The effect of ERAS management in gastric cancer: assessment from the IMIGASTRIC study

Background:Establish protocols to enhance the surgical management (ERAS) can improve outcomes, shortening hospital stay and save resources. Several studies have carried out for colorectal surgery, while a lack of evidence for gastrectomy remains.This study aims to evaluate the impact of ERAS strategies in a large series of patients underwent gastric cancer surgery.Methods:This is a propensity score-matched case-control study, comparing an ERAS group with a control group. Data were recorded through a tailored and protected web-based system. Primary outcomes: hospital stay, complications rate. Among the secondary outcomes, there are: POD of mobilization, POD of starting liquid diet and soft solid diet.Results:Patients in the ERAS and control groups were 1:1 matched by the closest propensity score on the logit scale and with a Caliber = 0.2. The successful matching resulted in a total sample of 440 patients. The two groups showed no differences in all baseline patients characteristics, type of surgery (P=0.31) and stage of the disease (P=0.61). A benefit in favor of the ERAS management was found in the length of hospital stay (P=0.0004) and complications rate (P=0.001).Conclusion:An ERAS program can safely be established in referral centers for gastric cancer, enabling to significantly improve the main clinical outcomes

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

1024-81 Aortic Dilation in Young Males with Isolated Normally Functioning Bicuspid Aortic Valve

Bicuspid aortic valve (BAV) is a common congenital disorder frequently coexisting with abnormalities of the aortic arch including aortic coarctation, dissecting aneurysm and aortic root dilation: it has been suggested that these associations result from a common developmental defect. Moreover, aortic root dimensions are influenced by age and body size; thus, in order to test the hypothesis of a common congenital disorder underlying BAV and aortic dilation, we prospectively studied young males with isolated, normally functioning bicuspid aortic valve during the medical examinations for the military service, in comparison with a age-matched group with no cardiovascular abnormalities.Sixty-three patients (aged 17.8±0.6 year, range 17-19) whose echocardiograms showed a normally functioning BAV were studied at the Military Hospital in Verona by 2D echocardiography with PW, CW and Color Doppler. Seventy subjects, comparable for age (17.82±0.7, range 17-19) and body surface area (1.79±0.09 vs 1.82±0.08, respectively) without clinical and echocardiographic evidence of cardiac abnormalities, were used as control group. Aortic root dimensions were measured by 2D-echocardiography at four levels: 1) anulus, 2) sinuses on Valsalva, 3) supraaortic ridge and 4) proximal ascending aorta.Results (mean±SD):LevelBAVNormalspAnulus2.36±0.312.27±0.29NSSinuses of Valsalva3.16±0.382.90±0.32<0.01Supraaortic ridge2.64±0.462.50±0.280.03Proximal Ascending Aorta3.12±0.482.71±0.29<0.01ConclusionAortic root dimensions are significantly greater in young men with normally functioning BAV than in control subjects comparable for gender, age and body size. Noticeably, the aortic root dimensions in patients with BAV are still within the range of normality. These data confirm the hypothesis that BAV and aortic dilation are expression of a common developmental defect

A close adherence to a Stoma-Therapic Pathway improves immediate stoma-related outcomes and reduces the length of hospital stay

Abstract Purpose: New stoma creation is related with a wide range of implications and stoma-related complications could occur frequently. Aim was to assess the impact of a close stoma-therapic-care pathway (STCP) in terms of length of stay, autonomy in the management of the pouch, readmission rate and stoma-related complicationsMethods: Patients undergoing surgery for colorectal disease and first stoma creation from January 2017 to December 2020 were analyzed. All patients enrolled had joined the ERAS protocol. Results: Among 143 enrolled, 56 (40%) didn’t follow completely the STCP (group A), whereas 87 (60%) demonstrated a strictly compliance (group B). The hospital stay was 8 days in the group B vs 11,5 in the group A (p=0,001). The first look at the stoma needed 1 day in the group B vs 3 days in the group A (p&lt;0,001), emptying the pouch 2 day in the group B vs 5 days in the group A (p&lt;0,001) and ability to change the pouch 3 day in the group B vs 6 days in the group A (p&lt;0,001). Stoma related complications were 9 (16.1%) in the group B and 16 (18.4%) in the group A, and 30 days readmission was 10,1% in the group B and 11,5% in the group A, p=0,82 and p=1, respectively, not significant. Conclusions: The STCP has been shown to reduce the hospital stay and to have a protective role making the patient autonomous in the management of the stoma.</jats:p