Ejso最新文献

{"title":"Histopathological outcomes of transanal, robotic, open, and laparoscopic surgery for rectal cancer resection. A Bayesian network meta-analysis of randomized controlled trials.","authors":"Nicola de'Angelis, Carlo Alberto Schena, Danila Azzolina, Maria Clotilde Carra, Jim Khan, Caroline Gronnier, Sébastien Gaujoux, Paolo Pietro Bianchi, Antonino Spinelli, Philippe Rouanet, Aleix Martínez-Pérez, Patrick Pessaux","doi":"10.1016/j.ejso.2024.109481","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109481","url":null,"abstract":"<p><strong>Background: </strong>While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.</p><p><strong>Materials and methods: </strong>MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024. Of the 4186 articles screened, 27 RCTs were selected. Pairwise comparisons and Bayesian network meta-analyses applying random effects models were performed.</p><p><strong>Results: </strong>The 27 RCTs included a total of 8696 patients. Bayesian pairwise meta-analysis revealed significantly lower odds of non-complete mesorectal excision with Ta-RR (Odds Ratio, OR, 0.60; 95%CI, 0.33, 0.92; P = .02; I²:11.7 %) and R-RR (OR, 0.68; 95%CI, 0.46, 0.94; P = .02; I²:41.7 %) compared with laparoscopy. Moreover, lower odds of positive CRMs were observed in the Ta-RR group than in the L-RR group (OR, 0.36; 95%CI, 0.13, 0.91; P = .02; I²:43.9 %). The R-RR was associated with more lymph nodes harvested compared with L-RR (Mean Difference, MD, 1.24; 95%CI, 0.10, 2.52; P = .03; I²:77.3 %). Conversely, Ta-RR was associated with a significantly lower number of lymph nodes harvested compared with all other approaches. SUCRA plots revealed that Ta-RR had the highest probability of being the best approach to achieve a complete mesorectal excision and negative CRM, followed by R-RR, which ranked the best in lymph nodes retrieved.</p><p><strong>Conclusion: </strong>When comparing the effectiveness of the available surgical approaches for rectal cancer resection, Ta-RR and R-RR are associated with better histopathological outcomes than L-RR.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109481"},"PeriodicalIF":3.5,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for surgical site infections following hepatobiliary surgery: An umbrella review and meta-analyses","authors":"Madeline Bone (PhD Candidate) ,&nbsp;Sharon Latimer ,&nbsp;Rachel M. Walker ,&nbsp;Lukman Thalib ,&nbsp;Brigid M. Gillespie","doi":"10.1016/j.ejso.2024.109468","DOIUrl":"10.1016/j.ejso.2024.109468","url":null,"abstract":"<div><h3>Background</h3><div>In the hepatobiliary (HPB) surgical cohort, surgical site infections (SSI) can extend hospital stays, result in higher morbidity, and poor patient outcomes. This umbrella review and meta-analysis aimed to synthesise the evidence for the association between clinical and patient risk factors and SSI in patients following HPB surgery.</div></div><div><h3>Methods</h3><div>We searched MEDLINE, CINAHL, EMBASE and Scopus from January 2000 to April 2023 to identify systematic reviews and meta-analyses where patient and/or clinical factors of SSIs following HPB surgery were reported. The summary effect size, its 95 % CI and the 95 % PI were calculated for each meta-analysis using random-effects models. 30-day cumulative SSI incidence was presented as the pooled estimate with 95 % CIs. Between-study heterogeneity was explored using the <em>I</em>^<em>2</em> statistic.</div></div><div><h3>Results</h3><div>Nine systematic reviews and meta-analyses were included. Our findings suggest open surgical approach, type of pancreas procedure, preoperative biliary drainage, older age, male sex and high BMI (&gt;25mg/k²) as statistically significant factors for increasing a patient's risk of SSI following HPB surgery. The cumulative incidence of SSI in the HPB cohort of 43,296 was 11 % (95 % CI 6%–20 %), with substantial variation between the reviews.</div></div><div><h3>Conclusion</h3><div>We identified several patient and clinical factors, however only one was graded as a high level of evidence.