Preoperative albumin level is a marker of alveolar echinococcosis recurrence after hepatectomy.

To identify a preoperative blood marker predictive of alveolar echinococcosis (AE) recurrence after hepatectomy. All consecutive patients who underwent operation for liver AE at the Lausanne University Hospital (CHUV) between January 1992 and December 2015 were included in this retrospective study. Preoperative laboratory values of leukocytes, mean corpuscular volume (MCV), red blood cell distribution width (RDW), thrombocytes, C-reactive protein (CRP) and albumin were collected and analyzed. Univariate and multivariate Cox regression analyses were performed to determine the risk factors for AE recurrence after liver resection. A receiver operating characteristic (ROC) curve was used to define the best discrimination threshold of the blood marker. Moreover, recurrence-free survival curves were calculated using the Kaplan-Meier method. The cohort included 68 adult patients (37 females) with median age of 61 years [interquartile range (IQR): 46-71]. Eight of the patients (12%) presented a recurrence over a median follow-up time of 76 mo (IQR: 34-128). Median time to recurrence was 10 mo (IQR: 6-11). Median preoperative leukocyte, MCV, RDW, thrombocyte and CRP levels were similar between recurrent and non-recurrent cases. Median preoperative albumin level was 43 g/L (IQR: 41-45) for non-recurrent cases and 36 g/L (IQR: 33-42) for recurrent cases (P = 0.005). The area under the ROC curve for preoperative albumin level to predict recurrence was 0.840 (95%CI: 0.642-1, P = 0.002). The cut-off albumin level value was 37.5 g/L for sensitivity of 94.5% and specificity of 75%. In multivariate analysis, preoperative albumin and surgical resection margins were independent predictors of AE recurrence (HR = 0.099, P = 0.007 and HR = 0.182, P = 0.045 respectively). Low preoperative albumin level was associated with AE recurrence in the present cohort. Thus, preoperative albumin may be a useful biomarker to guide follow-up

Future development of gastrointestinal cancer incidence and mortality rates in Switzerland: a tumour registry- and population-based projection up to 2030.

QUESTIONS UNDER STUDY: Since tumour burden consumes substantial healthcare resources, precise cancer incidence estimations are pivotal to define future needs of national healthcare. This study aimed to estimate incidence and mortality rates of oesophageal, gastric, pancreatic, hepatic and colorectal cancers up to 2030 in Switzerland. METHODS: Swiss Statistics provides national incidences and mortality rates of various cancers, and models of future developments of the Swiss population. Cancer incidences and mortality rates from 1985 to 2009 were analysed to estimate trends and to predict incidence and mortality rates up to 2029. Linear regressions and Joinpoint analyses were performed to estimate the future trends of incidences and mortality rates. RESULTS: Crude incidences of oesophageal, pancreas, liver and colorectal cancers have steadily increased since 1985, and will continue to increase. Gastric cancer incidence and mortality rates reveal an ongoing decrease. Pancreatic and liver cancer crude mortality rates will keep increasing, whereas colorectal cancer mortality on the contrary will fall. Mortality from oesophageal cancer will plateau or minimally increase. If we consider European population-standardised incidence rates, oesophageal, pancreatic and colorectal cancer incidences are steady. Gastric cancers are diminishing and liver cancers will follow an increasing trend. Standardised mortality rates show a diminution for all but liver cancer. CONCLUSIONS: The oncological burden of gastrointestinal cancer will significantly increase in Switzerland during the next two decades. The crude mortality rates globally show an ongoing increase except for gastric and colorectal cancers. Enlarged healthcare resources to take care of these complex patient groups properly will be needed

Short-term outcomes after distal pancreatectomy: Laparotomy vs. laparoscopy - A single-center series.

