Comparative outcomes of laparoscopic and open surgery in inflammatory bowel disease in pediatric and young adult patients: a systematic review and meta-analysis

BACKGROUND

Pediatric inflammatory bowel disease (IBD), encompassing Crohn's disease, ulcerative colitis, and indeterminate colitis, often necessitates surgical intervention in cases of severe or refractory disease. Although biologic therapies have significantly reduced the need for surgery, operative management remains essential for certain patients. The choice between laparoscopic (laparoscopy group [LG]) and open conventional surgery (open group [OG]) continues to be a subject of debate. This meta-analysis aimed to compare the postoperative outcomes of LG and OG in pediatric patients with IBD.

METHODS

We conducted a meta-analysis of observational studies comparing LG and OG outcomes in pediatric patients with IBD. Key outcomes analyzed included major and minor postoperative complications, reoperations, readmissions, operative time, and length of hospital stay.

RESULTS

Seven studies met the inclusion criteria, analyzing 3417 patients, with 1399 (41%) undergoing OG and 2018 (59%) undergoing LG. Our analysis revealed no significant differences in major postoperative complications, reoperation, and readmissions between LG and OG (P = .114, P = .082, and P = .641, respectively). However, LG was associated with shorter hospital stays (6.04 vs 8.35 days; P < .05). Conversions from LG to open surgery amounted to a total of 153 (7.57%). Open surgery had a significantly shorter operative time (173.8 vs 195.5 min; P = .005).

CONCLUSION

Both laparoscopic and open conventional surgeries are safe, effective, and reliable in managing pediatric IBD. Although open surgery offers shorter operative times, laparoscopy reduces hospital stay and minor postoperative complications. The choice of approach depends on the surgeon's experience and patient-specific factors.

Prophylactic drain placement after emergency general surgery procedures? A scoping review of the literature challenging common practice

BACKGROUND

This scoping review aims to map the existing literature on the use of prophylactic drainage (PD) after Emergency General Surgery procedures (EGS) and to change the current practice according to evidence.

METHODOLOGY

Data from an exhaustive literature search conducted across Embase (Ovid), Medline(R) ALL (Ovid), Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials was summarized. Literature published between January 2013 and December 2024 was included.

RESULTS

Most studies found better outcomes for the no-drain group. Implementing a drain after EGS procedures potentially increases hospital stays, postoperative pain, and surgical site infection rates. For conditions such as peritonitis and perforated ulcers, only a few studies were available, with some showing benefits of PD.

CONCLUSION

For some conditions, like colorectal emergencies, there is a scarcity of evidence. The outcomes suggest that PD is not recommended in most EGS cases. In high-risk cases, there are some reports on improved outcomes for PD use. Further research is imperative to create science-based clinical guidelines, especially for less-researched conditions.

Assessment of negative appendectomy in acute appendicitis diagnoses

Background

A negative appendectomy is a surgery performed due to a clinical suspicion of acute appendicitis, but no evidence of inflammation is identified upon examination. The main reason is the incorrect diagnosis of acute appendicitis, which remains a challenge, especially in developing countries, where the rates are different among populations. This study aims to explore the prevalence of negative appendectomies in a regional hospital and evaluate the diagnostic methods used in clinical practice.

Materials and methods

A retrospective analysis was conducted on patients who underwent emergency appendectomy between 2021 and 2022. Negative appendectomy was defined as the absence of histopathological evidence of acute appendicitis postoperatively.

Results

Out of 324 patients, 38 were found to have undergone a negative appendectomy, representing a two-year rate of 11.7%. Imaging was performed in 78% of cases, but no significant difference was observed in its use between patients with positive and negative appendectomies. Differential diagnoses showed pathologies such as cysts and intestinal lesions. The Alvarado score was found to be a useful tool when applied with a threshold score of 7. However, variability in clinical presentations such as nausea/vomiting, anorexia, right iliac fossa tenderness and fever highlighted the limitations of relying solely on this metric. The factors associated with negative appendectomy were previous abdominal surgery, Alvarado score <7, abdominal pain, rebound tenderness, leukocytosis and neutrophilia.

Conclusions

The prevalence of negative appendectomies at our institution was 11.7%. Despite the widespread use of diagnostic imaging and clinical scoring systems, improvements in diagnostic accuracy are necessary to reduce the rate of unnecessary surgeries.

Hand-Assisted Laparoscopic Surgery (HALS) as an Alternative to Unplanned Laparoscopic Conversion to Open Surgery (LCOS) in Colectomies for Acute Diverticulitis

BackgroundIn difficult colorectal cases, surgeons may opt for a hand-assisted laparoscopic (HALS) colectomy or attempt a laparoscopic surgery that may require an unplanned conversion to open (LCOS). We aimed to compare the clinical outcomes of these 2 types of surgeries.MethodsColectomies for acute diverticulitis with a HALS or LCOS surgery were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2022 Targeted Colectomy Database. After confirming a difference in propensity scores between the cohorts, they were matched using propensity score matching (PSM) based on preoperative factors. RStudio was utilized for filtering and performing the PSM, while Minitab was used for statistical analysis.ResultsWe identified 804 HALS colectomies and 284 LCOS colectomies. After PSM, both cohorts contained 284 patients. Absolute standardized mean errors for all matched factors were less than 0.1, confirming well-balanced cohorts. Following PSM, preoperative and perioperative factors were similar between both colectomy groups. Postoperatively, HALS surgeries had a shorter average length of stay (7.67 ± 0.38 vs 10.57 ± 0.41, P < 0.001) as well as lower rates of ileus (13.73% vs 22.54%, P = 0.007) and superficial surgical site infection (2.11% vs 5.28%, P = 0.045).ConclusionTo the best of our knowledge, this is the first national database study comparing HALS and LCOS colectomies. After accounting for confounding variables, our PSM analysis showed the benefits of HALS colectomies for acute diverticulitis. Future studies may use single-center data containing risk adjustment profiles to create an even more uniform comparison.

The safety and efficacy of endoscopic submucosal dissection for superficial pharyngeal squamous cell neoplasms: a single-center study in China

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) is a mainstream treatment for superficial pharyngeal squamous cell neoplasms (SPSCN) in Japan. There were few reports of it in China, which were small in scale and lack long-term follow-up data. Quality of life (QoL) outcomes of ESD for SPSCN have also not been studied. The aims of this study were to clarify the safety and efficacy of ESD for SPSCN and its outcomes in the Chinese setting.

METHODS

Eighty-four consecutive patients with 145 lesions treated with ESD for SPSCN from January 2014 to August 2022 were enrolled. Their curability, complications, metachronous SPSCN, local recurrence, lymph node metastasis, and overall and disease-specific survival rates were analyzed. The quality of life was measured by MD Anderson Symptom Inventory-Head and Neck (MDASI-HN).

RESULTS

The en-bloc resection rate was 94.5%, and the R0 resection rate was 74.5%. The postoperative adverse event rate was 2.6%. The median follow-up period was 36.28 months. The 3-year rates of metachronous pharyngeal cancer, local recurrence, lymph node metastasis, overall survival, and disease-specific survival were 14.1%, 7.6%, 9.6%, 92.4%, and 98.0%, respectively. The mean symptom composite score and interference score of MDASI-HN were 10.3 and 2.3, respectively.

CONCLUSIONS

In the Chinese setting, pharyngeal ESD achieves curability, safety, and long-term outcomes comparable to those observed in Japan. The postoperative QoL is satisfactory.

PErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial

Background

Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO2) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.

Methods

Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO2 to prevent surgical site infection (SSI) versus 21-35% FiO2. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.

Results

We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO2 increases in the 21-35% FiO2 arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.

Conclusion

This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.

Trial registration

ClinicalTrials.gov NCT04256798.

Systematic Review of Surgical Site Infection Prevention Guideline Recommendations for Maintenance of Homeostasis in the Perioperative Period

Surgical site infections are common, result in increased patient morbidity and mortality, and increase the economic burden to society. Anesthesiologists play a key role in perioperative infection prevention, with data suggesting that evidence-based measures can significantly reduce the incidence of these infections. This systematic review aimed to identify and compare current recommendations for the maintenance of homeostasis in surgical site infection prevention guidelines. Eight surgical site infection prevention guidelines published in the past 10 yr were identified. There was broad consensus regarding the importance of optimizing intraoperative homeostasis to reduce infections. However, there was substantial heterogeneity in both the studies cited and the specific recommendations provided regarding maintenance of oxygenation, normovolemia, normothermia and glycemic targets. High-quality randomized controlled trials are required to close existing knowledge gaps, with adaptive platform trials likely to play a key role in improving the current evidence base for preventing surgical site infection.

Radiolucent gallstone ileus causing proximal small bowel obstruction: A case report

Gallstone ileus occurs when gallbladder stones erode and become lodged in the small bowel, thereby causing obstruction. These stones usually impact the terminal ileum because of its narrow lumen; however, they can also be found in less common locations, as observed in our case. The presence of pneumobilia can indicate gallstone ileus even without visible radiopaque stones because not all gallstones are detectable on computed tomography (CT). A 74-year-old woman presented to the emergency department with severe right upper quadrant pain that started 1 week previously and became more aggressive associated with fever, leukocytosis, and vomiting. The pain was colicky, intermittent, and aggravated by movement but did not radiate. Further imaging was requested to investigate the cause of the pain, which revealed evidence of proximal small bowel obstruction due to radiolucent gallstone ileus. Radiolucent gallstone ileus is a rare but serious condition requiring prompt surgical intervention. The presence of pneumobilia can indicate gallstone ileus even when the stones are not visible on CT. Large stones can cause blockages in the proximal small bowel. The ability of radiological imaging to detect gallstones varies according to their composition.

Effects of a high-fiber, high-fruit and high-vegetable, low-fat dietary intervention on the rectal tissue microbiome

BACKGROUND

Emerging evidence suggests that bacteria residing in colorectal tissue are plausibly associated with colorectal cancer. Prior studies investigated the effects of dietary interventions on the fecal microbiome, but few assessed colorectal tissue microbiome endpoints. We investigated the effects of a high-fiber, high-fruit, high-vegetable, and low-fat dietary intervention on the rectal tissue microbiome in the Polyp Prevention Trial (PPT).

METHODS

PPT is a 4-year randomized clinical trial with intervention goals of consuming (1) at least 18 g of fiber per 1000 kcal/day; (2) at least 3.5 servings of fruits and vegetables per 1000 kcal/day; and (3) no more than 20% of kcal/day from fat. Using 16S ribosomal RNA gene sequencing, we characterized bacteria in rectal biopsies collected at baseline and the end of years 1 and 4 (n = 233 in intervention arm and n = 222 in control arm). We estimated effects of the intervention on alpha and beta diversity and relative abundance of a priori-selected bacteria using repeated-measures linear mixed-effects models.

RESULTS

The intervention did not statistically significantly modify rectal tissue alpha diversity. Compared with the control arm, relative abundance of a priori-selected Porphyromonas (absolute intervention effects [standard errors] at T1 vs T0 = -0.24 [0.07] and T4 vs T0 = -0.12 [0.07]; P = .004) and Prevotella (absolute intervention effects at T1 vs T0 = -0.40 [0.14] and at T4 vs T0 = -0.32 [0.15]; P = .01) were more strongly decreased in the intervention arm.

CONCLUSION

The PPT intervention did not influence rectal tissue microbiome diversity or the relative abundance of most bacteria, except for 2 oral-originating bacteria that were previously associated with colorectal cancer presence.

Postoperative adjuvant chemotherapy in patients with stage II early onset colorectal cancer: exploration and discovery using real-world data and the SEER database

Background and aim

The incidence of early-onset colorectal cancer (EOCRC) is rising, yet intensive postoperative adjuvant chemotherapy (ACT) often results in overtreatment with minimal prognostic benefit. This study aims to assess the therapeutic necessity of ACT in stage II EOCRC patients and to identify potential ACT candidates.

Methods

A total of 296 non-ACT and 50 ACT patients with stage II EOCRC were included from Xijing Hospital (XJCRC), and 2067 non-ACT and 1163 ACT patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) cohort. To address selection bias and confounding, propensity score matching, inverse probability treatment weighting (IPTW), and multivariate Cox regression analyses were utilized. Survival curves and landmark analysis were employed to compare Overall Survival (OS) differences.

Results

Similar OS were observed between ACT and non-ACT groups in both cohorts before and after adjustment for confounders. No significant survival differences were noted in dMMR (P = 0.48), pMMR (P = 0.07), and T3 (P = 0.83) subgroups. However, T4 stage patients receiving ACT demonstrated prolonged survival compared to non-ACT counterparts, particularly after three years (P = 0.007), as identified by landmark analysis.

Conclusions

Most stage II EOCRC patients might yield limited benefits from postoperative ACT, with the sole exception of those at T4 stage, who could experience long-term clinical advantages.

Clinical Trial Registration

https://clinicaltrials.gov/study/, identifier NCT06308354.

Safety and efficacy of gastrointestinal motility agents following elective colorectal surgery: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Postoperative ileus (POI) is a frequent complication after elective colorectal surgery, delaying gastrointestinal (GI) recovery and discharge. While pharmacologic agents such as laxatives and prokinetics are often included in enhanced recovery after surgery (ERAS) protocols, their efficacy and safety remain uncertain.

METHODS

A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to evaluate the effect of Gastrointestinal (GI) motility agents on postoperative recovery in elective colorectal surgery. Primary outcomes included GI-2 recovery (tolerance of solid diet and stool passage), time to first defaecation, and safety endpoints. Data was pooled using random-effects models.

RESULTS

Seven RCTs involving 849 patients were included. GI motility agents significantly accelerated GI-2 recovery (mean difference -1.01 days; 95% CI -1.29 to -0.73; p < 0.001) and reduced time to first defaecation (mean difference -1.07 days; 95% CI -1.40 to -0.73; p < 0.001). No significant differences were observed in safety outcomes, including anastomotic leak (OR 0.97; 95% CI 0.53 to 1.77), nasogastric tube reinsertion (OR 0.86; 95% CI 0.49 to 1.51), or readmission rates (OR 1.03; 95% CI 0.62 to 1.72).

CONCLUSION

Motility agents enhance postoperative GI recovery without compromising safety in patients undergoing elective colorectal surgery. Given their low cost, wide availability, and favourable safety profile, gastrointestinal motility agents may be considered for integration into ERAS protocols. However, further high-quality, standardised trials are needed to confirm their benefits across diverse surgical populations.

Cultural differences in attitudes towards surgical site infections among French anesthetists and surgeons in digestive surgery in 2022

BACKGROUND

Although it generates a significant burden, little attention has been paid to preventing Surgical Site Infection (SSI) in digestive surgery.

OBJECTIVE

This study explored the factors underpinning anesthetists' and surgeons' attitudes toward SSI prevention in digestive surgery, focusing on their perceptions of SSI, preventive measures, guidelines, and cooperation across both specialties.

METHODS

Qualitative semi-structured interviews were conducted with 15 surgeons and 19 anesthetists working in digestive surgery. Participants were approached through established mailing lists and snowball sampling. Interviews were recorded and transcribed verbatim. Transcripts were coded and analyzed thematically using a constant comparative approach.

RESULTS

SSI in digestive surgery was perceived as an inevitable consequence and ranked down in the priorities of surgeons. A paradox existed between the low consideration of superficial infections that are easily manageable through antibiotics and the strong awareness of the antibiotic resistance threat. Global trust appeared regarding the guidelines, but a knowledge gap of the guidelines was observed among surgeons in comparison with anesthetists. SSI ownership was perceived as collective, but the responsibility belonged to the surgeon alone. Surgeons focused on actions and short-term tasks within a culture of individualism, whereas anesthetists worked collectively with systemic approaches. Overall, the cooperation between both specialties was positive, but tightly reliant on teamwork, workload, and organization in the operating theatre.

CONCLUSIONS

The cultural differences between surgeons and anesthetists should be recognized as a key overarching factor in defining their respective roles in the prevention of SSI and in establishing accountability in digestive surgery - including aspects such as adherence to guidelines, and the implementation of preventive measures.

Hospital Ownership and Surgical Outcomes in East, Central, and Southern Africa

Importance

Surgical mortality remains a critical public health issue in resource-limited settings. Hospital ownership type may influence surgical outcomes, yet this relationship is not well understood in East, Central, and Southern Africa, where a diverse mix of public, private, and faith-based hospitals provides care.

Objective

To determine whether hospital ownership type (public, private, or faith-based) is associated with differences in surgical mortality rates in East, Central, and Southern Africa.

Design, Setting, and Participants

This retrospective cohort study analyzed operative cases recorded by 214 general surgery trainees enrolled in surgical training programs at 85 public, private, and faith-based hospitals in East, Central, and Southern Africa from January 1, 2005, to December 31, 2020. Cases were documented in mandatory operative logbooks. Reported mortalities were analyzed using multilevel logistic regression to account for clustering by trainee while controlling for age category, emergency status, case complexity, specialty type, country Human Development Index, trainee postgraduate year, and self-reported autonomy. Data were analyzed in July 2024.

Exposures

Hospital ownership type categorized as public, private, or faith-based.

Main Outcomes and Measures

The primary outcome was perioperative mortality, defined as in-hospital, all-cause mortality before discharge. Mortality rates were compared across hospital types.

Results

Of the 106 106 operative cases analyzed, 48 474 (45.7%) were performed in public, 3507 (3.3%) in private, and 54 125 (51.0%) in faith-based hospitals. Patients' median (IQR) age was 34 (20-51) years, and 61.5% were male. The overall perioperative mortality rate was 1.6% (95% CI, 1.5%-1.6%). Among major cases (mortality, 1138 of 53 718 [2.1%; 95% CI, 2.0%-2.2%]), faith-based hospitals had 57% lower mortality (518 of 35 370 [1.5%; 95% CI, 1.3%-1.6%]) than public hospitals (589 of 17 223 [3.4%; 95% CI, 3.2%-3.7%]) and 47% lower mortality than private hospitals (31 of 1125 [2.8%; 95% CI, 1.9%-3.9%]). Mixed-effects logistic regression revealed that faith-based hospitals had lower odds of mortality compared with public hospitals (odds ratio, 0.67; 95% CI, 0.51-0.86; P = .002) and private hospitals (odds ratio, 0.57; 95% CI, 0.34-0.95; P = .03).

Conclusions

In this study, faith-based hospitals in East, Central, and Southern Africa were associated with significantly lower surgical mortality rates compared with public and private hospitals. These findings suggest that practices and resources in faith-based hospitals contribute to improved surgical outcomes, warranting further investigation to inform health care policy and improve surgical care and outcomes in the region.

Efficacy of reinforcing sutures in preventing anastomotic leakage after surgery for rectal cancer: A systematic review and metaanalysis

BACKGROUND

Anastomotic leakage (AL) is a challenging complication following rectal cancer surgery, often leading to increased morbidity and healthcare costs. The use of reinforcement sutures is expected to reduce the rate of AL, their preventive effects are controversial.