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 109468"},"PeriodicalIF":3.5,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"The mode of circumferential margin involvement in rectal cancer determines its impact on outcomes: A population-based study\".","authors":"Chong-Jie Zhang","doi":"10.1016/j.ejso.2024.109458","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109458","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109458"},"PeriodicalIF":3.5,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of diaphragm with cadaveric fascia lata during extended surgery for pleural mesothelioma: A single-center experience","authors":"Eleonora Faccioli ,&nbsp;Giovanni Zambello ,&nbsp;Diletta Trojan ,&nbsp;Gianluca Canu ,&nbsp;Viola Sambataro ,&nbsp;Chiara Giraudo ,&nbsp;Marco Schiavon ,&nbsp;Andrea Dell’Amore ,&nbsp;Federico Rea","doi":"10.1016/j.ejso.2024.109480","DOIUrl":"10.1016/j.ejso.2024.109480","url":null,"abstract":"<div><h3>Introduction</h3><div>Synthetic materials have traditionally been used to reconstruct the diaphragm during extensive surgery for pleural mesothelioma. However, new biomaterials have shown promising results in various surgical fields. This study describes our experience using homologous fascia lata for diaphragm reconstruction in patients undergoing surgery with radical intent for pleural mesothelioma.</div></div><div><h3>Material and methods</h3><div>Data from patients who underwent extensive surgery for pleural mesothelioma requiring diaphragm reconstruction from January 2021 to December 2023 were extracted and analyzed. Patients were divided in two groups based on the type of material used for diaphragm reconstruction: expanded polytetrafluoroethylene (ePTFE) and cadaveric homologous fascia lata.</div></div><div><h3>Results</h3><div>Forty-three consecutive patients were included in the analysis. Of these, 22 patients (51 %) underwent diaphragm reconstruction with expanded ePTFE prostheses, while 21 patients (49 %) had reconstruction using homologous fascia lata. No significant differences were found between the two groups in terms of in-hospital stay (14.5 vs 17 days, p = 0.865) and early post-operative complications (19 % vs 18 %, p = 0.943). Concerning long-term complications, a lower rate was found in the group treated with fascia lata (5 % vs 23 %, p = 0.09).</div></div><div><h3>Conclusions</h3><div>Diaphragm reconstruction using cadaveric homologous fascia lata after extended surgery for pleural mesothelioma is feasible and results in satisfactory post-operative outcomes. Although the trend suggests fewer long-term complications with fascia lata, further research is needed to confirm these findings and determine the ideal prosthetic material for diaphragm reconstruction.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 109480"},"PeriodicalIF":3.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in health-related quality of life following breast cancer surgery: A systematic review of the literature on the role of surgical approaches.","authors":"Theodora Fteropoulli, Eleni Tzounaka, Aliya Amirova, Georgios Nikolopoulos, Anneza Yiallourou","doi":"10.1016/j.ejso.2024.109467","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109467","url":null,"abstract":"<p><strong>Background: </strong>This systematic review aimed to examine changes in health-related quality of life (HRQoL) in women with breast cancer from pre-to post surgery, comparing mastectomy (M), mastectomy with breast reconstruction (MBR), and breast conserving surgery (BCS).</p><p><strong>Methods: </strong>We included English-language randomised and non-randomised controlled trials and observational studies involving adult women, pre-operatively diagnosed with breast cancer (excluding metastatic cases). Studies needed to assess HRQoL pre- and post-surgery using validated questionnaires and include women undergoing M, MBR, and BCS. Searches in six electronic databases were supplemented by checking reference lists. Two independent researchers conducted the article selection, data extraction, and quality assessment. Narrative synthesis included categorisation of HRQoL in physical and psychosocial HRQoL domains with calculation and interpretation of minimally important differences (MID).</p><p><strong>Results: </strong>Six prospective studies of fair quality (n = 172 to n = 1178, follow-up: 1-120 months) were included. By 24 months, HRQoL, anxiety, and depression either returned to pre-surgery levels or improved for all surgical groups, with comparable outcomes. Physical HRQoL deteriorated following MBR and BCS at 6 months and 12 months post-surgery, respectively, while poor psychosocial HRQoL was prominent following M at 12 months. MBR fared worse in anxiety and depression compared with the other groups.</p><p><strong>Discussion: </strong>HRQoL challenges are evident following all surgical approaches, albeit at different timepoints along the treatment pathway. The evidence is limited due to a small number of studies and considerable methodological variation. Systematic assessment of HRQoL in routine care is recommended to monitor trajectories throughout the care pathway and guide psychological interventions.