Tailgut cyst adenocarcinoma

Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. We described the case of a 54-year-old female who presented with complaints of pelvic and perineal pain of several weeks. After the initial work-up, a mass in the right presacral location was diagnosed. She underwent radical resection of the tumor, using a posterior approach. The lesion was removed en bloc with the middle rectum, coccyx, and sacrum (S4–S5). The histopathologic examination revealed an adenocarcinoma arising in a TGC, and the patient received adjuvant chemoradiotherapy. Our case underlines that diagnosing a TGC is difficult as it is a rare congenital lesion. Clinical examination may be challenging as TGCs present with various symptoms, which can mimic other commonly proctologic disorders. Patients should be referred to a tertiary center with experience in pelvic surgery and must be managed by a multidisciplinary approach to maximize successful treatment. The recommended treatment is surgical excision given the malignant potential of TGCs and their risk of causing local complications

Editorial [to UNIO - EU Law Jounal. Vol. 4, No. 1, Jul. 2018]

info:eu-repo/semantics/publishedVersio

O IMPACTO DA MUTAÇÃO KRAS NAS METÁSTASES HEPÁTICAS DO CANCRO COLORRETAL NAS MARGENS CIRÚRGICAS E NA CIRURGIA HEPÁTICA

Introduction: The impact of kirsten rat sarcoma viral oncogene homolog (KRAS) mutational status on surgery planning for colorectal liver metastases (CRLM) remains unknown. The aim of the study was to evaluate the impact of type of liver surgery and margin status in recurrence free survival (RFS) of patients with CRLM, according to KRAS mutational status. Materials and methods: Retrospective review of all patients consecutively submitted to CLRM surgery between January 2011 and December 2016 with KRAS determination. Exclusion criteria were 2-stage hepatectomy strategy, loss to follow up and non-anatomical and anatomical resections performed simultaneously. Results: 114 patients were included, with a median age of 61 [31-80] years old. 67.5% of patients were male. KRAS mutation was present in 46.5% of patients, 58.8% had non-anatomical resections and R0 surgery was obtained in 69.3%. With a median follow up of 43 [4-105] months, recurrence rate was 86.8%, median overall survival and RFS were 53 and 11 months, respectively. In the mutated KRAS (mKRAS) group, the detection of R1 margins was the only predictor of worse RFS (31 versus 13 months, p=0.022). In the wild-type KRAS (wtKRAS) group a similar difference was not observed (24 versus 19 months, p=0.310). The most common form of recurrence after R1 resections in the mKRAS group was extra-hepatic, while in the wtKRAS was isolated hepatic recurrence. Conclusion: In patients with mKRAS, R1 resection was associated with a decreased RFS, mainly due to extra-hepatic recurrence. These findings were not replicated in the wtKRAS group. KRAS mutational status should be considered while planning liver resection for CRLM, namely when deciding optimal margin width. Introdução: O impacto do estado mutacional do kirsten rat sarcoma viral oncogene homolog (KRAS) no planeamento da cirurgia por metastização hepática de carcinoma colorretal permanece desconhecido. O objetivo do estudo foi avaliar o impacto do tipo de cirurgia hepática e do status das margens de resseção hepática na sobrevivência livre de recidiva (SLR) em doentes com metastização hepática de carcinoma colorretal, de acordo com o estado mutacional do KRAS. Material e métodos: Revisão retrospetiva de todos os doentes consecutivamente submetidos a cirurgia hepática por metastização de carcinoma colorretal entre janeiro de 2011 e dezembro de 2016, com determinação do estado mutacional do KRAS. Os critérios de exclusão foram estratégia de hepatectomia em 2 tempos, perda de seguimento e resseção anatómica e não-anatómica no mesmo tempo cirúrgico. Resultados: Foram incluídos 114 doentes na análise, com mediana de idade de 61 [31-80] anos e 67.5% de doentes do sexo masculino. KRAS mutado estava presente em 46.5% dos doentes, 58.8% realizaram uma resseção não anatómica e uma cirurgia R0 foi obtida em 69.3%. Com uma mediana de tempo de seguimento de 43 [4-105] meses, a taxa de recidiva foi de 86.8%, a mediana de sobrevivência global e de SLR foi de 53 e 11 meses, respetivamente. No grupo com KRAS mutado (mKRAS), as margens R1 foram o único fator preditor de pior SLR (31 versus 13 meses, p=0.022), o que não se verificou no grupo KRAS wild-type (wtKRAS) (24 versus 19 meses, p=0.310). A forma mais comum de recidiva após resseção R1 no grupo mKRAS foi extra-hepática, enquanto que no grupo wtKRAS foi a recidiva hepática isolada. Conclusão: Em doentes do grupo mKRAS, a resseção R1 associou-se a diminuição da SLR, sobretudo à custa de recidiva extra-hepática. Estes achados não foram replicados no grupo wtKRAS. O estado mutacional do KRAS deve ser tido em consideração aquando do planeamento da resseção hepática em doentes com metastização de carcinoma colorretal, nomeadamente na decisão da margem cirúrgica ótima.&nbsp

The impact of electronic versus paper-based data capture on data collection logistics and on missing scores in thyroid cancer patients

Purpose: The purpose of this study was to investigate the impact of the type of data capture on the time and help needed for collecting patient-reported outcomes as well as on the proportion of missing scores. Methods: In a multinational prospective study, thyroid cancer patients from 17 countries completed a validated questionnaire measuring quality of life. Electronic data capture was compared to the paper-based approach using multivariate logistic regression. Results: A total of 437 patients were included, of whom 13% used electronic data capture. The relation between data capture and time needed was modified by the emotional functioning of the patients. Those with clinical impairments in that respect needed more time to complete the questionnaire when they used electronic data capture compared to paper and pencil (ORadj 24.0; p = 0.006). This was not the case when patients had sub-threshold emotional problems (ORadj 1.9; p = 0.48). The odds of having the researcher reading the questions out (instead of the patient doing this themselves) (ORadj 0.1; p = 0.01) and of needing any help (ORadj 0.1; p = 0.01) were lower when electronic data capture was used. The proportion of missing scores was equivalent in both groups (ORadj 0.4, p = 0.42). Conclusions: The advantages of electronic data capture, such as real-time assessment and fewer data entry errors, may come at the price of more time required for data collection when the patients have mental health problems. As this is not uncommon in thyroid cancer, researchers need to choose the type of data capture wisely for their particular research question.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

SARS-CoV-2 vaccination modelling for safe surgery to save lives: Data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research