14 research outputs found
Hyperthermic intraperitoneal chemotherapy with oxaliplatin—Still not the standard of care for patients with colorectal peritoneal metastases
No full textComment on “Outcomes of a Multicenter Training Program in Laparoscopic Pancreatoduodenectomy (LAELAPS-2)”
No full textDetermination of the Length of Pancreatic Ductotomy by Pancreaticoscopy During Frey’s Procedure for Chronic Pancreatitis
No full textObjective:. To study the impact of pancreaticoscopy during Frey’s procedure for treating chronic pancreatitis (CP).
Background:. Excision of the central part of the head of the pancreas along with longitudinal pancreaticotomy (Frey’s procedure) is widely performed for the treatment of CP. However, there is no reliable method to determine the necessary length of longitudinal pancreaticotomy during surgery for CP.
Methods:. Thirty-five consecutive patients with CP were scheduled for Frey’s procedure with intraoperative pancreaticoscopy. The length of the longitudinal pancreaticotomy was tailored by pancreaticoscopy in the following manner: (1) it did not extend beyond the neck in case of a uniformly dilated main duct with patent branch duct confluences and a clear lumen; (2) in case of an obstructed main duct or branch duct confluence of any cause, the main duct was opened to include the most distal obstruction.
Results:. All patients underwent Frey’s procedure and intraoperative pancreaticoscopy. Based on the pancreaticoscopy findings, pancreaticotomy over the body of the gland was not necessary in 34% of the patients. A short (4–6 cm) ductotomy extension over the pancreatic body was required in 14% of the patients. Full-length pancreaticotomy was required in 52% of the patients. The median operative time was 145 minutes, and the median blood loss was 70 mL. Four patients (11.4%) experienced postoperative complications. There were no 90-day postoperative mortality or hospital readmission rates. At the median follow-up of 19 months, 31 patients (88.5%) had no pain attacks requiring medication.
Conclusions:. Intraoperative pancreaticoscopy helps to determine the length of longitudinal pancreaticotomy and reduce pancreatic trauma during Frey’s procedure for treating CP
40Ar/39Ar dating of Quaternary lavas in northwest Iran: constraints on the landscape evolution and incision rates of the Turkish-Iranian plateau
No full textWe report five new <sup>40</sup>Ar/<sup>39</sup>Ar ages for basaltic lavas in the Maku region of northwest Iran, between ca. 1.87 and 0.40 Ma, which help constrain the tectonic and landscape evolution of this part of the Turkish–Iranian plateau. Flows originated from the composite volcanoes Ararat (Agri Dagi), Tendürek and Yigit Dagi, in eastern Turkey (Anatolia). These volcanoes are within the Turkish–Iranian plateau, which is a consequence of the Arabia–Eurasia collision, but has a poorly constrained evolution and surface uplift history. Current plateau elevations are typically 1.5–2 km, and relief between non-volcanic summits and basins is typically on the scale of ∼1 km. Samples are from flows that passed along pre-existing river valleys. Gorges were cut by re-established rivers after the eruptions, but the great majority of the local relief (∼95 per cent) lies above the sampled flows and so most likely pre-dates the volcanism. Gorge depths and lava ages allow local Quaternary fluvial incision rates to be calculated, which are ∼0.01 to 0.05 mm yr−1. These rates imply slow surface uplift of this part of the Turkish–Iranian plateau during the Quaternary. We therefore constrain the generation of the great majority of relief in the study area to be pre-Quaternary, and caused by the tectonic construction of the plateau, rather than a subcrustal origin related to the Quaternary magmatism
Echinococcosis - New Perspectives
No full textEchinococcosisis a disease caused by Echinococcus spp. cestode parasites. There are more than20 species of this parasite, Echinococcus (E.) spp. Four important species are E. granulosus (Batsch, 1786) that causes“Cystic echinococcosis” (CE), E.multilocularis (Leuckart, 1863) that causes “Alveolar echinococcosis” (AE),E. oligarthrus (Diesing, 1863) and E. vogeli (Rausch and Bernstein, 1972).Definitive host of the parasite, are wide-spread in the world, for instance;fox, cat, wolf, raccoon–dog (Nyctereutesprocyonoides albus), American cervid strain (European or Fennoscandiancervid strain), pigs, lions (Panthera leo), jackals (Canis mesomelas and C. aureus),wild canids (eg. hunting dogs (Lycaonpictus), hyaenas (Crocuta crocuta).Echinococcus spp live in theintestines of definitive hosts. The parasites are transmitted to intermediatehosts by eggs that are spread around by the feces of the definitive host.Intermediate hosts are again very wide-spread such as humans, sheep, buffalo,horse, cattle, camel, pig Although affected organs in the intermediate hosts varyaccording to species, the liver, lungs, brain, kidney are commonly involvedorgans. The disease can last for 20-30 years. Itis more common in the northern hemisphere of the world. It is especially commonin Asia and Europe. Echinococcosis has a global distribution with an estimated2–3 million people affected and 200,000 new cases diagnosed annually. WorldHealth Organization (WHO) accepted "echinococcosis" as one of the 17neglected diseases for year 2050 and included this parasitic disease in"elimination program". the World Health Organization/Food andAgriculture Organization included Taeniasolium, E. granulosus, and E. multilocularis in the food borneparasitic diseases. Thereare two main issues in “echinococcosis” that inspired us to write this book.Firstly, it is a “neglected disease”. Secondly, due to the rough use of industry,the pollution of our world's waters and the increase in global warming cause anincrease the possibility of the spread of disease. Inthe chapters of our book; you can find epidemiological information aboutechinococcosis species, classical, molecular, serological diagnosis methods,medical and surgical treatment methods, control mechanisms of the disease,vaccine studies, information and suggestions about what needs to be done in thefuture. The Department of Medical Parasitology,Dokuz Eylul University of Medical Facultyİzmir, Türkiye</p
Current status of liver surgery for non-colorectal non-neuroendocrine liver metastases: the NON.LI.MET. Italian Society for Endoscopic Surgery and New Technologies (SICE) and Association of Italian Surgeons in Europe (ACIE) collaborative international survey