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109467"},"PeriodicalIF":3.5,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative prediction of post hepatectomy liver failure after surgery for hepatocellular carcinoma on CT-scan by machine learning and radiomics analyses.","authors":"Simone Famularo, Cesare Maino, Flavio Milana, Francesco Ardito, Gianluca Rompianesi, Cristina Ciulli, Simone Conci, Anna Gallotti, Giuliano La Barba, Maurizio Romano, Michela De Angelis, Stefan Patauner, Camilla Penzo, Agostino Maria De Rose, Jacques Marescaux, Michele Diana, Davide Ippolito, Antonio Frena, Luigi Boccia, Giacomo Zanus, Giorgio Ercolani, Marcello Maestri, Gian Luca Grazi, Andrea Ruzzenente, Fabrizio Romano, Roberto Ivan Troisi, Felice Giuliante, Matteo Donadon, Guido Torzilli","doi":"10.1016/j.ejso.2024.109462","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109462","url":null,"abstract":"<p><strong>Introduction: </strong>No instruments are available to predict preoperatively the risk of posthepatectomy liver failure (PHLF) in HCC patients. The aim was to predict the occurrence of PHLF preoperatively by radiomics and clinical data through machine-learning algorithms.</p><p><strong>Materials and methods: </strong>Clinical data and 3-phases CT scans were retrospectively collected among 13 Italian centres between 2008 and 2022. Radiomics features were extracted in the non-tumoral liver area. Data were split between training(70 %) and test(30 %) sets. An oversampling was run(ADASYN) in the training set. Random-Forest(RF), extreme gradient boosting (XGB) and support vector machine (SVM) models were fitted to predict PHLF. Final evaluation of the metrics was run in the test set. The best models were included in an averaging ensemble model (AEM).</p><p><strong>Results: </strong>Five-hundred consecutive preoperative CT scans were collected with the relative clinical data. Of them, 17 (3.4 %) experienced a PHLF. Two-hundred sixteen radiomics features per patient were extracted. PCA selected 19 dimensions explaining >75 % of the variance. Associated clinical variables were: size, macrovascular invasion, cirrhosis, major resection and MELD score. Data were split in training cohort (70 %, n = 351) and a test cohort (30 %, n = 149). The RF model obtained an AUC = 89.1 %(Spec. = 70.1 %, Sens. = 100 %, accuracy = 71.1 %, PPV = 10.4 %, NPV = 100 %). The XGB model showed an AUC = 89.4 %(Spec. = 100 %, Sens. = 20.0 %, Accuracy = 97.3 %, PPV = 20 %, NPV = 97.3 %). The AEM combined the XGB and RF model, obtaining an AUC = 90.1 %(Spec. = 89.5 %, Sens. = 80.0 %, accuracy = 89.2 %, PPV = 21.0 %, NPV = 99.2 %).</p><p><strong>Conclusions: </strong>The AEM obtained the best results in terms of discrimination and true positive identification. This could lead to better define patients fit or unfit for liver resection.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109462"},"PeriodicalIF":3.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142727102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and oncologic outcomes for liver resections of cystic neuroendocrine tumor liver metastasis.","authors":"Markus Ammann, Stella K Adjei Antwi, Hallbera Gudmundsdottir, Hubert Hackl, Jonas Santol, Benedetto E Guillot, Giulia Pappalettera, Cornelius A Thiels, Susanne G Warner, Mark J Truty, Michael L Kendrick, Rory L Smoot, David M Nagorney, Sean P Cleary, Thorvardur R Halfdanarson, Patrick P Starlinger","doi":"10.1016/j.ejso.2024.109464","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109464","url":null,"abstract":"<p><strong>Background: </strong>Cystic neuroendocrine tumor liver metastases (NETLM) are rare and dynamics in the liquid compartment often misinterpreted as rapid progression, affecting selection for liver resection candidates. This study retrospectively evaluates surgical and oncologic outcomes in patients with cystic versus solid NETLM from small bowel and pancreatic primaries.</p><p><strong>Methods: </strong>Between 2000 and 2020, 12 patients with cystic NETLM were identified among 464 patients who underwent >90 % tumor cytoreduction debulking hepatectomy at the Mayo Clinic. Tumor and patient characteristics, as well as surgical and oncologic outcomes, were compared with the total cohort of patients with solid NETLM, including a propensity-matched cohort.</p><p><strong>Results: </strong>Patients with cystic NETLM were similar in age (55.4 vs. 59.7 years; p = 0.113) and sex (58 % vs. 51 % men; p = 0.772) to those with solid NETLM. Synchronous metastases (92 % vs. 77 %; p = 0.314), bilobar distribution (83 % vs. 79 %; p = 1.000), lesion numbers (p = 0.547), Ki67 % expression (p = 0.311), and extrahepatic lesions (8 % vs. 18 %; p = 0.702) were similar. Cystic metastases were larger (7.3 vs. 3.8 cm; p < 0.001). Surgical risk did not differ, with major morbidity (25 % vs. 22 %; p = 0.729) and mortality (0 % vs. <2 %; p = 1.000). Median overall survival (OS) was 13.8 vs. 10.6 years (p = 0.513), and hepatic-progression-free survival (PFS) was 0.71 vs. 1.78 years (p = 0.507). Matched cohorts showed no significant difference in OS (13.80 vs. 8.57; p = 0.316) or hepatic-PFS (0.71 vs. 1.33; p = 0.620).