bluuebunny/crossref_metadata_2025 huggingface dataset:
Robotic versus laparoscopic distal pancreatectomy: multicentre analysis
Authors: Lof S , van der Heijde N , Abuawwad M , Al-Sarireh B , Boggi U , Butturini G , Capretti G , Coratti A , Casadei R , D’Hondt M , Esposito A , Ferrari G , Fusai G , Giardino A , Groot Koerkamp B , Hackert T , Kamarajah S , Kauffmann E F , Keck T , Marudanayagam R , Nickel F , Manzoni A , Pessaux P , Pietrabissa A , Rosso E , Salvia R , Soonawalla Z , White S , Zerbi A , Besselink M G , Abu Hilal M ,   the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS), Botti M , Cacciaguerra A Benedetti , van Dam C , van Dieren S , Ferraro D , French J , Frigerio I , Gonzalez C Alejandro , Hammoda M , Kulkarni R , Mazzola M , Moraldi L , Muller-Stich B P , Napoli N , Nappo G , de Pastena M , Ramera M , Ricci C , Rompianesi G , Sutcliffe R , Wellner U
Published: January 2021

Background

The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP.

Methods

A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien–Dindo grade IIIa or above).

Results

A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225–350) versus 240 (195–300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7–12) versus 7 (6–10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004).

Conclusion

The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
Laparoscopic and open liver resection for hepatocellular carcinoma with Child–Pugh B cirrhosis: multicentre propensity score-matched study
Authors: Troisi R I , Berardi G , Morise Z , Cipriani F , Ariizumi S , Sposito C , Panetta V , Simonelli I , Kim S , Goh B K P , Kubo S , Tanaka S , Takeda Y , Ettorre G M , Russolillo N , Wilson G C , Cimino M , Montalti R , Giglio M C , Igarashi K , Chan C -Y , Torzilli G , Cheung T T , Mazzaferro V , Kaneko H , Ferrero A , Geller D A , Han H -S , Kanazawa A , Wakabayashi G , Aldrighetti L , Yamamoto M
Published: January 2021

Background

Laparoscopic liver resection for hepatocellular carcinoma (HCC) in Child–Pugh A cirrhosis has been demonstrated as beneficial. However, the role of laparoscopy in Child–Pugh B cirrhosis is undetermined. The aim of this retrospective cohort study was to compare open and laparoscopic resection for HCC with Child–Pugh B cirrhosis.

Methods

Data on liver resections were gathered from 17 centres. A 1 : 1 propensity score matching was performed according to 17 predefined variables.

Results

Of 382 available liver resections, 100 laparoscopic and 100 open resections were matched and analysed. The 90-day postoperative mortality rate was similar in open and laparoscopic groups (4.0 versus 2.0 per cent respectively; P = 0.687). Laparoscopy was associated with lower blood loss (median 110 ml versus 400 ml in the open group; P = 0.004), less morbidity (38.0 versus 51.0 per cent respectively; P = 0.041) and fewer major complications (7.0 versus 21.0 per cent; P = 0.010), and ascites was lower on postoperative days 1, 3 and 5. For laparoscopic resections, patients with portal hypertension developed more complications than those without (26 versus 12 per cent respectively; P = 0.002), and patients with a Child–Pugh B9 score had higher morbidity rates than those with B8 and B7 (7 of 8, 10 of 16 and 21 of 76 respectively; P < 0.001). Median hospital stay was 7.5 (range 2–243) days for laparoscopic liver resection and 18 (3–104) days for the open approach (P = 0.058). The 5-year overall survival rate was 47 per cent for open and 65 per cent for laparoscopic resection (P = 0.142). The 5-year disease-free survival rate was 32 and 37 per cent respectively (P = 0.742).

Conclusion

Patients without preoperative portal hypertension and Child–Pugh B7 cirrhosis may benefit most from laparoscopic liver surgery.
Surgical decisions in older women with early breast cancer: patient and disease factors
Authors: Jauhari Y , Gannon M R , Dodwell D , Horgan K , Clements K , Medina J , Cromwell D A
Published: January 2021

Background

Studies reporting lower rates of surgery for older women with early invasive breast cancer have focused on women with oestrogen receptor (ER)-positive tumours. This study examined the factors that influence receipt of breast surgery in older women with ER-positive and ER-negative early invasive breast cancer .

Methods

Women aged 50 years or above with unilateral stage 1–3A early invasive breast cancer diagnosed in 2014–2017 were identified from linked English and Welsh cancer registration and routine hospital data sets. Logistic regression analysis was used to evaluate the influence of tumour and patient factors on receipt of surgery.

