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

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

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

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.

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

Mean Square Stability of Linear Dynamical Systems with Small Markov Perturbations. III. Markov Impulse Perturbations

This paper deals with linear dynamical dystem in R n of impulse type with dynamical characteristics dependening on the step Markov process {y(t), t ≥ 0}. The phase motion x(t)∈ G R n as a result of impulse type Markov perturbations has jumps at the times of switchings of the above MP and satisfies a linear differential equation with an additive Markov perturbation of coefficients in the interval of constancy of the MP. Both the quantities of jumps and the perturbations of the right part of the differential equation are proportional to a small parameter, and are linear on phase coordinate and dependent on MP. An algorithm for mean square stability analysis based both on decomposition of a specially constructed spectral projector, the second Lyapunov method and on decomposition of a Lyapunov functional in a Laurent series in terms of powers of a small parameter is proposed. © VSP 1996

Surgical treatment of the fistulizing Crohn's disease with anterior abdominal wall reconstruction (Clinical case)

Aim of clinical case presentation. To discuss the consequences of erroneous management approach at suspicion for appendicular infiltrate, as well as options and difficulties of complicated Crohn’s disease treatment. Summary. Surgical treatment of fistulizing Crohn's disease with interorgan and external fistulas with development of pathological cavity having anterior abdominal wall opening is described. Past history of disease was five years. The patient underwent appendectomy in the presence of infiltrate with subsequent development of external intestinal fistula. Repeated surgery for fistula elimination was unsuccessful, however allowed to establish Crohn's disease diagnosis. Patient refused from surgical treatment, therefore despite the lack of permanent remission at infliximab treatment, therapy was maintained until patient developed anaphylactic reaction. As a result, ileocecal resection along with resection of ileum fragment and distal third of sigmoid colon, restoration of intestinal continuity, and resection of anterior abdominal wall with fistulous tract block and subsequent reconstruction were executed. The collagen allo-graft is applied to restore anterior abdominal wall defect. At continuation of biological therapy by adalimumab no data on disease relapse were received. Conclusion. The presence of infiltration in the right iliac area requires ruling out of the Crohn's disease diagnosis. At fistulizing form treatment should be provided at the specialized institutions. It is important to note that treatment efficacy at exclusively conservative management, including biological therapy is quite low. Biological therapy allows to suppress disease manifestations and facilitate conditions for subsequent surgical intervention

The short-term and long-term results of three-stage surgical treatment of ulcerative colitis with formation of ileal J-pouch

Aim of investigation. To estimate results of three- stage treatment approach in severe ulcerative colitis aimed for resection of affected colon and restoration of intestinal continuity. Material and methods. Overall 22 patients were treated according to the three-stage mode, of them 20 were operated urgently due to development of acute complications. The average duration of conservative treatment was 32,8±42,5 months. All patients at the first stage underwent operations related to the emergency state, at the second stage - reconstructive surgery with formation of the ileal J-pouch followed by closure of ileostoma. Results. Patients, who underwent the first stage of treatment on the basis of our institution, had shorter time of surgical treatment, as compared to the cases when colectomy was performed in the other clinics: 4,7±1,6 and 46,1±39,8 months respectively (p=0,02). The average work capacity recovery after surgical treatment was 4±2 months. Stool frequency was 6,1±2,45 times per day, every fifth patient had nighttime defecation; 19 of 21 patients could distinguish type of their reservoir contents and were able to provide its retention. Pouchitis was observed in 21% of cases. The pouch malfunction requiring its resection occurred in 4%. Conclusions. The three-stage surgery for ulcerative colitis is an optimum management approach in the presence of complicated ulcerative colitis. It allows to carry out colonic resection with the lowest risk of morbidity, to create the intestinal reservoir , to provide social professional rehabilitation of patients and to reduce postoperative complications rate significantly. Key words: ulcerative colitis, ileal pouch, colectomy, proctectomy, laparoscop

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

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 >70 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 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

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

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 >70 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 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