Surgical Practice最新文献

{"title":"Analysis of risk factors associated with distant metastasis detected at laparotomy in patients with radiologically resectable pancreatic ductal adenocarcinoma","authors":"Pipit Burasakarn MD, PhD,&nbsp;Kwanchanok Yochum MD,&nbsp;Sermsak Hongjinda MD,&nbsp;Anuparp Thienhiran MD,&nbsp;Pusit Fuengfoo MD","doi":"10.1111/1744-1633.12669","DOIUrl":"10.1111/1744-1633.12669","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>This study aimed to evaluate the preoperative risk factors in patients with radiologically resectable pancreatic ductal adenocarcinomas (PDACs), deemed to be unresectable intraoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on patients radiologically diagnosed with resectable PDACs and subsequently underwent pancreatectomy between January 2020 and December 2021 were retrospectively collected. Preoperative risk factors were also analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three patients with resectable PDAC who underwent laparotomy for curative intent were divided into the no-metastases (n = 32) and distant metastases (n = 21) groups. Univariate analysis identified factors associated with distant metastases found intraoperatively, such as significant weight loss (odds ratio [OR] 5.29, <i>P</i> = .02), tumour size &gt;35 mm (OR 4.15, <i>P</i> = .017), tumours located at the body and tail of the pancreas (OR 6, <i>P</i> = .041), superior mesenteric vein (SMV) abutment from the tumour (OR 7.5, <i>P</i> = .02), serum carbohydrate antigen 19-9 &gt; 385 IU/mL (OR 3.58, <i>P</i> = .031) and serum carcinoembryonic antigen (CEA) levels &gt;9 IU/mL. However, multivariate analysis showed that only significant weight loss (adjusted OR 27.19, <i>P</i> = .011), SMV abutment from the tumour (adjusted OR 52.64, <i>P</i> = .01) and serum CEA levels &gt;9 IU/mL were associated with distant metastases found intraoperatively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Significant weight loss, SMV abutment and serum CEA levels of &gt;9 IU/mL were intraoperatively associated with distant metastases. Staging laparoscopy and positron emission tomography–computed tomography may reduce unnecessary laparotomies and change clinical management in these patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"28 2","pages":"76-81"},"PeriodicalIF":0.3,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139221430","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":"Use of a lockable pigtail catheter (Cook Dawson-Mueller Multipurpose Drainage Catheter) for nephrostomy reduces the risk of slippage of the catheter","authors":"Shugo Yajima MD,&nbsp;Yasukazu Nakanishi MD, PhD,&nbsp;Kohei Hirose MD,&nbsp;Madoka Kataoka MD,&nbsp;Hitoshi Masuda MD, PhD","doi":"10.1111/1744-1633.12668","DOIUrl":"10.1111/1744-1633.12668","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study compared the outcomes of using Mac-Loc catheters and non–Mac-Loc catheters for percutaneous nephrostomy (PCN). Mac-Loc catheters have a locking mechanism that forms a curl at the tip by pulling a suture and securing it in place.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This retrospective study compared the outcomes of consecutive patients who received PCN with catheters equipped with Mac-Loc versus those with catheters without Mac-Loc. Catheter failure was the primary endpoint of the study and was defined as all cases of catheter malfunction after PCN. A propensity score was calculated from covariates based on clinical variables, and patients in each group were matched 1:1 based on the propensity score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the follow-up period, a total of 289 cases underwent PCN, 72 with catheters equipped with Mac-Loc and 217 without Mac-Loc. Failure of the catheter occurred in 63 cases (22%). There were 44 cases (70%) of slippage, 18 cases (29%) of obstruction, and 1 case (2%) of catheter rupture. After propensity score matching, catheter failure–free survival was significantly higher in the group with catheters equipped with Mac-Loc than in the group without Mac-Loc (<i>P</i> = .003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The use of catheters equipped with Mac-Loc for PCN reduces the risk of unintentional catheter slippage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"28 1","pages":"27-31"},"PeriodicalIF":0.8,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139219733","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":"Comparison of nephrostomy and double-J stent in the management of percutaneous nephrolithotomy–induced renal pelvis trauma: A prospective randomized controlled trial","authors":"Kaveh Mehravaran MD,&nbsp;Mohammad Kolbadinezhad MD,&nbsp;Robab Maghsoudi MD,&nbsp;Amir Hossein Kashi MD,&nbsp;Saeed Reza Ghanbarizadeh MD,&nbsp;Behzad Narouie MD,&nbsp;Hamidreza Rouientan MD","doi":"10.1111/1744-1633.12667","DOIUrl":"10.1111/1744-1633.12667","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to compare the efficacy of nephrostomy versus double-J (DJ) ureteral stent in managing kidney pelvis trauma during percutaneous nephrolithotomy (PCNL) procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This prospective parallel-group clinical trial involved 60 PCNL patients diagnosed with kidney pelvis perforation during PCNL through nephroscopy (inclusion criteria). Exclusion criteria comprised a history of previous renal surgery or prior PCNL. Eligible patients were alternately assigned to either the insertion of a nephrostomy or a ureteral DJ stent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 31 patients were included in the nephrostomy group, and 29 were in the DJ group. The mean ± SD of operation duration in nephrostomy and DJ groups were 50.8 ± 23.7 and 45.7 ± 19.3 min, respectively (<i>P</i> = .17). Two-access PCNLs were performed in 13% and 18% of PCNL operations in the nephrostomy and DJ groups, respectively (<i>P</i> = .72). In the nephrostomy group, 5 patients (17%) had urinoma collection around the kidney, compared with 11 (39%) in the DJ group, showing a statistically significant difference between the two groups (<i>P</i> = .036). Post-operative fever and urinary leakage were observed in 48% and 32% of patients in nephrostomy group versus 44% and 22% of patients in group DJ (<i>P</i> = .76 and <i>P</i> = .39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings of this study indicate a higher percentage of urinoma detected one week after the