Background
Several challenging clinical situations in patients with peritonitis can result in an open abdomen (OA) and subsequent temporary abdominal closure (TAC). Indications and treatment choices ...differ among surgeons. The risk of fistula development and the possibility to achieve delayed fascial closure differ between techniques. The aim of this study was to review the literature on the OA and TAC in peritonitis patients, to analyze indications and to assess delayed fascial closure, enteroatmospheric fistula and mortality rate, overall and per TAC technique.
Methods
Electronic databases were searched for studies describing the OA in patients of whom 50 % or more had peritonitis of a non-traumatic origin.
Results
The search identified 74 studies describing 78 patient series, comprising 4,358 patients of which 3,461 (79 %) had peritonitis. The overall quality of the included studies was low and the indications for open abdominal management differed considerably. Negative pressure wound therapy (NPWT) was the most frequent described TAC technique (38 of 78 series). The highest weighted fascial closure rate was found in series describing NPWT with continuous mesh or suture mediated fascial traction (6 series, 463 patients: 73.1 %, 95 % confidence interval 63.3–81.0 %) and dynamic retention sutures (5 series, 77 patients: 73.6 %, 51.1–88.1 %). Weighted rates of fistula varied from 5.7 % after NPWT with fascial traction (2.2–14.1 %), 14.6 % (12.1–17.6 %) for NPWT only, and 17.2 % after mesh inlay (17.2–29.5 %).
Conclusion
Although the best results in terms of achieving delayed fascial closure and risk of enteroatmospheric fistula were shown for NPWT with continuous fascial traction, the overall quality of the available evidence was poor, and uniform recommendations cannot be made.
Purpose
Gastrointestinal mesenchymal tumors (GMTs) include malignant, intermediate malignancy, and benign lesions. The aim is to propose a new surgical classification to guide the intraoperative ...minimally invasive surgical strategy in case of non-malignant GMTs less than 5 cm.
Methods
Primary endpoint is the creation of a classification regarding minimally invasive surgical technique for these tumors based on their gastric location. Secondary endpoint is to analyze the R0 rate and the postoperative morbidity and mortality rates. Tumors were classified in two groups based on their morphology (group A: exophytic, group B: transmural/intragastric). Each group is then divided based on the tumor location and consequently surgical technique used in subgroup: AI (whole stomach area) and AII (iuxta-cardial and pre-pyloric areas) both for the anterior and posterior gastric wall; BIa (greater curvature on the anterior and posterior wall), BIb (lesser curvature on the anterior wall); BII (iuxta-cardial and pre-pyloric area in the anterior and posterior wall, including the lesser curvature on the posterior wall).
Results
Forty-two patients were classified and allocated in each subgroup: 17 in AI, 2 in AII, 5 in BIa, 3 in BIb, and 15 in BII. Two postoperative Clavien-Dindo I complications (4.8%, subgroup BIa and BIb) occurred. One patient (2.4%, subgroup AI) underwent reintervention due to R0 resection.
Conclusions
This classification proved to be able to classify gastric lesions based on their morphology, location, and surgical treatment, obtaining encouraging perioperative results. Further studies with wider sample of patients are required to draw definitive conclusions.
Background
The incidence of thyroid cancer is increasing globally. This is mainly due to the increase in the detection of small papillary carcinomas, including papillary microcarcinomas (PMC) 1 cm or ...smaller. It was suggested recently that PMCs are overdiagnosed and overtreated.
Methods
In 1993, the author proposed a clinical trial to compare surgery and observation for low-risk PMC at doctors’ meeting in Kuma Hospital, which was approved and the trial started in the same year. Patients choose immediate surgery or observation. This paper shares our 22-year experience with the active surveillance of more than 2000 patients with low-risk PMC and compares the outcomes of immediate surgery with that of active observation.
Results
The oncological outcomes of these management groups were similarly excellent. In our active surveillance trial on 1235 patients, 8 % of patients showed tumor enlargement by 3 mm or more at 10 years of observation, and 3.8 % of the patients showed novel appearance of lymph node metastasis at 10 years. Patients 40 years or younger tended to show progression of the disease. Patients with these slight progressions of the disease were successfully treated with a rescue surgery. None of the patients in both study groups died of the disease. However, incidences of unfavorable events, such as temporary vocal cord paralysis (VCP) and temporary and permanent hypoparathyroidism, were significantly higher in the immediate surgery group than in the observation group (4.1 vs. 0.6 %,
p
< 0.0001; 16.7 vs. 2.8 %,
p
< 0.0001; and 1.6 vs. 0.08 %,
p
< 0.0001, respectively). Permanent VCP occurred in two of the surgery group.
