Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Immunohistochemical study of skin tumors

INTRODUCTION: Keratoacanthoma (KA) is a highly differentiated, biologically benign non metastasizing tumor characterized by the rapid development and a tendency for spontaneous regression. Squamous Cell Carcinoma (SCC) consists of altered keratinocytes presents variable differentiation, inexorably progresses and on occasion metastasizes. The study aimed to investigate the epidermal cells biological activity in KAs and SCCs by counting the number of silver stained Nucleolar Organizer Regions (AgNORs), to estimate the quantity of Ig producing cells and the Inflammatory Cellular Infiltrate (ICI) to elucidate the expression of PGP 9.5 and cyclin D1 using immunohistochemistry and to achieve a comparative evaluation. MATERIAL AND METHODS: Thirty-two KAs (10 in growth stage 10 in mature stage and 12 in involution stage) and 39 SCCs including 13 well differentiated cases, 12 moderately differentiated tumors, 7 poorly differentiated lesions and 7 pseudoadenoid entities were investigated. RESULTS: The KAs examined had a mean number of 1.727 AgNORs (S.D. 0.232) and IgG predominated in most cases IgG and IgE increase at the involution. IgA remains at almost the same level and IgM decreases during the maturity stage. The SCCs examined had a mean number of 2.105 AgNORs (S.D. 0.446) IgG predominated and gradually increases in proportion to the degree of malignancy. PGP 9.5 expression was positively correlated with tumor stage (p<0.001) and potential perineural invasion (p<0.001). There was no significant difference in the distribution of patients presenting variable levels of PGP 9.5 staining with regard to maximal tumor size and the extent and degree of stromal invasion. Cyclin D1 expression correlated inversely with the degree of cellular differentiation (p<0.001) and PGP 9.5 immunostaining (p<0.001). DISCUSSION: There is a significant difference in the number of AgNORs and the proportion of Ig subclasses in contrast to the cellular infiltrate among the three stages of KA. In SCCs the number of AgNORs and the percentage of Igs and ICI increased gradually in proportion to the degree of malignancy. In addition PGP 9.5 and cyclin D1 co expression proved closely associated with tumor aggressiveness and can be classified as a marker for predicting the outcome of resection-treated skin cancer patients.ΕΙΣΑΓΩΓΗ: Σε αντιδιαστολή με τα επιδερμοειδή καρκινώματα, τα κερατοακανθώματα συνιστούν καλοήθεις δερματικές αλλοιώσεις οι οποίες υπόκεινται στη διεργασία της ανάπτυξης και ωρίμανσης και τελικά υποστρέφουν αυτόματα. Η μελέτη αποσκοπεί στην αναζήτηση ανοσοϊστοχημικών παραγόντων που επιτρέπουν τη διερεύνηση του μηχανισμού έκθυσης των δερματικών νεοπλασιών που προέρχονται από τα κερατινοποιούμενα κύτταρα προοιωνίζουν την έκβαση της νόσου και προδιαγράφουν την ενδεχομένη βιολογική συμπεριφορά του όγκου. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΣ: Η μελέτη αφορά 39 επιδερμοειδή καρκινώματα δέρματος (13 καλώς διαφοροποιημένα - Grade Ι, 12 μετρίως διαφοροποιημένα Grade II, 7 χαμηλής διαφοροποίησης Grade III και 7 ψευδοαδενοειδή νεοπλάσματα) και 32 κερατοακανθώματα (10 αρχόμενα, 10 νεοπλάσματα στη φάση ηρεμίας και 12 αλλοιώσεις στο στάδιο της υποστροφής). ΑΠΟΤΕΛΕΣΜΑΤΑ: Στα κερατοακανθώματα ο MO της τιμής των AgNORs ήταν 1.727 (S.D. 0.232) ενώ η IgG υπερίσχυσε σε κάθε περίπτωση. Επιπλέον η IgG και IgE εκφράζονται στο στάδιο της υποστροφής, η IgA δεν παρουσιάζει διακυμάνσεις και η IgM μειώνεται στη φάση της ωρίμανσης. Τα επιδερμοειδή καρκινώματα παρουσιάζουν MO επίπεδων AgNORs 2.105 (S.D. 0.446) ενώ η IgG παρουσιάζει προοδευτικά ενισχυμένη έκφραση σε συνάρτηση με το βαθμό κακοήθειας. Επιπρόσθετα η PGP 9.5 ανοσοϊστοχημική έκφραση συνδέεται θετικά με το εξελικτικό στάδιο της νεοπλασματικής εξεργασίας (p<0.001) και την ενδεχομένη περινευρική διήθηση (p<0.001). Τέλος, η έκφραση της κυκλίνης D1 αυξάνεται παράλληλα με το βαθμό κακοήθειας του επιδερμοειδούς καρκινώματος (p<0.001) και συνάδει με την έκφραση του δείκτη PGP 9.5 (p<0.001). ΣΥΖΗΤΗΣΗ: Πιστοποιείται στατιστικώς σημαντική διαφορά στην έκφραση των AgNORs ανάλογα με το βαθμό κακοήθειας του επιδερμοειδούς καρκινώματος σε αντιδιαστολή με τα κερατοακανθώματα. Επιπλέον, η φλεγμονώδης κυτταρική διήθηση που περιβάλλει τα επιδερμοειδή καρκινώματα αυξάνεται παράλληλα με το βαθμό κακοήθειας του όγκου. Η PGP 9.5 ανοσοϊστοχημική χρώση ανιχνεύεται στα νεοπλασματικά κύτταρα ανεξάρτητα από το νευροενδοκρινικό πρότυπο έκφρασης και επισημαίνεται κατά τη διάρκεια ενδεχόμενου κακοήθους μετασχηματισμού των κερατινοποιουμένων κυττάρων. Τέλος, η αξιολόγηση της συν έκφρασης των πρωτεϊνικών μορίων PGP 9.5 και κυκλίνης D1 συμβαδίζει με την επιθετικότητα της δερματικής νεοπλασίας αναδεικνύοντας τους παράγοντες σε αξιόπιστους δείκτες εκτίμησης της έκβασης της νόσου μετά από τη ριζική χειρουργική αφαίρεση του όγκου