AIM

To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.

METHODS

A systematic search of major medical databases was conducted to identify studies up to June 2024. Intraoperative and postoperative outcomes were assessed; the primary outcome assessed was the incidence of AL. Pooled odds ratios (ORs) and mean differences (MDs) with a 95% confidence interval (CI) were calculated using fixed-effect or random-effect models under heterogeneity.

RESULTS

This meta-analysis incorporated 20 studies involving 3726 patients. Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group (OR: 0.26, 95%CI: 0.19-0.35, P < 0.001) than the unreinforced suture group. The reinforced suture group also exhibited a shorter hospital stay (MD: -1.17, 95%CI: -1.78 to -0.57, P < 0.001), earlier anal exhaust (MD: -0.13, 95%CI: -0.22 to -0.05, P = 0.002), longer operative time (MD: 15.25, 95%CI: 10.71-19.80, P < 0.001), lower infection rate (OR: 0.54, 95%CI: 0.29-1.00, P = 0.05) and lower reoperation rate (OR: 0.19, 95%CI: 0.08-0.45, P < 0.001).

CONCLUSION

The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence post-rectal cancer surgery. Nevertheless, these conclusions warrant verification through additional high-quality randomized controlled trials.

Effect of perioperative disinfection and isolation measures in infection control after gastrointestinal surgery: A retrospective analysis

BACKGROUND

The application of perioperative disinfection and isolation measures to patients undergoing gastrointestinal surgery with postoperative infection can provide a data reference for reducing the postoperative infection rate, improving postoperative biochemical markers, and enhancing postoperative recovery outcomes.

AIM

To explore the effectiveness of perioperative disinfection and isolation measures in controlling postoperative infection following gastrointestinal surgery. It also sought to compare infection rates and biochemical markers between the observation and control groups and evaluate the impact of disinfection and isolation measures on reducing postoperative complications.

METHODS

A retrospective analysis was conducted. Ninety-six patients who underwent gastrointestinal surgery between January 2022 and December 2023 were selected and divided into an observation group and a control group, with 48 cases in each. The observation group received disinfection and isolation measures during the perioperative period, whereas the control group received standard nursing care. The incidence of infection, white blood cell count, C-reactive protein levels, hemoglobin levels, and liver function markers (alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen) were monitored postoperatively in both groups.

RESULTS

The postoperative infection rate in the observation group was significantly lower than that in the control group (P < 0.05). White blood cell and C-reactive protein levels decreased significantly after surgery in the observation group and were significantly lower than those in the control group (P < 0.05). Alanine aminotransferase, aspartate aminotransferase, creatinine, and blood urea nitrogen levels in the observation group were lower than those in the control group on postoperative days 1 and 3, showing a significant difference (P < 0.05).

CONCLUSION

Perioperative disinfection and isolation measures effectively reduce postoperative infection rates in gastrointestinal surgery patients and improve biochemical markers, thereby enhancing recovery outcomes. This study provides a valuable basis for postoperative infection control and has significant clinical applications.

Postoperative outcomes in older patients living with frailty and multimorbidity in the UK: SNAP-3, a snapshot observational study

BACKGROUND

Older surgical patients experience longer hospital stays and a higher risk of morbidity and mortality than their younger counterparts. Frailty (19.6% of cohort) and multimorbidity (63.1% of cohort) increase these risks. The 3rd Sprint National Anaesthesia Project (SNAP-3) describes the impact of frailty and multimorbidity on postoperative outcomes.

METHODS

We conducted a prospective observational cohort study over 5 days in 2022 aiming to recruit all UK patients aged ≥60 yr undergoing surgery (excluding minor procedures). Data included patient characteristics, clinical variables, Clinical Frailty Scale (CFS), multimorbidity (two or more comorbidities), length of stay (LOS), postoperative delirium, morbidity, and mortality. Quantile regression and mixed effects logistic regression were used to analyse relationships.

RESULTS

We recruited 7129 patients from 214 hospitals. Increasing frailty was associated with longer LOS, higher odds of delirium, morbidity, and mortality ≥1 yr, with a clear increase noted from CFS of 4 (19.0% of cohort). Amongst those without multimorbidity, individuals with CFS score of 4 had longer admissions than non-frail individuals (median LOS 0.75 days longer, 95% confidence interval [CI] 0.34-1.16), increasing to 2.69 days longer for CFS 5 (95% CI 0.76-4.62). Multimorbidity increased the odds of postoperative morbidity by 46% (adjusted odds ratio 1.46, 95% CI 1.24-1.73), but there was no evidence for multimorbidity impacting LOS, delirium, or mortality.

CONCLUSIONS

SNAP-3 highlights the impact of frailty on postoperative outcomes. Multimorbidity had less impact, with an effect on postoperative morbidity the only one to have strong statistical evidence. The impact of these conditions must be discussed with older patients considering surgical intervention.

Global Epidemiology of Early-Onset Digestive System Malignancy: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND AND AIM

The researches on the global burden of digestive system malignancy in young populations were limited. This study aimed to comprehensively investigate the burden of early-onset digestive system malignancy (often defined as cancers diagnosed below the age of 50) based on the Global Burden of Disease 2021.

METHODS

Data of incidence, prevalence, deaths, disability-adjusted life years (DALYs), and risk factors for the five major early-onset digestive system malignancies, including early-onset esophageal cancer (EOEC), early-onset gastric cancer (EOGC), early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset colorectal cancer (EOCRC), were extracted from GBD 2021. The average annual percent change (AAPC) was calculated using joinpoint regression analysis. The Bayesian age-period-cohort (BAPC) model was utilized to predict the burden up to 2030.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) of early-onset digestive system malignancies, except for EOCRC (AAPC, 0.37), showed a decreasing pattern. Meanwhile, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of early-onset digestive system malignancy presented a downward trend. Notably, high-middle sociodemographic index (SDI) countries experienced higher disease burdens. Dietary risk factors, tobacco, alcohol consumption, and metabolic factors were the main risk factors. The ASIR of EOEC and EOCRC was projected to increase in 2030, whereas the trend for EOGC, EOLC, and EOPC was projected to decrease.

CONCLUSIONS

Early-onset digestive system malignancy presented notable heterogeneity across gender, geography, and cancer types. This emphasizes the urgency of addressing the public health challenge of early-onset digestive system malignancy.

The clinical relevance of microplastic exposure on colorectal cancer: A systematic review

Microplastic exposure can contaminate multiple organs through nasal, dermal, and respiratory routes. The effect of microplastic exposure on colorectal adenocarcinoma development has gained attention. This systematic review aimed to summarize studies of microplastic exposure in humans with colorectal cancer. The relevant studies were collected through a computer-assisted search in PubMed, ISI Web of Science, Embase, Scopus, and Google Scholar databases. A total of 747 documents were evaluated for eligibility by two independent authors. The quality assessment of eligible studies was evaluated by the JBI checklist, and required data were collected and extracted from the included studies. After analysis, four studies were found eligible. The microplastic infiltration in colorectal tissue biopsies was relatively high; polyamide, polycarbonate, and polypropylene polymers were among the most common polymers in colorectal tissue samples of patients with colorectal adenocarcinoma. The average particle size was 0.1 µm to 1.6 mm. Microplastics shape in colorectal cancerous tissue, including fibers, fragments, and films. Microplastic abundance in colorectal tumor tissue was 25.9-32.2 particles/g tissue. In the case-control study, the microplastic accumulation in colorectal cancer tissue samples was significantly higher than in controls. The etiology of colorectal cancer remains unclear; however, environmental factors are actively contributing to colorectal cancer development. While there are few studies on microplastics in patients with colorectal adenocarcinoma, existing evidence indicates microplastic accumulation in the colorectal tissue of these patients. Further research is needed to determine if microplastic exposure initiates or leads to the development of colorectal cancer events.

Effect of interventions on surgical site infections in Sub-Saharan Africa: a systematic review

BACKGROUND

Surgical site infections (SSI) are a major concern due to their contributions to morbidity, economic loss, and death among individuals who underwent operations in healthcare institutions. To decrease this infection, various pharmacological and non-pharmacological interventions have been devised and implemented for major surgery patients. Pharmacological interventions include the provision of antibiotic prophylaxis and antiseptic agents, whereas non-pharmacological interventions encompass programmatic interventions such as protocols, policies, quality improvement initiatives, training, and education that are given at the institutional level. However, the effect of particularly non-pharmacological interventions on the reduction has not been comprehensively evaluated for over a decade. This systematic review attempts to synthesize a piece of evidence on the effect of non-pharmacological intervention in Sub-Saharan Africa on minimizing SSI and enhancing health outcomes.

METHODS

Databases including MEDLINE, Google Scholar, Cochrane Library, AJOL, Hinari, search platforms, and open-access repositories were accessed. Two investigators conducted a literature selection process, and the quality of selected articles was assessed using a JBI quality evaluation checklist.

RESULTS

A total of 11 studies that met the inclusion criteria were analyzed. Three main intervention categories were identified, which focused on improving adherence to protocol, policy change or induction, and delivery of multimodal strategies. These interventions led to a reduction in SSI rates in varying degrees (15% to 95%). Multimodal interventions are the most widely implemented and comprehensive approaches that integrate multiple evidence-based practices, which have demonstrated a substantial reduction of SSI in different surgical populations. The rates of improvement with these interventions were influenced by intervention type, patient characteristics, surgical urgency, healthcare setting, follow-up time, and criteria for measuring the outcomes that may influence the SSI rates.

