Annali italiani di chirurgia最新文献

{"title":"A Novel Ensemble Approach for Rib Fracture Detection and Visualization using CNNs and Grad-CAM.","authors":"Ling Wu, Hongyu Chen, Puxu Li, Kai Yang","doi":"10.62713/aic.3666","DOIUrl":"10.62713/aic.3666","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to develop a reliable and efficient system for predicting and locating rib fractures in medical images using an ensemble of convolutional neural networks (CNNs).</p><p><strong>Methods: </strong>We employed five CNN architectures-Visual Geometry Group Network 16 (VGG16), Densely Connected Convolutional Network 169 (DenseNet169), Inception Version 4 (Inception V4), Efficient Network B7 (EfficientNet-B7), and Residual Network Next 50 layers (ResNeXt-50)-trained on a dataset of 840 grayscale computed tomography (CT) scan images in .jpg format collected from 42 patients at a local hospital. The images were categorized into two groups representing healed and fresh fractures. The ensemble model was designed to improve predictive accuracy and robustness, utilizing techniques like gradient-weighted class activation mapping (Grad-CAM) for visualization of fracture locations.</p><p><strong>Results: </strong>The ensemble model achieved an accuracy of 0.96, area under the curve (AUC) of 0.97, recall of 0.97, and F1 score of 0.96. Grad-CAM visualizations could effectively locate rib fractures, providing crucial assistance in diagnostics.</p><p><strong>Conclusions: </strong>The ensemble model demonstrates high accuracy and robustness in fracture detection, underscoring its potential for enhancing diagnostic processes in clinical settings. Despite limitations such as the small dataset size and lack of diverse demographic representation, the results are promising for future clinical application.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 1","pages":"86-97"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999011","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":"Incidence and Outcomes of Low Anterior Resection Syndrome in Patients Undergoing Preventive Ostomy for Laparoscopic Rectal Cancer Surgery.","authors":"Guizhi Luo, Jinhong Lu, Youzhuan Yang, Hongchao Ma","doi":"10.62713/aic.3773","DOIUrl":"10.62713/aic.3773","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the incidence and risk factors of low anterior resection syndrome (LARS) in patients undergoing preventive colostomy following laparoscopic rectal cancer surgery. Additionally, the outcomes of LARS were analyzed to provide evidence for effective prevention and treatment strategies.</p><p><strong>Methods: </strong>The medical records of 143 patients with laparoscopic rectal cancer who underwent preventive ostomy at the Zhujiang Hospital of Southern Medical University between January 2020 and October 2022 were retrospectively reviewed. All patients underwent ostomy reversal within 2 to 6 months post-surgery. The LARS score scale was used to evaluate the occurrence of LARS at 3, 6, and 12months post-surgery. Based on LARS scores, patients were divided into LARS and non-LARS groups. Clinical characteristics, including gender, TNM stage, and other related data, were compared between the two groups. Multivariate logistic regression analysis was conducted to identify risk factors for LARS, and the predictive performance of the regression model was evaluated using the receiver operating characteristic (ROC) curve.</p><p><strong>Results: </strong>The LARS score demonstrated a significant decrease over time after surgery (p < 0.05). LARS was identified in 80 patients (55.94%) at 3 months post-surgery, with no new cases reported after this period. Statistically significant differences between the LARS and non-LARS groups were observed in body mass index (BMI), tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal (p < 0.05). The ROC curve analysis revealed that the logistic regression model predicting LARS had an area under the curve (AUC) of 0.809 (95% CI: 0.735-0.870), with a sensitivity of 76.25% and a specificity of 79.37%. Among the LARS patients 3 months post-surgery, 73.75% (59/80) showed improvement by 12 months. The improvement rate in patients with mild LARS (87.93%) was significantly higher than in those with severe LARS (36.36%) (p < 0.05).</p><p><strong>Conclusions: </strong>The incidence of LARS is relatively high in patients undergoing preventive ostomy after laparoscopic rectal cancer surgery. Key factors associated with LARS include BMI, tumor distance from the anal margin, postoperative anastomotic fistula, and the timing of ostomy reversal. Over time, the incidence of LARS decreases, and outcomes improve, especially in patients with mild LARS.