Laparoscopic distal pancreatectomy was introduced 15 years ago, but it is still not widely used. The aim of the study was to compare the postoperative complications and length of stay between open and laparoscopic distal pancreatectomy. A search of our institutional pancreas database was performed. All consecutive distal pancreatectomy patients from 2000 to 2015 were identified. Demographics, peri- and postoperative outcomes were reviewed. Postoperative complications were graded using Clavien classification. Standard statistical analyses were performed. One hundred and five patients underwent distal pancreatectomy (45 women, 60 men, median age of 63 years). Seventy-nine cases were performed open and 26 by laparoscopy (conversion rate from laparoscopy to laparotomy: 7/26). Characteristics of both groups were similar. The tumor proportion was similar in both groups (56/79 and 23/26, p = 0.114). Overall complication rate was 41/79 (52%) in the open group and 9/26 (36%) in the laparoscopy group (p = 0.175). Two patients died during hospital stay in the open group compared to 0 in the laparoscopy group (p = 1). The fistula rates were comparable (17/79 and 5/26, p = 1). Median length of stay was shorter for the laparoscopy group (8 vs. 12 days, p < 0.001), as well as the median intermediate care stay (1 vs. 3 days, p = 0.004). Short-term outcomes after open and laparoscopic distal pancreatectomy regarding postoperative complications and mortality were similar, but length of stay was significantly shorter for the laparoscopic approach. Hence, laparoscopic distal pancreatectomy should be offered to all suitable patients

Serum albumin is an early predictor of complications after liver surgery.

The morbidity associated with liver surgery remained substantially high despite considerable surgical and anesthetic improvements. The unmet need of accurate biomarkers to predict postoperative complications is widely accepted. This pilot study aimed to assess serum albumin as a surrogate marker of surgical stress and to test its potential predictive role for postoperative complications. This retrospective pilot study included 106 patients who underwent liver surgery between 2010 and 2014. Serum albumin levels were measured pre- and post-operatively. Maximal albumin decrease (AlbΔmin) was correlated with complications. Serum albumin rapidly dropped after surgery. AlbΔmin was significantly increased in patients with complications (14.5±6.0g/L vs. 10.3±7.2, p=0.009). On multivariate analysis, ASA III/IV (p=0.016) and AlbΔmin (p=0.037) were the only predictors of overall complications. Early postoperative drop of serum albumin reflects the intensity of the surgical stress and may predict complications after liver surgery. Serum albumin is a biomarker displaying precious features and deserving further prospective investigations

Single-incision vs. conventional laparoscopic appendectomy : a case-match study

Background: Three-port laparoscopic appendectomy is considered standard in many countries for the surgical treatment of acute appendicitis. Single-incision laparoscopic technique has been recently introduced and is supposed to minimize the aggression induced by surgery. Regarding appendectomy, comparison with standard laparoscopy, benefits and drawbacks of this novel technique remain to be evaluated. The goal of this study was to assess single-incision laparoscopic appendectomy compared to conventional laparoscopic appendectomy in terms of operation time, length of hospital stay, complication rate, and postoperative antibiotherapy rate. Methods: From February 2011 to December 2011, single-incision laparoscopic appendectomy was proposed to patients admitted to the emergency room of the University Hospital of Lausanne (CHUV, Lausanne, Switzerland), diagnosed with uncomplicated acute appendicitis. Preoperative patients' information, technical difficulties during the operation, and postoperative follow-ups were recorded. Every patient who underwent single-incision laparoscopic appendectomy (n = 20) was matched 1:3 conventional laparoscopic appendectomy (n = 60), controlling for age, gender, body mass index, American Society of Anesthesiologists score, and histopathological findings. Results: No statistically significant differences for median operation time, length of hospital stay, complication rate, and need for postoperative antibiotherapy were found. In 5 out of 20 single-incision laparoscopic appendectomy patients the Endoloop® Ligature was judged difficult to put in place. Conclusion: This study suggests that single-incision laparoscopic appendectomy is a feasible and effective operative technique for uncomplicated acute appendicitis

Surgical site infections after pancreatic surgery in the era of enhanced recovery protocols.