CONCLUSION

Interventions focusing on policy, protocol, and multimodal strategies can effectively reduce SSI rates, with the latter being the most effective. Patient and clinical characteristics, along with the healthcare setting, were influential factors affecting the interventions' impact on SSI. This systematic review is registered in PROSPERO, in the number CRD42024524963.

TreatmENT of AnastomotiC LeakagE after colon cancer resection: the TENTACLE - Colon study

BACKGROUND

Anastomotic leakage (AL) is a common and severe complication after colon cancer resection, but studies investigating various treatment strategies and factors influencing outcomes are scarce.

OBJECTIVES

(1) To identify predictive factors associated with 90-day mortality and 90-day Clavien-Dindo grade 4-5 complications amongst patients who developed AL following colon cancer resection with subsequent development and validation of prediction models, and (2) to explore and compare the effectiveness of various treatment strategies for AL following colon cancer resection, adjusting for type of index surgery, different leak entities and patient factors.

METHODS

The TENTACLE - Colon is an international multicentre retrospective cohort study. Consecutive patients with AL after colon cancer resection operated between 1 January 2018 and 31 December 2022 from participating centres will be included. The planned sample size is 2000 patients. The primary outcome is 90-day mortality and the co-primary composite endpoint is Clavien-Dindo grade 4-5 complications. Secondary outcomes include: hospital and intensive care unit length of stay, number of radiological and surgical reinterventions within one year after resection, mortality (in-hospital, 30-day, and 1-year), the comprehensive complication index, and 1-year stoma-free survival. For objective 1, regression models will be used to identify predictors associated with 90-day mortality and grade 4-5 complications. For objective 2, comparative analyses of various treatment strategies will be performed for the specified outcomes, adjusting for patient, tumour, resection and leakage characteristics.

TRIAL REGISTRATION

This study is registered at clinicaltrials.gov (NCT06528054) since July 30th, 2024.

Risk factors for permanent stoma following sphincter-preserving anterior resection in rectal cancer: A retrospective multicenter observational study

BACKGROUND

Sphincter-sparing rectal cancer surgery seeks to avoid terminal stomas, yet they remain common. To identify patients who may benefit from an upfront terminal ostomy, we aimed to determine preoperative risk factors and develop a risk calculator.

METHODS

This multicenter observational retrospective cohort study included consecutive patients undergoing sphincter-sparing anterior resection for rectal cancer between January 2016 and January 2020 at 6 tertiary hospitals. The stoma-free status was analyzed 2 years after surgery.

RESULTS

We included 639 patients: 373 with primary stoma (58.4%) and 29 with secondary stoma (4.5%). Two years after surgery, 76 (11.9%) patients had permanent stoma. Patients with anastomotic leakage showed a lower rate of stoma closure 2 years after surgery (No 86.3% vs Yes 69.4%; P = .002). The main causes for non-primary stoma reversal were disease progression (52.4%) and patient decision (19.0%). Preoperative factors independently associated with permanent stoma 2 years after surgery were male sex (P = .016; OR = 2.16), tumor height (P = .001; OR = 0.88), synchronous liver metastases (P = .025; OR = 2.71) and lung metastases (P = .001: OR = 7.05).

CONCLUSIONS

Preoperative risk factors associated with permanent stoma in patients undergoing anterior rectal resection include sex, tumor height, and synchronous liver or lung metastases. Surgeons should consider preoperative factors associated with the risk of permanent stoma and inform patients about the potential need for a permanent stoma.

A comprehensive exploration of the impact and contribution of polygenic risk score on age at onset of 30 complex diseases

OBJECTIVES

Polygenic risk score (PRS) has increasingly shown promise in predicting disease risk; however, studies examining the influence of PRS on age at onset remain limited. This study aimed to systematically assess the impact of PRS on age at onset across multiple diseases.

STUDY DESIGN

Prospective cohort study METHODS: We calculated PRS with two methods (C+T and PRS-CS) and compared their predictive capability in age at onset of 30 diseases in the UK Biobank. We next evaluated the effect of PRS on age at onset and quantified the influence of PRS on disease risk across early and late onset cases.

RESULTS

PRS-CS behaved better in predicting age at onset of most diseases (except for Alzheimer's disease) compared to C+T. Higher PRS was associated with earlier age at onset for 23 diseases, with the average age at onset advanced by 1.94 years. Compared to women, men faced an advanced onset for 5 diseases. Compared to average PRS (20-80 %), individuals in the top 2.5 % of the PRS distribution displayed a significantly earlier age at onset for 19 diseases, ranging from 2.85 (1.68-4.03) years advancement for gout to 13.70 (9.88-17.52) years advancement for Crohn's disease. Compared to the late-onset group, the early-onset group exhibited a greater onset risk in 21 diseases, with the early-onset risk of colon cancer being 2.78-fold higher than the late-onset risk (OR = 11.42 [9.77-12.45] vs. 3.95 [3.85-4.06], P < 0.001).

CONCLUSIONS

Higher PRS generally leads to earlier age at onset, which supports the potential role of PRS in screening high early-onset risk individuals susceptible to chronic diseases.

Advances in the application of hydrogel adhesives for wound closure and repair in abdominal digestive organs

The abdominal cavity houses the majority of the digestive system organs, which frequently suffer from diseases with limited responsiveness to pharmacological treatments, such as bleeding, perforation, cancer, and mechanical obstruction. Invasive procedures, including endoscopy and surgery, are typically employed to manage these conditions. Currently, sutures and staplers remain the gold standard for internal wound closure. However, these methods inevitably cause secondary tissue damage. Unlike superficial organs such as the skin, the abdominal cavity presents a relatively confined environment where postoperative complications tend to be more severe. To achieve wound closure and repair, hydrogel adhesives have garnered attention due to their minimal invasiveness, robust sealing, and ease of application. Nonetheless, the application of hydrogel adhesives within the abdominal cavity faces several challenges, including adhesion in moist environments, selective adhesion, and resistance to acids and digestive enzymes. To date, there has been no comprehensive review focused on the use of hydrogel adhesives for wound closure in abdominal digestive organs. This review introduces the design principles of hydrogel adhesives tailored for abdominal organs and provides a detailed overview of recent advances in their applications for esophageal endoscopic submucosal dissection, gastric perforation, hepatic bleeding, pancreatic leakage, and intestinal anastomotic leakage. Additionally, the current challenges and future directions of hydrogel adhesives are discussed. This review aims to provide valuable insights for the development of next-generation hydrogel adhesives for wound closure and repair in abdominal digestive organs.

Effects of Prehabilitation Concurrent Exercise on Functional Capacity in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

Purpose: Our aim was to examine the efficacy of concurrent exercise (i.e., aerobic and strength exercise) during prehabilitation programs on functional capacity in comparison with standard cancer care strategies in colorectal cancer (CRC) patients scheduled for surgery. Methods: A systematic review of randomized controlled trials was performed. A search of electronic databases [PubMed, Web of Science, and EBSCO Host] was conducted to identify all publications employing concurrent exercise in patients with CRC. Random-effects meta-analyses were used to calculate the standardized change in mean difference (SMD) and 95%CI between exercise intervention and control groups for the 6 min walking test (6MWT) distance covered before and after prehabilitation. Results: Six studies met the inclusion criteria (379 patients with CRC). Concurrent training during prehabilitation led to significant positive effects on the 6MWT (0.28 SMD [0.03-0.54], p = 0.037). Subgroup analyses showed a higher SMD (0.48 [0.00-0.98], p = 0.050) in younger (i.e., <70 years) CRC patients compared to their older counterparts (0.10 [0.08-0.11], p = 0.310). Meta-regression models between SMD of the 6MWT and body mass index, prehabilitation program duration, and baseline 6MWT distance covered did not show any significant relationship. Conclusions: This meta-analysis demonstrates the superiority of concurrent exercise prehabilitation in improving functional capacity related to cardiometabolic changes and lowering postoperative risk in patients with CRC.

Complexity of insulin resistance in early-onset colorectal cancer

Early-life exposure to lifestyle-associated metabolic alterations could be a key contributor to early-onset colorectal cancer (EOCRC). Notably, insulin resistance (InsR)-linked hyperinsulinemia, elevated levels of insulin-like growth factors, and chronic inflammation could trigger EOCRC by modulating gene expression/pathways that support carcinogenesis/anti-apoptosis. Here, we discuss how InsR could be the trigger that offsets metabolic homeostasis in young individuals, leading to EOCRC. Furthermore, we emphasize the need for lifestyle interventions, early detection, and targeted therapeutic interventions to mitigate this growing health concern.

Protective nutrition strategy in the acute phase of critical illness: why, what and how to protect

Nutritional support is crucial for critically ill patients. Recent clinical studies suggest that both overfeeding during the acute phase of critical illness and overly conservative or delayed nutritional therapy can pose significant risks. Given substantial individual variability among critically ill patients, it is challenging to prescribe universally applicable and objective feeding strategies; Instead, we pointed out which nutritional interventions were harmful. We also summarized the reasons for protective nutrition, and elaborated the advantages of protective nutrition from three perspectives: gastrointestinal protection, nutritional protection and metabolic protection. In particular, it is emphasized that overfeeding will lead to metabolic disorders, such as mitochondrial dysfunction, autophagy inhibition, ketogenic inhibition, hyperglycemia, insulin resistance, etc. These detrimental processes can exacerbate one another, contributing to multiple organ dysfunction syndrome and poorer clinical outcomes. We also propose protective nutrition strategies comparable to lung protective ventilation strategies, which may benefit patients. Vigilant monitoring during nutritional implementation is also paramount, enhancing awareness of adverse events for early diagnosis and intervention to mitigate their harm.

