Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Comparative analysis of bone and soft tissue vs. visceral synovial sarcoma: Demographic, clinical, and survival outcomes; a retrospective population-based study.","authors":"Asad Ullah, Mya Goodbee, Kali Malham, Abdul Qahar Khan Yasinzai, Muhammad Bilal Mirza, Bisma Tareen, Aimal Khan, Kamran Idrees","doi":"10.1016/j.surge.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>Synovial sarcoma (SS) is typically diagnoses in young adults and usually appears in the extremities and soft tissues. However, it can sometimes arise in visceral organs. This study examines the differences in patient demographics, clinical features, and survival rates between soft tissue and visceral synovial sarcoma.</p><p><strong>Methods: </strong>We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2000-2018. ANOVA (analysis of variance) was used to identify significant factors for multivariate analysis. Cox regression modeling was used to determine independent risk factors for survival.</p><p><strong>Results: </strong>Of the 2,776 SS patients included, the median age was 39.0 years, predominating male (53.0 %) and white (81.3 %). Bone and soft tissue sarcomas were more common, accounting for 86.4 % of cases (p-value<0.001), while the rest were diagnosed as visceral sarcomas. Visceral SS patients were typically older (p-value<0.001), male (56.8 %), and white (84.8 %). They also presented more frequently with distant metastasis (HR 3.8, 95 % CI, 2.4-6.1), had larger tumors on average (HR for tumors >10 cm: 2.9, 95 % CI, 2.0-4.1), and were less likely to undergo surgery (HR 0.4, 95 % CI, 0.3-0.6). Despite receiving multimodal treatments, including surgery, radiation, and/or chemotherapy, visceral SS patients exhibited poorer overall survival compared to their bone and soft tissue SS counterparts (p-value<0.001).</p><p><strong>Conclusion: </strong>Visceral SS often presents in older patients with advanced-stage and larger tumor size as compared to bone and soft tissue SS, which likely contributes to poorer survival. Advanced age, regional spread, and larger tumor size were all found to worsen outcomes, while surgery and radiation were found to be protective factors.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of post-iliac crest bone harvesting hernias: Insights from a case series and systematic review.","authors":"Kirengo Thomas Onyango, Azhar Zubair, Maraqa Abdelrahman, Mazumdar Eshan, Rafiq Sarmad, Ramanand Bangalore","doi":"10.1016/j.surge.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.surge.2024.11.001","url":null,"abstract":"<p><strong>Introduction: </strong>Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repairing these hernias is challenging. Appropriate repair techniques are needed to minimise morbidity and recurrence. We present our experience with three cases of post-iliac graft hernia repair with mesh anchored to titanium mini-plates and a systematic review of current literature.</p><p><strong>Method: </strong>We conducted a systematic review of the literature in February 2024 on two online databases, PubMed®/MEDLINE and EMBASE, in accordance with PRISMA guidelines. Keywords used were \"Hernia,\" \"Iliac,\" and \"Graft.\" Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded.</p><p><strong>Results: </strong>We included 30 studies out of 751 results, spanning from 1975 to 2023. There were 40 reported cases of hernias post iliac bone grafting. The age distribution ranged from 37 to 88 years, with a median age of 60. The majority of patients (40 %) presented within one year. Fracture management, accounting for 19 cases (47.5 %), was the main indication for bone grafting. Mesh repair was performed in 31 cases (77.5 %). Seven cases (17.5 %) of recurrence were reported.</p><p><strong>Conclusion: </strong>Recurrence is a common complication in patients with post-iliac graft hernias. Open mesh repair is the most frequently performed surgery and involves various techniques. While titanium mini-plates as anchors enable a pre-peritoneal plane mesh repair, long-term follow-up and comparative studies are needed to evaluate its efficacy compared to simple mesh.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty-day outcomes of Asian Americans in endovascular repair of intact infrarenal abdominal aortic aneurysm.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1016/j.surge.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.surge.2024.10.005","url":null,"abstract":"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.</p><p><strong>Methods: </strong>Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p < 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.</p><p><strong>Conclusion: </strong>Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter arterial embolisation (TAE) to treat acute upper gastrointestinal bleeding secondary to gastric cancer: A systematic review and meta-analysis","authors":"Tamzin Hall ,&nbsp;Hugo C. Temperley ,&nbsp;Benjamin M. Mac Curtain ,&nbsp;Niall J. O'Sullivan ,&nbsp;Ned Quirke ,&nbsp;Niall McEniff ,&nbsp;Ian Brennan ,&nbsp;Kevin Sheahan ,&nbsp;Noel E. Donlon","doi":"10.1016/j.surge.2024.09.009","DOIUrl":"10.1016/j.surge.2024.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute upper gastrointestinal bleeding (UGIB) secondary to gastric cancer presents a significant clinical challenge due to its high morbidity and mortality rates. Transcatheter arterial embolisation (TAE) has emerged as a potential therapeutic option for managing this condition, especially in the context of failed endoscopic management. This systematic review aims to evaluate the efficacy and safety of TAE in treating acute upper gastrointestinal (GI) bleeding caused by gastric cancer.