Annals of Surgical Treatment and Research最新文献

Purpose: We investigated the factors that affect the occurrence of sinusoidal obstruction syndrome (SOS) and the effect of SOS on the patient's perioperative outcomes through histological review of liver resection specimens from patients who underwent chemotherapy.

Methods: From December 2007 to December 2020, liver specimens from patients who underwent liver resection for colorectal liver metastasis after neoadjuvant chemotherapy were analyzed regarding liver damage in the nontumorous lesion. Through pathological review, patients with grade 1-3 sinusoidal dilatation were categorized into the SOS (+) group, compared to a control group (grade 0, SOS [-]).

Results: Of 286 patients, 175 were included. Preoperative factors were similar between the groups. Although not statistically significant, the SOS (+) group had a shorter chemotherapy-free interval before resection (7.96 weeks vs. 10.0 weeks, P = 0.069). The SOS (+) group had higher intraoperative blood loss (889.1 ± 1,126.6 mL vs. 555.3 ± 566.7 mL, P = 0.012) and transfusion rates (46.6% vs. 25.3%, P = 0.003). SOS correlated with increased liver surgery-specific complications (40.9% vs. 26.4, P = 0.043). Patients with SOS experienced adverse effects on intrahepatic recurrent-free survival and overall survival (5-year survival, 46.0% vs. 33.9%; P = 0.014).

Conclusion: SOS development during liver surgery is associated with increased intraoperative blood loss, transfusion volume, and liver surgery-specific complications and has a higher risk of early recurrence and decreased overall survival. Thus, it is crucial to exercise caution during liver surgery in these patients.

Purpose: Laparoscopic cholecystectomy is the gold standard procedure for benign gallbladder disease. However, reducing ports still causes frustration when using various instruments. We investigated early perioperative outcomes of laparoscopic single site + 1 cholecystectomy using ArtiSential instruments (ArtiSential laparoscopic cholecystectomy [ALC], LIVSMED).

Methods: From July 2022 to December 2022, 116 patients underwent ALC in Severance Hospital and Yongin Severance Hospital. From May 2019 to December 2022, 210 patients underwent robotic single-port cholecystectomy (RSPC). We compared clinical characteristics, perioperative outcomes, and postoperative pain scores between the ALC and RSPC groups.

Results: Patients in the ALC group were significantly older than those in the RSPC group (51.9 years vs. 43.9 years, P < 0.001), and the ALC group had a larger proportion of male patients (50.9% vs. 24.8%, P < 0.001) and cases of acute cholecystitis with stones (21.6% vs. 0.5%, P < 0.001) than the RSPC group. The groups did not differ in their estimated blood loss, postoperative complications, or hospital stays. The mean operation time of the ALC group was shorter than that of the RSPC group (56.5 minutes vs. 94.8 minutes, P < 0.001). Although the pain scores reported on discharge day did not differ, the ALC group reported significantly lower immediate postoperative pain scores than the RSPC group (2.7 vs. 5.4, P < 0.001).

Conclusion: ALC is a safe and feasible procedure. ALC patients reported markedly lower immediate postoperative pain scores than RSPC patients, with comparable operative outcomes for estimated blood loss, hospital stay, and postoperative complication rates.

Purpose: Intrahepatic biliary cysts (IBCs) after Kasai portoenterostomy (KPE) are associated with intractable recurrent cholangitis. This study aimed to investigate the feasibility of its use as well as indication for surgical management of IBCs in pediatric patients.

Methods: We retrospectively reviewed the medical records and imaging studies of patients who underwent KPE for biliary atresia from 2010 to 2020.

Results: An imaging study identified IBCs in 28 of 129 patients who underwent KPE with biliary atresia (21.7%). Among them, 5 patients were subjected to surgical treatment for intractable cholangitis. The median time from KPE to the development of IBCs was 1.7 years. Four out of 5 patients had IBCs confined to the left lateral lobe, and in one patient, the IBCs were in the hepatic hilum. All 5 patients experienced more than one cholangitis. Although they received intravenous antibiotic treatment and percutaneous transhepatic cholangiodrainage as treatment, they were intractable. Three patients underwent hepatectomy, and 2 underwent cystojejunostomy. There was no recurrence of cholangitis during the median follow-up period of 2.9 years.

Conclusion: Surgical treatment for IBCs after KPE could be considered a safe and effective surgical procedure for children if appropriate indications are applied.

Purpose: In 2024, South Korea experienced a substantial shortage of medical practitioners, primarily residents and interns, owing to mass resignation from training hospitals. This study aimed to evaluate whether the quality of medical care declined because of this shortage by comparing postoperative complications before and during the period of mass resignation.

