14 research outputs found

    Image fusion performed with noncontrast computed tomography scans during endovascular aneurysm repair

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    We report two endovascular aneurysm repair procedures achieved under image fusion guidance accomplished with noncontrast injected preoperative computed tomography scans. Such use of this advanced imaging application reduces contrast media injection volume (respectively, 27 and 24 mL throughout the patients' hospital course). No changes in creatinine clearance occurred after the procedures. Contrast-enhanced ultrasound imaging confirmed technical success in both cases

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    The use of liquid embolic agents in peripheral vessels : current status, challenges and future perspectives : proof of concept of a new sclero-embolic agent Alconyx : Alconyx

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    Les agents d'embolisation liquides utilisĂ©s dans le traitement endovasculaire ont de nombreuses limitations. Des polymĂšres, tels que l’Onyx et les cyanoacrylates sont disponibles. L’alcool est un agent puissant, mais non radio-opaque. Les cyanoacrylates entrainent une rĂ©action inflammatoire significative. Leur polymĂ©risation rapide est responsable d’un comportement mal prĂ©visible.Il existe une possibilitĂ© de traitement incomplet.L’Onyx est efficace pour le traitement des MAV.Une pĂ©nĂ©tration plus distale est obtenue avec l’alcool, mais associĂ©e Ă  un risque de migration systĂ©mique. Nous avons Ă©valuĂ© les propriĂ©tĂ©s d'un nouvel agent embolique (Alconyx) composĂ© d'un mĂ©lange d'alcool et d'Onyx. Cet agent devrait cumuler les avantages respectifs de l'alcool et de l'onyx avec une visualisation adĂ©quate sous fluoroscopie, une meilleure pĂ©nĂ©tration distale que l'Onyx seul et moins de toxicitĂ© systĂ©mique liĂ©e Ă  la rĂ©duction de quantitĂ© d’alcool injectĂ©. Divers mĂ©langes ont Ă©tĂ© testĂ©s avec diffĂ©rentes concentrations d'Onyx 18 et d’alcool absolu. Alconyx 25 (75% Onyx 18; 25% d'Ă©thanol) est la formulation la plus prometteuse. Nous avons dĂ©montrĂ© sa facilitĂ© d'injection in vivo, sa nature cohĂ©sive sans fragmentation ainsi que sa bonne visualisation sous fluoroscopie. En raison de sa moindre viscositĂ© dĂ©montrĂ©e in vitro, Alconyx a Ă©tĂ© capable de pĂ©nĂ©trer profondĂ©ment dans le lit artĂ©riel.. L'occlusion proximale par Alconyx 25 devrait permettre d'amĂ©liorer le contact entre l'Ă©thanol et la paroi vasculaire et donc augmenter son pouvoir sclĂ©rosant et limiter son passage systĂ©mique. Les propriĂ©tĂ©s occlusives d’Alconyx 25 sont similaires Ă  celle de l’Onyx 18 sous haute pression in vitro.Commercially available liquid embolization agents used in endovascular treatment have many limitations. Polymeric agents as Onyx and cyanoacrylate are available. Ethanol also is a potent sclero-embolic agent. Cyanoacrylates are effective liquid embolic agents, however, their rapid polymerization makes their behaviour unpredictable with possibility of incomplete treatment. These properties render their use challenging.Onyx is easy to use. However, in very small arterial niduses, Onyx, is unable to penetrate deeply. Deep penetration is obtained with ethanol, associated with risk of systemic migration.Poor visualization of ethanol under fluoroscopy is major drawback. Mixing Onyx with ethanol had never been described in the literature till now. In this work, various mixtures have been tested with different concentrations of Onyx 18 and absolute ethanol. Alconyx 25 (75% Onyx 18; 25% ethanol) seems to be a promising product. We proved its ease of injection in vivo and in vitro, its cohesive nature showing no fragmentation or interruption of the injected column as well as its good visualization under fluoroscopy. It was able to penetrate deeply in the arterial bed. The occlusive properties of Alconyx 25 were rated as good as Onyx 18 under high pressure in vitro. Further investigation is needed to better understand the behavior of ethanol in the suspension and its effect on tissues compared to Onyx diluted simply with an equivalent amount of DMSO. Studies on other commercially available concentrations of Onyx would certainly be interesting

    The use of liquid embolic agents in peripheral vessels : current status, challenges and future perspectives : proof of concept of a new sclero-embolic agent Alconyx : Alconyx

    Get PDF
    Les agents d'embolisation liquides utilisĂ©s dans le traitement endovasculaire ont de nombreuses limitations. Des polymĂšres, tels que l’Onyx et les cyanoacrylates sont disponibles. L’alcool est un agent puissant, mais non radio-opaque. Les cyanoacrylates entrainent une rĂ©action inflammatoire significative. Leur polymĂ©risation rapide est responsable d’un comportement mal prĂ©visible.Il existe une possibilitĂ© de traitement incomplet.L’Onyx est efficace pour le traitement des MAV.Une pĂ©nĂ©tration plus distale est obtenue avec l’alcool, mais associĂ©e Ă  un risque de migration systĂ©mique. Nous avons Ă©valuĂ© les propriĂ©tĂ©s d'un nouvel agent embolique (Alconyx) composĂ© d'un mĂ©lange d'alcool et d'Onyx. Cet agent devrait cumuler les avantages respectifs de l'alcool et de l'onyx avec une visualisation adĂ©quate sous fluoroscopie, une meilleure pĂ©nĂ©tration distale que l'Onyx seul et moins de toxicitĂ© systĂ©mique liĂ©e Ă  la rĂ©duction de quantitĂ© d’alcool injectĂ©. Divers mĂ©langes ont Ă©tĂ© testĂ©s avec diffĂ©rentes concentrations d'Onyx 18 et d’alcool absolu. Alconyx 25 (75% Onyx 18; 25% d'Ă©thanol) est la formulation la plus prometteuse. Nous avons dĂ©montrĂ© sa facilitĂ© d'injection in vivo, sa nature cohĂ©sive sans fragmentation ainsi que sa bonne visualisation sous fluoroscopie. En raison de sa moindre viscositĂ© dĂ©montrĂ©e in vitro, Alconyx a Ă©tĂ© capable de pĂ©nĂ©trer profondĂ©ment dans le lit artĂ©riel.. L'occlusion proximale par Alconyx 25 devrait permettre d'amĂ©liorer le contact entre l'Ă©thanol et la paroi vasculaire et donc augmenter son pouvoir sclĂ©rosant et limiter son passage systĂ©mique. Les propriĂ©tĂ©s occlusives d’Alconyx 25 sont similaires Ă  celle de l’Onyx 18 sous haute pression in vitro.Commercially available liquid embolization agents used in endovascular treatment have many limitations. Polymeric agents as Onyx and cyanoacrylate are available. Ethanol also is a potent sclero-embolic agent. Cyanoacrylates are effective liquid embolic agents, however, their rapid polymerization makes their behaviour unpredictable with possibility of incomplete treatment. These properties render their use challenging.Onyx is easy to use. However, in very small arterial niduses, Onyx, is unable to penetrate deeply. Deep penetration is obtained with ethanol, associated with risk of systemic migration.Poor visualization of ethanol under fluoroscopy is major drawback. Mixing Onyx with ethanol had never been described in the literature till now. In this work, various mixtures have been tested with different concentrations of Onyx 18 and absolute ethanol. Alconyx 25 (75% Onyx 18; 25% ethanol) seems to be a promising product. We proved its ease of injection in vivo and in vitro, its cohesive nature showing no fragmentation or interruption of the injected column as well as its good visualization under fluoroscopy. It was able to penetrate deeply in the arterial bed. The occlusive properties of Alconyx 25 were rated as good as Onyx 18 under high pressure in vitro. Further investigation is needed to better understand the behavior of ethanol in the suspension and its effect on tissues compared to Onyx diluted simply with an equivalent amount of DMSO. Studies on other commercially available concentrations of Onyx would certainly be interesting

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

    Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

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