Anastomotic leak in ovarian cancer cytoreduction surgery: a systematic review and meta-analysis

Introduction: Anastomotic leaks (AL) following ovarian cytoreduction surgery could be detrimental, leading to significant delays in commencing adjuvant chemotherapy, prolonged hospital stays and increased morbidity. The aim of this study was to investigate risk factors associated with anastomotic leaks after ovarian cytoreduction surgery. Material and methods: The MEDLINE (via PubMed), Cochrane Library, EMBASE and Scopus bibliographical databases were searched. Original clinical studies investigating risk factors for AL in ovarian cytoreduction surgery were included. Results: Eighteen studies with non-overlapping populations reporting on patients undergoing cytoreduction surgery for ovarian cancer (n = 4622, including 344 cases complicated by AL) were included in our analysis. Patients undergoing ovarian cytoreduction surgery complicated by AL had a significantly higher rate of 30-day mortality but no difference in 60-day mortality. Multiple bowel resections were associated with an increased risk of postoperative AL, while no association was observed with body mass index (BMI), American Society of Anesthesiologists (ASA) score, age, smoking, operative approach (primary versus interval cytoreductive, stapled versus hand-sewn anastomoses and formation of diverting stoma), neoadjuvant chemotherapy and use of hyperthermic intraperitoneal chemotherapy (HIPEC). Discussion: Multiple bowel resections were the only clinical risk factor associated with increased risk for AL after bowel surgery in the ovarian cancer population. The increased 30-day mortality rate in patients undergoing ovarian cytoreduction complicated by AL highlights the need to minimize the number of bowel resections in this population. Further studies are required to clarify any association between neoadjuvant chemotherapy and decreased AL rates

Portomesenteric vein thrombosis in patients undergoing sleeve gastrectomy: An updated meta-analysis of 101,865 patients

Background: Portomesenteric vein thrombosis (PMVT) is a rare but potentially fatal complication of sleeve gastrectomy (SG). The rising prevalence of SG has led to a surge in the occurrence of PMVT, while the associated risk factors have not been fully elucidated.Objectives: This study aims to determine the incidence and risk factors of PMVT in patients undergoing SG.Methods: A comprehensive literature search was performed in PubMed (MEDLINE) and EMBASE databases. Proportion and regression meta-analyses were conducted.Results: A total of 75 studies and 101,865 patients undergoing SG and 355 patients with PMVT were identified. At a mean follow-up of 14.4 (SD: 16.3) months the incidence of PMVT was found to be 0.48% (95%CI: 0.39-0.60%). The majority of the population presented with abdominal pain (91.8%) at an average of 22.4 days postoperatively and PMV was mainly diagnosed with CT scan (96.0%). Hematologic abnormalities predisposing to thrombophilia were identified in 34.9% of the population. Age (p=0.02) and center volume (p &lt;0.0001) were significantly associated with PMVT, while gender, BMI, hematologic abnormality, prior history of deep vein thrombosis or pulmonary embolism, type of prophylactic anticoagulation, and duration of prophylactic anticoagulation were not associated with the incidence of PMVT in meta-regression analyses. Treatment included therapeutic anticoagulation in 93.4% and the mortality rate was 4/355 (1.1%).Conclusion: PMVT is a rare complication of sleeve gastrectomy with an incidence rate &lt;1% that is associated with center volume and age but is not affected by the duration or type of thromboprophylaxis administered postoperatively.<br/

Long Term Weight Loss and Comorbidity Resolution of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass and the Impact of Pre-operative Weight Loss on Overall Outcome.

The impact of pre-operative weight loss of on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported but is necessary to guide surgeons towards appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes, including comorbidity resolution, of LSG and LRYGB and investigates the effect of pre-operative variables on long-term outcomes

The Association between Bariatric Surgery Outcomes and Socioeconomic Deprivation

BACKGROUND: Obesity is a multifaceted problem for global healthcare, influenced by socioeconomic factors. Bariatric surgery is an effective treatment where less invasive management has been unsuccessful. The impact of socioeconomic deprivation on surgical outcomes is a novel area of research. The present study aims to investigate the effect of socioeconomic deprivation on bariatric surgery outcomes.METHODS: Data was prospectively collected at a regional bariatric centre in Scotland. The study included patients who received either a Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) (2008-2022). Follow-up occurred postoperatively at 6 months, 1 year and annually thereafter. Socioeconomic deprivation was measured using the Scottish Index of Multiple Deprivation (SIMD) using residential postcodes to generate a deprivation quintile (Q1-5). The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included postoperative complications, comorbidity status, nutritional status, length of stay and re-admissions. Grouped analysis was conducted to represent a more deprived group (Q1-3) and a less deprived group (Q4-5). Statistical analysis was carried out of the data. The study was carried out using the STROBE principles.RESULTS: 316 patients were included (median follow-up, 7 years; median %TWL, 23.8%). There was no significant difference in median %TWL (p = 0.528), short-term (p = 0.619) or long-term (p = 0.164) complications and resolution (p = 0.472), improvement (p = 0.282) or exacerbation of comorbidities (p = 0.717) between socioeconomic quintiles.CONCLUSION: Socioeconomic deprivation does not limit bariatric surgery outcomes and should not be a barrier to surgery.</p

Long Term Weight Loss and Comorbidity Resolution of Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass and the Impact of Pre-operative Weight Loss on Overall Outcome.

