10 research outputs found

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Managing endoscopic retrograde cholangiopancreatography-related complications in patients referred to the surgical emergency unit

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    BACKGROUND: The goal of this study was to present our experience in the management of endoscopic retrograde cholangiopan-creatography-related complications in patients referred to our surgical emergency unit by various endoscopy centers

    Management of the Splenic Artery Aneurysm: with a Six Different Clinical Presentation and Treatment Modality

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    Splenic artery aneurysm is the enlargement of the splenic artery more than 1 cm and can be a life-threatening condition. Trauma, pregnancy, portal hypertension, atherosclerosis, advanced age, and female gender are underlying risk factors. Although the patients are mostly asymptomatic, the symptoms may range from pain in the epigastrium, left upper quadrant, to sudden onset of severe abdominal pain and shock as a result of rupture. In our study, the data of six splenic artery aneurysm patients who applied to Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty General Surgery Clinic, between 2015 and 2019 with different clinical presentations and treated with different methods were retrospectively analyzed. Six patients with splenic artery aneurysm were reviewed. They were 4 women and 2 men aged 28 to 66 years. The mean diameter of aneurysms was 4.42 cm and the average hospitalization duration was 6.8 days. All patients presented with abdominal pain. Two patients had also low hemoglobin value and hypovolemic shock due to intraabdominal bleeding. Splenic artery aneurysm rupture was diagnosed in 1 patient who was 28 weeks of gestation. Only aneurysmectomy was performed on 2 patients, aneurysmectomy + splenectomy on 3, and coil embolization on 1. Since splenic artery aneurysm may present with different clinical signs and may have high mortality due to the risk of rupture, it can be safely treated by using different modalities according to the patient's specifications after the appropriate and early diagnosis

    Solid Pseudopapillary Neoplasm of the Pancreas: A Good Prognostic Tumor of the Bad Lucky Organ

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    Introduction Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare clinical entity with low malignant potential and good clinical prognosis. It was first defined by Frantz Virginia in 1959 and was renamed solid pseudopapillary tumor by the World Health Organization (WHO) in 2010. SPN is more common in young women with an average age of 28-32 years and a female: male ratio of 3-10:1 in different publications. Material & Method The data were retrospectively analyzed for 26 patients whose pathology was compatible with SPN and operated on between 2003 and 2019 in the General Surgery Clinic at XXX. Results Of the patients, 25 (96.2%) were female and 1 (3.8%) was male; the mean age at diagnosis was 37.1 (range: 18-69, eight patients <30 years); mean body mass index was 28.8 kg/m(2). The most common reason for referral was abdominal pain (n=13, 50%); three patients (11%) had nausea and vomiting, and one patient (3.8%) had jaundice with mass at the head of the pancreas. Ten patients (38%) were asymptomatic and were diagnosed incidentally during examinations performed for other reasons. The most frequent tumor localization was the head and neck part of the pancreas (n=10, 38%); eight patients (31%) had body, and eight patients (31%) had tail localization. Ten patients (38%) had Whipple procedure (pancreaticoduodenectomy), 15 patients (53%) had distal pancreatectomy, and one patient had intra-abdominal mass excision and segmental small bowel resection operation in addition to distal pancreatectomy. Six (37%) of the 16 patients who underwent distal pancreatectomy had splenectomy too. One of the patients had laparoscopic distal pancreatectomy and splenectomy. The mean tumor diameter was 7.2 cm (range: 2-23 cm). Conclusion SPN is a rare tumor, and even though it is diagnosed late and in large sizes, it has prolonged survival when appropriate surgical resection is applied. The ability to perform surgery even in cases with relapse or meta stasis during the SPN follow-up reveals the importance of accurate diagnosis

    Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

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    Aim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age &gt;70&nbsp;years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7&nbsp;days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery

    Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

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    BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas
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