Radioguided Occult Lesion Localization Techniques for Nonpalpable Breast Cancer Identification

Background: The main goal of successful management of nonpalpable breast tumors is accurate preoperative localization. A hooked wire inserted under radiographic guidance has been the technique used most often to remove occult breast lesions. Because of several disadvantages of wire-guided localization (WGL), new modalities have been investigated. These include radioguided occult lesion localization (ROLL) and radioguided seed localization (RSL). Objective: The aim of this review is to elucidate the diagnostic efficacy of ROLL and RSL techniques and to evaluate the results of subsequent surgical procedures in cases of nonpalpable breast lesions, with special reference to the extent of histologic spread and adequate excision. Methods: A comparison with the standard of care, WGL, as well as an assessment of the recent literature was performed in order to provide an update on the current concepts of diagnostic approach of early breast cancer. Results: The ROLL technique is as effective as WGL for excision of nonpalpable breast lesions, reduces localization time, and probably reduces the incidence of pathologically involved margins of excision. Therefore, ROLL is an attractive alternative to WGL. Moreover, a statistically significant benefit for RSL versus WGL in the form of involved surgical margin status, reoperation rates, and operative time has been documented. Conclusions: This systematic review provides evidence that both ROLL and RSL techniques are not only useful methods for three-dimensional localization of impalpable breast tumors but also are superior in terms of surgical-margin status, reoperation need, and operative duration, compared to WGL. (J GYNECOL SURG 20XX:000

Giant Intracystic Papillary Carcinoma of the Breast Report of a Case and Review of the Literature

Background: Intracystic papillary carcinoma (IPC) is a distinctive variant of a papillary ductal neoplasm confined to a dilated cystic space. This rare mammary tumor typically appears as a discrete solitary mass in the central region of the breast in a postmenopausal woman. This article presents the case of a female patient with a giant IPC. Relevant literature is briefly reviewed. Case: A 65-year-old woman was admitted for the management of a palpable mass of the left breast. On clinical examination, it was noted that the entire left breast was replaced by an extremely large, irregularly shaped, relatively mobile lesion. The mass was almost fixed to surrounding tissues including skin and pectoral muscle. Due to the size of the tumor the patient underwent a left modified radical mastectomy. Results: The final histopathologic diagnosis was defined as an IPC. Concomitant vascular invasion or metastasis to 19 removed lymph nodes were not noted. Conclusions: Because of its relevant growth pattern and indolent clinical behavior, IPC is conventionally regarded as a variant of intraductal papillary carcinoma with an absence of myoepithelial cells. There have been several cases that indicated a slow evolution of the mass, verifying the perception that IPC is associated with a favorable clinical outcome. Differential diagnoses include colloid or medullary carcinoma, invasive ductal carcinoma, hematoma, benign cyst, or adenofibroma. Axillary lymph-node metastases and markers related to invasion have been documented. Due to the rarity of the tumor and variability observed in treatment strategies, only a few surveys have assessed the significance of lymph-node status and the role of adjuvant treatment. (J GYNECOL SURG 2017:1

Prognostic Benefit of Surgical Management of Renal Cell Carcinoma Invading the Inferior Vena Cava

