Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Human Colonic Microbiota and Short-Term Postoperative Outcomes in Colorectal Cancer Patients: A Pilot Study

Despite the advances in surgical techniques and perioperative care, the complication rates after colorectal cancer surgery have remained stable. Recently, it has been suggested that colon microbiota may be implicated in several pathways that can lead to impaired colonic homeostasis and, thereby, to the development of complications after colorectal surgery. The aim of this study was to evaluate the potential impact of colonic dysbiosis on postoperative course. This prospective human clinical study recruited patients operated on for left colon, sigmoid colon or rectal cancer. Colon mucosa and fecal samples were collected to study mucosa associated microbiota (MAM) and luminal microbiota (LM), accordingly. Preliminary analysis for the first 25 consecutive patients with V3–V4 16S rRNA metagenomic analysis was performed. Bacterial composition and abundance in patients who developed postoperative complications over a 90-day follow-up period were compared to those without postoperative complications. Abundance and distribution of genera in MAM differed significantly when compared to LM with a significant impact on neoadjuvant therapy on bacterial composition. Preliminary analysis revealed no statistically significant differences in LM nor in MAM composition when individuals with and without postoperative surgical complications were compared. In cases of postoperative complications, LM and MAM showed significantly decreased diversity. Composition of the colonic microbiota is altered by neoadjuvant therapy. Results on the impact of colonic dysbiosis on postoperative complications are pending the end of the present study, with 50 patients enrolled

Achieving Sustainability in Non-ETS Sectors Using System Dynamics Modelling Practice

The European Union (EU) has recently agreed on an ambitious framework for climate and energy policies by 2030. The new commitment foresees greenhouse gas (GHG) emissions reduction by 40 % compared to 1990. The part of these reductions is going to come from the EU Emission trading system (ETS) and other part from the sectors outside the EU ETS or, so called, non-ETS sectors: agriculture, transport, waste management and the part of energy sector and industry, which is not included in the ETS. As for now, much research has focused on studies relevant to the ETS; meanwhile, the largest part of GHG emissions in Europe is generated by non-ETS sectors. Therefore our study aims to strengthen the decision making capacity by providing the comprehensive modelling tool for policy analysis in non-ETS sectors. This tool is based on system dynamics modelling approach and encompasses the mathematical model for non-ETS sectors. With this model we analyse the effectiveness of various policy measures aiming to reduce GHG emissions in non-ETS sectors. The obtained results are compared with the benchmarks set by the EU climate and energy policy. Latvia is selected as a case study. We perform the analysis of baseline and green scenarios and test the model for sensitivity. The obtained results show that with the existing policy framework, in 2030, GHG emissions would increase by 19 % above the 2005 level. Since the developed model is white-box modelling approach therefore the dynamic relationships of driving forces behind the GHG emissions in non-ETS sectors can be transferred to other case studies and extended to the EU

Minimally invasive right colectomy - from conventional laparoscopic resection to robotic-assisted surgery: a narrative review

Robotic-assisted abdominal surgery was introduced with the aim of overcoming the drawbacks of the conventional laparoscopic approach. The present narrative review focuses on the comparison between laparoscopic and robotic-assisted approaches for right colectomy (RC) regarding short- and long-term outcomes, costs, and learning curve. The main technical aspects related to the use of robotic assistance for this specific procedure are further discussed. Minimally invasive RC is considered technically challenging due to the particularities of the right and middle colic vascular anatomy. Robotic RC is not yet widespread due to its high cost and longer operating time. However, its use may result in advantages regarding short-term clinical outcomes, and it facilitates the acquisition of basic surgical skills by speeding up the learning curve of minimally invasive colorectal surgery

Laboratorijas darbu krājums vides inženierzinātņu studentiem. 3.daļa

Laboratorijas darbu krājuma III daļa vides inženierzinātņu studentiem aptver laboratorijas un praktiskos darbus, kas paredzēti atsevišķu priekšmetu padziļinātai apguvei. Darbos iekļauti gan eksperimenti ar biomasu, gan energoefektivitātes jautājumi, kā arī eksperimentu plānošana un optimizācijas aprēķini. Mācību līdzeklis būs noderīgs ne tikai RTU vides inženierzinātņu studentiem, bet arī citu RTU un pārējo Latvijas augstskolu specialitāšu studentiem

Laboratorijas darbu krājums vides inženierzinātņu studentiem. 2.daļa

Šis mācību izdevums ir izveidots, par pamatu ņemot oriģinālus laboratorijas un praktiskos darbus. Laboratorijas darbu krājuma mērķauditorija ir ne tikai vides inženierzinātņu studenti, bet arī pārējo inženierzinātņu un vides zinātņu studenti, kā arī Rīgas Tehniskās universitātes un pārējo Latvijas universitāšu mācību spēki, kuri strādā ilgtspējīgas attīstības jomā. Grāmatā apkopotie darbi ir ļoti atšķirīgi pēc savas struktūras un uzdevumiem, un ietver gan lietišķo zinātni, gan datorsimulācijas un eksperimentu veikšanu

Role of the intestinal microbiome in colorectal cancer surgery outcomes.

OBJECTIVES Growing evidence supports the role of the intestinal microbiome in the carcinogenesis of colorectal cancers, but its impact on colorectal cancer surgery outcomes is not clearly defined. This systematic review aimed to analyze the association between intestinal microbiome composition and postoperative complication and survival following colorectal cancer surgery. METHODS A systematic review was conducted according to the 2009 PRISMA guidelines. Two independent reviewers searched the literature in a systematic manner through online databases, including Medline, Scopus, Embase, Cochrane Oral Health Group Specialized Register, ProQuest Dissertations and Theses Database, and Google Scholar. Human studies investigating the association between the intestinal microbiome and the short-term (anastomotic leakage, surgical site infection, postoperative ileus) and long-term outcomes (cancer-specific mortality, overall and disease-free survival) of colorectal cancer surgery were selected. Patients with any stage of colorectal cancer were included. The Newcastle-Ottawa scale for case-control and cohort studies was used for the quality assessment of the selected articles. RESULTS Overall, 8 studies (7 cohort studies and 1 case-control) published between 2014 and 2018 were included. Only one study focused on short-term surgical outcomes, showing that anastomotic leakage is associated with low microbial diversity and abundance of Lachnospiraceae and Bacteroidaceae families in the non-cancerous resection lines of the stapled anastomoses of colorectal cancer patients. The other 7 studies focused on long-term oncological outcomes, including survival and cancer recurrence. The majority of the studies (5/8) found that a higher level of Fusobacterium nucleatum adherent to the tumor tissue is associated with worse oncological outcomes, in particular, increased cancer-specific mortality, decreased median and overall survival, disease-free and cancer-specific survival rates. Also a high abundance of Bacteroides fragilis was found to be linked to worse outcomes, whereas the relative abundance of the Prevotella-co-abundance group (CAG), the Bacteroides CAG, and the pathogen CAG as well as Faecalibacterium prausnitzii appeared to be associated with better survival. CONCLUSIONS Based on the limited available evidence, microbiome composition may be associated with colorectal cancer surgery outcomes. Further studies are needed to elucidate the role of the intestinal microbiome as a prognostic factor in colorectal cancer surgery and its possible clinical implications

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied. Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2: 1). Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days). Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding