Background: Our aim was to evaluate the impact of obesity on operative and long-term oncological outcomes following rectal cancer surgery. Methods: Single-center retrospective review of all patients that underwent rectal resection for primary rectal adenocarcinoma between 2010 and2020. Divided into two groups based on preoperative body mass index (BMI): obese-BMI ≥ 30 kg/m2, non-obese-BMI < 30 kg/m2. Results: Total of 513 patients included 100 in the obese group (mean BMI 33.5 kg/m2, range 30-45.6) and 413 in the non-obese group (mean BMI 24.9 kg/m2, range 15.6-29.9, p < 0.001). The groups exhibited a similar age distribution (63.94 and 63.23, p = 0.59) or gender distribution (p = 0.83) between the groups. The obese group had higher conversion rates to open approach (22% versus 11.6%, p = 0.007), and longer surgeries (median 300 min, versus 260 min, p = 0.003), but similar overall postoperative complications (73% versus 64.4%, p = 0.1), 30-day readmission (19% versus 17.4%, p = 0.71), harvested lymph nodes (16 versus 14, p = 0.38), incidence of positive resection margins, 5-year overall survival (94.2% versus 88.7%, p = 0.97), and 5-year disease-free survival (70.4% versus 72%, p = 0.59). Conclusions: Obesity did not affect immediate overall surgical outcomes, surgical pathology quality indexes or long-term oncological outcomes.

BACKGROUND:Diverticulitis is a common cause of acute abdominal conditions, often requiring urgent or elective surgical intervention. Both psoas muscle area (PMA) and bone mineral density (BMD) have been linked to postoperative outcomes, but their role in diverticulitis remains unclear. OBJECTIVES:To evaluate the relationship between PMA, BMD, and their combined effect on surgical outcomes in patients undergoing colectomy for diverticulitis. METHODS:In this retrospective, single-center study, we analyzed patients who underwent colectomy for diverticulitis. PMA and BMD were measured using preoperative computerized tomography. Statistical analysis assessed the association between postoperative outcomes and PMA, BMD, and their combined product (PMA × BMD). RESULTS:The cohort included 66 patients; median age 68.5 years (range 34-94); 41 (62.12%) females. Of the cases, 42 (63.63%) were urgent. Postoperative complications occurred in 38 patients (57.58%). Patients who developed major postoperative complications had lower PMA (1116.74 ± 716.31 mm² vs. 1948.01 ± 0.01 mm², P = 0.02). The area under the curve (AUC) for major postoperative complications was 0.94 for BMD. The AUC for postoperative ileus was 0.73, 0.69, and 0.76 for PMA, BMD, and PMA × BMD, respectively. The AUC for 30-day mortality was 0.66, 0.7, and 0.73. The AUC for ostomy reversal was 0.71, 0.71, and 0.76. CONCLUSIONS:PMA and BMD were associated with postoperative complications after colectomy for diverticulitis. Their combined assessment may improve predictive accuracy. Current evidence regarding the impact of body composition on surgical outcomes in diverticulitis remains limited and inconsistent. Further research is warranted.

