Synchronous abdominal tumors: is combined laparoscopic surgery in a single approach a safe option?

ABSTRACT Background and Purpose: Recent advances in cancer treatment have resulted in bet- ter prognosis with impact on patient's survival, allowing an increase in incidence of a second primary neoplasm. The development of minimally invasive surgery has provided similar outcomes in comparison to open surgery with potentially less mor- bidity. Consequently, this technique has been used as a safe option to simultaneously treat synchronous abdominal malignancies during a single operating room visit. The objective of this study is to describe the experience of two tertiary cancer hospitals in Brazil, in the minimally invasive treatment of synchronous abdominal neoplasms and to evaluate its feasibility and peri-operative results. Materials and Methods: We retrospectively reviewed the data from patients who were submitted to combined laparoscopic procedures performed in two tertiary hospitals in Brazil from May 2009 to February 2015. Results: A total of 12 patients (9 males and 3 females) with a mean age of 58.83 years (range: 33 to 76 years) underwent combined laparoscopic surgeries for the treatment of at least one urological disease. The total average duration of surgery was 339.8 minutes (range: 210 to 480 min). The average amount of intraoperative bleeding was 276.6mL (range: 70 to 550mL) and length of hospitalization was 5.08 days (range: 3 to 10 days). Two patients suffered minor complications regarding Clavien system during the immediate postoperative period. Conclusions: Combined laparoscopic surgery for the treatment of synchronous tumors is feasible, viable and safe. In our study, there was a low risk of postoperative morbidity.

Descemet stripping with automated endothelial keratoplasty: a comparative study of outcome in patients with preexisting glaucoma

To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty [DSAEK] in patients with and without glaucoma. For this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication [55] or with previous glaucoma surgeries [64] with a time-matched group of all other DSAEK cases [179, control]. With a mean follow-up of 1.85 +/- 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure [odds ratio OR = 12.35, 95% confidence interval CI [5.46-27.90], P < 0.001]. Graft detachment was not associated with either history of glaucoma or glaucoma surgery [P > 0.05]. Glaucoma on medication had no increased risks of graft failure compared to normal eyes [P = 0.38]. However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries [OR = 4.26, 95% CI [1.87-9.71], P < 0.001]. Medically managed glaucoma has increased risks of postoperative IOP elevation [OR = 2.39, 95% CI [1.25-4.57], P = 0.013], whereas surgically managed glaucoma has no significant elevation [P = 0.23]. Elevation of IOP was not significantly correlated with graft failure [P = 0.21]. DSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival