (5.7) ml/kg/min, whereas with SC it remained unchanged at 19.6 (5.4) to 20.1 (5.7) ml/kg/min from pre-intervention to post-intervention. Sit-to-stand scores were significantly ( P =0.02) improved with HIIT.

Conclusions: HIIT is effective for eliciting meaningful gains in preoperative fitness in a deconditioned cohort within short timeframes.