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 2","pages":"152-159"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432361","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":"Effects of Interactive Health Education Combined With Evidence-based Pain Management Nursing on Disease Cognition, Postoperative Pain and Post-traumatic Growth in Patients Undergoing Laparoscopic Salpingectomy.","authors":"Ye Cheng, Weiwei Shao, Lixia Li, Yewei Ding, Xueping Zou","doi":"10.62713/aic.3945","DOIUrl":"https://doi.org/10.62713/aic.3945","url":null,"abstract":"<p><strong>Aim: </strong>Laparoscopic salpingectomy has been widely used in the clinical treatment of benign tubal lesions. This study aims to explore the effects of interactive health education combined with evidence-based pain management nursing on disease cognition, postoperative pain and post-traumatic growth in patients undergoing laparoscopic salpingectomy, in order to provide new insights into clinical nursing for these patients.</p><p><strong>Methods: </strong>In this retrospective study, 360 patients who underwent laparoscopic salpingectomy in our hospital from January 2022 to December 2023 were included. Patients receiving routine care were included in the control group (n = 213) and patients receiving interactive health education combined with evidence-based pain care were classified under the study group (n = 147). General data, disease cognition, postoperative pain and post-traumatic growth of the two groups were collected and compared.</p><p><strong>Results: </strong>The awareness rate regarding pathogenesis, cardinal symptom, surgical and postoperative precautions, prevention of complications, medication management, diet management, sleep management, and review time and project in the study group were all significantly higher than those in the control group (p < 0.05). The numerical rating scale (NRS) scores of the study group were lower than those of the control group at 6 h, 12 h, 24 h and 48 h post-surgery (p < 0.001). Before discharge, all dimensions of the post-traumatic growth inventory (PTGI) scores like relating to others, new possibilities, personal strength, spiritual change, and appreciation of life of the study group patients were significantly higher than those of the control group (p < 0.05). The time to get out of bed, exhaust time, and hospitalization stay of the study group patients were significantly shorter than those of the control group (p < 0.05). The total incidence of complications in the study group was significantly lower than that in the control group (p < 0.05).</p><p><strong>Conclusions: </strong>Interactive health education combined with evidence-based pain management nursing is conducive to improving disease cognition, reducing postoperative pain, enhancing post-traumatic growth, and promoting postoperative recovery in patients undergoing laparoscopic salpingectomy.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"664-672"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075364","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":"Investigating Clinical Significance of 3D Single-hole Thoracoscopy Surgery for Mediastinal Tumor Resection With Artificial Pneumothorax.","authors":"Qingpeng Li, Bo Peng, Jiajun Pan, Yongyuan Li, Weimin Qian","doi":"10.62713/aic.3897","DOIUrl":"https://doi.org/10.62713/aic.3897","url":null,"abstract":"<p><strong>Aim: </strong>This study aims to analyze and compare the clinical efficacy and safety between single-hole approach and two-hole video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection.</p><p><strong>Methods: </strong>This study included 62 patients who received VATS mediastinal tumor resection in the Thoracic Department of the Affiliated Hospital of Xuzhou Medical University, between March 2020 and March 2022. Patients were divided into a single-hole VATS group (27 cases) and a two-hole VATS group (35 cases). The two groups were compared for their clinical characteristics (such as age, gender, tumor size, body mass index (BMI), comorbidities, and pathological findings), postoperative outcomes (such as operation time, intraoperative bleeding, transfer to open surgery, drainage volume, extubating time, and hospital stay), postoperative complications, and pain score.</p><p><strong>Results: </strong>There were no significant differences in operation time, introperative bleeding volume, and postoperative complication rates between the two groups (p > 0.05). However, extubating time and hospital stay were significantly shorter in the single-hole VATS group than the two-hole VATS group (p < 0.05). Moreover, drainage volume was decreased in the single-hole VATS group compared to the two-hole VATS group (p < 0.05). The pain score was significantly lower on days 1 and 3 post-surgery in the single-hole VATS group than in the two-hole VATS group (p < 0.05).