</p><p><strong>Conclusion: </strong>Surgical risk and long-term outcomes do not significantly differ between cystic and solid NETLMs. Given excellent long-term survival rates with >90 % cytoreduction, radical debulking is advised for both phenotypes when clinically feasible.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109464"},"PeriodicalIF":3.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response prediction for neoadjuvant treatment in locally advanced rectal cancer patients-improvement in decision-making: A systematic review.","authors":"Luca Boldrini, Diepriye Charles-Davies, Angela Romano, Matteo Mancino, Ilaria Nacci, Huong Elena Tran, Francesco Bono, Edda Boccia, Maria Antonietta Gambacorta, Giuditta Chiloiro","doi":"10.1016/j.ejso.2024.109463","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109463","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Predicting pathological complete response (pCR) from pre or post-treatment features could be significant in improving the process of making clinical decisions and providing a more personalized treatment approach for better treatment outcomes. However, the lack of external validation of predictive models, missing in several published articles, is a major issue that can potentially limit the reliability and applicability of predictive models in clinical settings. Therefore, this systematic review described different externally validated methods of predicting response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) patients and how they could improve clinical decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;An extensive search for eligible articles was performed on PubMed, Cochrane, and Scopus between 2018 and 2023, using the keywords: (Response OR outcome) prediction AND (neoadjuvant OR chemoradiotherapy) treatment in 'locally advanced Rectal Cancer'.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Inclusion criteria: &lt;/strong&gt;(i) Studies including patients diagnosed with LARC (T3/4 and N- or any T and N+) by pre-medical imaging and pathological examination or as stated by the author (ii) Standardized nCRT completed. (iii) Treatment with long or short course radiotherapy. (iv) Studies reporting on the prediction of response to nCRT with pathological complete response (pCR) as the primary outcome. (v) Studies reporting external validation results for response prediction. (vi) Regarding language restrictions, only articles in English were accepted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exclusion criteria: &lt;/strong&gt;(i) We excluded case report studies, conference abstracts, reviews, studies reporting patients with distant metastases at diagnosis. (ii) Studies reporting response prediction with only internally validated approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and quality assessment: &lt;/strong&gt;Three researchers (DC-D, FB, HT) independently reviewed and screened titles and abstracts of all articles retrieved after de-duplication. Possible disagreements were resolved through discussion among the three researchers. If necessary, three other researchers (LB, GC, MG) were consulted to make the final decision. The extraction of data was performed using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) template and quality assessment was done using the Prediction model Risk Of Bias Assessment Tool (PROBAST).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4547 records were identified from the three databases. After excluding 392 duplicate results, 4155 records underwent title and abstract screening. Three thousand and eight hundred articles were excluded after title and abstract screening and 355 articles were retrieved. Out of the 355 retrieved articles, 51 studies were assessed for eligibility. Nineteen reports were then excluded due to lack of reports on external validation, while 4 wer","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109463"},"PeriodicalIF":3.