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Sekkat H, Agouzoul H, Loudyi Z, Naddouri J, El Hamzaoui J, El Fakir S, Omari M, Bakali Y, Alaoui MM, Raiss M, Hrora A, Sabbah F. Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study. Langenbecks Arch Surg 2023; 408:414. [PMID: 37864631 DOI: 10.1007/s00423-023-03156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. METHODS All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. RESULTS Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). CONCLUSIONS This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.
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Affiliation(s)
- Hamza Sekkat
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - Hassan Agouzoul
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Zineb Loudyi
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jaouad Naddouri
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Jihane El Hamzaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Samira El Fakir
- Statistics Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mohammed Omari
- Statistics Department, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Youness Bakali
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mouna Mhamdi Alaoui
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohammed Raiss
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelmalek Hrora
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Farid Sabbah
- Digestive Surgical Department C, Ibn Sina University Hospital, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Loudyi Z, Benammi S, Bakali Y, Aguouzoul H, Alaoui M, Sebbah F, Raiss M, Hrora A. Primary umbilical endometriosis: Surgical case report. JRSM Open 2023; 14:20542704231182057. [PMID: 37529011 PMCID: PMC10387687 DOI: 10.1177/20542704231182057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Introduction Endometriosis is a benign nevertheless a chronic condition which impacts greatly the quality of life through cyclic discomfort. We aim to report the case of umbilical endometriosis and a literature review of the different treatment modalities. Case Report This was a case of a 43-year-old woman, with no history, who presented with a painful hemorrhagic umbilical swelling during the menstrual period associated with dysmenorrhea. Abdominal ultrasound revealed a subcutaneous umbilical mass of non-vascularized tissue nature confirmed on Doppler. Pelvic MRI which confirms the diagnosis of primary umbilical endometriosis. The patient underwent wide local excision of the endometriotic nodule with umbilical reconstruction. Histology confirmed the diagnosis of umbilical endometriosis. Resection margins were clear. Discussion Extra-pelvic endometriosis sites are not common, especially the umbilicus. It usually occurs secondary to surgical scars, specifically after laparoscopy or open abdominal surgery. Surgical management is currently described as gold standard. Laparoscopic approach is recommended as it allows better visual inspection for secondary localization of endometriosis. Medical management corresponds to combined oral contraceptives (COCs) or progestins for management of endometriotic implants decreasing inflammatory effects, or Gonadotropin-releasing hormone for long-course treatment. Malignant transformation of the umbilical nodule has been described in literature with a reported risk of malignant transformation to be 3%. Conclusion Current management of extragenital endometriosis suggest radical surgery with wide local excision. Due to the rarity, there is a paucity of data on umbilical endometriosis and mostly reported from case reports.
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Affiliation(s)
- Zineb Loudyi
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - S Benammi
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - Y Bakali
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - Hassan Aguouzoul
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - M Alaoui
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - F Sebbah
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - M Raiss
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
| | - A Hrora
- Surgical Department C IBN SINA Hospital, Rabat, Morocco
- Université Mohamed V of Rabat, Rabat, Morocco
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