Techniques and Current Role of Sentinel Lymph Node (SLN) Concept in Gastric Cancer Surgery

Gastric cancer patients represent a rather divergent patient group and in certain carefully selected cases of early forms of gastric cancer the D2 gastrectomy could be considered a more radical procedure than the biological and oncological characteristics of the primary tumor on the gastric wall would require. As any unnecessary dissection increases morbidity without always respective survival benefits, an approach that could accurately predict and actually dictate the exact extent of lymph node dissection would be ideal. It is more than logical the assumption that the standard D2 lymphadenectomy could represent an overtreatment in distinct patients groups such as patients with early gastric cancer with favorable pathological characteristics and clinically negative nodes not suitable for endoscopic treatment because this early stage disease shows limited lymph node metastasis incidence and excellent overall survival. Considering that the D2 gastrectomy has a negative impact on the quality of life of gastric cancer patients due to the post-gastrectomy functional results, a concept of a more targeted lymph node dissection, when appropriate, is certainly appealing. It is yet to be proven whether sentinel lymph node navigation surgery can fulfill such expectations providing the appropriate balance between morbidity and oncological safety in selected gastric cancer patients

Circulating microRNAs and Clinicopathological Findings of Papillary Thyroid Cancer: A Systematic Review

BACKGROUND/AIM: Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a rising incidence. There is a need for a non-invasive preoperative test to enable better patient counselling. The aim of this systematic review was to investigate the potential role of circulating microRNAs (miRNAs) in the diagnosis and prognosis of PTC. MATERIALS AND METHODS: A systematic literature search was performed using MEDLINE, Cochrane, and Scopus databases (last search date was December 1, 2021). Studies investigating the expression of miRNAs in the serum or plasma of patients with PTC were deemed eligible for inclusion. RESULTS: Among the 1,533 screened studies, 39 studies met the inclusion criteria. In total, 108 miRNAs candidates were identified in the serum, plasma, or exosomes of patients suffering from PTC. Furthermore, association of circulating miRNAs with thyroid cancer-specific clinicopathological features, such as tumor size (13 miRNAs), location (3 miRNAs), extrathyroidal extension (9 miRNAs), pre- vs. postoperative period (31 miRNAs), lymph node metastasis (17 miRNAs), TNM stage (9 miRNAs), BRAF V600E mutation (6 miRNAs), serum thyroglobulin levels (2 miRNAs), 131I avid metastases (13 miRNAs), and tumor recurrence (2 miRNAs) was also depicted in this study. CONCLUSION: MiRNAs provide a potentially promising role in the diagnosis and prognosis of PTC. There is a correlation between miRNA expression profiles and specific clinicopathological features of PTC. However, to enable their use in clinical practice, further clinical studies are required to validate the predictive value and utility of miRNAs as biomarkers

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prospective comparative evaluation of different anesthetic and surgical techniques for inguinal hernia repair