Metabolic reprogramming in cancer therapy-related cardiovascular toxicity: Mechanisms and intervention strategies

Cancer therapy-related cardiovascular toxicity (CTR-CVT) poses a major challenge in managing cancer patients, contributing significantly to morbidity and mortality among survivors. CTR-CVT includes various cardiovascular issues, such as cardiomyopathy, myocardial ischemia, arrhythmias, and vascular dysfunction, which significantly impact patient prognosis and quality of life. Metabolic reprogramming, characterized by disruptions in glucose, lipid, and amino acid metabolism, represents a shared pathophysiological feature of cancer and cardiovascular diseases; however, the precise mechanisms underlying CTR-CVT remain inadequately understood. In recent years, strategies targeting metabolic pathways have shown promise in reducing cardiovascular risks while optimizing cancer treatment efficacy. This review systematically summarizes metabolic reprogramming characteristics in both cancer and cardiovascular diseases, analyzes how anticancer therapies induce cardiovascular toxicity through metabolic alterations, and explores emerging therapeutic strategies targeting metabolic dysregulation. By integrating current research advancements, this review aims to enhance the understanding of CTR-CVT and provide groundwork for the development of safer and more effective cancer approaches.

Integrating machine learning and genetic evidence to uncover novel gene biomarkers for colorectal cancer diagnosis

From 2020 to 2022, colorectal cancer (CRC) cases increased, making it the third most common cancer and the second leading cause of cancer-related deaths worldwide. Early detection remains a significant challenge due to the lack of reliable diagnostic biomarkers. This study aimed to develop a robust gene diagnostic model for CRC using publicly available databases, such as GEO and GEPIA2. The approach integrated differential expression analysis, weighted gene co-expression network analysis (WGCNA), and the application of 113 machine learning combinations derived from 12 algorithms. The most effective model was then validated using independent datasets, which included analyses such as Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), protein-protein interaction (PPI) networks, and receiver operating characteristic (ROC) curves, along with assessments of immune infiltration and tumor-node-metastasis (TNM) staging. Notably, the glmBoost + RF algorithm identified an eight-gene diagnostic model with high precision, pinpointing key genes such as CLDN1, IFITM1, and FOXQ1, which exhibited strong diagnostic performance (AUC > 0.9). Furthermore, Mendelian randomization (MR) analysis suggested that IFITM1 may be a potential causal gene for CRC, with significant associations to immune cell profiles and established roles in immune regulation and tumor progression. Collectively, these findings highlight IFITM1, SCGN, and FOXQ1 as promising early diagnostic biomarkers and therapeutic targets for CRC, laying a foundation for future research focused on enhancing early detection and intervention strategies in colorectal cancer management.

Analgesic benefits of regional anesthesia in the perioperative management of transition-related surgery: a systematic review

INTRODUCTION

Transition-related surgery is an effective treatment for gender dysphoria, but the perioperative analgesic management of transgender patients is nuanced and potentially complicated by higher rates of mood and substance use disorders. Regional anesthetic techniques are known to reduce pain severity and opioid requirements; however, little is known regarding the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery.

METHODS

We performed a systematic review of the literature to evaluate original reports characterizing the analgesic effectiveness of regional anesthetic techniques for patients undergoing chest and/or genital transition-related surgery. Our primary outcomes were pain severity and opioid requirements on the first postoperative day.

RESULTS

Of the 1863 records identified, 10 met criteria for inclusion and narrative synthesis. These included two randomized controlled trials, three cohort studies, and five case reports/series, comprising 293 patients. Four reports described 243 patients undergoing chest surgery, of whom 86% were transgender men undergoing mastectomy with pectoralis nerve blocks or local anesthetic instillation devices. The remaining six reports comprised 50 patients undergoing genital surgery, of whom 56% were transgender women undergoing vaginoplasty with erector spinae plane blocks or epidural anesthesia. Three studies directly compared regional techniques to parenteral analgesia alone. Two of these studies reported lower pain scores and opioid requirements on the first postoperative day with nerve blocks compared with none while the third study reported no difference between groups. Complications related to regional anesthetic techniques were rare among patients undergoing transition-related surgery.

DISCUSSION

Despite the ever-growing demand for transition-related surgery, the relative analgesic effectiveness of regional anesthesia for transgender patients undergoing transition-related surgery is very understudied and insufficient to guide clinical practice. Our systematic review of the literature serves to underscore regional anesthesia for transition-related surgery as a priority area for future research.

Prospective Evaluation of Multimodal Prehabilitation in Esophagogastric Cancer Surgery: Enhancing Patient Outcomes

BACKGROUND

The significance of prehabilitation in contemporary esophagogastric surgical procedures is yet to be fully understood, due to heterogeneity in the available research. This research was conducted to assess the impact of a structured home-based multimodal prehabilitation approach on the postsurgical outcomes of patients undergoing surgery for esophagogastric cancer.

METHODS

This study was a prospective, nonrandomized investigation carried out on individuals scheduled for curative esophagogastric cancer surgery. Participants underwent a home-based, multimodal prehabilitation regimen that incorporated structured physical exercises, nutritional support, psychological counseling, and assistance in quitting smoking and alcohol use. The primary outcome measured was the incidence of postoperative pneumonia, defined according to the revised Uniform Pneumonia Scoring system from day 1 to day 4 post-surgery.

RESULTS

A total of 94 patients were analyzed. A total of 50 patients underwent multimodal prehabilitation for a minimum of 2 weeks with a compliance rate of more than 60% and were included in the intervention group, whereas the rest 44 with compliance less than 60% or unwilling to undergo prehabilitation were included in the control group. A statistically significant difference was seen in the incidence of postoperative pneumonia between the two groups.

CONCLUSION

Structured multimodal prehabilitation done for 2 weeks before surgery improves outcomes in patients undergoing esophagogastric cancer surgery.

Development of a machine learning-based tension measurement method in robotic surgery

BACKGROUND

Over 300,000 colorectal surgeries are performed annually in the U.S. with up to 10% complicated by anastomotic leaks, which cause significant morbidity and mortality. Despite its significant association with anastomotic leaks, tension is predominantly assessed intraoperatively using subjective metrics. This study aims to assess the feasibility of a novel objective method to assess mechanical tension in ex vivo porcine colons.

METHODS

This research was conducted using the da Vinci Research Kit (dVRK). First, a machine learning algorithm based on a long short-term memory neural network was developed to estimate the pulling forces on robotic arms of dVRK. Next, two robotic arms were used to apply upward forces to five ex vivo porcine colon segments. A force sensor was placed underneath the colons to measure ground-truth forces, which were compared to estimated forces calculated by the machine learning algorithm. Root mean square error and Spearman's Correlation were calculated to evaluate force estimation accuracy and correlation between measured and estimated forces, respectively.

RESULTS

Measured forces ranged from 0 to 17.2 N for an average experiment duration of two minutes. The algorithm's force estimates closely tracked the ground-truth sensor measurements with an accuracy of up to 88% and an average accuracy of 74% across all experiments. The estimated and measured forces showed a very strong correlation, with no Spearman's Correlation less than 0.80 across all experiments.

CONCLUSION

This study proposes a machine learning algorithm that estimates colonic tension with a close approximation to ground-truth data from a force sensor. This is the first study to objectively measure tissue tension (and report it in Newtons) using a robot. Our method can be adapted to measure tension on multiple types of tissue and can help prevent surgical complications and mortality.

How can we deal with stoma supplies in a resource-limited setting? The Golbasi earthquake experience

Introduction

In winter 2023, two earthquakes struck southern and central Turkey, resulting in an estimated 56.000 deaths and more than 100.000 persons with injuries. The management of patients presenting post-earthquake injuries and the usual surgical emergencies was highly challenging in these extremes' conditions. This report presents a home-made temporary solution for ostomy care and supplies in a resource-limited setting.

Case presentation

A 72-year-old woman, admitted 9 days after the earthquake, presented with a transverse colonic incarceration in a Morgagni-Larrey parasternal diaphragmatic hernia, associated with Hinchey III peritonitis. Extended right colectomy was performed with right ileostomy and left colostomy. A home-made ostomy was designed using as supplies an empty intravenous perfusion bag and transparent film dressings. This cheap, homemade and ready-to-use stoma supply was used during the first 3 postoperative days, without any leak or peri-ostomy skin irritation.

Conclusion

In extreme perioperative condition, in a resource-limited setting, ostomy can be temporary equip using a homemade and ready-to-use stoma supply. This equipment is feasible at a low cost in all condition and fit until definitive ostomy supplies can be provided.

Risk-Adjustment of Perioperative Mortality Rate Measurement in a Low-Income Country

BACKGROUND

The health care systems in low-income countries have extremely limited capacity to treat surgical diseases. The perioperative mortality rate has been suggested as a key quality metric to guide the expansion of care, but there is little information on how to risk-adjust this outcome measure.

METHODS

We did a 42-month observational cohort study of surgical operations at a Ugandan secondary referral hospital. We examined factors associated with in-hospital 30-day perioperative mortality outcomes. The aim of the study was to suggest a suitable indicator metric for comparative health service research in low-income countries.

