Postoperative length of stay (LOS) is a key indicator of surgical efficiency. Although ERAS protocols standardize care, significant heterogeneity in LOS remains. This study aimed to develop and validate a simplified nomogram based solely on preoperative indicators for predicting LOS after colorectal cancer surgery. A retrospective analysis was conducted on 260 patients undergoing elective colorectal cancer resection. Predictors were selected using Elastic Net regression combined with clinical dimension reduction. Three models were constructed: linear regression, random forest, and XGBoost. Patients were randomly split into development (n = 184) and validation (n = 76) cohorts. Performance was assessed using R2, RMSE, and MAE, with calibration and decision curve analysis. The final model incorporated six preoperative variables: number of comorbidities, age, clinical stage, albumin, white blood cell count, and alkaline phosphatase. Comorbidity count was an independent predictor of prolonged LOS (β = 0.610, P = 0.004). Owing to inherent noise in LOS, all models showed limited explanatory power in the validation set (linear model R2 = –0.051; RMSE = 2.1 days; MAE = 1.6 days). Calibration was satisfactory (mean absolute error, 0.49 days). The preoperative nomogram identifies high-risk patients before surgery and may support perioperative resource planning. Given the negative R2 values, the tool should be interpreted as a risk-stratification aid rather than a precise LOS predictor, and further multicenter validation is required.
A 60-year-old gentleman presented with right upper abdominal pain and vomiting, with previously unrecognised clinical features of neurofibromatosis type 1. Examination revealed multiple neurofibromas, café-au-lait spots, and scoliosis. Abdominal examination revealed a large lump measuring 15 × 15 cm, predominantly in the right upper quadrant, which was firm, immobile, and non-tender. Contrast-enhanced computed tomography demonstrated a large predominantly cystic peri duodenal lesion with an eccentric enhancing solid component and multiple hyper enhancing nodules in the small bowel, creating a diagnostic dilemma by mimicking benign cystic pathology. Magnetic resonance imaging further delineated the cystic nature of the lesion and its relationship with the biliary and pancreatic ducts. The presence of multifocal small bowel lesions in the setting of NF1 suggested gastrointestinal stromal tumour. Due to severe restrictive lung disease, the patient was not a candidate for definitive surgical resection. CT-guided biopsy was not performed due to concern regarding tumour rupture during percutaneous needle access, and laparoscopic biopsy was therefore performed to obtain tissue under direct visualisation. Laparoscopic biopsy confirmed spindle-cell gastrointestinal stromal tumor with DOG1 and CD117 positivity. The patient was started on imatinib therapy with symptomatic improvement. As the patient was unfit for major surgical resection, the plan was to continue imatinib therapy lifelong until radiological progression or development of unacceptable treatment-related adverse effects, with regular radiological follow-up. This case highlights the importance of recognising key imaging features such as cystic degeneration with peripheral enhancement and multifocality in neurofibromatosis 1 associated gastrointestinal stromal tumor, which can otherwise mimic benign intra abdominal cystic lesions and delay appropriate management.
The conventional Bogota bag provides an inexpensive method of temporary abdominal closure, but it does not provide a simple mechanism for repeated wound irrigation with controlled drainage. We describe a modification, termed the Irrigation Bogota Bag (iBogota), prepared from a sterile urinary drainage bag with a dedicated irrigation access window and a dependent drainage outlet. The bag was trimmed to the laparostoma, secured circumferentially to the wound edge, and connected to a collection bag for gravity drainage. Irrigation was performed with 1–1.5 L of sterile normal saline two to three times daily, usually over 10–15 min, according to the degree of contamination. The approximate basic material cost was ₹80, excluding saline and replacement consumables. The technique was used in three patients with postoperative abdominal wound dehiscence and evisceration. Definitive fascial closure was subsequently achieved in one patient; the other two were managed without attempted fascial re-closure because of dense adhesions or high operative risk. The report describes the construction and application of the technique rather than comparative clinical effectiveness. The iBogota may provide a simple temporary abdominal coverage and irrigation option where conventional commercial systems are unavailable or impractical.
Chest wall perforator flaps (CWPFs) have emerged as reliable options for volume replacement in breast-conserving surgery (BCS). While their surgical feasibility and cosmetic utility are established, evidence on patient-reported outcomes (PROMs) remains sparse. This hybrid study combined a prospective cohort with a systematic review. The prospective arm included women who underwent CWPF reconstruction at a tertiary center. Surgical complications and PROMs were assessed using a modified version of the National Mastectomy and Breast Reconstruction Audit (NMBRA, UK) questionnaire administered at baseline, 1, 3, and 6 months postoperatively. In parallel, a systematic review of six published studies was conducted, extracting data on complications, PROMs, cosmetic outcomes, and oncological parameters. In the prospective cohort of 15 patients, indications included invasive ductal carcinoma (73
Gastric cancer remains prevalent in East Asia. This study evaluated 10-year chronological trends in patient profiles and real-world surgical practices at a Korean tertiary referral center. A retrospective cohort analysis was conducted on 2,810 patients who underwent curative-intent surgery for gastric adenocarcinoma (2012–2021). Chronological trends in demographics, ASA physical status, surgical approach, lymphadenectomy extent, and 30-day complications were analyzed using linear regression and chi-square tests for trend. Mean age rose from 59.6 to 63.0 years, and high-risk patients (ASA class ≥ III) increased significantly (p < 0.001). Totally laparoscopic gastrectomy (TLG) utilization grew from 34.3