insertion of a ureteral DJ compared with nephrostomy in PCNL patients who experienced renal pelvis injury during the operation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"28 2","pages":"63-67"},"PeriodicalIF":0.3,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139230822","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":"Acknowledgements to reviewers","authors":"","doi":"10.1111/1744-1633.12663","DOIUrl":"https://doi.org/10.1111/1744-1633.12663","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"250"},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432480","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":"Surgical Practice August 2023 CME for Fellows","authors":"","doi":"10.1111/1744-1633.12652","DOIUrl":"https://doi.org/10.1111/1744-1633.12652","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"251-252"},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432481","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":"Personal knowledge management for surgeons","authors":"Paul B. S. Lai","doi":"10.1111/1744-1633.12666","DOIUrl":"https://doi.org/10.1111/1744-1633.12666","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"203-204"},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432455","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":"Surgical practice November 2023 CME for Fellows","authors":"","doi":"10.1111/1744-1633.12664","DOIUrl":"https://doi.org/10.1111/1744-1633.12664","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"253-254"},"PeriodicalIF":0.8,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432503","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 and poor prognostic factors in endovascular thrombectomy for octo- and nonagenarians with large vessel occlusion: A real-world experience","authors":"Stephanie Wing Yin Yu,&nbsp;James Tin-Fong Zhuang,&nbsp;Yin Lun Edward Chu,&nbsp;Kay-Cheong Teo,&nbsp;Kui Kai Lau,&nbsp;Anderson Chun-On Tsang,&nbsp;Wai-Man Lui","doi":"10.1111/1744-1633.12665","DOIUrl":"10.1111/1744-1633.12665","url":null,"abstract":"<p>Endovascular thrombectomy (EVT) is the preferred treatment for eligible patients with acute large vessel occlusions (LVOs). However, its role in very elderly patients remains uncertain. This study retrospectively analysed EVT outcomes, including successful reperfusion, change in National Institutes of Health Stroke Scale (NIHSS) score at 24 h after EVT, inpatient haemorrhagic transformation and favourable functional outcomes and mortality at 90 days after EVT in patients aged over 80 years. The primary outcome of the study was risk factors significantly associated with poorer functional outcomes at 90 days after EVT. The secondary outcomes were risk factors associated with higher NIHSS scores at 24 h after EVT and higher mortality rates at 90 days after EVT. Among the 73 octo- and nonagenarians, successful reperfusion was achieved in 86.3%, and up to 35.6% maintained functional independence at 90 days. Poorer outcomes were associated with internal carotid artery occlusion; risk factors such as hypertension, diabetes mellitus and atrial fibrillation; higher admission NIHSS score; longer time between symptom onset and successful reperfusion and unsuccessful reperfusion. EVT is both safe and effective in our elderly population, with over one-third of very elderly patients achieving satisfactory functional outcomes after EVT. Therefore, age alone should not be the sole criterion for excluding very elderly LVO patients from EVT. Instead, each patient should undergo individual assessment based on their premorbid condition, clinical presentation and LVO characteristics before making a treatment decision.</p>","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 4","pages":"232-238"},"PeriodicalIF":0.8,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1744-1633.12665","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135406300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free paper","authors":"","doi":"10.1111/1744-1633.12654","DOIUrl":"https://doi.org/10.1111/1744-1633.12654","url":null,"abstract":"","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 S1","pages":"3-6"},"PeriodicalIF":0.8,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1744-1633.12654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50139083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Poster Round","authors":"","doi":"10.1111/1744-1633.12657","DOIUrl":"https://doi.org/10.1111/1744-1633.12657","url":null,"abstract":"Aim: Skin-staining characteristic of SPIO raises cosmetic concerns especially in the setting of breast conservative therapy (BCT). A comparison of skin stains from SPIO versus blue dye was performed as a predefined longterm analysis of a previously reported randomised controlled trial (RCT). Method: Following the RCT which was conducted between July 2018 and August 2022 to primarily study the efficacy of SPIO in sentinel lymph node detection, this follow-up analysis investigates skin stains in patients who received BCT. Patients with clinically node negative T1-3 invasive ductal or lobular carcinoma receiving surgeries were eligible. Study patients were given SPIO and radioisotope as tracers. Control patients were given blue dye and radioisotope. Skin stains were documented till 18 months postoperatively. Results: Ninety-eight patients have received BCT and completed 18 months of follow-up, of which 50 patients were in the study group and 48 were in the control group. Patients in the study arm had significantly larger and higher incidences of skin stains throughout the follow-up period in contrast to the control group. Larger volumes of breast tissue excised were associated with smaller incidences and sizes of skin stains from 6 months onwards ( p < .05). Younger patients were also found to have smaller skin stains by 18 months ( p = .04). Conclusion: Greater incidences and sizes of skin stains were observed in patients given SPIO. Excision of a larger breast volume was associated with faster skin stain clearance postoperatively. Cosmetic outcomes of SPIO should be discussed during patient counselling on treatment options for a personalised","PeriodicalId":51190,"journal":{"name":"Surgical Practice","volume":"27 S1","pages":"13-16"},"PeriodicalIF":0.8,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1744-1633.12657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50139086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}