INTRODUCTION:Colorectal peritoneal metastases (CRPM) and retroperitoneal lymphatic metastases (RLM) are each considered poor prognostic indicators in colorectal cancer (CRC). Current data suggests that surgery for each including cytoreductive surgery and heated intraperitoneal chemotherapy (CRS/HIPEC) for CRPM and retroperitoneal resection (RR) for RLM may improve survival. Given the poor prognosis of each finding individually, each condition is generally considered a contraindication to the other. We describe the first series of combined RR and CRS/HIPEC. MATERIALS AND METHODS:Retrospective analysis of a prospectively maintained tertiary institution database comparing perioperative and oncological outcomes of combined RR + CRS/HIPEC to CRS/HIPEC only in CRC. RESULTS:Included 238 CRS/HIPEC and divided to 17 with RR + CRS/HIPEC and 221 with CRS/HIPEC only. Demographic/perioperative characteristics were similar including tumor characteristics and peritoneal cancer index. Longer operative times observed in RR + CRS/HIPEC cohort (5 versus 4 h, p = 0.024). Complications were similar except more postoperative bleeding events and deep vein thrombosis in the RR + CRS/HIPEC cohort (24 % versus 5.0 %, p = 0.024 and 12 % versus 2.3 %, p = 0.026, respectively). This did not translate to longer length of stay, reoperations, or major complications. Median disease free survival was shorter in the RR + CRS/HIPEC cohort (7.3 versus 11.3 months, p = 0.032), but similar overall survival observed (29.5 versus 43.9 months, p = 0.34). Less retroperitoneal recurrences occurred after regional lymphadenectomy (12 %) compared to mass only resection (44 %). CONCLUSION:Our study demonstrates the safety and oncological efficacy of RR + CRS/HIPEC. We believe that RR + CRS/HIPEC in highly selected patients is a suitable option and hope this leads to larger multi-institutional studies to corroborate these findings.

Background: Pathological complete response (pCR) following neoadjuvant therapy and surgery for locally advanced rectal cancer is associated with improved prognosis. Accurately predicting who will achieve pCR could theoretically eliminate the need for surgery for these patients. We aimed to compare pCR and non-pCR rectal cancer patients following neoadjuvant therapy, searching for clinical predictors for pCR and comparing oncological outcomes between these groups. Methods: This is a single-center retrospective analysis of all patients who underwent a curative-intent rectal resection between 2010 and 2020 for primary non-metastatic rectal cancer following neoadjuvant therapy. The cohort (263 patients) was divided into two groups according to the pathological results from surgery: the pCR group (53 patients) and the non-pCR group (210 patients). Results: The groups were similar in terms of baseline characteristics, clinical presentation, and staging, but tumors of the pCR group were significantly higher in the rectum (mean distance from the anal verge 7.92 cm versus 6.9 cm respectively, p = 0.04), and more of them were located at the posterior rectal wall (37.7% versus 24.3%, p = 0.049). Multivariate analysis found posterior location and tumor height to be significantly associated with pCR (OR 2.23, 95% CI 1.11-4.45, p = 0.023), (OR 1.14, 95% CI 1.03-1.27, p = 0.015). The 5-year overall survival was 95.6% in the pCR group compared with 87.5% in the non-pCR group (p = 0.09), and the 5-year disease-free survival was 92.7% versus 64.5%, respectively (p < 0.001). Conclusions: Tumor location at the posterior wall of the rectum and higher tumor location were found to be associated with pCR. Patients achieving pCR demonstrate improved prognosis compared with non-pCR patients.

BACKGROUND:Cytoreductive surgery (CRS) with Hyperthermic Intra-peritoneal Chemotherapy (HIPEC) has become a successful, potentially curative, treatment option for peritoneal surface malignancies (PSM). CRS and HIPEC (CRS/HIPEC) are performed with curative intent for several intra-peritoneal pathologies. An increasing number of patients with PSM are diagnosed at a relatively young age. Given the long-term survival in some patients following CRS/HIPEC, the reproductive health of patients in this age group requires consideration. METHODS:Surgical oncology teams participating in the Peritoneal Surface Oncology Group International (PSOGI) were offered the opportunity to share their experience and data regarding the obstetric outcomes of female patients who had undergone CRS/HIPEC. RESULTS:Nineteen (19) patients were reported to have had a baby following CRS/HIPEC. The median interval between CRS/HIPEC and pregnancy was 37 months, and 16 patients had a normal vaginal delivery. All of the newborns were healthy, without medical issues attributed to CRS or HIPEC chemotherapy. Overall, 89 % of mothers had no evidence of disease at their last follow-up. CONCLUSION:Successful pregnancies following CRS/HIPEC are seldom reported in the literature, and fertility preservation is not uniformly discussed. Data from this international collaboration highlights the reproductive potential in patients with PSM following CRS/HIPEC and the value of pre-operative obstetric and fertility advice and management to achieve that end.

