21 research outputs found

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    S79 Bilateral renal carcinoma

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    /STRU^NI RAD UDK 616.62-006.04-089.844 Local Recurrence of Bladder Cancer after Cystectomy with Orthotopic Bladder Substitution and Ileal Conduit

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    Objective: To present the local recurrence rates after radical cystectomy for advanced bladder cancer and to compare them between patients with orthotopic neobladder and ileal conduit. Patients and methods: 97 patients with radical cystectomy were analyzed: 75 patients with orthotopic ileal neobladder, operated from 1985. to 2006, and 22 patients with ileal conduit, operated fro

    S79 Bilateral renal carcinoma

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    Comparison of two Wallace’s technique of implantation of the ureter to the ileal conduit: Five year experience

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    At the Clinic of Urology, at the Clinical Centre of Serbia, within the formation of ileal conduit as a form of urinary diversion, we apply three techniques of implantation of the ureter. A technique Nesbit-Bricker is the oldest technique described, and it sovereign occupies deserved place as a form of implantation of the ureter into an isolated segment of the intestinal tract. Technique by Wallace is the second technique which is applied at the Clinic of Urology, and has undergone some changes during the time, so that in the current practice we offer two modes of this technique. This paper present the postoperative results these two techniques, trying to answer the question which one of these two techniques is superior.</jats:p

    Laparoscopic ligature of spermatic veins as a method of surgical management of varicocele

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    Objective: To present the surgical technique of laparoscopic ligation spermatic vein in the treatment of varicocele as well as the results of this procedure. Material and methods: The study was conducted at the Clinic of Urology, Clinical Centre of Serbia, during the seventeen months, from November 2012 till March of 2014. During this time, the thirteen patients underwent laparoscopic ligation of spermatic vein. Including factors for this type of surgical treatment were clinically manifest varicocele and/or bad finding of semen. Results: During the seventeen months, thirteen patients underwent laparoscopic spermatic vein ligature. The youngest patient was 21 years old, while the oldest patient was 38 years old. The median was 28.46 years. 6 patients had varicocele Gr III, and with 7 patients we verified varicocele Gr II. The duration of surgery ranged from 15 to 70 minutes, with a median of 35.46 minutes. The amount of gas that was insufflated during surgery ranged from 14.1 l to 45 l, with a median of 23:32 litters. Three patients underwent laparoscopic ligature of spermatic vein with preservation of spermatic artery. Interventions in which underwent preservation of artery lasted longer (median 60 minutes) than it was the case in the group of patients without preservation (the median 28.1 minutes). Conclusion: Laparoscopic ligation of spermatic veins is a safe, minimally invasive, rapid and effective procedures. The level of postoperative complications is minimal learning curve fast and patient discomfort is minimized. The procedure is the financial cost effective, especially compared with the open surgical procedure.</jats:p
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