Results

Among 83 188 women, 86.8 per cent had ER-positive and 13.2 per cent had ER-negative early invasive breast cancer. These proportions were unaffected by age at diagnosis. Compared with women with ER-negative breast cancer, a higher proportion of women with ER-positive breast cancer presented with low risk tumour characteristics: G1 (20.0 versus 1.5 per cent), T1 (60.8 versus 44.2 per cent) and N0 (73.9 versus 68.8 per cent). The proportions of women with any recorded co-morbidity (13.7 versus 14.3 per cent) or degree of frailty (25 versus 25.8 per cent) were similar among women with ER-positive and ER-negative disease respectively. In women with ER-positive early invasive breast cancer aged 70–74, 75–79 and 80 years or above, the rate of no surgery was 5.6, 11.0 and 41.9 per cent respectively. Among women with ER-negative early invasive breast cancer, the corresponding rates were 3.8, 3.7 and 12.3 per cent. The relatively lower rate of surgery for ER-positive breast cancer persisted in women with good fitness.

Conclusion

The reasons for the observer differences should be further explored to ensure consistency in treatment decisions.
Impact of COVID 19 on the provision of surgical services in Ontario, Canada: population-based analysis
Authors: Gomez D , Dossa F , Sue-Chue-Lam C , Wilton A S , de Mestral C , Urbach D , Baxter N
Published: January 2021

In this population-based analysis, the rate of surgical procedures decreased during the COVID period with hospitals rapidly reducing ambulatory and in-patient elective procedures in response to government directives. However, the observed and unexpected large reduction in urgent surgical procedures highlights the need to prioritize access to care for patients with emergency surgical conditions as part of pandemic planning.
Developing a prioritization model for endoscopy and colorectal cancer 2-week wait referrals during the COVID-19 pandemic—is faecal immunochemical testing the answer?
Authors: Habib Bedwani N , English W , Coda S , Akinlade F , Elzayat I , Seward E W , Hayee B , Hanson M , Banerjee S
Published: January 2021

The COVID-19 pandemic has significantly delayed 2-week wait (2WW) bowel cancer endoscopy. We propose a FIT (Faecal Immunochemical Test) based model to risk-stratify patients for 2WW endoscopy.
Strengths and limitations of video-conference multidisciplinary management of breast disease during the COVID-19 pandemic
Authors: Cathcart P , Smith S , Clayton G
Published: January 2021

MDT participant survey assessing the strength and limitations of video-conferencing for delivering a safe, effective cancer meeting for our patients.
Omission of lateral lymph node dissection in medullary thyroid cancer without a desmoplastic stromal reaction
Authors: Niederle M B , Riss P , Selberherr A , Koperek O , Kaserer K , Niederle B , Scheuba C
Published: January 2021

Background

Medullary thyroid cancer can be subdivided during surgery into tumours with or without a desmoplastic stromal reaction (DSR). DSR positivity is regarded as a sign of disposition to metastasize. The aim of this study was to analyse whether lateral lymph node dissection can be omitted in patients with DSR-negative tumours.

Methods

This was a retrospective cohort study of a prospectively maintained database of patients with medullary thyroid cancer treated using a standardized protocol, and subdivided into DSR-negative and -positive groups based on the results of intraoperative frozen-section analysis. Patients in the DSR-negative group did not undergo lateral lymph node dissection. Long-term clinical and biochemical follow-up data were collected, and baseline parameters and histopathological characteristics were compared between groups.

Results

The study included 360 patients. In the DSR-negative group (17.8 per cent of all tumours) no patient had lateral lymph node or distant metastases at diagnosis or during follow-up, and all patients were biochemically cured. In the DSR-positive group (82.2 per cent of all tumours), lymph node and distant metastases were present in 31.4 and 6.4 per cent of patients respectively. DSR-negative tumours were more often stage pT1a and were significantly smaller. The median levels of basal calcitonin and carcinoembryonic antigen were significantly lower in the DSR-negative group, although when adjusted for T category both showed widely overlapping ranges.

Conclusion

Lymph node surgery may be individualized in medullary thyroid cancer based on intraoperative analysis of the DSR. Patients with DSR-negative tumours do not require lateral lymph node dissection.
Value of a 21-gene expression assay on core biopsy to predict neoadjuvant chemotherapy response in breast cancer: systematic review and meta-analysis
Authors: Boland M R , Al-Maksoud A , Ryan É J , Balasubramanian I , Geraghty J , Evoy D , McCartan D , Prichard R S , McDermott E W
Published: January 2021

Background

A recurrence score based on a 21-gene expression assay predicts the benefit of adjuvant chemotherapy in oestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer. This systematic review aimed to determine whether the 21-gene expression assay performed on core biopsy at diagnosis predicted pathological complete response (pCR) to neoadjuvant chemotherapy.

Methods

The study was performed according to PRISMA guidelines. Relevant databases were searched to identify studies assessing the value of the 21-gene expression assay recurrence score in predicting response to neoadjuvant chemotherapy in patients with breast cancer. The Newcastle–Ottawa Scale was used to assess the quality of the studies. Results are reported as risk ratio (RR) with 95 per cent confidence interval using the Cochrane–Mantel–Haenszel method for meta-analysis. Sensitivity analyses were carried out where appropriate.

Results

Seven studies involving 1744 patients reported the correlation between pretreatment recurrence score and pCR. Of these, 777 patients (44.6 per cent) had a high recurrence score and 967 (55.4 per cent) a low–intermediate score. A pCR was achieved in 94 patients (5.4 per cent). The pCR rate was significantly higher in the group with a high recurrence score than in the group with a low–intermediate score (10.9 versus 1.1 per cent; RR 4.47, 95 per cent c.i. 2.76 to 7.21; P < 0.001). A significant risk difference was observed between the two groups (risk difference 0.10, 0.04 to 0.15; P = 0.001).

Conclusion

A high recurrence score is associated with higher pCR rates and a low–intermediate recurrence score may indicate chemoresistance. Routine assessment of recurrence score by the 21-gene expression assay on core biopsy might be of value when considering neoadjuvant chemotherapy in patients with ER-positive, HER2-negative breast cancer.
Chronic pain after open inguinal hernia repair: expertise-based randomized clinical trial of heavyweight or lightweight mesh
Authors: Rutegård M , Lindqvist M , Svensson J , Nordin P , Haapamäki M M
Published: January 2021

Background

There is a shortage of high-quality studies regarding choice of mesh in open anterior inguinal hernia repair in relation to long-term chronic pain. The authors hypothesized that heavyweight compared with lightweight mesh causes increased postoperative pain.

Methods

An RCT was undertaken between 2007 and 2009 at two sites in Sweden. Men aged 25 years or older with an inguinal hernia evaluated in the outpatient clinic were randomized in an unblinded fashion to heavyweight or lightweight mesh for open anterior inguinal hernia repair. Data on pain affecting daily activities, as measured by the Short-Form Inguinal Pain Questionnaire 9–12 years after surgery, were collected as the primary outcome. Differences between groups were evaluated by generalized odds and numbers needed to treat.

Results

A total of 412 patients were randomized; 363 were analysed with 320 questionnaires sent out. A total of 271 questionnaires (84.7 per cent) were returned; of these, 121 and 150 patients were in the heavyweight and lightweight mesh groups respectively. Pain affecting daily activities was more pronounced in patients randomized to heavyweight versus lightweight mesh (generalized odds 1.33, 95 per cent c.i. 1.10 to 1.61). This translated into a number needed to treat of 7.06 (95 per cent c.i. 4.28 to 21.44). Two reoperations for recurrence were noted in the heavyweight mesh group, and one in the lightweight mesh group.

Conclusion

A large-pore lightweight mesh causes significantly less pain affecting daily activities a decade after open anterior inguinal hernia repair. Registration number: NCT00451893 (http://www.clinicaltrials.gov).
Non-operative treatment of children with simple appendicitis: long-term follow-up (5 years) in a prospective cohort study
Authors: . Knaapen M , Van der Lee J H , Gaillard E L , Cense H A , in ‘t Hof K H , Kneepkens C M F , Wijnen M H , Heij H A , Bakx R , van Heurn L W E , Gorter R R
Published: January 2021

Long-term results after non-operative treatment for children with simple appendicitis seem promising, possibly avoiding appendicectomy in 70 per cent of children after a median follow-up of 5 years. The need for delayed appendicectomy more than 2 years after the initial treatment is rare (0–5 per cent) and no complications occurred past 1 year, including children who underwent delayed appendicectomy.
Randomized clinical trial on closure versus non-closure of mesenteric defects during laparoscopic gastric bypass surgery
Authors: Kristensen S D , Gormsen J , Naver L , Helgstrand F , Floyd A K
Published: January 2021

Background

Internal herniation is a well known and potentially life-threatening complication of laparoscopic Roux-en-Y gastric bypass (LRYGB). The aim of this study was to evaluate the benefit and harm of closing the mesenteric defects with clips during LRYGB to prevent internal herniation.

Methods

This was a single-centre, single-blinded RCT. Patients eligible for LRYGB were randomized to surgery with or without closure of mesenteric defects with clips. The primary endpoint was the incidence of (intermittent) internal herniation after LRYGB with a minimum follow-up of 24 months. Secondary outcomes were duration of surgery, number of clips used, trocars and sutures used, postoperative pain measured by a visual analogue scale (VAS), and postoperative complications.

Results

Between 13 August 2012 and 18 May 2017, 401 patients were randomized to closure (201) or non-closure (200) of mesenteric defects. Median follow-up for both groups was 59 months (range 8–67 and 16–67 months in non-closure and closure groups respectively). The cumulated risk of internal herniation after 2 years was 8.0 per cent in the non-closure group compared with 4.5 per cent in the closure group (hazard ratio (HR) 1.81, 95 per cent c.i. 0.80 to 4.12; P = 0.231). At 5 years, rates were 15.5 and 6.5 per cent respectively (HR 2.52, 1.32 to 4.81; P = 0.005). Closure of mesenteric defects increased operating time by a median of 4 min (95 per cent c.i. 52 to 56 min for the non-closure group and 56 to 60 min for the closure group; P = 0.002). There was no difference in postoperative blood transfusion rates and VAS scores between the groups.

Conclusion

Routine closure of the mesenteric defects in LRYGB with clips is associated with a lower rate of internal herniation. Registration number: NCT01595230 (http://www.clinicaltrials.gov).
Acute kidney injury following endovascular intervention for peripheral artery disease
Authors: Katsogridakis E , Lea T , Yap T , Batchelder A , Saha P , Diamantopoulos A , Saratzis N , Davies R , Zayed H , Bown M J , Saratzis A
Published: January 2021

Background

The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors.

Methods

Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death.

Results

Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality.

Conclusion

AKI is a common complication after intervention for PAD and is associated with medium-term mortality.
Damage control strategies in gallbladder-preserving cholecystolithotomy: from incision to channel establishment to non-invasive procedure
Authors: Liu W H , Ren L N , Huang S Q , Li Z S , Wen X D
Published: January 2021

Damage control strategies for cholecystolithotomy are summarized as incision–suture technique, puncture and channel establishment method, and physiological duct-directed approach. Cultural influence, medical assessment, complications, recurrences, and further direction for cholecystolithotomy are involved.
Does playing video games provide a benefit for acquiring laparoscopic surgical skills?
Authors: Emmanuel S , Badiani S , Wong J , Willcock H , Cash B , Lord R V
Published: January 2021

This study assessed whether playing video games enhanced laparoscopic skill acquisition for preclinical medical students with no past surgical exposure. By the second attempt on a peg transfer task, there was no significant difference in timing between the two groups, indicating that video games did not confer a skill acquisition benefit in the gamer group.
Comment on: Novel approaches to surgical trials and the assessment of new surgical technologies
Authors: El-Hussuna A , Emile S H , Wexner S D
Published: January 2021

Open Source Research
Universal preoperative SARS-CoV-2 testing can facilitate safe surgical treatment during local COVID-19 surges
Authors: Kothari A N , Trans A T , Caudle A S , Clemens M W , Katz M H G , Woodman S E , Chang G J
Published: January 2021

This research letter details the experience of a large cancer center's experience with a universal asymptomatic preoperative SARS-CoV-2 testing program that facilitated safe surgical treatment during a local surge of coronavirus cases. A total of 5,234 asymptomatic tests were performed with a test positivity rate that correlated with the increase in community prevalence of COVID-19 infections. No patients developed a postoperative SARS-CoV-2 infection with no documented patient-to-patient or patient-to-provider spread.
Urogenital function following robotic and laparoscopic rectal cancer surgery: meta-analysis
Authors: Fleming C A , Cullinane C , Lynch N , Killeen S , Coffey J C , Peirce C B
Published: January 2021

Background

Mixed results are reported on clinical and cancer outcomes in laparoscopic rectal cancer surgery (LRCS) compared with robotic rectal cancer surgery (RRCS). However, more favourable functional outcomes are reported following RRCS. This study compared urinary and sexual function following RRCS and LRCS in male and female patients.

Methods

A systematic review and meta-analysis of urinary and sexual function after RRCS and LRCS was performed following PRISMA and MOOSE guidelines, and registered prospectively with PROSPERO (ID:CRD42020164285). The functional outcome reporting tools most commonly included: the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI). Mean scores and changes in mean scores from baseline were analysed using RevMan version 5.3.