Several factors have been known to correlate with the early and long-term outcomes of patients undergoing CRS/HIPEC. However, the relation between surgical approach (open vs laparoscopic colectomy) at the index colectomy and oncological outcomes following CRS/HIPEC have not been studied. Patients who underwent CRS/HIPEC after previous colectomy for colorectal cancer with peritoneal metastases from 2015 to 2022 were identified from a prospectively maintained database of peritoneal surface malignancies and were divided into two groups according to the primary colectomy approach open or laparoscopic colectomy. Operative and 30-day outcomes were compared between groups, as well as survival outcomes. A total of 159 patients met inclusion criteria, of those 101 patients were in the open group and 58 patients were in the laparoscopic group. Both groups had similar demographics and comorbidities. TNM staging at index colectomy was similar between the groups as well as peritoneal cancer index (PCI) score for CRS/HIPEC surgery; however, there was more upper jejunal disease involvement in the laparoscopic group compared with the open group (45.5

BACKGROUND:Enhanced recovery after surgery protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease the length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal nonopiate analgesia using nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors. OBJECTIVE:To compare the incidence of postoperative GI bleeding between patients treated with and without an enhanced recovery after surgery protocol. DESIGN:Retrospective review of a prospectively maintained colorectal registry. SETTINGS:Large colorectal referral center. PATIENTS:Preoperative elective colorectal surgery requiring an anastomosis. INTERVENTION:Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac. MAIN OUTCOME:Postoperative outcomes included bleeding (±sequelae), reduction in hematocrit after the operation, intervention for bleeding (transfusion, endoscopy, or surgery), length of stay, and hospital readmission. RESULTS:The enhanced recovery after surgery group (n = 630) and nonenhanced recovery after surgery group (n = 739) were comparable in baseline clinical features except for surgical indication, with more IBD and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae ( p < 0.0001) and bleeding without sequelae ( p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the nonenhanced recovery after surgery group. In addition, a significantly larger hematocrit decline after the operation was noted in the enhanced recovery after surgery group ( p < 0.0001). However, both the need for transfusion and intervention for bleeding did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR 2.68; 95% CI, 1.49-4.81; p < 0.001). LIMITATIONS:Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol increased the risk of bleeding. CONCLUSIONS:Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract . EL USO DE PROTOCOLOS DE RECUPERACIN MEJORADA EN CIRUGA COLORRECTAL HA AUMENTADO LAS COMPLICACIONES HEMORRGICAS POSTOPERATORIAS:ANTECEDENTES:Los protocolos de recuperación mejorada después de la cirugía (ERAS) son vías de atención perioperatoria multimodal que han demostrado mejorar las complicaciones posoperatorias y disminuir la duración de la estancia después de la cirugía. Un componente crítico de un protocolo ERAS es el uso de analgesia multimodal no opiácea mediante fármacos antiinflamatorios no esteroideos e inhibidores de la COX-2.OBJETIVO:Comparar la incidencia de sangrado gastrointestinal posoperatorio entre pacientes tratados con y sin un protocolo ERAS.DISEÑO:Revisión retrospectiva de un registro colorrectal prospectivo mantenido.ESCENARIO:Centro de referencia colorrectal grande.PACIENTES:Cirugía colorrectal electiva preoperatoria que requiere una anastomosis.INTERVENCIÓN:El protocolo ERAS estandarizado incluyó celecoxib y ketorolaco.RESULTADO PRINCIPAL:Los resultados posoperatorios incluyeron sangrado (+/- secuelas), reducción del hematocrito después de la operación, intervención para el sangrado (transfusión, endoscopia o cirugía), duración de la estancia hospitalaria y reingreso hospitalario.RESULTADOS:El grupo ERAS (n = 630) y los grupos no ERAS (n = 739) fueron comparables en las características clínicas iniciales excepto por la indicación quirúrgica, con más enfermedad inflamatoria intestinal y menos enfermedad maligna en el grupo ERAS (Tabla 1). La cirugía mínimamente invasiva se realizó con mayor frecuencia en el grupo ERAS. Tanto el sangrado con secuelas ( p < 0,0001) como el sangrado sin secuelas ( p = 0,0004) fueron significativamente más comunes en el grupo ERAS en comparación con el grupo no ERAS. Además, se observó una disminución significativamente mayor del hematocrito después de la operación en el grupo ERAS ( p < 0,0001). Sin embargo, tanto la necesidad de transfusión como la intervención por sangrado no difirieron significativamente entre los grupos de pacientes. Los factores asociados con el sangrado fueron el uso de un protocolo ERAS (OR=2,96; IC del 95% 1,57-5,58; p < 0,001) y la realización de una anastomosis de intestino delgado a grueso (OR= 2,68; IC del 95% 1,49-4,81; p < 0,001).LIMITACIÓN:Diseño observacional retrospectivo e imposibilidad de determinar qué componente del protocolo ERAS causó el sangrado.CONCLUSIÓN:El uso de un protocolo ERAS en pacientes sometidos a cirugía colorrectal con anastomosis se asocia con una mayor incidencia de sangrado sin diferencia significativa en la necesidad de transfusión o intervención. (Traducción-Dr Yolanda Colorado ).

