1,721,146 research outputs found
[Postoperative mortality and morbidity of patients in their late eighties]
No full textDuring the 12 year period, 1978-1989, 555 operations were performed at the Department of Clinica Chirurgica III of the University of Bologna, on 530 patients greater than 80 years old at the time of surgery. These were the indications for surgical procedure in these patients: malignant neoplasm of digestive system (243), other diseases of the digestive system (111), abdominal wall hernia (74), biliary disease (77), miscellaneous (50). The purpose of this paper is to define the role of surgery in patients over 80 years old. An acute complication required an emergency operation in 295 cases (53%). In all the other cases (260, 47%) an elective operation was performed. There were 63 deaths with an operative mortality rate of 11%. Among the patients who underwent elective surgery there were 11 deaths (4%); in the emergency group there were 52 deaths (17.6%). These rates were found to be statistically significant. The overall morbidity rate was 37.6% in the elective group and 49% in the emergency group. Also these rates were found to have a statistic significance. Then we have compared morbidity and operative mortality of over-eighty years old patients with the ones of two younger groups of patients: I group (age greater than 80 years), II group (age 65-80 years), III group (age less than 65 years). Patients of the three groups had undergone identical surgical operations for the same pathology. The operative mortality was 11% in the I group, 5.2% in the II group and 1.4% in the III group. The morbidity was 46%, 30% and 17% respectively.(ABSTRACT TRUNCATED AT 250 WORDS
Impact of COVID-19 on vascular patients worldwide: Analysis of the COVIDSurg data
No full textBACKGROUND: The COVIDSurg collaborative was an international multicenter prospective analysis of perioperative data from 235 hospitals in 24 countries. It found that perioperative COVID-19 infection was associated with a mortality rate of 24%. At the same time, the COVERstudy demonstrated similarly high perioperative mortality rates in vascular surgical patients undergoing vascular interventions even without COVID-19, likely associated with the high burden of comorbidity associated with vascular patients. This is a vascular subgroup analysis of the COVIDSurg cohort. METHODS: All patients with a suspected or confirmed diagnosis of COVID-19 in the 7 days prior to, or in the 30 days following a vascular procedure were included. The primary outcome was 30-day mortality. Secondary outcomes were pulmonary complications (adult respiratory distress syndrome, pulmonary embolism, pneumonia and respiratory failure). Logistic regression was undertaken for dichotomous outcomes. RESULTS: Overall, 602 patients were included in this subgroup analysis, of which 88.4% were emergencies. The most common operations performed were for vascular-related dialysis access procedures (20.1%, N.=121). The combined 30-day mortality rate was 27.2%. Composite secondary pulmonary outcomes occurred in half of the vascular patients (N.=275, 45.7%). CONCLUSIONS: Mortality following vascular surgery in COVID positive patients was significantly higher than levels reported pre-pandemic, and similar to that seen in other specialties in the COVIDSurg cohort. Initiatives and surgical pathways that ensure vascular patients are protected from exposure to COVID-19 in the peri-operative period are vital to protect against excess mortality
Complications of colonic diverticulosis
No full textFrom 1978 to 1993, 220 patients were admitted at the Cl. Chirurgica III of the University of Bologna because of acute colonic diverticulitis. During the same period 108 patients (58 females and 50 males; mean age 65 years) were operated on for complications of the disease; 21 acute diverticulitis, 10 pericolic or pelvic abscess, 30 purulent peritonitis, 7 fecal peritonitis, 19 obstruction, 14 hemorrhage and 7 fistula. Surgical techniques were: resection and primary anastomosis (n. = 46), two or three stage procedure (n. = 49), Hartmann's resection (n. = 13). Mortality rate was 15%, 14,2% and 7,6% respectively. The advantages or disadvantages of the various surgical approaches in relation to the type of complications were evaluated. In conclusion appropriate segmental resection of the colon with or without primary anastomosis is recommended
Pancreatic cancer in 2021: What you need to know to win
No full textPancreatic cancer is one of the solid tumors with the worst prognosis. Five-year survival rate is less than 10%. Surgical resection is the only potentially curative treatment, but the tumor is often diagnosed at an advanced stage of the disease and surgery could be performed in a very limited number of patients. Moreover, surgery is still associated with high post-operative morbidity, while other therapies still offer very disappointing results. This article reviews every aspect of pancreatic cancer, focusing on the elements that can improve prognosis. It was written with the aim of describing everything you need to know in 2021 in order to face this difficult challenge
Factors influencing prognosis of gastric cancer after curative resection
No full textFour hundred eighty eight patients with gastric cancer were admitted to the Department of III Clinica Chirurgica of the University of Bologna-Italy; 451 patients underwent surgery: there were 17 deaths with an operative mortality rate of 3.8%. Only 286 curative resections were performed 252 sub-total gastrectomies and 34 total gastrectomies. The purpose of this paper is to define the prognostic role of some clinical and pathological variables in patients with carcinoma of the stomach who underwent curative resection. The hospital records of 229 patients submitted to curative resection between 1969 and 1982 were retrospectively reviewed. Fifty two patients were lost to follow-up study and 4 died for post-operative complications. The variables analyzed included: age (greater than 65 years, less than 65 years), sex, time of onset of clinical symptoms (greater than 6 months, less than 6 months), site of cancer (lower, two thirds, upper), size (greater than 3 cm, less than 3 cm), gross appearance (ulcerating, non ulcerating), histologic type (intestinal, diffuse), invasion of the gastric wall (T1-T2 vs. T3-T4), nodal status (negative, positive), stage (S1-S2 vs. S3-S4). The statistical significance of the results was calculated using chi 2 test and comparing survival at 1, 3 and 5 years. Of the variables selected only six (age greater than 65 years, size greater than 3 cm, diffuse histologic type, degree of the gastric wall invasion, positive nodal involvement, stage 3-4) were validated by statistic evaluation, whereas the others lost their prognostic relevance
Early diagnosis of pancreatic cancer: What strategies to avoid a foretold catastrophe
Full text linkWhile great strides in improving survival rates have been made for most cancers in recent years, pancreatic ductal adenocarcinoma (PDAC) remains one of the solid tumors with the worst prognosis. PDAC mortality often overlaps with incidence. Surgical resection is the only potentially curative treatment, but it can be performed in a very limited number of cases. In order to improve the prognosis of PDAC, there are ideally two possible ways: the discovery of new strategies or drugs that will make it possible to treat the tumor more successfully or an earlier diagnosis that will allow patients to be operated on at a less advanced stage. The aim of this review was to summarize all the possible strategies available today for the early diagnosis of PDAC and the paths that research needs to take to make this goal ever closer. All the most recent studies on risk factors and screening modalities, new laboratory tests including liquid biopsy, new imaging methods and possible applications of artificial intelligence and machine learning were reviewed and commented on. Unfortunately, in 2022 the results for this type of cancer still remain discouraging, while a catastrophic increase in cases is expected in the coming years. The article was also written with the aim of highlighting the urgency of devoting more attention and resources to this pathology in order to reach a solution that seems more and more unreachable every day
En bloc resection of giant retroperitoneal liposarcoma involving the right colon – a video vignette
No full textWe present a video vignette illustrating an en bloc resection
of a giant retroperitoneal liposarcoma (RPLS)
involving the right kidney and colon in a 65-year-old
woman (Video S1).
She presented with a 2-month history of non-specific
abdominal pain. Abdominal CT scan showed a large
retroperitoneal tumour. A biopsy was performed and
the histopathological diagnosis was RPLS. At laparotomy,
a mass of 20 9 23 9 25 cm was removed en bloc
with the right kidney and right colon. A stapled sideto-
side ileocolic anastomosis was done. The histopathological
diagnosis was of well-differentiated RPLS (sclerosing
and adipocytic variety) with MDM2 gene
amplification. The patient was discharged on the eighth
postoperative day. After 5 years of follow-up, she is
alive and disease-free.
RPLS is usually associated with a high rate of recurrence.
In the absence of effective systemic therapies,
surgery represents the mainstay of treatment with curative
intent and complex multivisceral resections are frequently
required. Studies have demonstrated that the
prognosis of patients with RPLS is better when surgeons
adopt an aggressive surgical approach [1–5].
Contiguous organs need to be resected en bloc with the
tumour, even if they are not clearly infiltrated by RPLS.
Because the best chance of cure is at the time of primary
surgery, this rare and complex malignancy should
be managed by an experienced surgical team in a specialized
referral centre [2,4,5]. As the colon is one of
the organs more frequently involved, surgery for RPLS
should be carried out by sarcoma surgeons with experience
in colorectal surgery
Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience from St. Orsola University Hospital—Bologna
Full text linkThis is a report of the daily experience from February 28 to April 5, 2020, collected by our Emergency Endoscopy Service during the COVID-19 (coronavirus disease 2019) pandemic in the North of Italy, throughout the pre-peak and peak phases
Obstructing Left-Sided Colonic Cancer: Is Endoscopic Stenting a Bridge to Surgery or a Bridge to Nowhere?
No full textFor the 8–29% colorectal cancers that initially manifest with obstruction, emergency surgery (ES) was traditionally considered the only available therapy, despite high morbidity and mortality rates and the need for colostomy creation. More recently, malignant obstruction of the left colon can be temporized by endoscopic placement of a self-expanding metallic stent (SEMS), used as bridge to surgery (BTS), facilitating a laparoscopic approach and increasing the likelihood that a primary anastomosis instead of stoma would be used. Despite these attractive outcomes, the superiority of the BTS approach is not clearly established. Few authors have stressed the potential cancer risk associated with perforations that may occur during endoscopic stent placement, facilitating neoplastic spread and negatively impacting prognosis. For this reason, the current literature focuses on long-term oncologic outcomes such as disease-free survival, overall survival and recurrence rate that do seem not to differ between the ES and BTS approaches. This lack of consensus has spawned differing and sometimes discordant guidelines worldwide. In conclusion, 20 years after the first description of a colonic stent as BTS, the debate is still open, but the growing number of articles about the use of SEMS as a BTS signifies a great interest in the topic. We hope that these data will finally converge on a single set of recommendations supporting a management strategy with well-demonstrated superiority
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