Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery.

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Did the COVID-19 lockdown result in a delay of colorectal cancer presentation and outcomes? A single centre review.

PURPOSE: The COVID-19 pandemic and resultant lockdown measures potentially delay management of non-communicable, life-limiting diseases like colorectal cancer (CRC) through avoidance of healthcare facilities by the public and diversion of resources within healthcare systems. This study aims to evaluate the impact of Singapore's "Circuit Breaker (CB)" lockdown measures on CRC disease presentation and short-term surgical outcomes, while comparing Singapore's approach against other countries which employed similar lockdown measures. METHODS: Patients whose initial diagnosis of CRC was made within the 6-month pre-CB (6/10/19-6/4/20) ("pre-CB group") and post-CB (7/4/20-7/10/20) ("post-CB group") period were enrolled retrospectively. The groups were compared based on severity of disease on presentation and short-term operative outcomes. RESULTS: In total, 105 patients diagnosed with CRC were enrolled in this study. When comparing pre-CB and post-CB groups, there was no significant difference in stage of CRC on presentation (p = 0.850). There was also no increase in need for emergent operations (p = 0.367). For patients who had undergone an operation, postoperative morbidity was not significantly higher in the post-CB group (p = 0.201). Both groups of patients had similar length of stay in the hospital (p = 0.438). CONCLUSION: Unlike similar high-income countries, Singapore did not see later stage disease on presentation and poorer operative outcomes after lockdown measures. Possible reasons include lesser healthcare avoidance behaviours amongst Singaporeans, and adequate preparation of resources and contingency plans formed by hospitals after previous pandemics.

Clinical outcome and cost comparison between laparoscopic and open appendicectomy.

INTRODUCTION: Local data comparing laparoscopic appendicectomy (LA) and open appendicectomy (OA) is lacking. We perform a cost and outcome comparison between LA and OA. MATERIALS AND METHODS: A retrospective review of all appendicectomies performed for suspected appendicitis from July 2010 to December 2010 was conducted. Patient demographics, duration of surgery, complication rates, total cost of stay (COS) and length of stay (LOS) were compared between LA and OA. RESULTS: A total of 198 patients underwent appendicectomy during the duration of study; 82 LA and 116 OA. There were 115 males (58.1%) and 83 females (41.9%). Median age was 33 years. Patients who underwent LA were significantly younger (P <0.001) with a greater proportion of females (P <0.0001) and were more likely to be negative appendicectomies (18.3% vs. 6.9%, P = 0.023). Duration of surgery was significantly longer in LA patients (86 min vs. 74 min, P = 0.003). LOS in the LA group was shorter by 1.3 days compared to OA (2.0 days vs. 3.3 days, P <0.0001). The differences in operative duration and LOS between LA and OA remained significant on multivariate analysis (P = 0.001 and P = 0.008, respectively). The COS (P = 0.359), wound infection rates (P = 0.528) and complication rates (P = 0.131) were not significantly different between the 2 groups. CONCLUSION: LA is associated with a shorter LOS while its cost is equivalent to OA. From the perspective of utilisation of healthcare resources, LA appears to be superior.

An audit study of the sensitivity and specificity of ultrasound, fine needle aspiration cytology and frozen section in the evaluation of thyroid malignancies in a tertiary institution.

INTRODUCTION: The aim of this study was to conduct an audit of the sensitivity and specificity of ultrasound, fi ne needle aspiration cytology (FNAC) and frozen section in the evaluation of thyroid malignancies in our practice. MATERIALS AND METHODS: The medical records of all the patients who underwent thyroid surgery in a tertiary institution's General Surgery Department between January 2005 and December 2007 were retrospectively reviewed using a standardised data collection template. Results of the ultrasounds, FNACs and frozen sections were compared with the fi nal histological diagnosis. RESULTS: A total of 112 patients underwent thyroid surgery in the 3-year study period. Thyroid malignancy constituted 34 (30%) of all patients who underwent thyroid surgery. The most popular diagnostic tools used were ultrasound (81%), FNAC (69%) and frozen section (59%). The sensitivity of ultrasound, FNAC and frozen section were 41.4%, 86.4% and 68.8%, respectively. FNAC was shown to be a superior diagnostic test in detecting malignancy compared to ultrasound. FNAC was able to pick up 53% of thyroid cancers missed by ultrasound. Frozen section was able to pick up 33% of thyroid cancers that were missed by both ultrasound and FNAC. CONCLUSION: FNAC is the most reliable tool in detecting malignancies and ought to form the mainstay for investigation of thyroid nodules. The utilisation of ultrasonographic features in the evaluation of thyroid nodules might not necessary improve the detection rate of thyroid malignancy. Frozen section helps to improve the detection rate of thyroid malignancy but further studies into its cost-effectiveness ought to be performed.