Results

Ten studies were included reporting on 1286 patients. Some 672 patients underwent LRCS, of whom 380 (56.5 per cent) were men and 116 (17.3 per cent) were women (gender not specified in 176 patients, 26.2 per cent). A total of 614 patients underwent RRCS, of whom 356 (58.0 per cent) were men and 83 (13.5 per cent) were women (gender not specified in 175 patients, 28.5 per cent). Regarding urinary function in men at 6 months after surgery, IPSS scores were significantly better in the RRCS group than in the LRCS group (mean difference (MD) −1.36, 95 per cent c.i. −2.31 to −0.40; P = 0.005), a trend that persisted at 12 months (MD −1.08, −1.85 to −0.30; P = 0.007). ΔIIEF scores significantly favoured RRCS at 6 months [MD –3.11 (95%CI –5.77, –0.44) P <0.021] and 12 months [MD –2.76 (95%CI –3.63, –1.88) P <0.001] post-operatively. Mixed urinary and sexual function outcomes were reported for women.

Conclusion

This meta-analysis identified more favourable urinary and erectile function in men who undergo robotic compared with conventional laparoscopic surgery for rectal cancer. Outcomes in women did not identify a consistently more favourable outcome in either group. As robotic rectal cancer surgery may offer more favourable functional outcomes it should be considered and discussed with patients.
Outcomes of gallstone complications during the COVID pandemic
Authors: Isherwood J , Karki B , Chung W Y , AlSaoudi T , Wolff J , Malde D , Bhardwaj N , Garcea G , Dennison A R
Published: January 2021

As data and metadata from the SARS-CoV-2 pandemic mature, the true impact on non-cancer, non-emergency surgical practice is becoming apparent. The authors present data on the impact of gallstone disease in their unit during 5 months of the COVID-19 pandemic (March 2020 to August 2020) compared with the equivalent period in 2019. Although the total number of patients presenting with gallstone disease was comparable, there was a decrease in patients with cholecystitis and perforation (although it is possibly too early for these to have presented), and there was a small but worrying increase in patients with gallstone pancreatitis. With the recent increase in alert level to 4 and increased government restrictions in an attempt to avoid a second national lockdown, a consistent national approach is required to mitigate these risks.
Breast cancer surgery in patients with schizophrenia: short-term outcomes from a nationwide cohort
Authors: Konishi T , Fujiogi M , Michihata N , Tanaka-Mizutani H , Morita K , Matsui H , Fushimi K , Tanabe M , Seto Y , Yasunaga H
Published: January 2021

Background

Although patients with schizophrenia have a higher risk of developing breast cancer than the general population, studies that have investigated postoperative complications after breast cancer surgery in patients with schizophrenia are scarce. This study examined associations between schizophrenia and short-term outcomes following breast cancer surgery.

Methods

Patients who underwent surgery for stage 0–III breast cancer between July 2010 and March 2017 were identified from a Japanese nationwide inpatient database. Multivariable analyses were conducted to compare postoperative complications and hospitalization costs between patients with schizophrenia and those without any psychiatric disorder. Three sensitivity analyses were performed: a 1 : 4 matched-pair cohort analysis with matching for age, institution, and fiscal year at admission; analyses excluding patients with schizophrenia who were not taking antipsychotic medication; and analyses excluding patients with schizophrenia who were admitted to hospital involuntarily.

Results

The study included 3660 patients with schizophrenia and 350 860 without any psychiatric disorder. Patients with schizophrenia had a higher in-hospital morbidity (odds ratio (OR) 1.37, 95 per cent c.i. 1.21 to 1.55), with more postoperative bleeding (OR 1.34, 1.05 to 1.71) surgical-site infections (OR 1.22, 1.04 to 1.43), and sepsis (OR 1.20, 1.03 to 1.41). The total cost of hospitalization (coefficient €743, 95 per cent c.i. 680 to 806) was higher than that for patients without any psychiatric disorder. All sensitivity analyses showed similar results to the main analyses.

Conclusion

Although causal inferences remain premature, multivariable regression analyses showed that schizophrenia was associated with greater in-hospital morbidity and higher total cost of hospitalization after breast cancer surgery than in the general population.
Acute appendicitis during the COVID-19 lockdown: never waste a crisis!
Authors: Podda M , Pata F , Pellino G , Ielpo B , Di Saverio S
Published: January 2021

1. Whilst the number of Covid-19 cases increases, fewer patients present with appendicitis to the emergency department, and those who do, present with more advanced disease. 2. These findings are consistent with the hypothesis of a pre-hospital selection, with high rates of successful resolution of uncomplicated appendicitis following patients self-medication with antibiotics at home. 3. Patients admitted with suspected appendicitis during the pandemic are more likely to undergo preoperative imaging, which possibly explains the fall in negative appendectomy rate, especially in the UK.
Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database
Authors: Abdelhamid A , Aspinall S
Published: January 2021

Background

Intraoperative nerve monitoring (IONM) is used increasingly in thyroid surgery to prevent recurrent laryngeal nerve (RLN) injury, despite lack of definitive evidence. This study analysed the United Kingdom Registry of Endocrine and Thyroid Surgery (UKRETS) to investigate whether IONM reduced the incidence of RLN injury.