RESULTS

The 30-day perioperative mortality rate was 5.3 % (n = 381/7170). The adjusted odds ratios (95% confidence interval) of variables associated with mortality were as follows: procedure (P < .001; laparotomy 2.6 [1.6, 4.3], P < .001; cranial surgery 2.8 [1.6, 4.9], P < .001); American Society of Anesthesiologists (ASA) rating 3.1 (2.6, 3.6), P < .001; HIV serostatus (P < .001; positive 2.7 [1.5, 4.8], P < .001); procedure urgency (urgent/emergent) 1.7 (1.2, 2.3), P = .003; home district location (P = .015; distant referral 1.4 [1.0, 1.9], P = .027); and age decile 1.1 (1.0,1.2, P = .001). Laparotomy was the commonest procedure performed (n = 2361) and was associated with 56.3% (n = 216/381) of deaths.

CONCLUSIONS

Laparotomy had a strong independent association with mortality at a Ugandan secondary hospital. The laparotomy perioperative mortality rate may be a suitable outcome measure for comparative health service research in low-income countries.

Quality of life outcomes in colorectal cancer survivors: insights from an observational study at a tertiary cancer center

PURPOSE

Colorectal cancer (CRC) significantly impacts the quality of life (QoL) of survivors, yet detailed assessments of long-term QoL are sparse. This study evaluates QoL among CRC survivors, examining the influence of different treatments and patient characteristics on outcomes.

METHODS

We conducted a cross-sectional study at a tertiary cancer center in Portugal, enrolling CRC patients who underwent curative surgery from 2013 to 2022. QoL was assessed using the EORTC QLQ-C30 and QLQ-CR29 at 1-, 3-, 5-, and 10-year follow-up intervals. Subgroup analyses were performed based on tumor location, radiotherapy administration, chemotherapy administration, presence of a stoma, and time since treatment, with sociodemographic and clinical factors examined on univariate and multivariate analysis.

RESULTS

Of the 825 eligible patients, 324 were invited and 179 participated (response rate: 55.2%). Overall, patients reported high global QoL and functional scores with low symptom scores, comparable to those of the general population. However, rectal cancer survivors experienced poorer outcomes in role and social functioning, body image, and symptom management. Those receiving radiotherapy or chemotherapy reported more symptoms, with chemotherapy recipients showing lower functional scores. Patients with a stoma had significantly lower QoL across functional and symptom scales. Long-term survivors reported decreased physical functioning. Multivariate analysis identified female gender, open surgery, and chemotherapy as factors associated with reduced QoL.

CONCLUSION

This study highlights significant disparities in QoL outcomes between CRC survivors, with QoL influenced by gender, cancer location, radiotherapy or chemotherapy, stoma presence, and survivorship duration, underscoring the need for personalized support programs and tailored care plans.

Tissue-Adhesive, Antibacterial, and Antioxidant Hydrogel Sealant for Sealing Colorectal Anastomotic Leakage and Preventing Postoperative Adhesion

Surgical treatment of colorectal diseases typically involves excising the diseased portion of the bowel and anastomosing the remaining sections to reestablish continuity. Surgical suturing has limitations in preventing anastomotic leakage and postoperative adhesion. To address these challenges, a tissue-adhesive, antibacterial, and antioxidant hydrogel is designed to cover and seal colorectal anastomotic wounds. The hydrogel is formed in situ by simply mixing oxidized hyaluronic acid, adipic acid dihydrazide-modified hyaluronic acid, ε-poly-l-lysine, and tannic acid. The hydrogel exhibits a rapid gelation rate and self-healing ability. Compared with commercial fibrin glue, the hydrogel has superior tissue-adhesive strength and wound sealing performance. The hydrogel displays potent reactive oxygen species scavenging ability and antibacterial activity against both Gram-positive and Gram-negative bacteria. The hydrogel also exhibits good biodegradation and biocompatibility. In a cecum-abdominal wall adhesion model in rats, the hydrogel attaches firmly to the injured tissues and serves as a physical barrier to prevent adhesion formation. In anastomotic leakage models after colon resection in rats and rabbits, the hydrogel effectively seals the anastomotic leakage, prevents postoperative adhesion, and promotes anastomotic healing. Thus, this multifunctional hydrogel has strong clinical potential for preventing anastomotic leakage and adhesion formation after colorectal surgery.

How Should Laparoscopic Surgery Training be Planned in a Resource-Limited Environment?

OBJECTIVE

Laparoscopic surgeries (LSs) are underperformed in low-income countries with inadequate health infrastructure due to many restrictive factors. In this study, we aimed to present the process and results of the first bilateral collaboration protocol (BCP) for LS in an African university hospital where laparoscopic surgery had not been performed before.

DESIGN

A 3-stage BCP was implemented between the University of Health Sciences (Turkey) and Jigjiga University Hospital (Somali State, Ethiopia) between January and June 2024. In the first stage, training was received in Turkey for 3-6 months. In the second stage, 2 general surgery, 2 gynecology and obstetrics, and one ear-nose-throat (ENT) clinic training officers from the University of Health Sciences went to Jigjiga University Hospital and provided the installation of laparoscopic devices, on-site training of surgeons and other operating room personnel, and the initiation of the first laparoscopic and minimally invasive surgeries for a week. In the third stage, LS performed in the first 30 days after the end of the program were connected via video call.

SETTING

This training was held at Jigjiga University Hospital, the only university hospital in the Somali state of Ethiopia.

PARTICIPANTS

The first stage of this training was attended by the teaching staff of the surgical clinics at Jigjiga University Hospital. The second stage of the program was attended by all surgeons, clinical assistants, operating room nurses and staff at Jigjiga University Hospital.

RESULTS

In the second stage of the program, a total of 25 patients underwent the first laparoscopic and minimally invasive surgeries in the state in 1 week. 13 (52%) were performed by general surgery, 7 (28%) by gynecology and 5 (20%) by ENT. In the third stage, 24 laparoscopic procedures were performed in the first 30 days.

CONCLUSIONS

In low-income countries with limited resources, laparoscopic surgeries can be introduced with the right training programs and appropriate bilateral collaboration programs.

Bathing with 2% chlorhexidine gluconate versus routine care for preventing surgical site infections after pancreatic surgery: a single-centre randomized controlled trial

OBJECTIVES

The study aims to investigate whether bathing with 2% chlorhexidine gluconate (CHG) reduces the incidence of surgical site infection (SSI) in patients undergoing routine pancreatic surgery.

METHODS

A randomized controlled trial was conducted at a large-volume pancreatic centre between 1 January 2021 and 31 December 2022. Patients undergoing clean-contaminated pancreatic surgery were enrolled and randomized into an intervention arm (bathing with a 2% CHG wipe) and a control arm (routine care, soap, and water). The primary outcome was the incidence of SSI after pancreatic surgery within 30 days.

RESULTS

Overall, 614 patients (intervention arm, 311; control arm, 303) were included in intention-to-treat analysis. In total, 8.8% (54/614) patients developed SSI. The incidence of SSI in the intervention arm was 6.8% (21/311) and 10.9% (33/303) in control arm, and the difference did not reach the level of statistical significance (p 0.070). The time to SSI was significantly extended when patients were in the intervention arm (log-rank test, p 0.047). The intervention did not significantly reduce the incidence of healthcare-associated infection, hospital-acquired pneumonia, and bloodstream infection. No adverse events were observed. However, in the per-protocol analysis among 519 patients, the intervention arm showed a significantly lower incidence of overall SSI than that of those in the control arm (21/272, 7.7% vs. 33/242, 13.4%, p 0.036).

DISCUSSION

Bathing with 2% CHG could potentially reduce the incidence of SSI for the patients scheduled to undergo pancreatic surgery for which further well-designed clinical trials are warranted.

Diverticulitis in Older Adults: A Review of Etiology, Diagnosis, and Management

BACKGROUND

Diverticulitis accounts for over 300,000 hospitalizations annually in the United States and its incidence increases with age. Among older adults, diverticulitis is the fourth leading cause for emergency surgery. Older adults with multimorbidity and geriatric syndromes are often excluded from clinical studies, leaving a gap in the evidence needed to guide management. Here, we provide a clinically oriented review of the diagnosis and management of older adults with diverticulitis through the lens of age-friendly care.

METHODS AND RESULTS

We reviewed the literature describing the epidemiology, diagnosis, management, and prevention of diverticulitis in older adults. Due to age-related physiologic changes, the presence of geriatric syndromes, and multimorbidity, older adults with diverticulitis often present with atypical symptoms, variable laboratory findings, and are at higher risk for complications than younger patients. Guidelines support a more aggressive approach to diagnosis in this population, with lower threshold for obtaining diagnostic imaging. Antibiotics remain a mainstay of treatment for uncomplicated disease, and surgical management should be focused on severity of disease and the balance between the likelihood of improving quality of life and risks and burden of treatment.

CONCLUSIONS

Diverticulitis is a common disease that has a unique presentation among older individuals with limited evidence to guide management. Diagnosis and treatment should focus on what matters most to the patient, providing the most meaningful outcome possible within the context of multimorbidity, patient goals, symptom burden, and anticipated treatment outcomes.

Burden of colorectal cancer attributable to high body-mass index in 204 countries and territories, 1990-2021: Results from the Global Burden of Disease Study 2021

OBJECTIVES

A strong association between high Body Mass Index (BMI) and Colorectal Cancer (CRC) has been well established. However, the global burden of CRC attributable to high BMI remains underexplored. This study aims to examine and analyze the burden of CRC linked to high BMI at global, regional, and national levels from 1990 to 2021.

STUDY DESIGN

A descriptive analysis of the Global Burden of Disease (GBD) Study 2021.

METHODS

Data on the number of deaths and disability-adjusted life years (DALYs), as well as age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), were extracted from the GBD 2021. Average annual percentage change (AAPC) was calculated to evaluate the temporal change in ASDR and ASMR using Joinpoint regression analysis. The Population Attributable Fractions (PAF) were used to analyze the CRC burden attributed to risk factors.

RESULTS

In 2021, the global deaths and DALYs of CRC attributed to high BMI were 99,270 deaths and 2,364,660 years respectively, more than double the figures from 1990. High SDI regions bore the greatest burden while low-middle and middle SDI regions experienced a faster rise, with individuals over 60 and males being the most affected. East Asia, particularly China, had the heaviest burden globally. ASMR and ASDR were correlated with SDI. The top five risk factors for CRC burden were a diet low in whole grains (17.72 %), a diet low in milk (15.10 %), a diet high in red meat (14.55 %), high BMI (9.69 %) and a diet low in calcium (8.20 %) in 2021.

CONCLUSION

High BMI is a significant risk factor for CRC, with aging, population growth, gender, and SDI contributing to geographic and temporal variations in the burden. These findings highlight the urgent need for targeted prevention strategies, especially in high-risk populations, and emphasize the role of obesity prevention, early screening, lifestyle and dietary modifications, and interventions such as AI-driven technologies to reduce the CRC burden.

Enhanced Recovery Independently Lowers Failure to Rescue After Colorectal Surgery

BACKGROUND

High adherence to the enhanced recovery after surgery pathway reduces morbidity and mortality rates after elective colorectal surgery.

OBJECTIVE

To evaluate the effect of adherence to the enhanced recovery after surgery pathway on the failure to rescue rates after elective colorectal surgery.

DESIGN

Retrospective analysis of a prospective database.

PATIENTS

Adults (18 years or older) who underwent elective colorectal resection with anastomosis for benign and malignant disease.

SETTINGS

Prospective enrollment in 78 centers in Italy from 2019 to 2021.

INTERVENTIONS

All outcomes were measured 60 days after surgery. Several patient-, disease-, treatment-, hospital-, and complication-related variables were analyzed. After univariate analyses, independent predictors of the end points were identified through logistic regression analyses, presenting ORs and 95% CIs.

MAIN OUTCOME MEASURES

Failure to rescue after any adverse event, defined as the ratio between the number of deaths and the number of patients showing any adverse event; failure to rescue after any major adverse event, with the denominator represented by the number of patients showing any major adverse event.

RESULTS

An adverse event was recorded in 2321 of 8359 patients (27.8%), a major adverse event in 523 patients (6.3%), and death in 88 patients (1.0%). The failure to rescue rates were 3.8% after any adverse event and 16.8% after any major adverse event. Independent predictors of primary end points were identified among patient- (age, ASA class, and nutritional status), treatment- (type of resection), and complication-related (anastomotic leakage and reoperation) variables. Enhanced recovery pathway adherence of more than 70% independently reduced failure to rescue rates.

LIMITATIONS

Clustering from multicenter data and unmeasured confounding from observational data.

CONCLUSIONS

After elective colorectal resection, adherence of more than 70% to the enhanced recovery pathway independently decreased failure to rescue rates, along with other patient- or treatment-related factors. See Video Abstract .

LA RECUPERACIN MEJORADA REDUCE DE FORMA INDEPENDIENTE LA POSIBILIDAD DE FRACASO EN EL RESCATE DESPUS DE UNA CIRUGA COLORRECTAL

ANTECEDENTES:La alta adherencia a la vía de recuperación mejorada después de la cirugía reduce las tasas de morbilidad y mortalidad después de la cirugía colorrectal electiva.OBJETIVO:Evaluar el efecto de la adherencia a la vía ERAS en las tasas de fracaso en el rescate después de la cirugía colorrectal electiva.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.PACIENTES:Adultos (≥ 18 años) que se sometieron a una resección colorrectal electiva con anastomosis por enfermedad benigna y maligna.ESCENARIO:Inscripción prospectiva en 78 centros en Italia de 2019 a 2021.INTERVENCIONES:Todos los resultados se midieron a los 60 días después de la cirugía. Se analizaron varias variables relacionadas con el paciente, la enfermedad, el tratamiento, el hospital y las complicaciones para los resultados. Después de los análisis univariados, se identificaron los predictores independientes de los puntos finales a través de análisis de regresión logística, presentando razones de probabilidades e intervalos de confianza del 95%.PRINCIPALES MEDIDAS DE RESULTADOS:Fallo en el rescate después de cualquier evento adverso, definido como la relación entre el número de muertes y el número de pacientes que presentaron cualquier evento adverso; fallo en el rescate después de cualquier evento adverso mayor, con el denominador representado por el número de pacientes que presentaron cualquier evento adverso mayor.RESULTADOS:Se registró un evento adverso en 2321 de 8359 pacientes (27,8%), un evento adverso mayor en 523 pacientes (6,3%) y muerte en 88 pacientes (1,0%). Las tasas de fallo en el rescate fueron del 3,8% después de cualquier evento adverso y del 16,8% después de cualquier evento adverso mayor. Se identificaron predictores independientes de los criterios de valoración primarios entre las variables relacionadas con el paciente (edad, clase de la Sociedad Americana de Anestesiólogos, estado nutricional), el tratamiento (tipo de resección) y las complicaciones (fuga anastomótica, reoperación). La adherencia a la vía de recuperación mejorada > 70% redujo de forma independiente las tasas de fallo en el rescate.LIMITACIONES:Agrupamiento de datos multicéntricos y factores de confusión no medidos a partir de datos observacionales.CONCLUSIONES:Después de una resección colorrectal electiva, la adherencia > 70 % a la vía de recuperación mejorada disminuyó de manera independiente las tasas de fracaso en el rescate, junto con otros factores relacionados con el paciente o el tratamiento. (Traducción-Dr Osvaldo Gauto).

Development and validation of predictive nomograms for survival in early-onset colon cancer patients with II-III stage across various tumor sites

Background

The incidence of colorectal cancer (CRC) has been escalating, with a concurrent rise in early-onset colon cancer (EOCC). Despite this alarming trend, the prognosis of EOCC has been understudied. Our study aims to identify risk factors associated with EOCC and develop nomograms for predicting overall survival (OS) and cancer-specific survival (CSS), with the goal of choosing suitable therapy for various patient subgroups.

Methods

Utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database, we conducted a comprehensive analysis to elucidate risk factors in EOCC patients. We developed and validated nomograms to predict OS and CSS, stratifying patients into left-sided and right-sided groups and further categorizing them into distinct risk categories. After propensity score matching, we assessed therapeutic benefits of various interventions across subgroups.

Results

We identified T stage, tumor histology, grade, size, N stage, carcinoembryonic antigen (CEA) levels, perineural invasion, tumor deposits, and race as independent risk factors for the left-sided group through univariate and multivariate Cox regression analyses. Those factors were integrated into the survival nomograms for this group. For the right-sided group, tumor histology, grade, N stage, CEA levels, perineural invasion, tumor deposits, radiation, and chemotherapy were identified as independent prognostic factors and were similarly incorporated into the survival nomograms. The concordance index (C-index) for our nomograms was significantly higher than that of the American Joint Committee on Cancer (AJCC) 7th edition staging system across all cohorts. Receiver operating characteristic (ROC) curve analysis demonstrated area under the curve (AUC) values of 0.72, 0.71, and 0.71 for 1-, 3-, and 5-year OS in the development cohort of the left-sided group, with comparable results in the validation cohort. The right-sided groups exhibited similarly favorable AUC outcomes. Calibration plots indicated a strong correlation between predicted and actual outcomes. Decision curve analysis (DCA) revealed the clinical utility of our nomograms to be superior to the AJCC 7th edition staging system. Analyses for CSS yielded analogous results. Kaplan-Meier curves highlighted significant differences in OS and CSS between low and high-risk groups. Notably, the right-sided groups derived greater benefits from adjuvant chemotherapy compared to the left-sided groups, whereas radiation therapy provided no discernible benefits across all subgroups.

Conclusions

Our study provides a comprehensive prognostic evaluation of EOCC patients and uses nomograms for predicting OS and CSS in left-sided and right-sided groups. Subgroup analyses underscore the potential advantages of adjuvant chemotherapy in high-risk groups of both cohorts and the low-risk group of the right-sided cohort. These findings may inform the optimization of therapeutic strategies for EOCC patients.

Influences of enteral nutritional enriched with n-3 polyunsaturated fatty acids on postoperative wound infection following gastrointestinal surgery: A meta-analysis

BACKGROUND AND AIM

Postoperative wound infections remain a significant challenge in gastrointestinal surgery, with substantial implications for prolonged hospital stays and healthcare costs. Immunonutrition with n-3 polyunsaturated fatty acids (PUFAs) offers potential preventive benefits through modulation of inflammatory responses. This study aimed to explore the impact of enteral nutritional enriched with n-3 PUFAs on wound infection in patients undergoing gastrointestinal surgery.

METHODS

A thorough search was carried out, from databases to December 2023, across Cochrane Library, Embase, CNKI, Google Scholar, Wanfang, and PubMed on randomized controlled trials (RCTs) examining the impacts of enteral nutritional enriched with n-3 PUFAs for treatment of patients with gastrointestinal surgery. Two independent researchers conducted literature screening, data extraction, and quality assessments. The primary outcome measures were wound infection and complications. Statistical analysis was conducted in Stata 17.0 and RevMan 5.4 software.

RESULTS

Fifteen RCTs involving 1442 patients who underwent gastrointestinal surgery were included. The analysis revealed the application of enteral nutritional enriched with n-3 PUFAs markedly decreased the occurrence of complications (odds ratio [OR] = 0.56, 95 % confidence intervals [CI]: 0.44-0.71, P < 0.001) and wound infection (OR = 0.68, 95 %CI: 0.47-0.98, P = 0.04) in patients who underwent gastrointestinal surgery.

CONCLUSIONS

This study demonstrates that postoperative support with enteral nutritional enriched with n-3 PUFAs can effectively decrease the occurrence of wound infections and postoperative complications following gastrointestinal surgery. These findings suggest that n-3 PUFAs supplementation should be considered as a standard component of perioperative nutritional protocols to improve surgical outcomes in patients undergoing gastrointestinal procedures.

Complicated appendicitis in low- and lower-middle-income countries: a systematic review and meta-analysis

BACKGROUND

Acute appendicitis is a common surgical emergency worldwide, with significant variations in prevalence, presentation and outcomes between high-income countries (HIC) and low- and middle-income countries (LMIC). Complicated appendicitis has significant implications for low- and lower-middle-income countries due to limited healthcare resources. While there is extensive evidence for HICs, the evidence for low- and lower-middle-income countries is lacking. This systematic review aimed to compare the prevalence of complicated appendicitis between low-income countries (LICs) and lower-middle-income countries (LoMICs).

METHODS

A systematic review was conducted following PRISMA guidelines (PROSPERO CRD42024526007). Observational studies and randomized controlled trials published in PubMed, MEDLINE, Embase and Scopus (1990-2024) were retrieved. A grey literature search of Google Scholar and the Cochrane Library was also performed to identify existing reviews on the topic. The primary outcome investigated was the incidence of complicated appendicitis.

RESULTS

Eighty-seven articles with 25 582 participants were included. Meta-analyses of outcomes comparing LICs to LoMICs identified an increased pooled proportion of complicated appendicitis (34% (95% CI 27%-41%) vs. 23% (95% CI 19%-27%) P < 0.001), increased post-operative morbidity (19% (95% CI 13%-27%) vs. 13% (95% CI 8%-20%): P < 0.01) and mortality (OR 2.36).

CONCLUSION

Appendicitis remains a major burden in LICs and LoMICs with higher rates of morbidity and mortality. These findings highlight critical deficiencies in surgical access and delivery, underscoring the need for targeted interventions to improve outcomes in these settings.

Incidence and predictors of perioperative mortality in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

The Lancet Commission on Global Surgery highlights perioperative mortality rate (POMR) as a key indicator of a nation's surgical system effectiveness. While POMR is often measured in high-income countries, it is less studied in low- and middle-income countries (LMICs). This study aims to assess the POMR and its predictors in Ethiopia.

METHODS

We conducted a thorough literature search across PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar for studies from Ethiopia between 2019 and 2023 reporting POMR for various surgical procedures. Data were extracted in duplicate from eligible studies. We used random-effects meta-analysis to pool estimates of POMR and its predictors.

RESULTS

The meta-analysis revealed a POMR of 5.36%. Identified predictors of perioperative mortality in Ethiopia included older age, comorbidities, ICU admission, and an ASA physical status classification of III or higher and emergency surgeries.

CONCLUSION

Ethiopia's perioperative mortality rate is significantly high. Improving surgical care quality and safety, along with expanding access to surgical services, is crucial for bettering surgical outcomes in the country.

Postoperative Geriatric Nutritional Risk Index as a Determinant of Tolerance to S-1 Adjuvant Chemotherapy After Curative Surgery for Pancreatic Ductal Adenocarcinoma: A Cohort Study with External Validation

S-1 adjuvant chemotherapy (AC) is the standard treatment for pancreatic ductal adenocarcinoma (PDAC) after curative surgery in Japan. Our prior research suggested that a lower postoperative geriatric nutritional risk index (GNRI) predicts S-1 discontinuation due to adverse events (AEs). This study aimed to validate the GNRI as a predictor of S-1 non-completion using an independent cohort. Methods: This retrospective study analyzed 180 patients who underwent curative PDAC resection at Dokkyo Medical University from January 2010 to March 2023. Postoperative GNRI values were recorded as part of nutritional screening. Data on S-1 therapy completion and related clinical factors were analyzed statistically. Results: Patients were classified based on S-1 completion (N = 93) and non-completion (N = 48). GNRI values were significantly lower in the non-completion group. A GNRI threshold of 94.4, identified in a prior study, effectively distinguished patients at risk of discontinuation. Univariate analysis confirmed that a GNRI of ≥94.4 was a significant predictor of successful S-1 completion [hazard ratio (HR) for recurrence-free survival (RFS), 1.54; 95% confidence interval (CI) 1.04-2.28 and for overall survival (OS), 1.89; 95% CI 1.20-2.99]. Conclusions: This study validated previous findings, confirming that the postoperative GNRI reliably identifies patients at risk of S-1 non-completion due to AEs after PDAC surgery. The GNRI serves as a practical marker for optimizing patient care and enhancing AC efficacy.

Age-specific trends in colorectal, appendiceal, and anal tumour incidence by histological subtype in Australia from 1990 to 2020: a population-based time-series analysis

Background

Early-onset bowel cancer incidence (age <50 years) has increased worldwide and is highest in Australia, but how this varies across histology and anatomical site remains unclear. We aimed to investigate appendiceal, proximal colon, distal colon, rectal, and anal cancer incidence trends by age and histology in Australia.

Methods

Cancer incidence rate data were obtained from all Australian cancer registries (1990-2020 period). Birth cohort-specific incidence rate ratios (IRRs) and annual percentage change in rates were estimated using age-period-cohort modelling and joinpoint regression.

Findings

After excluding neuroendocrine neoplasms, early-onset cancer incidence rose 5-9% annually, yielding 5,341 excess cases (2 per 100,000 person-years; 12% appendix, 45% colon, 36% rectum, 7% anus; 20-214% relative increase). Trends varied by site, period, and age: appendiceal cancer rose from 1990-2020 in 30-49-year-olds; colorectal cancers rose from around 1990-2010 in 20-29-year-olds and from 2010-2020 in 30-39-year-olds; anal cancer rose from 1990-2009 in 40-49-year-olds. Across all sites, IRRs increased with successive birth cohorts since 1960. Notably, adenocarcinoma incidence in the 1990s versus 1950s birth cohort was 2-3-fold for colorectum and 7-fold for appendix. The greatest subtype-specific increases occurred for appendiceal mucinous adenocarcinoma, colorectal non-mucinous adenocarcinoma, and anal squamous cell carcinoma. Only later-onset (age ≥50) colorectal and anal adenocarcinoma rates declined. Appendiceal tumours, neuroendocrine neoplasms (all sites), anorectal squamous cell carcinomas, and colon signet ring cell carcinomas rose across early-onset and later-onset strata.

Interpretation

Appendiceal, colorectal, and anal cancer incidence is rising in Australia with variation across age and histology, underscoring the need to identify factors driving these trends.

Funding

ALM is supported by an Australian Government Research Training Program Scholarship, Rowden White Scholarship, and WP Greene Scholarship. DDB is supported by a National Health and Medical Research Council of Australia (NHMRC) Investigator grant (GNT1194896), a University of Melbourne Dame Kate Campbell Fellowship, and by funding awarded to The Colon Cancer Family Registry (CCFR, www.coloncfr.org) from the National Cancer Institute (NCI), National Institutes of Health (NIH) [award U01 CA167551]. MAJ is supported by an NHMRC Investigator grant (GNT1195099), a University of Melbourne Dame Kate Campbell Fellowship, and by funding awarded to the CCFR from NCI, NIH [award U01 CA167551].

Trends in Clinical Outcomes After Major Emergency Abdominal Surgery in Denmark, Data From 2002-2022

Importance

Major emergency abdominal surgery is associated with high morbidity and mortality. Understanding trends in outcomes over time can reveal critical practice-changing improvements, identify gaps in postoperative care, and establish a large-scale benchmark for future research.

Objective

To investigate trends in morbidity and mortality after major emergency abdominal surgery in Denmark.

Design, Setting, and Participants

This was a nationwide, population-based cohort study. Analyses were performed based on data from Danish nationwide administrative registries. Within the public health care system in Denmark, all adult patients undergoing major emergency abdominal surgery from 2002 to 2022 were included. Major emergency abdominal surgeries included laparotomy or laparoscopy due to intra-abdominal pathologies, including intestinal perforation, ischemia, bowel obstruction, abscess, or bleeding.

Exposure

Major emergency abdominal surgery.

Main Outcomes and Measures

The primary outcome was the trend in 30- and 90-day mortality after major emergency abdominal surgery over time.

Results

A total of 61 476 patients (mean [SD] age, 66.2 [16.3] years; 34 827 female [56.7%]) were included. The annual number of surgeries remained constant, with a mean (SD) of 3044 (165) surgeries per year. The 30- and 90-day mortality was reduced from 25% and 33%, respectively, to 13% and 18%, respectively (P < .001). Median (IQR) hospital length of stay was decreased from 10 (5-17) days to 6 (4-13) days (P < .001). The rate of 30-day postoperative complications (classified Clavien-Dindo ≥3a) was reduced from 49% to 44% (P <.001) and the 90-day rate was reduced from 53% to 48% (P <.001), however, with a tendency toward more patients undergoing earlier intervention. The 30- and 90-day readmission rate increased drastically from 9% and 13%, respectively, to 25% and 33%, respectively (P < .001).

Conclusions and Relevance

Results of this cohort study suggest notable reductions in mortality and hospital length of stay after major emergency abdominal surgery. A marked increased readmission rate and a persistently high rate of postoperative complications were found. These shifts underscore the need for enhanced postoperative monitoring and postdischarge follow-up.