Methods: This retrospective observational study assessed patient outcomes among patients with gastric cancer before and during a period of mass resignation at a single tertiary training hospital. Outcomes analyzed included operation duration, length of hospital stays, and complication rates. The effects of the medical crisis on complication rates were analyzed using logistic regression.

Results: A total of 218 and 31 patients underwent surgery during the control and crisis periods, respectively. During the control period, approximately 73 surgeries were performed between February 20 and June 10 each year, which was reduced to 31 during the crisis period. The operation duration (minutes) was 164.5 before the medical crisis and 154.0 during it (P = 0.19). The incidence of postoperative complications before and during the medical crisis was 22.02% (48 of 218) and 9.68% (3 of 31), respectively (P = 0.15). No severe complications (Clavien-Dindo grade ≥IIIa) were observed during the crisis period. Multivariate logistic regression revealed that sex and body mass index were significant variables associated with postoperative complications, but the effects of medical crisis were not.

Conclusion: Despite the medical crisis in South Korea, patient outcomes for gastric cancer surgery were sustained in terms of the frequency of postoperative complications.

Purpose: Improvements in surgical quality and patient safety are critical components of the healthcare system. Despite excellent cancer survival rates in Korea, there is a lack of standardized postoperative complication management systems. To address this gap, the Korean Surgical Society initiated the development of the Korean Quality Improvement Platform in Surgery (K-QIPS) program.

Methods: K-QIPS was successfully launched in 87 general hospitals. This nationwide surgical quality improvement program covers 5 major surgical fields: gastric surgery, colorectal surgery, hepatectomy and liver transplantation, pancreatectomy, and kidney transplantation.

Results: Common and surgery-specific complication platforms will be developed, and the program will work toward the implementation of an artificial intelligence-based complication prediction system and the provision of evidence-based feedback to participating institutions. K-QIPS represents a significant step toward improving surgical quality and patient safety in Korea.

Conclusion: This program aims to reduce postoperative complications, mortality, and medical costs by providing a standardized platform for complication management and prediction. The successful implementation of this nationwide project may provide a good model for other countries that are required to improve surgical outcomes and patient care.

Purpose: Although the breast cancer susceptibility gene (BRCA)-associated invasive breast cancer is well studied, there are limited reports on ductal carcinoma in situ (DCIS) in patients with BRCA1/2 mutations. This study aims to evaluate the differential prognostic effect of DCIS in breast cancer patients with pathologic variants of BRCA1/2 genes.

Methods: Breast cancer patients who tested positive for BRCA1/2 mutations between August 2003 and January 2022 at a single tertiary referral center were retrospectively analyzed. Survival outcomes were compared between patients with both invasive ductal carcinoma (IDC) and DCIS (IDC-DCIS group, n = 121) and those with IDC alone (IDC group, n = 36).

Results: Of the 157 patients, 65 (41.4%) exhibited mutations in BRCA1, 90 (57.3%) in BRCA2, and 2 (1.3%) in both BRCA1/2. DCIS components were more frequently found in BRCA2 pathological variants (BRCA1, 46 [38.0%] vs. BRCA2, 76 [62.4%]; P = 0.030). No statistically significant difference was found in 10-year recurrence-free survival (IDC-DCIS, 89.3% vs. IDC, 83.6%; P = 0.989). Subgroup analysis indicated that the DCIS component correlated with improved survival outcomes in the BRCA1 subgroup (BRCA1 IDC-DCIS, 85.5% vs. BRCA1 IDC, 51.0%; P = 0.024). Conversely, in the BRCA2 subgroup, IDC-DCIS patients exhibited a worse prognosis (BRCA1 IDC-DCIS, 85.5% vs. BRCA2 IDC-DCIS, 65.8%; P = 0.045).

Conclusion: The presence of a DCIS component carries varied prognostic significance in BRCA1 and BRCA2 mutations. A tailored approach may be necessary when determining treatment options for breast cancer patients with BRCA1/2 mutations based on the presence of DCIS.

Purpose: The Vascular Study Group of New England (VSGNE) risk prediction model is a simple method for estimating risk for elective abdominal aortic aneurysm (AAA) repair. The model considers both treatment methods and the physical characteristics of the aneurysm type as well as comorbidities. This research aimed to validate its effectiveness by analyzing retrospective data on Korean patients.

Methods: Our single-center retrospective analysis included 1,227 patients who underwent elective open repair surgery (ORS) or endovascular aortic repair (EVAR) from 2005 to 2021. We assessed the discrimination of the risk score and the effects of several risk factors.