Methods

UKRETS data were extracted on 28 July 2018. Factors related to risk of RLN palsy, such as age, sex, retrosternal goitre, reoperation, use of energy devices, extent of surgery, nodal dissection and IONM, were analysed. Data with missing entries for these risk factors were excluded. Outcomes of patients who had preoperative and postoperative laryngoscopy were analysed.

Results

RLN palsy occurred in 4.9 per cent of thyroidectomies. The palsy was temporary in 64.6 per cent and persistent in 35.4 per cent of patients. In multivariable analysis, IONM reduced the risk of RLN palsy (odds ratio (OR) 0.63, 95 per cent confidence interval (CI) 0.54 to 0.74, P < 0.001) and persistent nerve palsy (OR 0.47, 0.37 to 0.61, P < 0.001). Outpatient laryngoscopy was also associated with a reduced incidence of RLN palsy (OR 0.50, 0.37 to 0.67, P < 0.001). Bilateral RLN palsy occurred in 0.3 per cent. Reoperation (OR 12.30, 2.90 to 52.10, P = 0.001) and total thyroidectomy (OR 6.52, 1.50 to 27.80; P = 0.010) were significantly associated with bilateral RLN palsy.

Conclusion

The use of IONM is associated with a decreased risk of RLN injury in thyroidectomy. These results based on analysis of UKRETS data support the routine use of RLN monitoring in thyroid surgery.
Patient engagement study to identify and improve surgical experience
Authors: Kennedy E D , McKenzie M , Schmocker S , Jeffs L , Cusimano M D , Pooni A , Nenshi R , Scheer A S , Forbes T L , McLeod R S
Published: January 2021

Background

Patient engagement is the establishment of active partnerships between patients, families, and health professionals to improve healthcare delivery. The objective of this project was to conduct a series of patient engagement workshops to identify areas to improve the surgical experience and develop strategies to address areas identified as high priority.

Methods

Faculty surgeons and patients were invited to participate in three in-person meetings. Evaluation included identifying and developing strategies for three priority areas to improve the surgical experience and level of engagement achieved at each meeting.

Results

Sixteen faculty surgeons and 32 patients participated. Some 63 themes to improve the surgical experience were identified; the three highest-priority themes were physician communication, discharge process, and expectations at home after discharge. Individual improvement strategies for these three prioritized themes (12, 36 and 6 respectively) were used to develop a formal strategic plan, and included a physician communication survey, discharge process worksheet and video, and guideline regarding what to expect at home after discharge. Overall, the level of engagement achieved was considered high by over 85 per cent of the participants.

Conclusion

A high level of patient engagement was achieved. Priorities were identified with patients and surgeons to improve surgical experience, and strategies were developed to address these areas.
Nationwide study of surgery for primary infected abdominal aortic and common iliac artery aneurysms
Authors: Hosaka A , Kumamaru H , Takahashi A , Azuma N , Obara H , Miyata T , Obitsu Y , Zempo N , Miyata H , Komori K ,   the Japanese Society for Vascular Surgery Database Management Committee, Zempo N , Azuma N , Obitsu Y , Shigematsu K , Inoue Y , Okazaki J , Obara H , Satokawa H , Sugimoto I , Banno H , Fujimura N , Hosaka A , Mii S , Morikage N , Yamaoka T
Published: January 2021

Background

Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined.

Methods

A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).

Results

Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).

Conclusion

In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
Cost-effectiveness of immediate total-body CT in patients with severe trauma (REACT-2 trial)
Authors: Treskes K , Sierink J C , Edwards M J R , Beuker B J A , Van Lieshout E M M , Hohmann J , Saltzherr T P , Hollmann M W , Van Dieren S , Goslings J C , Dijkgraaf M G W ,   REACT-2 study group, Luitse J S , Schepers T , Beenen L F M , Tromp T N , Brink M , El Moumni M , Harbers J S , Patka P , den Hartog D , Hagenaars T
Published: January 2021

Background

The effect of immediate total-body CT (iTBCT) on health economic aspects in patients with severe trauma is an underreported issue. This study determined the cost-effectiveness of iTBCT compared with conventional radiological imaging with selective CT (standard work-up (STWU)) during the initial trauma evaluation.

Methods

In this multicentre RCT, adult patients with a high suspicion of severe injury were randomized in-hospital to iTBCT or STWU. Hospital healthcare costs were determined for the first 6 months after the injury. The probability of iTBCT being cost-effective was calculated for various levels of willingness-to-pay per extra patient alive.