</p><p><strong>Conclusions: </strong>In conclusion, 3D single-hole VATS mediastinal tumor resection is a safe and feasible option for treating mediastinal tumors compared to the traditional approach. Furthermore, it significantly reduces postoperative pain, lowers drainage duration and volume, as well as extubating time, promotes faster recovery, and reduces hospital stays.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"626-633"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075383","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 Retrospective Analysis of Laparoscopic Totally Extraperitoneal (TEP) and Transabdominal Preperitoneal (TAPP) Techniques in the Treatment of Unilateral Inguinal Hernias.","authors":"Yahya Ozel, Muhammer Ergenc, Servet Emir, Yalcin Burak Kara","doi":"10.62713/aic.3852","DOIUrl":"https://doi.org/10.62713/aic.3852","url":null,"abstract":"<p><strong>Aim: </strong>Inguinal hernia is a common surgical issue, with laparoscopic techniques such as totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) being widely used. However, there is no clear consensus on the superiority of either method for unilateral primary or recurrent inguinal hernias. This study compares TEP and TAPP, focusing on efficacy, safety, and clinical outcomes.</p><p><strong>Methods: </strong>This study included patients who underwent elective laparoscopic surgery for unilateral inguinal hernias between April 2009 and May 2024. Patients who underwent inguinal hernia repair were divided into two groups according to whether the TAPP or TEP procedure was used. Primary and recurrent cases were analyzed, with data on demographic features such as age, gender, body mass index (BMI), operative duration, hospital stay, and complications compared between the groups.</p><p><strong>Results: </strong>Of the 985 patients, 72.6% underwent TAPP and 27.4% underwent TEP. The median BMI was significantly higher in the TAPP group (24.23 [23.4-25.6] vs. 24.00 [23.06-25.62], p = 0.038). The proportion of recurrent hernias was higher in the TEP group (15.6% vs. 9.0%, p = 0.004). Operative time was significantly longer for TEP compared to TAPP (60.0 [40-80] vs. 35.0 [25-45] minutes, p < 0.001). Although the median hospital stay was the same in both groups (1 [1] vs. 1 [1] days), the TAPP group had a wider range of hospital stays (p < 0.001). Complication rates were higher in the TEP group (11.1% vs. 4.3%, p < 0.001), primarily driven by increased seroma formation. Linear regression analysis revealed a significant association between case volume and operative duration for TEP primary cases (p < 0.001, R2 = 0.380), recurrent TEP cases (p = 0.024, R2 = 0.121), primary TAPP cases (p = 0.017, R2 = 0.009), and recurrent TAPP cases (p = 0.627, R2 = 0.004).</p><p><strong>Conclusions: </strong>Both TAPP and TEP are effective for unilateral inguinal hernia repair; however, TAPP demonstrated shorter operative times, and fewer complications compared to TEP. Case volume significantly influences operative duration, particularly in TEP repairs. Further studies with larger cohorts are warranted to refine surgical approaches and outcomes.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 5","pages":"703-712"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075574","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":"Well-Differentiated Extraosseous Chondrosarcoma Arising of Gall Bladder: A Detailed Case Report.","authors":"ZhangQiang Wu, QingQu Guo, YuLian Wu","doi":"10.62713/aic.3739","DOIUrl":"https://doi.org/10.62713/aic.3739","url":null,"abstract":"<p><p>This article reports a rare case of extraosseous myxoid chondrosarcoma originating from the gallbladder. The patient, a 50-year-old female, presented with recurrent right upper quadrant abdominal pain for over two months, with worsening symptoms in the month prior to admission. Before hospitalization, enhanced computed tomography (CT) of the upper abdomen performed at a local hospital suggested a malignant gallbladder tumor (gallbladder cancer) with lymphadenopathy near the hepatic portal, as well as chronic cholecystitis with gallstones. Upon admission, whole-abdomen enhanced CT and liver-enhanced magnetic resonance imaging (MRI) confirmed uneven thickening of the gallbladder wall and multiple enlarged lymph nodes in the hepatic portal, further supporting the suspicion of gallbladder cancer. Tumor marker tests revealed elevated levels of carbohydrate antigen 19-9 (CA19-9) and cytokeratin 19 fragment. On 12 March 2020, the patient underwent extended radical resection for gallbladder cancer. The procedure included the removal of the gallbladder, hepatic lobe, right half of the colon, and greater omentum, along with extensive lymphadenectomy of the hepatic portal and posterior of the pancreatic head. Postoperative pathological examination confirmed the diagnosis of extraosseous myxoid chondrosarcoma, with the tumor involving the full thickness of the gallbladder, intrahepatic parenchyma, and the serosa to the muscular layer of the intestinal wall. Hematoxylin and eosin staining results supported this diagnosis. The patient recovered well postoperatively and did not receive any additional antitumor therapies, such as chemotherapy or radiotherapy. During a 36-month follow-up period after surgery, no tumor recurrence or metastasis was observed.