(1) Background: Crohn’s disease (CD) and right-sided colorectal-carcinoma (CRC) are two common indications for right colectomies. Many studies have tried to identify risk factors associated with post-operative complications for both CD and CRC. However, data directly comparing the outcomes of the two are sparse. This study aims to compare the 30-day post-operative outcome after a right colectomy for CD versus CRC. Its secondary aim is to identify the factors associated with these outcomes for each group. (2) Methods: A retrospective cohort study of 123 patients who underwent a right colectomy for CD or CRC in a single institution between March 2011 and March 2016. (3) Results: There were no significant differences between the groups when comparing the overall complication rate, the median Clavien–Dindo score, reoperation rates and the length of hospitalization. The leak rate was higher in the Crohn’s group (13.95% (6/43) vs. 3.75% (3/80)), p = 0.049), although the stoma rate was the same (4/43 9.5%; 7/80 9.9%). (4) Conclusions: This study has shown that post-operative complication rate is similar for right colectomy in CD and CRC. However, Crohn’s disease patients did have a higher leak rate.

Background Despite major efforts in prevention, surgical site infections (SSIs) remain a burden on patients and the healthcare system and are associated with significant morbidity. SSIs are one of the costliest healthcare-associated infections. The diagnosis of SSIs is based mainly on clinical assessment, which may result in a delay in detection. The ability to detect SSIs in subclinical phase and initiate effective therapy earlier may reduce morbidity and hospital stay. In this study, we attempted to utilize long-wave infrared (LWIR) imaging to define the healing process of the surgical site and to detect abnormal healing. Methods In this prospective study, 50 patients undergoing elective abdominal surgery had LWIR images of their incision obtained at determined intervals from their operation to discharge. Images were processed with proprietary algorithms to create a thermal topograph used to define the healing process. Results Images of 45 patients were available for a final review. Of these 45 patients, 10 patients developed SSIs. Using the thermal topograph, 10 criteria for image analysis were defined, yielding a prediction of six out of the 10 SSIs and 35 out of the 35 normal healing wounds. Sensitivity was 60%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.1%, with 92% accuracy. A preliminary program was created that allows trained users to methodically evaluate images providing them with a risk estimate. Conclusions In this preliminary study, LWIR analysis of surgical wounds was able to identify normal and abnormal wound healing. Further large-scale studies are needed to validate results.