Renal cell carcinoma (RCC) accounts for approximately 3 % of adult malignancies and 90-95 % of neoplasms arising from the kidney. One of the unique features of RCC is the tumor thrombus formation that migrates into the venous system including renal vein (RV) and inferior vena cava (IVC). Only 10 % of patients with RCC present with the classic triad of flank pain, hematuria and defined mass, while 25-30 % of affected patients are asymptomatic. Signs of para-neoplastic syndrome such as hypercalcemia, hypertension, anemia, cachexia and increased erythrocyte sedimentation rate (ESR) are often apparent. Extension of tumor thrombus into the venous system is depicted by radiological examinations, such as contrast enhanced Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and vena cavography. The level of the thrombus is mostly determined according to the Mayo classification. Despite recent research on the therapeutic strategies against advanced RCC, surgical resection appears the only potentially curative approach. Aggressive surgical management including nephrectomy with thrombectomy is currently the standard therapeutic approach for RCC patients with tumor thrombus extending to the RV or the IVC. Pre-surgical down-staging with the use of molecular targeted therapy has also been proposed. Alternative therapies, such as radio- and chemotherapy proved insufficient. The aim of this review is to evaluate the results of surgical treatment for RCC invading IVC with special reference to the extent of its histological spread. Review of recent world literature was accomplished to provide an update on the current concepts of surgical management of the disease

Solid Pseudopapillary Neoplasms of the Pancreas: A Surgical and Genetic Enigma

Solid pseudopapillary neoplasms of the pancreas are rare tumors accounting for 1-2% of pancreatic exocrine neoplasms. This entity was first described by Dr. Frantz in 1959 and was defined by the World Health Organization in 1996 as “solid pseudopapillary tumor.” It is most often a benign neoplasm, but 10-15% of the cases are malignant. Over the past decades, the incidence of this tumor is increasing. However, many surgeons are still unfamiliar with this neoplasm and its unique characteristics, which can lead to pitfalls in the diagnosis and treatment. The correct diagnosis of SPNP is of utmost importance since it has a low malignant potential and with the appropriate treatment, patients have a long life expectancy. There are many genetic alterations, involving various signaling pathways that have been associated with SPNP and are very important in diagnosing the tumor. The cornerstone of SPNP treatment includes surgical excision of the tumor, preserving as much pancreatic tissue as possible. We review the information in the literature regarding more organ-preserving techniques and possible clinical features that might indicate a malignant potential, thus demanding a more radical intraoperative excision

Prophylactic total gastrectomy for hereditary diffuse gastric cancer. Review of the literature

Hereditary diffuse gastric cancer (HDGC) is characterized as an autosomal dominant cancer susceptibility syndrome largely attributable to germline mutations and deletions in the gene encoding E-cadherin, CDH1. Mutation carriers have a more than 70% lifetime risk of developing DGC and an elevated probability of lobular breast cancer. The aim of this review was to evaluate the results of surgical treatment for HDGC with special reference to the extent of its histological spread and to analyze the recent literature in order to provide an update on the current concepts of prophylactic gastrectomy for disease prevention. Nevertheless, it is not clear that our current knowledge of molecular and genetic diagnostics calls for the addition of HDGC to the roster of malignant familial syndromes in which early counseling and preventive surgical intervention should become the standard of care. Endoscopic screening cannot be recommended because the stomach appears normal and biopsies often fail to demonstrate signet ring cell adenocarcinoma. Prophylactic gastrectomy has provided many members of affected families with relief from GC with minimal implications. (C) 2011 Elsevier Ltd. All rights reserved

Imprint cytology versus frozen section analysis for intraoperative assessment of sentinel lymph node in breast cancer

Introduction: Sentinel lymph node (SLN) biopsy is the gold standard for surgical staging of the axilla in breast cancer (BC). Frozen section (FS) remains the most popular means of intraoperative SLN diagnosis. Imprint cytology (IC) has also been suggested as a less expensive and equally accurate alternative to FS. The aim of our study was to perform a direct comparison between IC and FS on the same SLNs of BC cases operated in a single center by the same surgical team. Materials and methods: Into this prospective study we enrolled 60 consecutive patients with histologically proven T1-T3 BC and clinically negative axilla. Sentinel nodes were detected using a standard protocol. The SLN(s) was always assessed by IC as well as FS analysis and immunohistochemistry. Nevertheless, all intraoperative decisions were based on FS analysis. Results: During the study period 60 patients with invasive BC were registered, with 80 SLNs harvested. Mean number of SLN(s) identified for each patient was 1.33. The sensitivity and specificity were 90% and 100%, respectively, for IC, and 80% and 100% for FS. Relevant positive/negative predictive values were 100%/98% for IC and 100%/96.15%, respectively, for FS. Overall accuracy was 98% for IC and 97% for FS. Therefore, statistically significant difference between the two methods in the detection of positive nodes was not elucidated (p=1.000). Conclusions: IC appeared to be marginally more sensitive than FS in detecting SLN metastatic activity. Overall accuracy was 98.75%. With regard to the primary lesion characteristics, we conclude that initial lesion size and lymphovascular invasion play a pivotal role in metastatic involvement of the SLN with the dimensions of metastasis bearing no correlation with tumor size. Therefore, IC appears to be a sensitive and accurate method for the intraoperative assessment of SLN in BC patients, but further studies are required to confirm this interesting data