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 4","pages":"437-442"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954054","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":"Investigating the Impact of Post-extubation Water Intake Timing in Cardiac Surgery With Cardiopulmonary Bypass on Patient Recovery Outcomes.","authors":"Dandan Geng, Yuzhen Guan, Zhen Lu, Yanyan Lu, Qingqing Chen, Wei Jiang, Wei Zhang","doi":"10.62713/aic.4042","DOIUrl":"https://doi.org/10.62713/aic.4042","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the efficacy and safety of various early post-extubation water intake regimens in cardiovascular disease (CVD) patients undergoing cardiac surgery with cardiopulmonary bypass.</p><p><strong>Methods: </strong>This retrospective analysis included 286 CVD patients admitted to The First Affiliated Hospital of Nanjing Medical University between October 2023 and September 2024. Among these patients, 84 drank water immediately after extubation (Group A), 92 started drinking water 1 hour after extubation (Group B), and 110 began drinking water 4 hours after extubation (Group C). The interval between extubation and water consumption across the three groups was carefully monitored. The degree of moisture of the lip and oral mucosa, as well as the Numerical Rating Scale (NRS), Visual Analogue Scale (VAS), and Self-Rating Anxiety Scale (SAS) were used to assess the postoperative experiences of patients. Additionally, gastrointestinal function recovery and incidence of adverse reactions in patients were recorded, and their satisfaction levels were assessed upon discharge from the hospital.</p><p><strong>Results: </strong>The interval between extubation and water intake was the shortest in Group A and the longest in Group C (p < 0.05). The scores of lip and oral mucosa moisture degree, NRS, VAS, and SAS before and after intervention in Group A were the lowest among the three groups, while the time for bowel sounds to return to normal, first exhaust, and first defecation was the shortest (p < 0.05). Furthermore, there was no significant difference in adverse reactions between Group A and Group B (p > 0.05). Group A had the highest overall satisfaction with treatment than the other two groups (p < 0.05).</p><p><strong>Conclusions: </strong>Giving water immediately after extubation to cardiac surgery patients with cardiopulmonary bypass can improve their postoperative experience and promote gastrointestinal function recovery, thereby improving patients' comfort.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"824-832"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301090","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":"Pancreatic Pseudocyst Following Spinal Surgery: Always Think About It-A Case Report.","authors":"Maria Vittoria Stern, Filomena Valentina Paradiso, Riccardo Rizzo, Sara Silvaroli, Simone Frediani, Lorenzo Nanni","doi":"10.62713/aic.3798","DOIUrl":"https://doi.org/10.62713/aic.3798","url":null,"abstract":"<p><strong>Aim: </strong>To report the conservative management of a pancreatic pseudocyst (PP) following spinal surgery for neurogenic scoliosis in a pediatric patient.</p><p><strong>Case presentation: </strong>A 12-years-old girl presented with spinal arthrodesis and lumbar fixation for neurogenic scoliosis secondary to cerebral palsy (CP). On postoperative day 11, abdominal computed tomography (CT) showed accumulated fluid (74 × 52 mm) extending along the greater gastric curvature, from the left liver lobe to the anterior abdominal wall.</p><p><strong>Results: </strong>The fluid was percutaneously drained. The fluid contained a high concentration of amylase; therefore, a diagnosis of PP was made. After 23 days, the symptoms progressively resolved, and the accumulated fluid disappeared. Gastrointestinal complications following spinal surgery in patients with CP are reported in 5%-55% of cases; among these, PP is extremely rare. Pancreatic postoperative ischemia or pancreatic iatrogenic trauma are possible causes of PP formation. In our case, conservative management was safe and effective.</p><p><strong>Conclusions: </strong>In patients with persistent postoperative abdominal symptoms following spinal surgery, pancreatic complications should be ruled out. If PP is diagnosed, conservative management is recommended, particularly in young patients with a poor general condition.