Results: Most patients (66.7%) were classified as low risk in the model, with only 5.6% considered high risk. The mean risk score was 2.81, significantly lower than reported in previous studies. The actual 30-day mortality was only 0.7%, less than the predicted 1.1%. The accuracy of the model in predicting 30-day mortality was statistically significant (area under the curve, 0.822). Patients with high scores were associated with significantly increased mortality (odds ratio, 3.9; P < 0.001). Factors such as advanced age, cerebrovascular disease, and elevated creatinine levels were influential in mortality outcomes. However, a significant difference was not found in short-term mortality between ORS and EVAR.

Conclusion: Although the VSGNE model is an objective tool for assessing death risk in elective AAA repair, the actual risk scores in our patient population were lower than predicted. To create a more representative tool for the Korean population, we suggest developing a novel model based on multicenter data collection.

Purpose: Liver transplantation (LT) in South Korea dates back to 1988. However, Asians may be reluctant to donate their organs because of the influence of their traditional religious and philosophical beliefs. We aimed to investigate the mortality and associated factors among patients admitted after LT in South Korea.

Methods: The South Korean National Health Insurance Service database was used as a data source. All adult patients who underwent LT between January 1, 2017 and December 31, 2021 (5 years) were included in the study.

Results: A total of 7,316 patients were included in the analysis (living donor LT [LDLT], 5,412; deceased donor LT [DDLT], 1,904). The 1-year mortality rate was 12.8% (LDLT, 8.2%; DDLT, 25.9%; P < 0.001), and the postoperative complication rate was 26.8% (LDLT, 16.7%; DDLT, 55.6%; P < 0.001). The average length of hospital stay was 30.8 days, and that in the intensive care unit was 6.1 days. The total mean cost was 69,954 US dollars, and the self-cost was 6,008 US dollars. After adjusting confounders, DDLT (hazard ratio [HR], 2.10; 95% confidence interval [CI], 1.79-5.20; P < 0.001), re-LDLT (HR, 4.82; 95% CI, 3.10-7.40; P < 0.001), re-DDLT (HR, 4.65; 95% CI, 3.55-7.12; P < 0.001), and postoperative complications (HR, 1.72; 95% CI, 1.39-2.12; P < 0.001) were potential risk factors for higher 1-year mortality after transplantation.

Conclusion: LDLT was performed at a higher rate in South Korea and was associated with lower mortality and fewer postoperative complications than DDLT. Redo LT led to higher mortality rates.

Purpose: This study evaluates the knowledge of surgical residents in a tertiary hospital regarding the operational principles, potential complications, and mechanisms of energy devices used in surgery.

Methods: A 16-question test was developed using educational materials in the "Fundamental Use of Surgical Energy (FUSE)" program, prepared by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for educational purposes, and from literature on energy devices. The test was shared online with surgical branch residents via Google Forms, and they were asked to complete it. Participants were given one week to complete the test and return the results online.

Results: A total of 108 residents voluntarily participated in the study. The average number of correct answers was 6.5 out of 16. There was no significant difference between the correct answer rates for surgical branches. However, an increase in surgical seniority was associated with a higher number of correct answers (P < 0.001).

Conclusion: Theoretical education about energy devices in surgical training needs to be improved. Surgical residents reported insufficient knowledge regarding the devices' operational principles and complication mechanisms.

Purpose: This study assessed the efficacy and safety of preoperative chlorhexidine gluconate (CHG) double-cleansing in reducing the incidence of surgical site infections (SSI) in surgical patients in neonatal intensive care units.

Methods: A retrospective chart review involved 56 patients who underwent 73 surgical procedures in the neonatal intensive care unit (NICU) from 2013 to 2022. CHG double-cleansing involves the following 2 processes. Firstly, preoperative cleansing with 0.5% CHG for elective surgeries the night before or at least 1 hour before emergency surgery. The anterior trunk cleansing spanned from the neck to the pubis, including both axillary lines. Secondly, the surgical site underwent skin preparation using 2% CHG with 72% isopropyl alcohol before an incision. A control group (2013-2018) that used iodine and a CHG group (2019-2022) employing CHG double-cleansing were compared. The occurrence of SSIs within 30 days after the surgical procedure was assessed.

Results: The overall SSI rate was 16.4% (n = 12) in the total procedures. The SSI rate was significantly higher (22.6%) in the control group; no SSI occurred in the CHG group (P = 0.029). No significant differences were observed in the other parameters. No adverse effects were observed in the CHG group.

Conclusion: CHG double-cleansing, a modified approach for surgical patients in the NICU, effectively reduced the incidence of SSI compared to traditional iodine-based skin preparations. This study supports the safe use of CHG in neonates, including premature infants, without significant complications.