Impact of surgical proficiency levels on postoperative morbidity: a single centre analysis of 558 ileostomy reversals

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

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Assessing the intra- and postoperative morbidity of kidney cancer surgery for organ-confined (cT1-T2N0M0) renal masses according to the eau quality criteria for standardized reporting: a prospective single-centre study

European Urology Open Science ◽

10.1016/s2666-1683(21)00999-x ◽

2021 ◽

Vol 32 ◽

pp. S151

Author(s):

S. Serni ◽

A. Pecoraro ◽

A. Rivetti ◽

F. Sessa ◽

P. Barzaghi ◽

...

Keyword(s):

Kidney Cancer ◽

Postoperative Morbidity ◽

Quality Criteria ◽

Cancer Surgery ◽

Single Centre ◽

Renal Masses ◽

Centre Study ◽

Single Centre Study ◽

Standardized Reporting

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Laparoscopic vs. open feeding jejunostomy insertion in oesophagogastric cancer

BMC Surgery ◽

10.1186/s12893-021-01318-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sotiris Mastoridis ◽

Giada Bracalente ◽

Christine-Bianca Hanganu ◽

Michela Neccia ◽

Antonio Giuliani ◽

...

Keyword(s):

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Early Postoperative Period ◽

Insertion Technique ◽

Single Centre ◽

Feeding Jejunostomy ◽

Nutritional Characteristics ◽

Laparoscopic Jejunostomy ◽

Enteral Access ◽

Oesophagogastric Cancer

Abstract Background Jejunal feeding is an invaluable method by which to improve the nutritional status of patients undergoing neoadjuvant and surgical treatment of oesophageal malignancies. However, the insertion of a feeding jejunostomy can cause significant postoperative morbidity. The aim of this study is to compare the outcomes of patients undergoing placement of feeding jejunostomy by conventional laparotomy with an alternative laparoscopic approach. Methods A retrospective review of data prospectively collected at the Oxford Oesophagogastric Centre between August 2017 and July 2019 was performed including consecutive patients undergoing feeding jejunostomy insertion. Results In the study period, 157 patients underwent jejunostomy insertion in the context of oesophageal cancer therapy, 126 (80%) by open technique and 31 (20%) laparoscopic. Pre-operative demographic and nutritional characteristics were broadly similar between groups. In the early postoperative period jejunostomy-associated complications were noted in 54 cases (34.4%) and were significantly more common among those undergoing open as compared with laparoscopic insertion (38.1% vs. 19.3%, P = 0.049). Furthermore, major complications were more common among those undergoing open insertion, whether as a stand-alone or at the time of staging laparoscopy (n = 11/71), as compared with insertion at the time of oesophagectomy (n = 3/86, P = 0.011). Conclusions This report represents the largest to our knowledge single-centre comparison of open vs. laparoscopic jejunostomy insertion in patients undergoing oesophagectomy in the treatment of gastroesophageal malignancy. We conclude that the laparoscopic jejunostomy insertion technique described represents a safe and effective approach to enteral access which may offer superior outcomes to conventional open procedures.

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