Minimally invasive surgery and cancer: controversies part 1

Perhaps there is no more important issue in the care of surgical patients than the appropriate use of minimally invasive surgery (MIS) for patients with cancer. Important advances in surgical technique have an impact on early perioperative morbidity, length of hospital stay, pain management, and quality of life issues, as clearly proved with MIS. However, for oncology patients, historically, the most important clinical questions have been answered in the context of prospective randomized trials. Important considerations for MIS and cancer have been addressed, such as what are the important immunologic consequences of MIS versus open surgery and what is the role of laparoscopy in the staging of gastrointestinal cancers? This review article discusses many of the key controversies in the minimally invasive treatment of cancer using the pro–con debate format

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effects of concentration methods and storage conditions on some bioactive compounds and color of tamarind sorbet: a traditional Turkish beverage

In this study, the effects of concentration methods on the bioactivity properties of traditional tamarind sorbet were investigated. For this purpose, tamarind sorbet produced according to proper recipe were concentrated with three different methods such as conventional, microwave and vacuum heating and stored at 4, 20 and 37 A degrees C for 90 days. During the course of storage at 0th, 30th, 60th and 90th days, beside color parameters, some bioactivity properties such as; total phenolic content, total flavonoid content, antiradical and antioxidant activities were evaluated. Phenolic content of tamarind sorbet samples (0th and 90th day), concentrated with different methods and stored at different temperatures, was evaluated with LC-MS/MS. Protocatechuic acid and coumarin were found to be the major components of tamarind sorbet. It was determined that sorbet produced with vacuum method was rich in phenolic compounds compared to those produced with other methods. Total phenolic content was higher in the vacuum concentrated sample (1384.85 mg GAE/kg) followed by microwave (1354.55 mg GAE/kg) and conventional heating (1300 mg GAE/kg), respectively. Higher antioxidant activity (108.77 mg AAE/g) was determined in vacuum applied samples, its 0th day sample also contained higher phenolic content. Higher antiradical activity was detected in microwave sample with 70.1% inhibition. It was found that storage temperature and time was effective on the bioactive properties of tamarind sorbet. It was determined that vacuum method could be applied successfully to tamarind sorbet concentration especially when regarded threshold values, phenolic and flavonoid content and antioxidant properties