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"725-730"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301092","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":"Splenectomy and Emergency Cesarean Delivery for Traumatic Splenic Rupture in a Patient in the Third Trimester of Pregnancy: A Case Report.","authors":"Miriam Biancu, Federico Cappellacci, Stefano Piras, Raffaela Bura, Alessandro Manca, Gian Luigi Canu, Pietro Giorgio Calò","doi":"10.62713/aic.3736","DOIUrl":"https://doi.org/10.62713/aic.3736","url":null,"abstract":"<p><p>Splenic rupture is one of the most frequent trauma-related injuries in the general population. While splenic injury is uncommon in pregnant patients, trauma is the leading non-obstetric cause of maternal death and is associated with significant maternal and fetal morbidity and mortality. The most frequent and life-threatening cause of trauma in this population is road traffic accidents. This article describes the case of a 32-week-pregnant patient who was involved in a car accident. She sustained a grade V splenic injury and a grade III left kidney injury, according to the classifications of the American Association for the Surgery of Trauma (AAST). The patient underwent laparotomy, an emergency cesarean section resulting in the delivery of a live-born female, and splenectomy. The renal injury was treated conservatively. The fetus required intensive care immediately after birth. The diagnostic approach, even during pregnancy, must address not only the uterus but also other potential injuries, which may lead to severe hemorrhage, shock, and possible maternal and fetal death. A multidisciplinary approach is essential to ensure the best outcomes for both mother and fetus.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"713-717"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301095","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 Procedures as Predictors of Postoperative Outcomes in Elderly Patients Undergoing Non-Emergency Colorectal Cancer Surgery.","authors":"Guanchi Chen, Zhonglin Liang, Long Cui","doi":"10.62713/aic.3919","DOIUrl":"https://doi.org/10.62713/aic.3919","url":null,"abstract":"<p><strong>Aim: </strong>Elderly patients are at increased risk of morbidity and prolonged hospital stays following non-emergency colorectal cancer (CRC) surgery. This study aimed to determine which surgical procedures are associated with postoperative morbidity and shorter postoperative hospital stay in elderly patients undergoing colorectal surgery.</p><p><strong>Methods: </strong>Patients aged ≥75 years who underwent CRC resection between June 2015 and May 2019 at one hospital were included in this observational study. Logistic regression models were used to analyze the relationship between different surgical procedures and both overall postoperative complications and surgery-related complications, expressed as odds ratios (ORs) with 95% confidence intervals (CIs). The relationship between surgical procedures and postoperative hospital stay was evaluated using negative binomial regression, reported as incidence rate ratios (IRRs) with 95% CI. Additionally, Cox regression models were applied to assess the association between surgical procedures and postoperative mortality, expressed as hazard ratios (HRs) with 95% CIs.</p><p><strong>Results: </strong>A total of 442 patients who underwent CRC resection were included, of whom 196 (44.34%) experienced postoperative complications and 121 (27.38%) had surgery-related complications. Patients undergoing anastomosis (adjusted OR = 0.43, 95% CI: 0.22-0.84, p = 0.014) had a lower risk of postoperative complications. Laparoscopy (adjusted OR = 0.51, 95% CI: 0.28-0.89, p = 0.019) was associated with a reduced risk of surgery-related complications. For postoperative hospital stay, laparoscopy (IRR = 0.883, 95% CI: 0.790-0.987, p = 0.027) was associated with shorter stays, whereas stoma formation (IRR = 1.154, 95% CI: 1.006-1.326, p = 0.044) was associated with prolonged hospital stay. Moreover, stoma formation (HR = 5.18, 95% CI: 1.03-25.91, p = 0.045) was associated with an increased risk of postoperative mortality.</p><p><strong>Conclusions: </strong>Anastomosis and laparoscopy were associated with a lower risk of complications, while stoma formation was related to poorer prognosis in elderly patients undergoing CRC resection. The influence of surgical procedure choice on postoperative outcomes should be carefully considered.</p>","PeriodicalId":8210,"journal":{"name":"Annali italiani di chirurgia","volume":"96 6","pages":"800-810"},"PeriodicalIF":0.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301096","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}