Purpose: To compare prospectively open and laparoscopic inguinal hernia repair performed under different anesthetic methods.Methods: One hundred seventy five patients scheduled for unilateral inguinal hernia repair were assigned into one of the following groups: (i) open repair under local anaesthesia, (ii) open repair under regional anaesthesia, (iii) open repair under general anaesthesia, and (iv) laparoscopic TAPP repair under regional anaesthesia. We recorded immediate postoperative pain, short and long-term complications as well as the degree of patient’s satisfaction were also assessed. Systematic immune response in all four categories by comparing pre and postoperative alboumin and CRP serum levels was also to be evaluatedResults: Laparoscopic repair under regional anesthesia yielded the lower while open repair under general anesthesia was associated with the higher recorded pain scores. The groups of open repair performed under local or general anesthesia were associated with a lower incidence of urinary retention compared with the spinal groups (P < 0.05). Chronic pain incidence was significantly lower for the laparoscopic repair group (P .003). No differences were observed regarding other short and long term complications. The group of laparoscopic repair under spinal anesthesia was associated with the greater induced systematic response.Conclusion: TAPP inguinal hernia repair under spinal anesthesia proved to be superior to the open tension-free repair performed under different types of anesthesia in terms of immediate postoperative and chronic pain with however the notable limitation of high urinary retention incidence as well as the increased induced systematic immune response.Σκοπός: Η προοπτική σύγκριση ανοικτών και λαπαροσκοπικών τεχνικών αποκατάστασης βουβωνοκήλης υπό διαφορετικές αναισθητικές μεθόδους.Υλικό και Μέθοδος: Συνολικά 175 ασθενείς προγραμματισμένοι για εκλεκτική ετερόπλευρη αποκατάσταση βουβωνοκήλης συμπεριελήφθησαν τελικά σε μία από τις παρακάτω ομάδες της μελέτης : (i) ανοικτή αποκατάσταση υπό τοπική αναισθησία (ii) ανοικτή αποκατάσταση υπό περιοχική αναισθησία (iii) ανοικτή αποκατάσταση υπό γενική αναισθησία, και (iv) λαπαροσκοπική TAPP αποκατάσταση υπό περιοχική αναισθησία. Καταγράψαμε τον μετεγχειρητικό πόνο, τις βραχυπρόθεσμες και μακροπρόθεσμες επιπλοκές καθώς και το βαθμό ικανοποίησης των ασθενών από την ακολουθούμενη διαδικασία. Επίσης μελετήσαμε τον βαθμό της συστηματικής φλεγμονώδους αντίδρασης με σύγκριση των προ- και μετεγχειρητικών επιπέδων της αλβουμίνης και της CRP.Αποτελέσματα: Η ομάδα της λαπαροσκοπικής αποκατάστασης υπό περιοχική αναισθησία εμφάνισε τα χαμηλότερα επίπεδα μετεγχειρητικού πόνου ενώ η ανοικτή αποκατάσταση υπό γενική αναισθησία τα μεγαλύτερα. Οι ομάδες της περιοχικής αναισθησίας επέδειξαν επίσης τα υψηλότερα ποσοστά επίσχεσης ούρων (P < 0.05). Ο χρόνιος πόνος ήταν μικρότερος για την ομάδα της λαπαροσκοπική αποκατάστασης (P 0.003). Δεν παρατηρήθηκαν άλλες διαφορές μεταξύ των ομάδων σε σχέση με τις άλλες βραχυπρόθεσμες και μακροπρόθεσμες επιπλοκές. Η ομάδα της λαπαροσκοπικής αποκατάστασης υπό περιοχική αναισθησία προκάλεσε την μεγαλύτερη συστηματική φλεγμονώδη απάντηση του οργανισμού, τουλάχιστον με την μεθοδολογία που ακολουθήθηκε στην παρούσα μελέτη.Συμπεράσματα: Η ομάδα της TAPP αποκατάστασης αποδείχθηκε ανώτερη των ανοικτών τεχνικών υπό διαφορετικούς αναισθητικούς συνδυασμούς από την άποψη του άμεσου και του χρόνιου πόνου λαμβάνοντας ωστόσο υπόψη την υψηλή επίπτωση επίσχεσης ούρων και το μεγαλύτερο μέγεθος της επαγόμενης συστηματικής φλεγμονώδους αντίδρασης

Software Defined Radio Certification in Europe: Challenges and Processes

Standardization and certification of Software Defined Radio technologies are closely related. This paper describes the current standardization efforts for Software Defined Radio technologies in Europe and the related certification processes with a specific focus to the public safety and military domain. This paper describes the regulatory and technical requirements for the certification of Software Defined Radio in the European context, which is characterized by various political entities and governmental institutions. We describe the development of an European Software Defined Radio certification process through a networked approach and we identify the main components including the Development and Testing tools, References Implementation, the Waveform Repository and the Issue Tracking system. The main stakeholders in the certification processes are identified and their roles are described. This paper describes also two specific certification processes, which are particularly important for Software Defined Radio technology: performance benchmark certification and security certification. Performance benchmark certification is used to evaluate the performance of Software Defined Radio against specific technical requirements. Security certification is needed to ensure that the Software Defined Radio platform and the waveforms validate security requirements. The conclusion is that Software Defined Radio certification at European level requires a comprehensive framework, which includes organizational, procedural and technical elements.JRC.DG.G.6-Security technology assessmen