Digestive Surgery最新文献

{"title":"Total Pancreatectomy with \"Superior Mesenteric Artery-First Approach\".","authors":"Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara, Kosei Takagi","doi":"10.1159/000546363","DOIUrl":"10.1159/000546363","url":null,"abstract":"<p><strong>Introduction: </strong>Total pancreatectomy (TP) is a technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) have been reported in pancreatic surgery, few studies have demonstrated surgical techniques of SMA-first approach in TP.</p><p><strong>Methods: </strong>This report presents our novel SMA-first approach for PC in TP, including six steps. First, the resectability was confirmed (step 1). Next, SMA approach was applied (step 2). In this step, the anterior and left sides of the SMA were dissected, and the left renal vein was confirmed. Following retroperitoneal dissection (step 3), the pancreatic body and tail were completely mobilized (step 4). Subsequently, Whipple procedure was performed with lymphadenectomy around the right side of the SMA (step 5). Finally, hepaticojejunostomy and gastrojejunostomy were performed (step 6). Using SMA-first approach, en bloc resection with adequate lymphadenectomy around the SMA and retroperitoneal dissection was performed.</p><p><strong>Conclusion: </strong>The present study presents surgical techniques of TP using the SMA-first approach for PC. This unique approach may be useful to perform TP for PC to obtain negative resection margins.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"155-159"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study.","authors":"David J Nijssen, Wytze Laméris, Quentin Denost, Antonino Spinelli, Eloy Espín-Basany, James Kinross, Jurriaan Tuynman, Roel Hompes","doi":"10.1159/000546041","DOIUrl":"10.1159/000546041","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL.</p><p><strong>Methods: </strong>This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at 1 year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate.</p><p><strong>Conclusion: </strong>The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"185-191"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empiric Antimicrobial Treatment of Anastomotic Leakage after Esophageal Resection: The Most Commonly Used Antimicrobial Regimens in the Netherlands and an Antimicrobial Treatment Recommendation Based on a Single-Center Population.","authors":"Nicole Chatain Lorza, Esther M van Wezel, M H Edwina Doting, Jasper B van Praagh, Jan Willem Haveman","doi":"10.1159/000545046","DOIUrl":"10.1159/000545046","url":null,"abstract":"<p><strong>Introduction: </strong>The development of anastomotic leakage (AL) after esophagectomy is a severe complication, often leading to mediastinitis and systemic infections. Effective empiric antimicrobial therapy is crucial, but there is no consensus on the optimal regimen. This study aimed to document antimicrobial regimens used in the Netherlands and to evaluate culture results from AL after esophagectomy at our center.</p><p><strong>Methods: </strong>An online questionnaire about the preferred antimicrobial treatment of AL after esophagectomy was sent to all upper gastrointestinal surgeons in the Netherlands. In addition, drain culture results from patients with AL after esophagectomy in our center were retrospectively analyzed.</p><p><strong>Results: </strong>From 76 responses, 28 were included, representing 13 of the 15 esophagectomy-performing centers in the Netherlands. For treating AL after esophagectomy, respondents typically choose broad-spectrum regimens covering Gram-negative, Gram-positive, and anaerobic bacteria. The cultures of 57 patients were analyzed. Overall, 61% had positive cultures for yeast, 61% of patients for Enterobacterales, and 16% for Pseudomonas and other non-fermenters.</p><p><strong>Conclusion: </strong>Based on the studied cultures, empiric antibiotics should cover Gram-positive, Gram-negative, anaerobe bacteria and Pseudomonas. We recommend the use of empiric amoxicillin/clavulanic acid with tobramycin for patients with AL after esophagectomy, which is now protocol in our center. The addition of antifungals remains debatable. Given the high incidence of yeast-positive cultures in the studied cohort, we recommend the addition of an echinocandin in clinically unstable patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"68-76"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Factors Influencing Surgical Technique in Hiatal Hernia Repair: In Search for Surgeons' Hidden Algorithm.","authors":"Berdel Akmaz, Amber Hameleers, Sander M J van Kuijk, Jan Willem M Greve, Roy F A Vliegen, Evert-Jan G Boerma, Berry Meesters, Jan H M B Stoot","doi":"10.1159/000545340","DOIUrl":"10.1159/000545340","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic fundoplication is the current standard for HH repair. HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS), or mesh placement. We analyzed the influence of patient factors on the surgical technique for laparoscopic repair in a teaching hospital.</p><p><strong>Methods: </strong>Between 2012 and 2019, all patients who underwent repair of HH were assessed in this retrospective cohort study. HH was measured on CT scans and baseline patient characteristics and surgical details were collected.</p><p><strong>Results: </strong>In total, 307 patients were included. A total of 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients, and mesh in 17 patients. The use of anterior sutures was significantly associated with female gender, higher type of HH, and higher age. The use of VMS during surgery was significantly associated with higher type of HH, higher age, and larger transverse diameter of the HH. The use of mesh during surgery was significantly associated with higher type of HH and larger transverse diameter of the HH.</p><p><strong>Conclusion: </strong>In this retrospective study, the reinforcement techniques used during surgery were significantly associated with patient factors such as gender, body length and weight, type of HH, and transverse diameter. An unexpected patient-associated factor was age.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"127-135"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Return of Gastrointestinal Function after Partial Hepatectomy: A Single-Center Cross-Sectional Study.","authors":"Giulia Piazza, Ismail Labgaa, Emilie Uldry, Emmanuel Melloul, Nermin Halkic, Gaëtan-Romain Joliat","doi":"10.1159/000542028","DOIUrl":"10.1159/000542028","url":null,"abstract":"<p><strong>Introduction: </strong>Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.</p><p><strong>Methods: </strong>This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.</p><p><strong>Results: </strong>A total of 501 patients were included. DRGF occurred in 82 patients (16%). Among DRGF patients, 17% (n = 14) needed a second NGT placement. DRGF incidences were similar before and after Enhanced Recovery after Surgery implementation in 2013 (16/78 = 20% vs. 66/423 = 16%, p = 0.305). A hundred-and-twelve patients (22%) underwent a minimally invasive approach and DRGF incidence was significantly lower in this group (5/112 = 4.5% vs. 77/389 = 19.8%, p < 0.001). DRGF was more frequent after major PH (55/238 = 23% vs. 27/263 = 10%, p < 0.001). DRGF occurred more often in patients with preoperative embolization (26/88 = 30% vs. 55/407 = 14%, p < 0.001), biliary anastomosis (20/48 = 42% vs. 61/450 = 14%, p < 0.001), and extrahepatic resection (37/108 = 34% vs. 45/393 = 11%, p < 0.001). Patients with DRGF had longer median operation duration (374 vs. 263 min, p < 0.001), more biliary leaks/bilomas (27/82 = 33% vs. 33/419 = 7.9%, p < 0.001), and higher median blood loss (1,088 vs. 701 mL, p < 0.001). DRGF patients developed more pneumonia (14/22 = 64% vs. 8/22 = 36%, p < 0.001) and had longer median length of stay (19 vs. 8 days, p < 0.001). On multivariable analysis, operation duration (OR 1.005, 95% CI: 1.002-1.008, p < 0.001), major hepatectomy (OR 3.606, 95% CI: 1.931-6.732), and postoperative biloma/biliary leak (OR 6.419, 95% CI: 3.019-13.648, p < 0.001) were independently associated with DRGF occurrence.</p><p><strong>Conclusion: </strong>Postoperative DRGF occurred in 16% of the patients and was associated with a longer length of stay. Surgery duration, major PH and postoperative biloma/biliary leak were found as independent predictors of DRGF.</p><p><strong>Introduction: </strong>Partial hepatectomy (PH) remains associated with complication rates around 30-50%. Delayed return of gastrointestinal function (DRGF) has been reported in 10-20%. This study aimed to assess DRGF predictors after PH.</p><p><strong>Methods: </strong>This study included all consecutive adult patients undergoing PH between January 01, 2010, and December 12, 2019. DRGF was defined as the need for postoperative nasogastric tube (NGT) insertion. Patients leaving the operation room with a NGT were excluded. Independent DRGF predictors were identified with multivariable logistic binary regression.</p><p><strong>Results: </strong>A","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"9-16"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratumoral Holmium-166 Microsphere Injection in Patients with Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Center, Single-Arm, Open-Label Feasibility and Safety Study.","authors":"C Ysbrand Willink, Sjoerd F M Jenniskens, Martijn W J Stommel, Marcel J R Janssen, John J Hermans, Harm Westdorp, Cornelis J H M van Laarhoven, Jurgen J Fütterer, J Frank W Nijsen","doi":"10.1159/000545246","DOIUrl":"10.1159/000545246","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and lacks local treatment options. This study aimed to assess the feasibility and safety of the first-in-human intraoperative ultrasound-guided intratumoral injection of radioactive holmium-166 microsphere in patients with PDAC.