Multidimensional evaluation of the learning curve for laparoscopic complete mesocolic excision for right colon cancer: a risk-adjusted cumulative summation analysis.

AIM: Despite the suggested potential benefit of complete mesocolic excision (CME) for right-sided colon cancer (RCC) for patient survival, concerns about its safety and feasibility have contributed to delayed acceptance of the procedure, especially when performed by a minimally invasive approach. Thus, the aim of this work was to evaluate the actual learning curve (LC) of laparoscopic CME for experienced colorectal surgeons. METHOD: Prospectively collected data for consecutive patients undergoing laparoscopic CME for RCC between October 2015 and January 2021 at our institution, operated on by experienced surgeons, were analysed. A multidimensional assessment of the LC was performed through cumulative sum (CUSUM) and risk-adjusted (RA) CUSUM analysis. RESULTS: Two hundred and two patients operated by on by three surgeons were considered. The CUSUM graphs based on operating time showed one peak of the curve between 17 and 27 cases. The CUSUM graphs based on surgical failure showed one peak of the curve between 20 and 24 cases The RA-CUSUM curve also showed one preeminent peak at 24-33 cases. Based on the CUSUM and RA-CUSUM analyses all the surgeons reached proficiency in 24-33 cases. CONCLUSIONS: Our study showed that an experienced minimally invasive colorectal surgeon acquires proficiency in laparoscopic CME for RCC after performing 24-33 cases.

Treatment of Wound Dehiscence Utilizing Negative Pressure Wound Therapy With Instillation and Dwell Time in Emergency Abdominal Surgery: A Step-by-step Closure Protocol.

BACKGROUND: The treatment of complex wounds often requires multiple surgical debridements and, eventually, reconstruction with skin grafts or flaps. Topical negative pressure therapy with a vacuum-assisted closure device can achieve wound healing with a reduction in healing time and easier management of the wound. OBJECTIVE: With a step-by-step closure protocol developed by the authors from July 2017 to the present, this case series highlights the advantages of using negative pressure wound therapy with instillation and dwell time (NPWTi-d). MATERIALS AND METHODS: The authors report the treatment of 13 patients undergoing emergency abdominal surgery. In total, 5 patients (38.46%) had hollow bowel perforation, 4 patients (30.77%) had intestinal occlusion, 3 patients had cancer (23.08%), and 1 patient (7.69%) underwent extensive ileal resection due to intestinal infarction. RESULTS: The use of NPWTi-d reduced the number of dressing changes compared with saline-soaked gauze dressings. Instillation resulted in faster and better wound bed cleansing compared with traditional dressings. Exudate management was better, and the average complete wound closure time was faster than with traditional dressings. The step-by-step closure protocol made it possible to accelerate wound healing; in synergy with NPWTi-d, tension at the edges of the middle third of the wound, especially in the xipho-pubic wounds, had reduced significantly. CONCLUSIONS: The synergistic action of step-by-step closure and NPWTi-d obtain excellent results in management of wound dehiscence, even in patients with muscle fascia defect and loop exposure.

Squamous cell carcinoma and pilonidal cyst disease.

AIM: Squamous cell carcinoma developed on a chronic pilonidal cyst. CASE REPORT: Authors describe the case of a squamous cell carcinoma developed on a chronic pilonidal cyst in a 63- years-old patient with a 43 years history of recurrent pilonidal sinus disease. RESULTS: The patient underwent incisional biopsy, staging with total body CT and, finally, radical surgery. After 30 months there were no evidence of recurrence. DISCUSSION: Pilonidal sinus disease is a common disease that affects especially male subjects, obese and with excess of body hair. The complications that arise most frequently are cellulitis, abscess formation and developments of recurrences. Malignant transformation appears rather rare and is reported in the literature with a percentage that goes from 0.02% to 0.1%. CONCLUSIONS: Authors recommend accurate inspection of the pilonidal area in all chronic and longstanding inflammatory lesions and possibly practice incisional biopsies to exclude malignant degeneration.