BACKGROUND:Retroperitoneal sarcomas (RPSs) present a surgical challenge, with complex anatomic relationships to organs and vascular structures. This pilot study investigated the role of three-dimensional (3D) augmented reality (3DAR) compared with standard imaging in preoperative planning and resection strategies. METHODS:For the study, 13 patients who underwent surgical resection of their RPS were selected based on the location of their tumor (right, left, pelvis). From the patients' preoperative computed tomography (CT) scans, 3DAR models were created using a D2P program and projected by an augmented-reality (AR) glass (Hololens). The 3DAR models were evaluated by three experienced sarcoma surgeons and compared with the baseline two-dimensional (2D) contrast-enhanced CT scans. RESULTS:Three members of the surgical team evaluated 13 models of retroperitoneal sarcomas, resulting in a total of 26 responses. When the surgical team was asked to evaluate whether the 3DAR better prepared the surgeon for planned surgical resection, 10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074). According to 15 (57.6 %) of the 26 responses, the 3DAR offered additional value over standard imaging in the preoperative planning (median score of 4; range, 1-5). The median stated likelihood that the surgeons would consult the 3DAR was 5 (range, 2-5) for the preoperative setting and 3 (range, 1-5) for the intraoperative setting. CONCLUSIONS:This pilot study suggests that the use of 3DAR may provide additional value over current standard imaging in the preoperative planning for surgical resection of RPS, and the technology merits further study.

BACKGROUND:Surgical resection in Crohn's disease is sometimes the only alternative treating disease complications or refractory disease. The implications of early resection on disease course are still debatable. We aimed to assess the influence of preoperative disease duration on long-term postoperative disease course. METHODS:A retrospective analysis of all Crohn's disease patients who underwent an elective primary ileocolic resection between 2010 and 2021 in a single tertiary medical center. The cohort was divided based on disease duration, Group A (47 patients) had a disease duration shorter than 3 years (median of 1 year) and Group B (139 patients) had a disease duration longer than 3 years (median of 11 years). RESULTS:Surgeries were less complex among Group A as noted by higher rates of laparoscopic assisted procedures (68.1% vs. 45.3%, P = 0.006), shorter surgery duration (134 vs. 167 min, P < 0.0001) less estimated blood loss (72.5 vs. 333 mL, P = 0.016) and faster return of bowel function (3 vs. 4 days, P = 0.011). However, propensity score matching nullified all the differences. Younger age (OR = 0.86, P = 0.004), pre-op steroids (OR = 3.69, P = 0.037) and longer disease duration (OR = 1.18, P = 0.012) were found to be independently significantly associated with severe complications. After a median follow-up time of 71.38 months no significant differences were found between the groups in terms of endoscopic (P = 0.59), or surgical recurrences rates (P = 0.82). CONCLUSIONS:The main effect of preoperative short disease duration was noted within the surgical complexity; however, matching suggests confounders as cause of the difference. No significant long-term implication was noted on disease recurrence.

