Open versus laparoscopic splenectomy a meta-analysis of larger series

Background: Minimally invasive surgery for elective splenectomy has become a routine procedure in all laparoscopic centers. After first case series, many groups has published comparative studies between open and laparoscopic approach. For this purpose, a meta-analysis investigating comparative studies of open versus laparoscopic approach for splenectomy was performed.Methods: All kinds of manuscripts were reviewed, and we included the only studies with a laparoscopic group number >= 50 cases.Results: The literature search, performed until December 31, 2019, identified a total of 564 records. After full-text analysis, twelve studies were included in the meta-analysis. Operative time was higher for the laparoscopic group in all but one study. The length of stay, morbidity and mortality were less frequent in the laparoscopic group.Conclusions: The gain of shorter hospital-stay associated with the good outcomes suggests performing splenectomy by a laparoscopic procedure

Keep It Small, Keep It Real: Efficient Run-Time Verification of Web Service Compositions

Abstract. Service compositions leverage remote services to deliver addedvalue distributed applications. Since services are administered and run by independent parties, the governance of service compositions is intrinsically decentralized and services may evolve independently over time. In this context, pre-deployment verification can only provide limited guarantees, while continuous run-time verification is needed to probe and guarantee the correctness of compositions at run time. This paper addresses the issue of efficiency in the run-time verification of service compositions described in BPEL. It considers an existing monitoring approach based on ALBERT, which is a temporal logic language suitable for asserting both functional and non-functional properties, and shows how to obtain the efficient run-time verification of ALBERT formulae. The paper introduces an operational semantics for ALBERT through an extension of alternating automata, and explains how to optimize it to produce smarter, and thus more efficient, encodings of defined formulae. The optimized operational semantics can then be the basis for an efficient implementation of the run-time verification framework

Minimally invasive vs. open segmental resection of the splenic flexure for cancer: a nationwide study of the Italian Society of Surgical Oncology-Colorectal Cancer Network (SICO-CNN)

Background Evidence on the efficacy of minimally invasive (MI) segmental resection of splenic flexure cancer (SFC) is not available, mostly due to the rarity of this tumor. This study aimed to determine the survival outcomes of MI and open treatment, and to investigate whether MI is noninferior to open procedure regarding short-term outcomes. Methods This nationwide retrospective cohort study included all consecutive SFC segmental resections performed in 30 referral centers between 2006 and 2016. The primary endpoint assessing efficacy was the overall survival (OS). The secondary endpoints included cancer-specific mortality (CSM), recurrence rate (RR), short-term clinical outcomes (a composite of Clavien-Dindo > 2 complications and 30-day mortality), and pathological outcomes (a composite of lymph nodes removed >= 12, and proximal and distal free resection margins length >= 5 cm). For these composites, a 6% noninferiority margin was chosen based on clinical relevance estimate. Results A total of 606 patients underwent either an open (208, 34.3%) or a MI (398, 65.7%) SFC segmental resection. At univariable analysis, OS and CSM were improved in the MI group (log-rank test p = 0.004 and Gray's tests p = 0.004, respectively), while recurrences were comparable (Gray's tests p = 0.434). Cox multivariable analysis did not support that OS and CSM were better in the MI group (p = 0.109 and p = 0.163, respectively). Successful pathological outcome, observed in 53.2% of open and 58.3% of MI resections, supported noninferiority (difference 5.1%; 1-sided 95%CI - 4.7% to infinity). Successful short-term clinical outcome was documented in 93.3% of Open and 93.0% of MI procedures, and supported noninferiority as well (difference - 0.3%; 1-sided 95%CI - 5.0% to infinity). Conclusions Among patients with SFC, the minimally invasive approach met the criterion for noninferiority for postoperative complications and pathological outcomes, and was found to provide results of OS, CSM, and RR comparable to those of open resection

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience.

