Recommendation Versus Current Status: Retrospective Analysis of Age to Circumcise in a District Hospital

Introduction:Circumcision is one of the oldest and most frequently performed surgeries worldwide. The age of circumcision varies according to the country and region. We aimed to analyze the age of circumcision in our hospital.Methods:We evaluated the children who underwent circumcision at Istanbul Sultanbeyli State Hospital between February 2012 and February 2022. The following parameters were analyzed: age at operation, surgery date, and surgeon provider type. Children’s age at operation were categorized as follows: neonatal period (<30 days), infancy (≥31 days and <1 year), early childhood (≥1 year and <5 years), late childhood (≥5 years and <13 years), and adolescence (≥13 years and ≤17 years).Results:Seventeen thousand three hundred forty-five children were analyzed. Children’s ages ranged from 0 to 209 months; the median age was 4.07 [interquartile range (IQR) 1.82-6.33] years. The percentage of the neonatal period, infancy, early childhood, late childhood, and adolescence were 1.1%, 13.6%, 46.3%, 38%, and 1%, respectively. Urology performed the most circumcisions in any age group (8374, 48.3%), followed by general surgery (4818, 27.8%) and pediatric surgery (4153, 23.9%). In all surgeon provider types, circumcision was performed primarily in early childhood.Conclusion:Our study showed that most circumcision operations were performed in the inappropriate age range. A multidisciplinary effort is needed to implement healthcare professionals’ recommendations from the neonatal period

Hand-sewn versus Stapled Anastomosis for Billroth II Gastrojejunostomy After Distal Gastrectomy: Comparison of Short-term Outcomes

Introduction:Subtotal gastrectomy is usually performed in patients with distal gastric cancer. After distal gastrectomy, which reconstruction method can be used is still controversial. This study evaluated the effect of the stapler and hand-sewn techniques on postoperative results.Methods:Patients who underwent distal gastrectomy in a single center were evaluated retrospectively in this study. Patients who underwent the Billroth II reconstruction method were analyzed. Hand-sewn and stapled techniques were compared in terms of operative and short-term postoperative outcomes.Results:Two hundred fourteen patients were included. Most of the patients (66.8%) were male. The median age was 61 years. Billroth-II reconstruction with hand-sewn was performed in 161 (75%) patients, and the double stapler technique was performed in 53 (25%) patients. When the hand-sewn and stapled groups were compared, no difference was found in age, sex, or American Society of Anesthesiology scores. There was no difference in choosing antecolic or retrocolic as the surgical technique (p=0.19). A shorter length of hospital stay was detected in the stapled group (p=0.01). The overall complication rate was higher in the hand-sewn group (21.7% vs. 7.5%, p=0.02). Clavien-Dindo grade 3 and above complications were significantly higher in the hand-sewn group (13.7% vs. 3.8%, p=0.02).Conclusion:Our study showed that the stapler anastomosis technique for Billroth II gastrojejunostomy after distal gastrectomy led to fewer overall complications and shortened hospital stays

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Mide kanserlerinde her-2 sıklığı, klinikopatolojik parametreler ve prognoz ile ilişkisi

ÖZET Giriş ve amaç: Her-2 pozitifliği meme kanserlerinde kötü prognostik kriter olarak kabul edilmektedir. Ancak mide kanserlerinde Her-2 pozitifliğinin prognostik önemi halen tartışmalıdır. Literatürde HER-2 expresyonu ile ilgili farklı oranlar verilmektedir. Bu çalışmada kliniğimizde opere edilen mide adenokarsinomlu hastalarda HER-2 overekspresyon oranının saptanması planlandı. HER-2 overekspresyonunun klinik, patolojik parametrelerle ilişkisi ve prognoz üzerine etkisi araştırıldı. Gereç ve yöntem: Ocak 2012 – Aralık 2013 tarihleri arasında Marmara Üniversitesi Tıp Fakültesi Pendik Eğitim ve Araştırma Hastanesi, Genel Cerrahi kliniğinde mide kanseri tanısı almış ve opere olan hastalar çalışmaya alınmıştır. Hastaların bilgileri prospektif olarak toplanarak retrospektif olarak değerlendirilmiştir. Spesmenler immünhistokimyasal (IHK) ve floreasans insitu hibridizasyon (FISH) yöntemiyle değerlendirilmiştir. HER-2 overekspresyonunun tümörün diğer histopatolojik özellikleri ile ilişkisi ve sağkalıma katkısı araştırılmıştır. Bulgular: Çalışmaya alınan 135 hastanın 88’i (%65) erkek, 47’si (%35) kadın, ortanca yaşı 61(29-84) yıl olarak hesaplanmıştır. Yüzotuzbeş hastadan sadece 11 tanesinde (%8) HER-2 pozitif olarak bulunmuştur. HER-2 pozitif hastalar ile negatif hastalar karşılaştırıldığında yaş, cinsiyet, tümör çapı, tümör lokalizasyonu, tümörün T evresi, lenf nodu metastazı, Histolojik tip, diferansiasyon, lenfovaskular invazyon, perinodal, perinöral invazyon ve evre açısından anlamlı fark saptanmamıştır. Sağ kalım analizlerinde HER-2 negatif ve HER-2 pozitif hasta grupları arasında 1 ve 2 yıllık genel ve hastalıksız sağ kalım açısından anlamlı fark saptanmamıştır. Sonuç: Çalışmamızda opere edilen mide kanserlerinde HER-2 pozitiflik oranı düşük (%8) olup literatürde bildirilen oranlarla uyumlu izlenmiştir. HER-2 pozitifliği ile klinik ve patolojik parametreler arasında ilişki bulunmamıştır. HER-2 pozitifliğinin genel ve hastalıksız sağ kalıma etkisi görülmemiştir. Anahtar kelimeler: mide kanseri, HER-2 overekspresyonu, prognoz ABSTRACT Introduction and aim: Human epidermal growth factor-2(HER-2) overexpression has prognostic value in breast cancer. However the value of HER 2 pozitivity on Gastric cancer remained the issue of interest. In this study, we investigated the frequency of overexpression of HER-2 and its relationship with clinicopathological findings and impact on survival in gastric cancer. Material and method: Gastric cancer patients, operated in Marmara University Faculty of Medicine, Pendik Training and Research Hospital, General Surgery Department, between January 2012 - December 2013 were enrolled in this study. Medical records were prospectively collected and retrospectively evaluated. Tissue samples were stained with immunehystochemistry (IHC) method and positive ones subsequently proceeded with floreasans insitu hybridization (FISH). HER-2 expression rates and its relation with other histopathological features and survival has been analysed. Results: Of 135 patients enrolled, 88 (65%)were male and 47 (35%) were female, median age was 61 (29-84) years, respectively. only 11 patients (8%) were positive for HER-2. When compared the HER-2 positive patients with negative patients no difference were detected among age, gender, tumor size, tumor location, tumor T stage, lymph node metastasis, histological type, differentiation, lymphovascular invasion, perinodal and perineural invasion. No significant difference were detected on 1 and 2-year overall and disease-free survival between receptor pozitive and negative groups. Conclusion: HER-2 pozitivity rate in this study was around 8% were consistent with literature findings but this pozitivity has not been found to be related with clinical and pathological parameters and overall and disease-free survival. Key Words: gastric cancer, overexpression of HER2, prognosi

Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis

Abstract Background Tumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery. Methods All patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01  0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups. Results After exclusion, 333 patients were analyzed. The mean age was 62 ± 14 years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%, n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II—III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9 months) compared to LNR 0–1–2. Conclusion Our study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients