Hepatic surgery at Sf. Ioan hospital Bucharest - completing an surgical oncology department

Spitalul Clinic Sf. Ioan, Bucureşti, Romania, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: În cadrul Spitalului Clinic de Urgență Sf. Ioan, departamentul dedicat Chirurgiei Oncologice a fost fondat în anul 2013. De la bun început, a existat un interes deosebit pentru chirurgia hepatică. Material și metode: În intervalul Octombrie 2013 și Aprilie 2019, au fost efectuate în clinica noastră 111 hepatectomii pentru tumori hepatice primare și secundare. Indicația principală a fost inițial reprezentată de metastazele din cancerul colorectal; ulterior, proporția tumorilor hepatice primare a crescut, în special în ultimii doi ani. Rezultate: În clinica noastră, chirurgia hepatică a debutat prin tratarea unor cazuri complexe de cancer colorectal; rezecții hepatice atipice și minore au fost asociate cu intervenții pe tractul digestiv; ulterior au urmat rezecții majore, asociate cu scăderea timpului operator și a duratei de spitalizare, odată ce curba de învățare a fost atinsă. Concluzii: Atât în cazurile de tumori hepatice primare cu patologie asociată precum și în cazurile de tumori avansate (stadiul IV), alegerea indicației și a momentului operator, au permis includerea acestei chirurgii în arsenalul chirurgiei oncologice printr-un efort constant al echipei complexe multidisciplinare formată din: oncolog, anestezist, anatomo-patolog și chirurg. * * * Introduction: Within the St John Emergency Clinical Hospital, a dedicated department for Surgical Oncology was founded in 2013. From the beginning, in this department there has always been an interest in liver surgery. Material and methods: Between October 2013 and April 2019, 111 hepatectomies were performed in our clinic for primary and secondary liver tumors. The main indication was initially represented by the metastases from colorectal cancer; subsequent the proportion of primary liver tumors increased, especially over the last two years. Results: Hepatic surgery started in our clinic by treating complex cases of colorectal cancer; minor and atypical liver resections were associated with interventions on the digestive tract. Subsequent, major resections found their natural place, associated with an important decrease of the operating time and periods of hospitalization, once the learning curve was completed. Conclusions: Both in cases of primary hepatic tumors with associated pathology and as well as stage IV advanced tumors, the choice of the indication and the operative moment allowed the integration of this surgery into the surgical oncology arsenal through the constant effort of a complex multi-disciplinary oncological - anesthetic-pathology-surgical team

A multidimensional approach to older patients during COVID-19 pandemic: a position paper of the Special Interest Group on Comprehensive Geriatric Assessment of the European Geriatric Medicine Society (EuGMS)

Purpose: The COVID-19 pandemic has been a dramatic trigger that has challenged the intrinsic capacity of older adults and of society. Due to the consequences for the older population worldwide, the Special Interest Group on Comprehensive Geriatric Assessment (CGA) of the European Geriatric Medicine Society (EuGMS) took the initiative of collecting evidence on the usefulness of the CGA-based multidimensional approach to older people during the COVID-19 pandemic. Methods: A narrative review of the most relevant articles published between January 2020 and November 2022 that focused on the multidimensional assessment of older adults during the COVID-19 pandemic. Results: Current evidence supports the critical role of the multidimensional approach to identify older adults hospitalized with COVID-19 at higher risk of longer hospitalization, functional decline, and short-term mortality. This approach appears to also be pivotal for the adequate stratification and management of the post-COVID condition as well as for the adoption of preventive measures (e.g., vaccinations, healthy lifestyle) among non-infected individuals. Conclusion: Collecting information on multiple health domains (e.g., functional, cognitive, nutritional, social status, mobility, comorbidities, and polypharmacy) provides a better understanding of the intrinsic capacities and resilience of older adults affected by SARS-CoV-2 infection. The EuGMS SIG on CGA endorses the adoption of the multidimensional approach to guide the clinical management of older adults during the COVID-19 pandemic

Comprehensive geriatric assessment in older people : an umbrella review of health outcomes

Background: Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older Methods: Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results: Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P < 0.05). There was high certainty of evidence that CGA reduces nursing home admission (risk ratio [RR] = 0.86; 95% confidence interval [CI]: 0.75–0.89), risk of falls (RR = 0.51; 95%CI: 0.29–0.89), and pressure sores (RR = 0.46; 95%CI: 0.24–0.89) in hospital medical setting; decreases the risk of delirium (OR = 0.71; 95%CI: 0.54–0.92) in hip fracture; decreases the risk of physical frailty in community-dwelling older adults (RR = 0.77; 95%CI: 0.64–0.93). Systematic reviews without meta-analysis indicate that CGA improves clinical outcomes in oncology, haematology, and in emergency department. Conclusions: CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings