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Topic Review
MPM Nodal Status: Where are We at?
Due to the lack of both prospective trial and high-volume retrospective studies, the management of clinical N+ malignant pleural mesothelioma (MPM) patients remain highly debated. Node positive patients show poor survival compared with node-negative ones; thus, lymph node staging appears crucial in determining treatment strategy. Notwithstanding the improvement in pre-treatment staging and the update on lymph node classification in the 8th edition of TNM, several open controversies remain on N parameter. How should people stage suspected N+ patients? How should people treat node positive patients?  Which is the definition of “resectable patient”?  Is the site or the number the main prognostic factor for node positive patients?  The aim of the entry is to analyse the existing relevant literature on lymph node status in MPM.
  • 467
  • 09 Nov 2021
Topic Review
Elective Early Upper Gastrointestinal Study
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear.  It aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention. 
  • 465
  • 23 Nov 2021
Topic Review
Perioperative Medication Therapy
Drug-related problems (DRPs) are common among surgical patients, especially older patients with polypharmacy and underlying diseases. DRPs can potentially lead to morbidity, mortality, and increased treatment costs. The enhanced recovery after surgery (ERAS) system has shown great advantages in managing surgical patients. Medication therapy management for surgical patients is an important part of the ERAS system. Improper medication therapy management can lead to serious consequences and even death.
  • 464
  • 02 Feb 2023
Topic Review
Systemic Antibiotic Prophylaxis in Maxillofacial Trauma
Infection after maxillofacial trauma remains an important complication, with a significant socio-economic impact. While consensus exists that systemic antibiotic prophylaxis reduces the risk of infection in the management of maxillofacial fractures, the type, and duration remain controversial. 
  • 461
  • 22 Jun 2022
Topic Review
EPPOCRATIS
Finally, EPPOCRATIS is an in-house (point-of-care) process that can be completed in 24-48 hours, allowing precise and expedited care of facial trauma patients. Bypassing outsourcing to third-party companies allows for the implementation of VSP/3DP in the acute trauma setting during the same hospitalization of trauma patients. Potential challenges with building an in-house VSP/3DP also exist including cost and personnel. However, as the technology becomes more readily available and cheaper, it will become more utilized in large volume centers.   
  • 459
  • 22 Dec 2021
Topic Review
Liver Transplantation for Perihilar Cholangiocarcinoma
Cholangiocarcinoma (CCA) encompasses all malignant neoplasms arising from the epithelial cells of the biliary tree. About 40% of CCAs are perihilar, involving the bile ducts distal to the second-order biliary branches and proximal to the cystic duct implant. About two-thirds of pCCAs are considered unresectable at the time of diagnosis or exploration. When resective surgery is deemed unfeasible, liver transplantation (LT) could be an effective alternative. The overall survival rates after LT at 1 and 3 years are 91% and 81%, respectively. The overall five-year survival rate after transplantation is 73% (79% for patients with underlying PSC and 63% for de novo pCCA). Multicenter case series reported a 5-year disease-free survival rate of ~65%.
  • 457
  • 30 May 2023
Topic Review
Surgical Treatment for Grade C Postoperative Pancreatic Fistula
Postoperative pancreatic fistula (POPF) is a troublesome complication after pancreatic surgeries, and grade C POPF is the most serious situation among pancreatic fistulas. The incidence of grade C POPF varies from less than 1% to greater than 9%, with an extremely high postoperative mortality rate of 25.7%. The patients with grade C POPF finally undergo surgery with a poor prognosis after various failed conservative treatments. Although various surgical and perioperative attempts have been made to reduce the incidence of grade C POPF, the rates of this costly complication have not been significantly diminished. Hearteningly, several related studies have found that intra-abdominal infection from intestinal flora could promote the development of grade C POPF, which would help physicians to better prevent this complication.
  • 456
  • 03 Jan 2023
Topic Review
Perianal Fistula with Crohn’s Disease
Crohn’s disease (CD) is a relapsing systemic inflammatory disease that can cause persistent transmural inflammation anywhere along the gastrointestinal tract.
  • 455
  • 12 Nov 2021
Topic Review
Robotic Approach in Liver Surgery
In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. 
  • 452
  • 21 Nov 2022
Topic Review
Immunotherapy or Immuno-Chemotherapy in Non-Small Cell Lung Cancer
Surgical resections remain the gold standard for early stages non-small-cell carcinoma (NSCLC) and may be considered for locally advanced tumors. Medical treatment has changed drastically, especially for advanced stages, for which the development of immunotherapy and molecular targeted therapy significantly increased survival and quality of life. The addition of radical surgical resection following immunotherapy or immuno-chemotherapy is feasible and safe with low surgical-related mortality and morbidity in selected patients with initially unresectable NSCLC.
  • 450
  • 05 May 2023
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