Results

A total of 928 Dutch patients with complete clinical follow-up were included. Mean costs of hospital care were €25 809 (95 per cent bias-corrected and accelerated (bca) c.i. €22 617 to €29 137) for the iTBCT group and €26 155 (€23 050 to €29 344) for the STWU group, a difference per patient in favour of iTBCT of €346 (€4987 to €4328) (P = 0.876). Proportions of patients alive at 6 months were not different. The proportion of patients alive without serious morbidity was 61.6 per cent in the iTBCT group versus 66.7 per cent in the STWU group (difference −5.1 per cent; P = 0.104). The probability of iTBCT being cost-effective in keeping patients alive remained below 0.56 for the whole group, but was higher in patients with multiple trauma (0.8–0.9) and in those with traumatic brain injury (more than 0.9).

Conclusion

Economically, from a hospital healthcare provider perspective, iTBCT should be the diagnostic strategy of first choice in patients with multiple trauma or traumatic brain injury.
Micronutrient deficiencies and anaemia in patients after pancreatoduodenectomy
Authors: Latenstein A E J , van Gerven R , Grevers F , Pek C J , Groot Koerkamp B , Hartog H , de van der Schueren M A E , Besselink M G , van Eijck C H J
Published: January 2021

In patients >4 months after PD, deficiencies of iron, ferritin, vitamin A, and vitamin D, and anaemia were common. Future, prospective studies should study determine the impact of standardized laboratory assessments during follow-up and supplementation of deficiencies.
Emergency department utilization by children with general surgical conditions during the COVID-19 pandemic
Authors: Balvardi S , Fiore J , Feldman L S , Emil S , Poenaru D
Published: January 2021

The authors observed a 36 per cent reduction in emergency department utilization by children with general surgical conditions during the first 2 months of the COVID-19 pandemic. In their institutional experience, timely implementation of operative safety protocols centred around universal preoperative COVID-19 testing, which enabled standard-of-care treatment for common paediatric surgical diseases to be upheld during the COVID-19 pandemic.
Transanal mesorectal excision: early outcomes in Australia and New Zealand
Authors: Lau S , Kong J , Bell S , Heriot A , Stevenson A , Moloney J , Hayes J , Merrie A , Eglinton T , Guest G , Clark D , Warrier S
Published: January 2021

Background

Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand.

Methods

Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed.

Results

A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m2. The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months.

Conclusion

This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery.
Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial
Authors: Attaallah Wafi
Published: January 2021

I read the article ‘Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial’ by C. Maulat et al. (1) with great interest.

I wanted to draw attention to certain details. The authors supposed that the use of transcystic drainage during hepatectomy to prevent postoperative biliary fistula is not recommended. However I think that this conclusion has some pitfalls which should be unadertaken to consideration.
Interventions for great saphenous vein reflux: network meta-analysis of randomized clinical trials
Authors: Siribumrungwong B , Wilasrusmee C , Orrapin S , Srikuea K , Benyakorn T , McKay G , Attia J , Rerkasem K , Thakkinstian A
Published: January 2021

Background

A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent.

Methods

A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates.

Results

Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons.

Conclusion

Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.
“Comment on the article titled “Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures” by Elliott JA et al
Authors: Agrawal Vikesh , Sharma Dhananjaya
Published: January 2021

Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality assumes great importance given the gradual re-booting of elective surgeries all over the world. It is interesting to see that laparoscopic surgery may be protective for nosocomial transmission of COVID-19 infection owing to reduced duration of hospital stay. For the same reason, the wider application of enhanced recovery after surgery protocols need to be explored. Additionally, now there is a definite need to differentiate COVID-specific deaths (deaths due to complications of COVID-19) from the COVID-related deaths (deaths due to complications of comorbidity or the surgical disease or surgery itself in a COVID-19 positive patient). This is required to identify the real risk of nosocomial infection and the subsequent mortality in elective surgery during this pandemic.
Comment: COVID-19 outbreak and the practice of surgery: do we need to change?
Authors: Sonmez Kaan , Turkyilmaz Zafer , Karabulut Ramazan , Kaya Cem , Polat Fazli , Pardaz Nassim , Oral Hayrunnisa
Published: January 2021

We aim to relate our practice during the COVID-19 pandemic between March 17 and May 17, 2020 in our pediatric surgery department.
Impact of SARS-CoV-2 on pancreas transplant activity: survey of international surgeons
Authors:   World Pancreas Transplant Covid-19 Collaborative Group, Kamarajah S K , Arbogast H , Berney T , Boggi U , Branchereau J , Socci C , Casanova D , Cooper M , Drage M , Elker D , Ferrer J , Furian L , Gruessner R , Harper S , Kwiatkowski A , Kenmochi T , Manas D , Morelon E , Odorico J , Oellinger R , Oniscu G , Perosa M , Saudek F , Scalea J , Schenker P , Stratta R , Vistulo F , Uva P , White S A
Published: January 2021