</div></div><div><h3>Methods</h3><div>A systematic search of medical databases, including PubMed, MEDLINE, and EMBASE, was conducted for studies published between 2000 and 2023. Included studies reported on the use of TAE for acute upper GI bleeding specifically due to gastric cancer, including retrospective analyses, case reports, and cohort studies. Demographics and clinical outcomes were reported.</div></div><div><h3>Results</h3><div>A total of 7 studies met the inclusion criteria, all being retrospective in nature. The overall technical success rate of TAE was 94.9 %. Overall clinical success rates were 72 % with a 95 % confidence interval (CI) of 66–79 %. Overall rebleeding rates were 11 % with a 95 % CI of 3–18 %. Major complications were reported in 2.4 % of patients, including ischemic complications and organ perforation. The overall 30-day mortality rate was 26.4 %, primarily due to underlying disease progression rather than procedural complications.</div></div><div><h3>Conclusion</h3><div>TAE is an effective and safe intervention for managing acute upper GI bleeding secondary to gastric cancer, with high success rates. TAE should be considered a viable treatment modality for this challenging condition, particularly for patients who are being considered for neoadjuvant therapy or indeed those not suitable candidates for curative surgical intervention.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e213-e220"},"PeriodicalIF":2.3,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery.","authors":"C Cullinane, A Edwards-Murphy, C Kennedy, C Toale, M Al Azzawi, M Davey, N Donlon, S Croghan, J Elliott, C Fleming","doi":"10.1016/j.surge.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.surge.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>In the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery.</p><p><strong>Methods: </strong>Subgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with >80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA).</p><p><strong>Results: </strong>Following three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care.</p><p><strong>Conclusion: </strong>As a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid cancer epidemiology in Ireland from 1994 to 2019 - Rising diagnoses without mortality benefit.","authors":"Gerard P Sexton, Thomas J Crotty, Susannah M Staunton, Marie Louise Healy, James Paul O'Neill, Conrad Timon, John B Kinsella, Paul Lennon, Conall Wr Fitzgerald","doi":"10.1016/j.surge.2024.08.017","DOIUrl":"https://doi.org/10.1016/j.surge.2024.08.017","url":null,"abstract":"<p><strong>Background: </strong>The epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland.</p><p><strong>Methods: </strong>A retrospective cohort study of National Cancer Registry of Ireland data, 1994-2019.</p><p><strong>Results: </strong>Records from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8-6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169-2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis - 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99).</p><p><strong>Conclusion: </strong>The epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes for centenarian patients admitted with orthopaedic trauma","authors":"Andrew P. Dekker ,&nbsp;Prateek A. Saxena ,&nbsp;Emma Westwood ,&nbsp;Niharika Kalla ,&nbsp;Nathan Sims ,&nbsp;Paul Wilson ,&nbsp;Neil Ashwood","doi":"10.1016/j.surge.2024.09.010","DOIUrl":"10.1016/j.surge.2024.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The United Kingdom (UK) and world's population is aging with patients living longer, often with many co-morbidities. It is expected that patients of extreme old age would have poor outcomes following trauma; however, this assumption is not clearly evidenced. This study aims to present the outcomes of patients aged 100 or older admitted to a single hospital trust following admission for orthopaedic trauma.</div></div><div><h3>Method</h3><div>A prospective cohort of patients aged 100 years and over admitted to the trauma and orthopaedic departments of two hospitals within the same trust between 2008 and 2022 was reviewed. Age was median 101 years (100–106 years). Outcome measures were length of stay, survival, complications and change in accommodation.</div></div><div><h3>Results</h3><div>80 patients met the inclusion criteria (71female, 9 male). Mean age at discharge was 102.5 years with survival mean 4.2 years. 2 patients with peri-prosthetic fracture survived a further 5 years. Mean length of stay was 17 days. 57 patients returned to their original place of residence. 72 patients (90 %) survived the acute hospital admission<strong>.</strong></div></div><div><h3>Conclusion</h3><div>Survival rates for patients aged over 100 years were high and most returned to the previous place of residence. This study supports the surgical management of trauma and helps inform patients and families expectations for mortality risk.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 354-357"},"PeriodicalIF":2.3,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Letter to the editor: Parastomal hernia repairs: A nationwide cohort study in the Republic of Ireland","authors":"Amir Farah","doi":"10.1016/j.surge.2024.09.007","DOIUrl":"10.1016/j.surge.2024.09.007","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e230-e231"},"PeriodicalIF":2.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Letter to the Editor: Sick-leave duration after elective day case surgery in ENT: Is it affected by the type of employment?","authors":"Amir Farah","doi":"10.1016/j.surge.2024.09.006","DOIUrl":"10.1016/j.surge.2024.09.006","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Page e234"},"PeriodicalIF":2.3,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Situational awareness - The surgeon and the advanced motorist","authors":"David J. O'Regan ,&nbsp;John Rudd","doi":"10.1016/j.surge.2024.09.001","DOIUrl":"10.1016/j.surge.2024.09.001","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e235-e236"},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}