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and long-term outcomes following perioperative ERAS management in patients undergoing minimally invasive radical gastrectomy after neoadjuvant chemotherapy: A single-center retrospective propensity score matching study","authors":"Gan Liu ,&nbsp;Shougen Cao ,&nbsp;Xiaodong Liu ,&nbsp;Yulong Tian ,&nbsp;Zequn Li ,&nbsp;Yuqi Sun ,&nbsp;Hao Zhong ,&nbsp;Kun Wang ,&nbsp;Yanbing Zhou","doi":"10.1016/j.ejso.2024.109459","DOIUrl":"10.1016/j.ejso.2024.109459","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastric cancer patients receiving neoadjuvant chemotherapy (NACT) are more vulnerable to perioperative stress. Enhanced recovery after surgery (ERAS) is widely used in surgical patients aiming at reducing stress responses. However, whether this approach is safe and feasible for gastric cancer patients received minimally invasive radical gastrectomy after NACT remained determined. So, the objective of this study is to investigate the effects of ERAS for this special group of gastric cancer patients.</div></div><div><h3>Material and methods</h3><div>The data of gastric cancer patients who underwent minimally invasive radical gastrectomy after NACT were collected. Patients were divided into an ERAS group and a conventional group based on whether they received perioperative ERAS management. Propensity score matching was conducted to eliminate bias. Pre- and postoperative inflammatory and nutritional marker levels, postoperative complications, recovery indices and 3-year OS and RFS were observed.</div></div><div><h3>Results</h3><div>A total of 252 patients were analyzed after 1:1 PSM, including 126 patients in the ERAS group and 126 in the conventional group. The results showed that the implementation of ERAS significantly reduced the levels of novel inflammatory indicators, improve nutritional status and accelerate postoperative recovery. We found that the 3-year OS (72.2 % vs. 66.7 %) and RFS (67.5 % vs. 61.9 %) in the ERAS group showed an improvement trend compared to those in the traditional group, especially for stage III patients, although these differences were not significant.</div></div><div><h3>Conclusion</h3><div>The perioperative ERAS program is safe and feasible for gastric cancer patients received minimally invasive radical gastrectomy after NACT.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 109459"},"PeriodicalIF":3.5,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Configuration of anastomotic doughnuts of stapled anastomoses in upper gastrointestinal surgery is associated with anastomotic leakage","authors":"Nicolas Jorek ,&nbsp;Marie-Christin Weber ,&nbsp;Atsuko Kasajima ,&nbsp;Stefan Reischl ,&nbsp;Benedict Jefferies ,&nbsp;Marcus Feith ,&nbsp;Rebekka Dimpel ,&nbsp;Daniel Reim ,&nbsp;Helmut Friess ,&nbsp;Alexander Novotny ,&nbsp;Philipp-Alexander Neumann","doi":"10.1016/j.ejso.2024.109460","DOIUrl":"10.1016/j.ejso.2024.109460","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study was to evaluate whether the configuration of anastomotic doughnuts from upper gastrointestinal surgeries was associated with anastomotic leakage (AL).</div></div><div><h3>Background</h3><div>AL is a severe postoperative complication after upper gastrointestinal cancer surgeries. AL is associated with an increase in overall and cancer-related morbidity and mortality in patients with esophageal and gastric cancer. New intraoperative biomarkers are needed to predict the risk of AL to implement early preventive measures.</div></div><div><h3>Materials and methods</h3><div>Anastomotic doughnuts from 102 patients undergoing surgery for esophageal or gastric cancer using circular staplers were examined. The minimal and maximal height and width of the anastomotic doughnuts were measured and correlated with the postoperative AL rate.</div></div><div><h3>Results</h3><div>The AL rate in our study collective was 15,7 %. The minimal width (Wmin) of the oral and aboral anastomotic doughnuts was significantly lower in patients with AL compared to patients without AL (p = 0.002 and p = 0.041 respectively). The Wmin of the esophageal anastomotic doughnut was an independent risk factor for AL in the multivariable analysis (p = 0.034). Negative predictive values for the measurements of anastomotic doughnuts (Wmin) with regard to the risk of AL were higher than for the commonly used postoperative biomarker C-reactive protein.</div></div><div><h3>Conclusion</h3><div>Minimal anastomotic doughnut width was statistically significantly associated with AL. Thus, not only the evaluation of the completeness of the anastomotic doughnuts but also intraoperative measurements could be used to predict the risk of AL to initiate early preventive measures to prevent the development of AL and/or reduce AL-associated morbidity.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"Article 109460"},"PeriodicalIF":3.5,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}