No full textDespite the increasing trend in liver resections for non-colorectal non-neuroendocrine liver metastases (NCNNLM), the role of surgery for these liver malignancies is still debated. Registries are an essential, reliable tool for assessing epidemiology, diagnosis, and therapeutic approach in a single hub, especially when data are dispersive and inconclusive, as in our case. The dissemination of this preliminary survey would allow us to understand if the creation of an International Registry is a viable option, while still offering a snapshot on this issue, investigating clinical practices worldwide. The steering committee designed an online questionnaire with Google Forms, which consisted of 37 questions, and was open from October 5th, 2022, to November 30th, 2022. It was disseminated using social media and mailing lists of the Italian Society of Endoscopic Surgery and New Technologies (SICE), the Association of Italian Surgeons in Europe (ACIE), and the Spanish Chapter of the American College of Surgeons (ACS). Overall, 141 surgeons (approximately 18% of the total invitations sent) from 27 countries on four continents participated in the survey. Most respondents worked in general surgery units (62%), performing less than 50 liver resections/year (57%). A multidisciplinary discussion was currently performed to validate surgical indications for NCNNLM in 96% of respondents. The most commonly adopted selection criteria were liver resectability, RECIST criteria, and absence of extrahepatic disease. Primary tumors were generally of gastrointestinal (42%), breast (31%), and pancreaticobiliary origin (13%). The most common interventions were parenchymal-sparing resections (51% of respondents) of metachronous metastases with an open approach. Major post-operative complications (Clavien-Dindo > 2) occurred in up to 20% of the procedures, according to 44% of respondents. A subset analysis of data from high-volume centers (> 100 cases/year) showed lower post-operative complications and better survival. The present survey shows that NCNNLM patients are frequently treated by surgeons in low-volume hospitals for liver surgery. Selection criteria are usually based on common sense. Liver resections are performed mainly with an open approach, possibly carrying a high burden of major post-operative complications. International guidelines and a specific consensus on this field are desirable, as well as strategies for collaboration between high-volume and low-volume centers. The present study can guide the elaboration of a multi-institutional document on the optimal pathway in the management of patients with NCNNLM
Devices for minimally invasive liver parenchyma transection: the SICE (Italian Society of Endoscopic Surgery) Italian and International survey
No full textBackgroundsMinimally Invasive Liver Surgery (MILS), encompassing laparoscopic (L-MILS) and robotic (R-MILS) approaches, has revolutionized liver surgery, offering reduced morbidity, shorter hospital stays, and improved outcomes while maintaining oncological efficacy. Despite the widespread use of L-MILS, parenchyma liver transection techniques and devices remain debated. This study investigates the adoption of transection devices (TDs) in MILS among 86 hospitals, focusing on surgical practices, device utilization, and outcomes.MethodsThe Italian Society of Endoscopic Surgery (SICE) endorsed a cross-sectional internet-based survey targeting general and Hepato-Pancreato-Biliary surgeons.ResultsResponses from 86 centers revealed that 77% of institutions is available a robotic platform, with an adoption rate of 87.50% in high-volume centers. L-MILS remains the predominant technique for liver resections, also in case of major hepatectomies, although R-MILS is increasingly utilized. For minor L-MILS, more than 50% of respondents use ultrasonic shears and electrosurgical pencil and advanced bipolar devices, while about 40% of surgeons adopt Cavitronic Ultrasonic Surgical Aspirator (CUSA) in major resections. R-MILS procedures predominantly used Maryland bipolar forceps and vessel sealers, with hybrid techniques (30%) integrating laparoscopic devices (e.g., CUSA) to address robotic device limitations.ConclusionThe minimally invasive approach to liver parenchymal transection is a key component of this surgical procedure. For major hepatectomies, the CUSA device remains the most effective tool, whereas ultrasonic shears, electrosurgical pencil, and advanced bipolar devices are more suited for minor resections. Despite limited access to specialized instruments, R-MILS achieves favorable outcomes in liver transection by employing the crash-clamp technique or hybrid strategies
OGC O01 - Stomach Cancer Elective Surgery Morbidity and Mortality at 90-Days (HOLD Study): A Prospective, International Collaborative Cohort Study
No full textAbstract
Background
Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors.
Method
We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01 April 2022 to 30 September 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression was used to identify variables associated to 90-day outcome.
Results
380 collaborators from 47 countries submitted data on 1538 patients. Mean age was 64.2 years and 58.5% were males. 90-day morbidity rate was 38.2% (n=587) and mortality rate was 2.9% (n=45).
Pre-operative higher CCI or ASA score, pre-operative weight loss >10%, and surgical determinants such as type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and post operative pathological IV staging (p value<0.05) were identified as predictors of postoperative severe complications and mortality.
Conclusion
Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and exemplified the importance of a unified language on surgical morbidity, pre-habilitation and ongoing audits to enhance patient outcomes
Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study): a prospective, international collaborative cohort study
No full textBackground
Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors.
Methods
We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome.
Results
380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19–94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality.
Conclusion
Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes
Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study
No full text