</p><p><strong>Methods: </strong>Patients with proven PDAC eligible for open surgical resection were included. If resection was abandoned during exploration, study intervention was performed. Feasibility was defined by injection success and on-/off-target radiation. Safety was based on adverse event (AE) monitoring for 12 weeks categorized by severity grade and study attribution.</p><p><strong>Results: </strong>Three of the thirteen included patients received study intervention. Injection was successful in all 3 patients. Mean tumor doses of 5.0, 17.0, and 39.0 Gy and maximum tumor doses of 25.0, 41.0 and 256.0 Gy were achieved. Off-target radiation was found once in the lungs and once in the colon with a mean dose <1.0 Gy. There were no AEs with high study attribution, 16, 14, and 19 AEs with low study attribution, including 3, 2, and 4 AEs with grade ≥3. Holmium-166 microspheres appeared hyperdense on CT.</p><p><strong>Conclusion: </strong>Intratumoral injection of holmium-166 microspheres in patients with unresectable PDAC seems feasible and safe. Research into minimally invasive image-guided application is advised.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"136-145"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-Assisted Minimally Invasive Esophagectomy: Current Best Practice.","authors":"Cezanne D Kooij, Lucas Goense, B Feike Kingma, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1159/000546749","DOIUrl":"10.1159/000546749","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy, the cornerstone in the multimodal treatment of esophageal cancer, has evolved from open surgery to minimally invasive esophagectomy (MIE) in recent decades. MIE reduces complications, facilitates faster recovery, and provides comparable or superior oncologic outcomes and survival rates compared to open surgery.</p><p><strong>Summary: </strong>Since the early 2000s, robot-assisted minimally invasive esophagectomy (RAMIE) has emerged, offering enhanced precision over MIE through features such as three-dimensional visualization, improved instrument dexterity, tremor filtration, and motion scaling. These innovations help overcome the challenges of MIE, particularly in the thoracic phase, where limited access and reduced instrument dexterity hamper the procedure. RAMIE is associated with lower complication rates, particularly pulmonary complications, improved recovery, and comparable oncological outcomes. Despite higher initial costs, its potential to reduce complications makes it financially comparable to other approaches. Moreover, mastering RAMIE requires navigating a significant learning curve, making collaboration and training vital. The integration of artificial intelligence and advancements in robotic platforms, including single-port systems, will broaden patient eligibility and improve outcomes.</p><p><strong>Key messages: </strong>RAMIE has established itself as an integral part of modern surgical practice and will continue to evolve, driving further innovation. Collaboration and training are essential for refining techniques and ensuring safe and effective implementation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"204-212"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PhotoNodes Protocol: A Multicenter Prospective Study for the Assessment of Proper Lymphadenectomy in Minimally Invasive Gastric Cancer Surgery Using Intraoperative Photographs.","authors":"Federico Marchesi, Marina Valente, Simone Giacopuzzi, Gian Luca Baiocchi, Paolo Morgagni, Lorena Torroni, Giorgio Dalmonte","doi":"10.1159/000545846","DOIUrl":"10.1159/000545846","url":null,"abstract":"<p><strong>Introduction: </strong>In gastric cancer surgery, an adequate D2 lymphadenectomy is associated with improved cancer-specific survival. The aim of this study was to test the reliability of a new score (PhotoNodes Score [PNS]) conceived to rate the quality of lymphadenectomy in minimally invasive gastrectomy. The primary outcome of the study was to assess the inter-observer agreement among the reviewers assigning the score. The secondary outcome was the association between PNS and survival.</p><p><strong>Methods: </strong>This is a multicentric observational prospective study enrolling patients undergoing minimally invasive gastrectomy for gastric cancer with D2 lymphadenectomy. A set of laparoscopic/robotic images will be collected from each patient. Based on each set of images, the quality of lymphadenectomy performed will be rated with the new PNS by three surgeons. Fleiss' Kappa measure of agreement will be used to study the rating agreement among examining surgeons. The PNS score will correlate with disease-free and overall survival.