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

Poly-Unsaturated Fatty Acids (PUFAs) from <i>Cunninghamella elegans</i> Grown on Glycerol Induce Cell Death and Increase Intracellular Reactive Oxygen Species

Cunninghamella elegans NRRL-1393 is an oleaginous fungus able to synthesize and accumulate unsaturated fatty acids, amongst which the bioactive gamma-linolenic acid (GLA) has potential anti-cancer activities. C. elegans was cultured in shake-flask nitrogen-limited media with either glycerol or glucose (both at ≈60 g/L) employed as the sole substrate. The assimilation rate of both substrates was similar, as the total biomass production reached 13.0–13.5 g/L, c. 350 h after inoculation (for both instances, c. 27–29 g/L of substrate were consumed). Lipid production was slightly higher on glycerol-based media, compared to the growth on glucose (≈8.4 g/L vs. ≈7.0 g/L). Lipids from C. elegans grown on glycerol, containing c. 9.5% w/w of GLA, were transformed into fatty acid lithium salts (FALS), and their effects were assessed on both human normal and cancerous cell lines. The FALS exhibited cytotoxic effects within a 48 h interval with an IC50 of about 60 μg/mL. Additionally, a suppression of migration was shown, as a significant elevation of oxidative stress levels, and the induction of cell death. Elementary differences between normal and cancer cells were not shown, indicating a generic mode of action; however, oxidative stress level augmentation may increase susceptibility to anticancer drugs, improving chemotherapy effectiveness

Oncological outcomes after trans-anal total mesorectal excision (TaTME) for rectal cancer

Trans-anal total mesorectal excision (TaTME) was developed to overcome the technical difficulties of a trans-abdominal minimal access approach to resect low rectal cancer (1–4). TaTME was reported to be feasible and effective with the potential advantage of better access to the distal rectum and mesorectum, theoretically capable of delivering oncologically superior specimens (5, 6). In the UK, a national training initiative was developed and piloted, confirming the feasibility and safety of this technique within a structured training framework (7, 8). However, a widely publicised moratorium on TaTME was issued in 2019 in Norway substantiated by reports of higher-than-expected local recurrence rates, in particular multi-focal recurrence (9). In response to this publication, the Association of Coloproctology of Great Britain and Ireland (ACPGBI) issued recommendations in 2020 proposing a pause to the practice of TaTME in the UK (10). The aim of the current study was to collate oncological data from English centers that had adopted TaTME to investigate the oncological safety of the technique and the factors associated with local recurrence. MethodsThis was an observational study, collating data from centres performing TaTME in England. Centres that performed over 10 cases were identified from the international TaTME registry and the designated Principal Investigator for each site was contacted to enter their data in a proforma developed by the steering committee. Adult patients undergoing TaTME performed for histologically proven rectal cancer with the intention to cure and no detectable metastases at time of diagnosis were eligible for inclusion. Oncological data were collected on:•Loco-regional recurrence (LR) - defined as any recurrent disease in the pelvis in the prior area of dissection, at the anastomotic site, or as pelvic nodal disease (11). Suspicion of LR had to be confirmed on imaging such as CT / MRI and/or Positron Emission Tomography (PET). •Disease Free Survival (DFS) measured from the date of surgery for rectal cancer by TaTME until the date of the first documented pelvic recurrence or development of metastatic disease •Overall survival (OS) measured from the date of surgery for rectal cancer by TaTME until the date of last follow-up or death from any cause. Demographic, patient, and histopathological data were also collected as well as postoperative short term outcomes including complications (classified by Clavien-Dindo). Data collection and analysis Demographic and short-term outcome data were displayed as percentages and mean ± standard deviations, or median with interquartile range for parametric and non-parametric data respectively. No formal sample size calculation was conducted for this pragmatic study.Differences in survival and DFS were compared using Kaplan-Meier curves and tested using the log-rank test. Cox proportional hazards regression model was used to predict the oncological outcomes, adjusted for the stratification factors used including tumour site, both distally and circumferentially, presence of liver metastases which were not detected preoperatively, preoperative radiotherapy administration, age, sex, and the final histological TNM staging system; where T2/T3/T4 were used and T0/T1 as references and N1/N2 with N0 as a reference. Results A total of 478 cases of TaTME were performed in 16 centres in England between February 2013 and September 2021. The median (IQR) age was 66 (59-73) years and 372 patients (78%) were male. Most patients had an ASA score of II (18.2%) to III (61.9%). The mean BMI was 28.2 ± 5.0 (Median 28, IQR 22 to 31, Range 18 – 50). The median tumour height from the anal verge on MRI was 7cm ± 2.1 (Median 7, IQR 6 – 9). One hundred and fifty-three (33.0%) patients received neoadjuvant therapy, where 75% had long course chemoradiotherapy and 24% short course radiotherapy. (Table 1). A restorative anterior resection was undertaken in 426 (79%) patients, with 57 (11.9%) undergoing abdominoperineal excision (44 of which were inter-sphincteric, 9.2%). The vast majority (86%) involved the use of an Airseal device (ConMed Surgiquest AirSeal iFS - Insufflator). Purse string failure was reported in 15 (3.1%) patients

Comparison between Enteroscopy-, Laparoscopy- and Endoscopic Ultrasound-Assisted Endoscopic Retrograde Cholangio-Pancreatography in Patients with Surgically Altered Anatomy: A Systematic Review and Meta-Analysis

Endoscopic retrograde cholangiopancreatography (ERCP), in surgically altered anatomy (SAA), can be challenging and the optimal technique selection remains debatable. Most common foregut interventions resulting to this burden consist of Billroth II gastrectomy, Whipple surgery and Roux-en-Y anastomoses, including gastric by-pass. This systematic review, with meta-analysis, aimed to compare the rates of successful enteroscope-assisted (EA)-, endosonography-directed transgastric- (EDGE), and laparoscopy-assisted (LA)-ERCP

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