Conclusions
As a result, although we still offer two options, immediate surgery or observation, to patients with low-risk PMC at Kuma Hospital, we now strongly recommend observation as the best choice.
Background
Endoscopic papillectomy (EP) offers a safe and effective method for resection of ampullary adenomas. Data regarding the long-term resolution of adenoma following EP are limited. The aim of ...this study therefore was to examine the timing of recurrence after EP of ampullary adenomas.
Methods
This was a single-center retrospective study including patients who received EP for ampullary adenomas from 8/2000 to 1/2018. Patients with confirmed complete eradication of adenoma were included in the recurrence analysis with recurrence defined as finding adenomatous histology after 1 negative surveillance endoscopy. Kaplan–Meier estimates were calculated to determine recurrence rates.
Results
Of the 165 patients who underwent EP, 136 patients (mean age 61.9, 51.5% female) had adenomatous histology with a mean lesion size of 21.2 mm. A total of 124 (91.2%) achieved complete eradication with a follow-up of 345.8 person-years. Recurrence occurred in 20 (16.1%) patients at a mean of 3.2 (± 3) years (range 0.5–9.75 years) for a recurrence rate of 5.8 (95% CI 3.6–8.8) per 100 person-years. Nine (45%) recurrences occurred after the 1st 2 years of surveillance. Recurrence rate did not differ by baseline pathology low-grade dysplasia: 5.2 (95% CI 3.0–9.0), high-grade dysplasia: 6.9 (95% CI 2.3–15.5), adenocarcinoma: 7.7 (95% CI 0.9–25.1).
Conclusion
Recurrence remains a significant concern after EP. Given the timing of recurrence, long surveillance periods may be necessary. Larger multicenter studies are needed, however, to determine appropriate surveillance intervals.
Introduction
Papillary thyroid carcinoma (PTC) generally shows an excellent prognosis except in cases with aggressive backgrounds or clinicopathological features. Although the cause-specific survival ...(CSS) of PTC patients has been extensively investigated, the overall survival (OS) of these patients is unclear. We herein investigated both the OS and CSS of a large PTC patient series.
Materials and methods
We enrolled 5897 PTC patients who underwent initial surgery between 1987 and 2005 (658 males and 5339 females; median age 51 years). Their median postoperative follow-up period was 177 months. Univariate and multivariate analyses for OS and CSS assessed the effects of gender, older age (≥55 years), distant metastasis at diagnosis (
M
1), significant extrathyroid extension, tumor size (cutoffs 2 and 4 cm), large node metastasis (
N
≥ 3 cm), and extranodal tumor extension.
Results
To date, 387 patients (7%) in this series have died from various causes, including 117 (2%) due to PTC. The 10-, 15-, and 20-year OS rates are 97, 95, and 90%, respectively. Older age and
M
1 were important prognostic factors for OS and CSS. Older age was a more significant factor than
M
1 for OS and vice versa for CSS. In the older patients,
M
1 was a prominent prognostic factor for both OS and CSS. In the young patients,
M
1 had less prognostic impact than in the older patients, and the prognostic values of
M
1 and
N
≥ 3 cm for OS and CSS were identical and similar, respectively.
Conclusions
The most important prognostic value for OS was patient age, indicating that PTC is generally indolent. However, the control of distant metastasis in older patients remains a future challenge in order to further improve their OS and CSS. PTC of ≥3 cm in young patients should be carefully followed, even in the absence of metastases, and these patients should undergo aggressive therapies for recurrent lesions and metastases.
Intraoperative fluorescence imaging in thoracic surgery Newton, Andrew D.; Predina, Jarrod D.; Nie, Shuming ...
Journal of surgical oncology,
August 1, 2018, 2018-Aug, 2018-08-00, 20180801, Letnik:
118, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Intraoperative fluorescence imaging (IFI) can improve real‐time identification of cancer cells during an operation. Phase I clinical trials in thoracic surgery have demonstrated that IFI with second ...window indocyanine green (TumorGlow®) can identify subcentimeter pulmonary nodules, anterior mediastinal masses, and mesothelioma, while the use of a folate receptor‐targeted near‐infrared agent, OTL38, can improve the specificity for diagnosing tumors with folate receptor expression. Here, we review the existing preclinical and clinical data on IFI in thoracic surgery.
30 Years of Robotic Surgery Leal Ghezzi, Tiago; Campos Corleta, Oly
World journal of surgery,
October 2016, Letnik:
40, Številka:
10
Journal Article
Recenzirano
The idea of reproducing himself with the use of a mechanical robot structure has been in man’s imagination in the last 3000 years. However, the use of robots in medicine has only 30 years of history. ...The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first “robot surgeon” used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of “master–slave” robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, EndoWrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci
®
robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.
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