The use of a protective stoma in anterior resection and in coloanal anastomoses for rectal cancer was, till now, controversial. [1] and [2] Neoadjuvant therapy is considered a risk factor for anastomotic complications. We read with interest the article by Tsikitis and colleagues3 and note their good results, but some points of their study have to be discussed

Benign Anorectal Disorders and Pelvic Floor Disease After Bariatric Surgery

: The correlations between morbid obesity, bariatric surgery and gastrointestinal disorders are well known and reported. Symptoms like abdominal pain, constipation, bloating, heartburn and gastroesophageal reflux disease are known to be significantly more prevalent in overweight patients and body mass index is associated positively with abdominal pain and diarrhea. In spite of these conditions, less is known about the lower gastrointestinal tract. Of these, anorectal disorders and pelvic floor disease are both believed to be more frequent in obese patients compared to the general population. Weight loss related to bariatric surgery seems to improve quality of life and weight-related symptoms, although some of these conditions may get worse. All these conditions are rarely studied in patients undergoing bariatric surgery for morbid obesity. This concise review aimed to focus on these conditions in patients undergoing bariatric surgery for morbid obesity in order to improve patient selection and post-operative management

A Timed extension of WSCoL

Web service based applications are expected to live in dynamically evolving settings. At run-time, services may undergo changes that could modify their expected behavior. Because of such intrinsic dynamic nature, applications should be designed by adhering to the principles of design- by-contract. Run-time monitoring is needed to check that the contract between service providers and service users is fulfilled while the collaboration is in place. We describe a language to specify the expected functional and non-functional requirements that a service provider should fulfill. The language (timed WSCoL) is a temporal extension of a previous proposal (WSCoL). We also illustrate the architecture of a run-time analyzer that checks timed WSCoL properties. Should such properties be disproved during execution, appropriate recovery and reconfiguration actions may be put in place

Major vessel sealing in laparoscopic surgery for colorectal cancer: a single-center experience with 759 patients

Abstract Background Efficient hemostatic techniques are essential in laparoscopic surgery for ideal intraoperative and postoperative results. A variety of advanced devices are available for the sealing of major vascular structures. The aim of this study is to assess effectiveness and safety of major vessel sealing with a radiofrequency device during laparoscopic colorectal resections for cancer based on the experience of a single hospital. Methods Early outcomes of a consecutive series of patients who received elective laparoscopic colorectal resections for cancer over a 10-year period (January 2008–September 2017) are analyzed. In all procedures, the Ligasure® electrothermal bipolar device was used for the closure of the major colonic vessels and the dissection of all the structures. No other products such clips, staplers, hemostatic products, or other devices were used. Results Seven-hundred fifty-nine procedures were performed in laparoscopy: 179 rectal resections, 247 sigmoidectomies and left hemicolectomies, 240 right hemicolectomies, 33 resections of the splenic flexure, 35 transverse colonic resections, and 25 other procedures. In 39 cases, the laparoscopic procedure was converted to open surgery, and in these cases, vessel sealing was also achieved with the radiofrequency device alone. Vessel dissection and sealing was realized in all cases without any intraoperative or postoperative bleeding. No reoperations for bleeding from major vessels were performed in any patients. One case of reoperation was recorded postoperatively, at 3 h after right hemicolectomy, due to a small bleeding from the fat of the transverse colon stump. Conclusions The use of Ligasure® radiofrequency device for sealing and dividing the major colonic vessels is safe, fast, and effective during laparoscopic colorectal resections

Validation of web service compositions

Web services support software architectures that can evolve dynamically. In particular, in this paper the focus is on architectures where services are composed (orchestrated) through a workflow described in the business process execution language (BPEL). It is assumed that the resulting composite service refers to external services through assertions that specify their expected functional and non-functional properties. On the basis of these assertions, the composite service may be verified at design time by checking that it ensures certain relevant properties. Because of the dynamic nature of Web services and the multiple stakeholders involved in their provision, however, the external services may evolve dynamically, and even unexpectedly. They may become inconsistent with respect to the assertions against which the workflow was verified during development. As a consequence, validation of the composition must extend to run time. In this work, an assertion language, called assertion language for BPEL process interactions (ALBERT), is introduced; it can be used to specify both functional and non-functional properties. An environment which supports design-time verification of ALBERT assertions for BPEL workflows via model checking is also described. At run time, the assertions can be turned into checks that a software monitor performs on the composite system to verify that it continues to guarantee its required properties. A TeleAssistance application is provided as a running example to illustrate our validation framework