BACKGROUND:Retroperitoneal sarcomas (RPS) present a surgical challenge with high rates of local recurrence (LR). We investigated the role of intraoperative electron radiotherapy (IOeRT) in reducing LR after surgical resection of RPS. METHODS:A retrospective analysis of all patients who underwent surgical resection for RPS between 2014 and 2021 at a tertiary academic referral center (n = 172). Patients included underwent surgical resection of their RPS and received IOeRT (n = 36) and were compared by case control matching to patients with similar tumor characteristics (recurrence status and tumor grade) that did not receive IOeRT (n = 36). RESULTS:The median length of hospitalization was 8 days (range, 4-34) in the IOeRT group and 10 days (range, 2-42) in the non-IOeRT group (p = 0.25). The mean operating room (OR) time was 4h (±1.3) and 4h (±1.9) in the IOeRT and non-IOeRT groups respectively, (p = 0.37). Complete resection with R0 margins was achieved in 30 patients (83.3%) and 24 patients (66.6%) in the IOeRT and non-IOeRT groups, respectively (p = 0.1). R1 resection was achieved in 6 patients (16.6%) and 12 patients (33.3%) respectively, (p = 0.1). The resected organ weighted score was significantly different between the groups; score 0 observed in 19 (52.7%) patients in the IOeRT group and 3 (8.3%) in the non-IOeRT group (p < 0.001), score 1 observed in 7 (19.4%) in the IOeRT group and 17 (47.2%) in the non-IOeRT group (p = 0.012). The rate of severe complications (CD score>3) did not differ between the groups, 5 (13.8%) patients in the IOeRT group and 9 (25%) patients in the non-IOeRT group (p = 0.23). No radiation associated complications were noted. The 2-year local recurrence free survival (LRFS) was 75.9% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.4). The 2-year IOeRT field recurrent free survival (IRFS) was 88.4% in the IOeRT group and 60.3% in the non-IOeRT group (p = 0.04). CONCLUSIONS:The use of IOeRT did not increase the rate of surgical complications and was associated with superior local control in the radiation field, improved organ preservation without an impact on overall survival.

Introduction Soft tissue sarcomas (STS) of the pelvis present a surgical and oncological challenge. We investigated the outcomes of patients undergoing resection of pelvic sarcomas. Methods A retrospective analysis of all patients who underwent surgical resection for STS between 2014 and 2021 at a tertiary academic referral center (n = 172). Included all patients with primary or recurrent STS which originated or extended to the pelvic cavity (n = 29). Results The cohort was divided into primary pelvic sarcomas (n = 18) and recurrent pelvic sarcomas (rPS, n = 11). Complete R0/R1 resection was achieved in 26 patients (89.6%). The postoperative complication rate was 48.3%. The rate of major complications was 27.5%. The median time of follow-up from surgery was 12.3 months (range, 0.6-60.3 months). Disease-free survival was superior in the primary pelvic sarcomas group compared to the rPS group (P = 0.002). However, there was no significant difference in overall survival, (P = 0.52). Univariant and multivariant analyses identified rPS group (Hazard Ratio 8.68, P = 0.006) and resection margins (Hazard Ratio 6.29, P = 0.004) to be independently associated with disease-free survival. Conclusions We have demonstrated that achieving R0/R1 resection is feasible. Oncological outcomes are favorable for primary tumors, whereas recurrent tumors exhibit early recurrences. Consideration of resection of recurrent pelvic STS should involve a careful multidisciplinary evaluation.

Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion. Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed. During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3–65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14 months (range 3–51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12–72) vs 14 (range 12–60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5

BACKGROUND:The neutrophil to lymphocyte ratio (NLR) has demonstrated prognostic value in various malignant conditions, including gastric adenocarcinoma. However, chemotherapy may affect NLR.OBJECTIVES:To evaluate the prognostic value of NLR as an accessory decision-making tool in terms of operating patients after neoadjuvant chemotherapy in patients with resectable gastric cancer.METHODS:We collected oncologic, perioperative, and survival data of patients with gastric adenocarcinoma who underwent curative intent gastrectomy and D2 lymphadenectomy between 2009 and 2016. The NLR was calculated from preoperative laboratory tests and classified as high (> 4) and low (≤ 4). The t-test, chi-square, Kaplan-Meier analysis, and Cox multivariate regression models were used to assess associations of clinical, histologic, and hematological variables with survival.RESULTS:For 124 patients the median follow-up was 23 months (range 1-88). High NLR was associated with greater rate of local complication (r=0.268, P < 0.01). The rate of major complications (Clavien-Dindo ≥ 3) was higher in the high NLR group (28% vs. 9%, P = 0.022). Among the 53 patients who received neoadjuvant chemotherapy, those with low NLR had significantly improved disease-free survival (DFS) (49.7 vs. 27.7 months, P = 0.025). Low NLR was not significantly associated with overall survival (mean survival, 51.2 vs. 42.3 months, P = 0.19). Multivariate regression identified NLR group (P = 0.013), male gender (P = 0.04), and body mass index (P = 0.026) as independently associated with DFS.CONCLUSIONS:Among gastric cancer patients planned for curative intent surgery who underwent neoadjuvant chemotherapy, NLR may have prognostic value, particularly regarding DFS and postoperative complications.

