Purpose To understand the actual impact of the Covid-19 pandemic and frame the future strategies, we conducted a pan India survey to study the impact on the surgical management of gastrointestinal cancers. Methods A national multicentre survey in the form of a questionnaire from 16 tertiary care gastrointestinal oncology centres across India was conducted from January 2019 to June 2021 that was divided into a 15-month pre-Covid era and a similar period of active Covid pandemic era. Results There was significant disruption of services; 13 (81%) centres worked as dedicated Covid care centres and 43% reported suspension of essential care for more than 6 months. In active Covid phase, there was a 14.5% decrease in registrations and proportion of decrease was highest in the centres from South zone (22%). There was decrease in resections across all organ systems; maximum reduction was noted in hepatic resections (33%) followed by oesophageal and gastric resections (31 and 25% respectively). There was minimal decrease in colorectal resections (5%). A total of 584 (7.1%) patients had either active Covid-19 infection or developed infection in the post-operative period or had recovered from Covid-19 infection. Only 3 (18%) centres reported higher morbidity, while the rest of the centres reported similar or lower morbidity rates when compared to pre-Covid phase; however, 6 (37%) centres reported slightly higher mortality in the active Covid phase. Conclusion Covid-19 pandemic resulted in significant reduction in new cancer registrations and elective gastrointestinal cancer surgeries. Perioperative morbidity remained similar despite 7.1% perioperative Covid 19 exposure. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02675-6.
Aranea is a question answering system that extracts answers from the World Wide Web using knowledge annotation and knowledge mining techniques. Knowledge annotation, which utilizes semistructured database techniques, is effective for answering large classes of commonly occurring questions. Knowledge mining, which utilizes statistical techniques, can leverage the massive amounts of data available on the Web to overcome many natural language processing challenges. Aranea integrates these two different paradigms of question answering into a single framework. For the TREC evaluation, we also explored the problem of answer projection, or finding supporting documents for our Web-derived answers from the AQUAINT corpus.
survival estimates and Cox proportional hazards model adjusted for covariates were used for analyses. ResultsThe risks of recurrence of EOC increased steadily with increasing time from the start of primary treatment from 13.6% in 6-months to 71.0% after 12-months. In the final multivariate analyses, recurrence within 6 months of treatment was a significant independent predictor of poor OS in EOC patients (HR=7.23, 95%CI: 3.87-13.51, P<0.01). Conclusions Our study suggests that recurrence within 6months is an important prognostic factor that predicts poor OS in EOC. Early tumour recurrence may be a useful surrogate of overall survival and thus this information should be considered in the design of future tailored randomized controlled trials. Future strategies to improve OS in EOC patients should focus on identifying effective measures to prevent early tumour recurrence.
Objectives The Enhanced recovery after surgery (ERAS) program is designed to achieve faster recovery by maintaining pre-operative organ function and reducing stress response following surgery. A two part ERAS guidelines specific for Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) was recently published with intent of extending the benefit to patients with peritoneal surface malignancies. This survey was performed to examine clinicians’ knowledge, practice and obstacles about ERAS implementation in patients undergoing CRS and HIPEC. Methods Requests to participate in survey of ERAS practices were sent to 238 members of Indian Society of Peritoneal Surface malignancies (ISPSM) via email. They were requested to answer a 37-item questionnaire on elements of preoperative (n=7), intraoperative (n=10) and postoperative (n=11) practices. It also queried demographic information and individual attitudes to ERAS. Results Data from 164 respondents were analysed. 27.4 % were aware of the formal ERAS protocol for CRS and HIPEC. 88.4 % of respondents reported implementing ERAS practices for CRS and HIPEC either, completely (20.7 %) or partially (67.7 %). The adherence to the protocol among the respondents were as follows: pre operative (55.5–97.6 %), intra operative (32.6–84.8 %) and post operative (25.6–89 %). While most respondents considered implementation of ERAS for CRS and HIPEC in the present format, 34.1 % felt certain aspects of perioperative practice have potential for improvement. The main barriers to implementation were difficulty in adhering to all elements (65.2 %), insufficient evidence to apply in clinical practice (32.4 %), safety concerns (50.6 %) and administrative issues (47.6 %). Conclusions Majority agreed the implementation of ERAS guidelines is beneficial but are followed by HIPEC centres partially. Efforts are required to overcome barriers like improving certain aspects of perioperative practice to increase the adherence, confirming the benefit and safety of protocol with level I evidence and solving administrative issues by setting up dedicated multi-disciplinary ERAS teams.
e18745 Background: We report our experience of implementation of ERAS protocol in patients undergoing CRS and HIPEC for peritoneal carcinomatosis. Methods: ERAS protocol for CRS± HIPEC was implemented in 90 patients from January 2021 to October 2022. We documented compliance rate and analysed the reason for non-compliance, effect of compliance on length of hospital stay, postoperative complications and readmission rate and compared the same with the 95 patients who had CRS HIPEC before adopting ERAS protocol from January 2019 to December 2020. Results: Of 185 patients in the study, 95 were in pre eras group and 90 in ERAS group. Demography, pre-operative and operative parameters were comparable between the groups. The average compliance rate achieved for entire cohort was 78.5%. Lowest compliance rates were seen for post-operative elements especially, early feeding and early mobilization. After implementation of ERAS, median length of hospital stay reduced from 12 to 9 days, length of ICU stay reduced from 4 to 2 days and postoperative complications sepsis reduced from 14.7% to 7%, respiratory complications 15.7% to 7%, surgical complications 10.5% to 2.9%, resurgery from 6.3% to 1.4% and in hospital mortality reduced from 5.3% to 1.4%. The ERAS group didn’t receive any long acting opioids, less usage of intraoperative crystalloids(7ml/kg/hr vs 13ml/kg/hr, p = 0.0001),early extubation and less readmission rates. Conclusions: The implementation of ERAS protocol is safe and feasible for CRS and HIPEC patients. Implementation of ERAS program has significantly reduced the length of hospital stay, length of ICU stay and postoperative morbidity.
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