This study has identified the need for clear and consistent national or international guidelines to be in place in the event of future pandemics to ensure a standardised level of care for all pancreas transplant patients.
Systematic review on reporting of components and outcomes in randomized clinical trials of paraoesophageal hernia mesh repair
Authors: Currie A C , Penney N , Kamocka A , Singh P , Abbassi-Ghadi N , Preston S R
Published: January 2021

Background

Surgical interventions, such as paraoesophageal hernia (POH) repair, are complex with multiple components that require consideration in the reporting of clinical trials. Many aspects of POH repair, including mesh hiatal reinforcement and fundoplication type, are contentious. This review summarizes the reporting of components and outcomes in RCTs of POH repair.

Methods

Systematic searches identified RCTs of POH repair published from 1995 to 2020. The patient selection criteria for RCT involvement were noted. The components of the surgical interventions in these RCTs were recorded using the CONSORT guidelines for non-pharmacological treatments, Template for Intervention Description and Replication (TIDieR) and Blencowe frameworks. The outcomes were summarized and definitions sought for critical variables, including recurrence.

Results

Of 1918 abstracts and 21 screened full-text articles, 12 full papers reporting on six RCTs were included in the review. The patient selection criteria and definitions of POH between trials varied considerably. Although some description of trial interventions was provided in all RCTs, this varied in depth and detail. Four RCTs described efforts to standardize the trial intervention. Outcomes were reported inconsistently, were rarely defined fully, and overall trial conclusions varied during follow-up.

Conclusion

This lack of detail on the surgical intervention in POH repair RCTs prevents full understanding of what exact procedure was evaluated and how it should be delivered in clinical practice to gain the desired treatment effects. Improved focus on the definitions, descriptions and reporting of surgical interventions in POH repair is required for better future RCTs.
Sexual function, quality of life, and fertility in women who had surgery for neonatal Hirschsprung’s disease
Authors: Davidson J R , Kyrklund K , Eaton S , Pakarinen M P , Thompson D S , Cross K , Blackburn S C , De Coppi P , Curry J
Published: January 2021

The authors explore multi-domain outcomes in a cross-sectional cohort study of patients with Hirschsprung's Disease. They identify hitherto unrecognised issues affecting sexual function and fertility specifically in female patients.
Prognostic grade for resecting hepatocellular carcinoma: multicentre retrospective study
Authors: Takayama T , Yamazaki S , Matsuyama Y , Midorikawa Y , Shiina S , Izumi N , Hasegawa K , Kokudo N , Sakamoto M , Kubo S , Kudo M , Murakami T , Nakashima O ,   the Liver Cancer Study Group of Japan
Published: January 2021

Background

Surgical treatment for hepatocellular carcinoma (HCC) is advancing, but a robust prediction model for survival after resection is not available. The aim of this study was to propose a prognostic grading system for resection of HCC.

Methods

This was a retrospective, multicentre study of patients who underwent first resection of HCC with curative intent between 2000 and 2007. Patients were divided randomly by a cross-validation method into training and validation sets. Prognostic factors were identified using a Cox proportional hazards model. The predictive model was built by decision-tree analysis to define the resection grades, and subsequently validated.

Results

A total of 16 931 patients from 795 hospitals were included. In the training set (8465 patients), four surgical grades were classified based on prognosis: grade A1 (1236 patients, 14.6 per cent; single tumour 3 cm or smaller and anatomical R0 resection); grade A2 (3614, 42.7 per cent; single tumour larger than 3 cm, or non-anatomical R0 resection); grade B (2277, 26.9 per cent; multiple tumours, or vascular invasion, and R0 resection); and grade C (1338, 15.8 per cent; multiple tumours with vascular invasion and R0 resection, or R1 resection). Five-year survival rates were 73.9 per cent (hazard ratio (HR) 1.00), 64.7 per cent (HR 1.51, 95 per cent c.i. 1.29 to 1.78), 50.6 per cent (HR 2.53, 2.15 to 2.98), and 34.8 per cent (HR 4.60, 3.90 to 5.42) for grades A1, A2, B, and C respectively. In the validation set (8466 patients), the grades had equivalent reproducibility for both overall and recurrence-free survival (all P < 0.001).

Conclusion

This grade is used to predict prognosis of patients undergoing resection of HCC.