Background The peritoneum is a common metastatic site of colorectal cancer (CRC) and associated with worse oncological outcomes. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been shown to improve outcomes in selected patients. Studies have demonstrated significant difference in survival of patients with primary colon and rectal tumors both in local and in metastatic setting; but only few assessed outcomes of CRS/HIPEC for rectal and colon tumors. We studied the perioperative and oncological outcomes of patients undergoing CRS/HIPEC for rectal cancer. Methods A retrospective analysis of a prospectively maintained database between 2009 and 2021 was performed. Results 199 patients underwent CRS/HIPEC for CRC. 172 patients had primary colon tumors and 27 had primary rectal tumors. Primary rectal location was associated with longer surgery (mean 4.32, hours vs 5.26 h, p = 0.0013), increased blood loss (mean 441cc vs 602cc , p = 0.021), more blood transfusions (mean 0.77 vs 1.37units, p = 0.026) and longer hospitalizations (mean 10 days vs 13 days, p = 0.02 ). Median disease-free survival (DFS) was shorter in rectal primary group; 7.03 months vs 10.9 months for colon primaries ( p = 0.036) . Overall survival was not statistically significant; 53.2 months for rectal and 60.8 months for colon primary tumors. Multivariate analysis indicated origin (colon vs rectum) and Peritoneal Cancer Index to be independently associated with DFS. Conclusions Patients with rectal carcinoma undergoing CRS/HIPEC for peritoneal metastasis had worse peri-operative and oncological outcomes. Overall survival was excellent in both groups. This data may be used for risk stratification when considering CRS/HIPEC for patients with rectal primary.

The purpose of this study was to evaluate the quality of life (QoL), early post-operative complications, and hernia recurrence rate following laparoscopic enhanced-view Totally Extra-Peritoneal (eTEP) Rives-Stoppa (RS) for incisional and primary ventral hernia repair. Retrospective review of a prospectively maintained database of all patients undergoing eTEP-RS between 2017 and 2020. Data retrieved included demographics, and clinical and operative variables. QoL was assessed using the EuraHS-QoL scale prior to- and following eTEP-RS. During the study period, 61 patients met the inclusion criteria. Age and BMI were 62 (60.4 ± 13.8) years and 29.7 (30.4 ± 6) kg/m2, respectively. Incisional hernia was the most common pathology (n = 40, 65

A surgical site infection (SSI) prediction model that identifies at-risk patients before leaving the operating room can support efforts to improve patient safety. In this study, eight pre-operative and five perioperative patient- and procedure-specific characteristics were tested with two scoring algorithms: 1) count of positive factors (manual), and 2) logistic regression model (automated). Models were developed and validated using data from 3,440 general and oncologic surgical patients. In the automated algorithm, two pre-operative (procedure urgency, odds ratio [OR]: 1.7; and antibiotic administration >2 hours before incision, OR: 1.6) and three intraoperative risk factors (open surgery [OR: 3.7], high-risk procedure [OR: 3.5], and operative time OR: [2.6]) were associated with SSI risk. The manual score achieved an area under the curve (AUC) of 0.831 and the automated algorithm achieved AUC of 0.868. Open surgery had the greatest impact on prediction, followed by procedure risk, operative time, and procedure urgency. At 80% sensitivity, the manual and automated scores achieved a positive predictive value of 16.3% and 22.0%, respectively. Both the manual and automated SSI risk prediction algorithms accurately identified at-risk populations. Use of either model before the patient leaves the operating room can provide the clinical team with evidence-based guidance to consider proactive intervention to prevent SSIs.