</p><p><strong>Conclusion: </strong>The spread of minimally invasive approaches in oncologic gastric surgery made the collection of intraoperative images easier; for this reason, we believe that PNS could represent a new and efficient tool to assess the quality of D2 lymphadenectomy in clinical practice. The PhotoNodes study was registered at <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> #NCT06466902.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"146-151"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer Term Outcomes of Laparoscopic Peritoneal Lavage in the Management of Acute Hinchey III Perforated Diverticulitis: A Systematic Review and Meta-Analysis.","authors":"David Sciascia, Paul Neary, Shaheel Sahebally, Maria Whelan, Cillian Clancy, James Michael O Riordan, Alwaleed Abdelgadir, Dara Oliver Kavanagh","doi":"10.1159/000543241","DOIUrl":"10.1159/000543241","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to investigate the current evidence regarding long-term outcomes using laparoscopic peritoneal lavage (LPL) versus primary bowel resection (PR) in Hinchey III diverticulitis.</p><p><strong>Methods: </strong>A systematic review was undertaken based upon articles published between January 1, 2000, and March 1, 2024. Databases Pubmed, Scopus, and Embase were used employing the key search terms \"Diverticulitis\" and \"Peritoneal Lavage.\" Articles were selected according to the PRISMA guidelines and statistical analysis was undertaken. Cumulative analysis of diverticulitis recurrence and secondary outcomes of disease-related mortality, serious adverse events, stoma incidence, reoperation, and readmission rates were performed.</p><p><strong>Results: </strong>An initial search identified 506 articles for review. A total of 294 patients were included for final analysis from 3 prospective randomized controlled trials. There was no significant difference in disease-related mortality or serious adverse events between LPL and PR. There was significantly decreased likelihood of having a stoma in the LPL group; however, there was also a significantly increased likelihood of having recurrent diverticulitis. There was heterogenicity across all trials.</p><p><strong>Conclusion: </strong>There is a paucity of level 1 evidence available regarding the long-term outcomes of Hinchey III diverticulitis managed with LPL. At 3-year follow-up, there is a significantly decreased likelihood of having a stoma, tempered by the fact that there is a significantly increased likelihood of having recurrent diverticulitis. Further homogenous high-quality randomized studies are required to clarify whether LPL shows long-term benefit over PR.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"36-47"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142902716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialist-Delivered Colonic Cancer Surgery in the Irish Model 3 Hospital: A Single-Centre Experience.","authors":"Patrick Anthony Boland, Enda Hannan, Gareth Murray, Kin Yik Chan, Desmond P Toomey","doi":"10.1159/000545434","DOIUrl":"10.1159/000545434","url":null,"abstract":"<p><strong>Introduction: </strong>The proposed centralisation of colonic cancer surgery (CCS) to dedicated cancer centres may overburden such units while removing the opportunity for patients to receive treatment locally. This study presents outcomes of patients undergoing CCS in a regional hospital by a fellowship-trained colorectal surgeon.</p><p><strong>Methods: </strong>Demographic, perioperative, postoperative, and oncological outcomes for 50 successive patients who underwent CCS in a regional hospital were collected. Outcomes were compared to colorectal cancer key performance indicators and textbook outcomes.</p><p><strong>Results: </strong>Fifty patients (56% male) were identified, of whom 41 (82%) underwent elective surgery. The median follow-up was 49 months. Operations performed included 31 (62%) right hemicolectomies, 18 (36%) high anterior resections, 1 (2%) subtotal colectomy, and 1 (2%) low anterior resection. The majority (64%, n = 32) were completed laparoscopically. Anastomotic leak rate was 4.3% (n = 2). The major morbidity rate (Clavien-Dindo ≥III) was 14% (n = 7). Readmission, reoperation, and mortality at 30 days were 0%, 8%, and 0%, respectively. The R0 resection rate was 98% with a median lymph node yield of 20. Textbook outcome was achieved in 27 patients (54%). Overall survival at 1, 3, and 5 years was 96%, 77%, and 77%, respectively. Disease-free survival at 1, 3, and 5 years was 86%, 77%, and 75%.</p><p><strong>Conclusion: </strong>CCS can be delivered safely and effectively in regional hospitals under the care of appropriately supported subspecialists. Both patient and healthcare system benefit from the delivery of high-quality oncological surgery locally, reducing the burden on tertiary centres. The projected doubling of colorectal cancer cases by 2040 requires appropriate utilisation of available resources.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"105-115"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}