The impact of pre-operative weight loss of on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported but is necessary to guide surgeons towards appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes, including comorbidity resolution, of LSG and LRYGB and investigates the effect of pre-operative variables on long-term outcomes

Predicting Inadequate Weight Loss After Bariatric Surgery:Derivation and Validation of a Four Factor Model

Introduction: Weight loss following bariatric surgery is variable and predicting inadequate weight loss is required to help select patients for bariatric surgery. The aim of the present study was to determine variables associated with inadequate weight loss and to derive and validate a predictive model. Methods: All patients who underwent laparoscopic sleeve gastrectomy and Roux-en-Y gastrectomy (2008–2022) in a tertiary referral centre were followed up prospectively. Inadequate weight loss was defined as excess weight loss (EWL) &lt; 50% by 24 months. A top-down approach was performed using multivariate logistic regression and then internally validated using bootstrapping. Patients were categorised into risk groups. Results: A total of 280 patients (median age, 49 years; M:F, 69:211) were included (146 LSG; 134 LRYGB). At 24 months, the median total weight loss was 30.9% and 80.0% achieved EWL ≥ 50% by 24 months. Variables associated with inadequate weight loss were T2DM (OR 2.42; p = 0.042), age 51–60 (OR 1.93, p = 0.006), age &gt; 60 (OR 4.93, p &lt; 0.001), starting BMI &gt; 50 kg/m² (OR 1.93, p = 0.037) and pre-operative weight loss (OR 3.51; p = 0.036). The validation C-index was 0.75 (slope = 0.89). Low, medium and high-risk groups had a 4.9%, 16.7% and 44.6% risk of inadequate weight loss, respectively. Conclusions: Inadequate weight loss can be predicted using a four factor model which could help patients and clinicians in decision-making for bariatric surgery. Graphical Abstract: (Figure presented.)</p

Circulating microRNAs and Clinicopathological Findings of Papillary Thyroid Cancer: A Systematic Review

BACKGROUND/AIM: Papillary thyroid cancer (PTC) is the most common endocrine malignancy with a rising incidence. There is a need for a non-invasive preoperative test to enable better patient counselling. The aim of this systematic review was to investigate the potential role of circulating microRNAs (miRNAs) in the diagnosis and prognosis of PTC. MATERIALS AND METHODS: A systematic literature search was performed using MEDLINE, Cochrane, and Scopus databases (last search date was December 1, 2021). Studies investigating the expression of miRNAs in the serum or plasma of patients with PTC were deemed eligible for inclusion. RESULTS: Among the 1,533 screened studies, 39 studies met the inclusion criteria. In total, 108 miRNAs candidates were identified in the serum, plasma, or exosomes of patients suffering from PTC. Furthermore, association of circulating miRNAs with thyroid cancer-specific clinicopathological features, such as tumor size (13 miRNAs), location (3 miRNAs), extrathyroidal extension (9 miRNAs), pre- vs. postoperative period (31 miRNAs), lymph node metastasis (17 miRNAs), TNM stage (9 miRNAs), BRAF V600E mutation (6 miRNAs), serum thyroglobulin levels (2 miRNAs), 131I avid metastases (13 miRNAs), and tumor recurrence (2 miRNAs) was also depicted in this study. CONCLUSION: MiRNAs provide a potentially promising role in the diagnosis and prognosis of PTC. There is a correlation between miRNA expression profiles and specific clinicopathological features of PTC. However, to enable their use in clinical practice, further clinical studies are required to validate the predictive value and utility of miRNAs as biomarkers

Pneumomediastinum in the COVID-19 era: to drain or not to drain?

Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis.  Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed

Pneumomediastinum in the COVID-19 era: to drain or not to drain?

Pneumomediastinum (PNM) is a rare clinical finding, usually with a benign course, which is managed conservatively in the majority of cases. However, during the COVID-19 pandemic, an increased incidence of PNM has been observed. Several reports of PNM cases in COVID-19 have been reported in the literature and were managed either conservatively or surgically. In this study, we present our institutional experience of COVID-19 associated PNM, propose a management algorithm, and review the current literature. In total, 43 Case Series were identified, including a total of 747 patients, of whom 374/747 (50.1%) were intubated at the time of diagnosis, 168/747 (22.5%) underwent surgical drain insertion at admission, 562/747 (75.2%) received conservative treatment (observation or mechanical ventilation. Inpatient mortality was 51.8% (387/747), while 45.1% of the population recovered and/or was discharged (337/747). In conclusion, with increased incidence of PNM in COVID-19 patients reported in the literature, it is still difficult to assign a true causal relationship between PNM and mortality. We can, however, see that PMN plays an important role in disease prognosis.  Due to increased complexity, high mortality, and associated complications, conservative management may not be sufficient, and a surgical approach is needed