Few data exist on risk factors (RF) for surgical site infections (SSI) among patients treated in an enhanced recovery after surgery (ERAS) pathway. This study aimed to assess RF for SSI after pancreas surgery in a non-ERAS group and an ERAS cohort.An exploratory retrospective analysis of all pancreas surgeries prospectively collected (01/2000-12/2015) was performed. RF for SSI were calculated using uni- and multivariable binary logistic regressions in non-ERAS and ERAS patients.Pancreas surgery was performed in 549 patients. Among them, 144 presented a SSI (26%). In the non-ERAS group (n = 377), SSI incidence was 27% (99/377), and RF for SSI were male gender and preoperative biliary stenting. Since 2012, 172 consecutive patients were managed within an ERAS pathway. Forty-five patients (26%) had SSI. On multivariable analysis no RF for SSI in the ERAS cohort was found. In the ERAS group, patients with a pathway compliance ≤70% had higher occurrence of SSI (30/45 = 67% vs. 7/127 = 6%, p < 0.001) and patients with and without SSI had similar median overall compliances (77%, IQR 71-80 vs. 80%, IQR 73-83, p = 0.097).In the non-ERAS cohort, male gender and preoperative biliary stenting were RF for SSI, whereas in the ERAS group no RF for SSI was found. In an ERAS pathway, having an overall compliance >70% might diminish the SSI rate

Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment.

Recurrent laryngeal nerve (RLN) injury is a feared complication after thyroid and parathyroid surgery. It induces important postoperative morbidity. The present study aimed to assess the incidence of transient/permanent postoperative RLN injuries after thyroid and parathyroid surgery in the present cohort, to observe the timing of recovery, and to identify risk factors for permanent RLN injury after thyroidectomy.All consecutive patients operated on at our institution for thyroid and parathyroid pathologies from 2005 to 2013 were reviewed for vocal cord paresis. Vocal cord paresis was defined based on postoperative fiberoptic laryngoscopy. Demographics, intraoperative details, and postoperative outcomes were collected. Treatment types were assessed, and recovery times collected. Patients with vocal cord paresis on preoperative fiberoptic laryngoscopy were excluded from the analysis.The cohort included 451 thyroidectomies (756 nerves at risk) and 197 parathyroidectomies (276 nerves at risk). There were 63 postoperative vocal cord pareses after thyroidectomy and 13 after parathyroidectomy. Sixty-nine were transient (10.6%) and 7 permanent (1.1%). The main performed treatment was speech therapy in 51% (39/76) of the patients. Median recovery time after transient injuries was 8 weeks. In the group with vocal cord paresis, risk factors for permanent injuries after thyroidectomy were previous thyroidectomy and intraoperative RLN injury on univariate analysis. On multivariate analysis, only intraoperative RLN injury remained significant.Most of the patients with transient postoperative RLN injury recovered normal vocal cord mobility within 6 months. The most common performed treatment was in this cohort speech therapy. Permanent RLN injuries remained rare (1.1%)

Metastasis to the rectum: A systematic review of the literature.

Metastatic spread to the rectum is a rare finding, and management of rectal metastases (RM) is not standardized. The aim of the present study was to review the evidence on diagnosis, management and outcomes of RM. A computerized literature search through MEDLINE/PubMed, Embase and the Cochrane databases was performed, applying a combination of terms related to RM. Articles and abstracts were screened and final selection was done after cross-referencing and by use of predefined eligibility criteria. Final analysis was based on 99 publications totaling 162 patients with RM from 16 different primary tumors. Most common origins of RM were breast (42 patients), stomach (38 patients), and prostate (16 patients). RM occurred metachronously in the majority of patients (77%). The main treatment was surgical resection (n = 32), followed by chemotherapy (n = 16). Median overall survival for breast RM, stomach RM, and prostate RM were 24 months (95% CI 9-39 months), 7 months (95% CI 0-14 months), and 24 months (95% CI 7-41 months), respectively. RM is a rare and highly heterogeneous condition. Surgical treatment appears to be a valuable treatment option in selected patients, while overall prognosis depends mainly on the primary tumor