ABSTRACT
(1) Background: The liver-first approach may be indicated for colorectal cancer patients with synchronous liver metastases to whom preoperative chemotherapy opens a potential window in which liver resection may be undertaken. This study aims to present the data of feasibility and short-term outcomes in the liver-first approach. (2) Methods: A prospective observational study was performed in Spanish hospitals that had a medium/high-volume of HPB surgeries from 1 June 2019 to 31 August 2020. (3) Results: In total, 40 hospitals participated, including a total of 2288 hepatectomies, 1350 for colorectal liver metastases, 150 of them (11.1%) using the liver-first approach, 63 (42.0%) in hospitals performing <50 hepatectomies/year. The proportion of patients as ASA III was significantly higher in centers performing ≥50 hepatectomies/year (difference: 18.9%; p = 0.0213). In 81.1% of the cases, the primary tumor was in the rectum or sigmoid colon. In total, 40% of the patients underwent major hepatectomies. The surgical approach was open surgery in 87 (58.0%) patients. Resection margins were R0 in 78.5% of the patients. In total, 40 (26.7%) patients had complications after the liver resection and 36 (27.3%) had complications after the primary resection. One-hundred and thirty-two (89.3%) patients completed the therapeutic regime. (4) Conclusions: There were no differences in the surgical outcomes between the centers performing <50 and ≥50 hepatectomies/year. Further analysis evaluating factors associated with clinical outcomes and determining the best candidates for this approach will be subsequently conducted.
ABSTRACT
BACKGROUND: Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS: Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS: Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS: Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER: ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
Subject(s)
Digestive System Surgical Procedures , Suture Techniques , Humans , Suture Techniques/adverse effects , Digestive System Surgical Procedures/adverse effects , Surgical Stapling , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Surgical Wound Infection/etiology , Sutures/adverse effectsABSTRACT
CT images and endoscopic findings in a case of Bouveret's syndrome.
Subject(s)
Gallstones/diagnosis , Ileus/diagnosis , Aged, 80 and over , Endoscopy, Gastrointestinal , Female , Gallstones/pathology , Gallstones/surgery , Gastrostomy , Humans , Ileus/pathology , Ileus/surgeryABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Radiography, Abdominal/instrumentation , Radiography, Abdominal/methods , Radiography, Abdominal , Calcinosis/complications , Calcinosis , Cholelithiasis/complications , Cholelithiasis/surgery , Cholelithiasis , Gastroscopy , Digestive System Surgical Procedures/methods , Pressure Ulcer/complications , Pressure Ulcer/therapy , Gallstones/surgery , GallstonesABSTRACT
Obstructive jaundice caused by a pancreaticoduodenal pseudoaneurysm, probably related to a chronic pancreatitis.
Subject(s)
Aneurysm, False/complications , Duodenal Diseases/complications , Jaundice, Obstructive/etiology , Pancreatic Diseases/complications , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/surgery , Humans , Male , Middle Aged , Pancreatic Diseases/diagnostic imaging , Pancreatic Diseases/surgery , Radiology, Interventional , Tomography, X-Ray Computed , UltrasonographyABSTRACT
No disponible
