Minimally invasive colectomies can be performed with similar outcomes to open counterparts for colorectal cancer emergencies: a propensity score matching analysis utilizing ACS-NSQIP.

PURPOSE: The safety and feasibility of minimally invasive surgery (MIS) in the setting of colorectal cancer emergencies have been debated. We sought to compare postoperative outcomes of MIS with open techniques in the setting of colorectal cancer emergencies from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. METHODS: We included patients undergoing colectomy for colorectal cancer emergency between 2012 and 2019 "2012-2019" from the ACS-NSQIP dataset. We compared short-term morbidity, mortality, short-term oncological outcomes, and secondary outcomes for MIS vs open colectomies using propensity score matching. We then evaluated the trends of MIS versus open colectomies using linear regression analysis. RESULTS: We examined a total of 5544 patients (open n = 4070; MIS n = 1474) and included 1352 patients for our postoperative outcome analyses after propensity score matching 1:1 (open n = 676; MIS n = 676). Within the matched cohort, mortality was significantly higher in the open group (open 6.95% vs MIS 3.99%, OR 1.8, p = 0.023). Anastomotic leak rates were comparable between the  two groups (open 4.46% vs MIS 4.02%, OR 1.12, p = 0.787). Pulmonary complications were significantly higher after open surgery (open 10.06% vs MIS 4.73%, OR 2.25, p < 0.001). Rates of ileus were significantly higher amongst open patients (open 29.08% vs MIS 19.94%, p < 0.001). Patients stayed on average 1 day longer in the hospital after open surgery (p < 0.001). Rates of MIS for early tumors (N0 and T1/T2, n = 289) did not significantly change over 7 years (p = 0.597, rate = - 0.065%/year); however, utilization of MIS for late tumors (N1 or T3/T4, n = 4359) increased by 2.06% per year (p < 0.001). CONCLUSIONS: This study demonstrates that MIS was associated with superior postoperative outcomes compared to open surgery without compromising oncological outcomes in patients undergoing emergency colectomy for colon cancer. Within the matched cohort, MIS was associated with lower rates of mortality, pulmonary complications, ileus, and shorter postoperative length of stay.

Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia.

OBJECTIVE: Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS: The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS: Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS: Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.

Neuropsychological and neurophysiological evaluation of cognitive deficits related to the severity of traumatic brain injury.

OBJECTIVES: Cognitive impairment is a common permanent sequela of traumatic brain injury (TBI). Its objectivization is based on neuropsychological and neurophysiological assessment. Neuropsychological evaluation requires a test battery, whereas for neurophysiological assessment the most significant is application of P300 Event-Related Potentials (ERPs). The aim of the study was to determine whether it is possible to differentiate between degrees of severity of TBI on the basis of neuropsychological and neurophysiological parameters. PATIENTS AND METHODS: A total of 90 patients with closed TBI were evaluated at least one year after trauma. Subjects were classified into three groups according to severity of TBI: mild, moderate and severe. In all subjects the Intelligence Test, the Wisconsin Card Sorting Test (WCST) and P300 ERPs were performed. RESULTS: General intelligence measures did not prove sensitivity enough to differentiate levels of severity of TBI, whereas the number of achieved categories on the WCST significantly discerned patients with mild and moderate TBI from patients with severe TBI. Perseverative errors significantly separated patients with mild TBI from patients with moderate and severe TBI. Non-perseverative errors significantly differentiated only patients with mild TBI from patients with severe TBI. Finally, P300 latency (EPLAT) significantly differentiated patients with mild TBI from patients with moderate and severe TBI. The results show that the applied test battery can discriminate between different levels of severity of TBI and emphasize the importance of P300 ERP in the evaluation of patients with brain injury. CONCLUSIONS: Our findings indicate that the WCST and ERP P300 latency have a significant role in the assessment of cognitive deficit related to TBI.

Alternative to the transvenous approach in pediatric pacing - long-term experiences with bipolar epicardial pacing leads.

BACKGROUND: Cardiovascular anatomy and limited venous access may preclude the implantation of endocardial pacing systems in children as well as adults with congenital heart disease. Thus, the implantation of myo/epicardial pacing leads is required in these patients. The less favorable long-term results experienced in the past with myocardial screw-in leads are often used to justify the transvenous approach whenever possible, even in infants. However, encouraging preliminary results were reported from modern bipolar steroid eluting epicardial pacing leads. Further follow-up data are now warranted to obtain arguments for the dispute regarding the preferable or optimal pacing approach in infants and small children. Methods From January 1994 to November 2000 a total of 64 bipolar steroid-eluting epicardial pacing leads (Medtronic CapSure Epi 10366 and 4968, Medtronic, Inc, Minneapolis, MN, USA) were implanted in 52 children at our institutions (52 electrodes in ventricular and 12 in atrial position). The median age of the children was 25.5 months (range 0.03 to 193 months). As part of a prospective multicenter study these leads were continuously followed in combination with AutoCapture devices since December 1996. Results Telemetry data demonstrated at discharge low pacing thresholds both for the ventricular (0.8±0.37Volt @ 0.5ms) and the atrial leads (0.8±0.4Volt @ 0.5ms) as well as excellent sensing signals (P wave 2.9±1.4mV and R wave 10.6±5.5mV) without significant changes during follow-up up to 24 months. AutoCapture controlled pacing could be applied in 46/52 (88%) children rendering a calculated battery service life of 14.8±2.9 years with a VVIR device (Regency SR 5130, St. Jude Medical, Sylmar, CA, USA) and 10.8±1.1 years with a dual chamber device (Affinity DR 5330, St. Jude Medical, Sylmar, CA, USA). Apart from the necessity to reposition three leads in the immediate postoperative period no late lead related complications have been experienced during follow-up. Conclusions The new steroid-eluting bipolar epicardial pacing lead demonstrates a high reliability and consistent extraordinary pacing as well as sensing thresholds. AutoCapture controlled pacing is feasible in most patients and may result in marked battery service life extension. Hence epicardial pacing can now be highly recommended as the first choice for permanent pacing in infants and children.