[Special situations of preconditioning and prehabilitation in oncological visceral surgery]

Artificial Neural Network Assisted Cancer Risk Prediction of Oral Precancerous Lesions

The incidence of oral cancer is still increasing. It has become very common in patients with malignant tumors, which has forced medical personnel to continuously explore its treatment methods. What kind of method can effectively and correctly diagnose the disease in the early stage and improve the survival rate has become one of the research topics that have attracted much attention. Aiming at this problem, it has great research significance for the field of oral precancerous lesions diagnosis. With the in-depth research on oral precancerous diagnosis, the research on artificial neural network (ANN) in medical diagnosis is gradually carried out. Its performance advantage is of great significance to solve the problem of early and correct disease diagnosis. This paper aimed to investigate the application of ANN-assisted cancer risk prediction method in risk prediction of oral precancerous lesions. Through the analysis and research of ANN and oral cancer, the construction of oral cancer risk prediction model was applied to solve the problem of improving the survival rate of oral cancer patients. In this paper, ANN and oral precancerous lesions were analyzed, the performance of the algorithm was experimentally analyzed, and the relevant theoretical formulas were used to explain. The results showed that the method had higher accuracy than traditional forecasting methods. When $N=2$ , the output accuracy was above 90%. It can be seen that the algorithm can meet the needs of the diagnosis of high-risk groups of oral cancer lesions, and the diagnosis efficiency and patient survival rate has been greatly improved.

Incisional negative pressure wound therapy does not reduce surgical site infections in abdominal midline incisions: a case control study

Purpose: There is evidence from various surgical specialties that incisional negative pressure wound therapy (iNPWT) might reduce postoperative surgical site infections (SSIs). In visceral and general surgery, there is varying evidence of its efficacy in reducing surgical site infections.Methods: A prospectively registered patient cohort of 43 patients with abdominal wall and visceral surgery received treatment with iNPWT and was compared to a matched retrospective cohort to analyze its effects on SSI occurrence and respective risk factors. Groups were matched by procedure, sex, body mass index and age. We used two different systems of iNPWT: (i) PREVENA^TM or (ii) self-made epicutaneous iNPWT from common VAC material.Results: We could not find a total reduction in postoperative SSIs by application of iNPWT. But within the iNPWT cohort, patients with self-made iNPWT suffered more often from SSIs compared to the commercial iNPWT subgroup. No patient specific risk factors could be identified to advocate the use of iNPWT.Conclusion: Our data do not support the use of an incisional negative pressure wound therapy on closed wounds in midline laparotomy incisions. Although, differences exist between the commmercial and self-made systems.

Use of a Perioperative Web-Based Exercise Program for a Patient with Barrett's Carcinoma Scheduled for Esophagectomy

A poor preoperative functional capacity increases the perioperative risk. Therefore, a web-based exercise approach has been initiated for a careful supervision and individual support of patients during their perioperative cancer therapy. Here, we present the data of a 57-year-old patient, scheduled for esophagectomy. Beside a five-week neoadjuvant chemoradiotherapy (CRT), the patient performed 10 weeks of a web-based prehabilitation exercise training (preconditioning) and continued the exercise program for 14 weeks after surgery. The patient performed 42 of 44 recommended training sessions in the preconditioning period in his home environment. This corresponds to a mean of 131 (±38) min of total training per week. The patient performed 52 of 48 recommended training sessions in the postconditioning period. This corresponds to a mean of 165 (±87) min of total training per week. The patient could maintain his functional capacity during CRT and enhanced his submaximal performance level to the end of the intervention. The patient's adherence to the program was noteworthy. The most important features of this approach are the personalized design and the flexible scheduling precisely in tune with the patient's needs, concerns, and therapy related downtimes. Thus, the patient nearly fulfilled the exercise guidelines at a sufficient exercise intensity even during the neoadjuvant therapy. The preconditional exercise prevented a presumed CRT-induced and tumor-associated loss of functional capacity. The postoperative exercise led to a structured and adequate return into regular physical activities after surgery. Finally, this approach complements a comprehensive clinical care, in a health-promoting, cost-effective, and patient-safely manner.