BackgroundColorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on complications after surgery for colorectal cancer in our population.MethodsA retrospective review of all patients who underwent surgery for pathologically confirmed colorectal cancer at Aga Khan University Hospital, Karachi between January 1999 and December 2008 was conducted. Using a cut-off of 70 years, patients were divided into two groups. Patient demographics, tumor characteristics and postoperative complications and 30-day mortality were compared. Multivariate logistic regression analysis was performed with clinically relevant variables to determine whether age had an independent and significant association with the outcome.ResultsA total of 271 files were reviewed, of which 56 belonged to elderly patients (≥ 70 years). The gender ratio was equal in both groups. Elderly patients had a significantly higher comorbidity status, Charlson score and American society of anesthesiologists (ASA) class (all p < 0.001). Upon multivariate analysis, factors associated with more complications were ASA status (95% CI = 1.30-6.25), preoperative perforation (95% CI = 1.94-48.0) and rectal tumors (95% CI = 1.21-5.34). Old age was significantly associated with systemic complications upon univariate analysis (p = 0.05), however, this association vanished upon multivariate analysis (p = 0.36).ConclusionOlder patients have more co-morbid conditions and higher ASA scores, but increasing age itself is not independently associated with complications after surgery for CRC. Therefore patient selection should focus on the clinical status and ASA class of the patient rather than age.
Over the past decade, enhanced preoperative imaging and visualization, improved delineation of the complex anatomical structures of the liver and pancreas, and intra-operative technological advances have helped deliver the liver and pancreatic surgery with increased safety and better postoperative outcomes. Artificial intelligence (AI) has a major role to play in 3D visualization, virtual simulation, augmented reality that helps in the training of surgeons and the future delivery of conventional, laparoscopic, and robotic hepatobiliary and pancreatic (HPB) surgery; artificial neural networks and machine learning has the potential to revolutionize individualized patient care during the preoperative imaging, and postoperative surveillance. In this paper, we reviewed the existing evidence and outlined the potential for applying AI in the perioperative care of patients undergoing HPB surgery.
81.2% mild); jaundice was observed in 62 patients. Preoperative radiologic imaging was done in 43 patients (CT scan in 7.1%, MRI in 31.3%). There were 70 transcystic and 42 transductal choledochoscopies with a median IQR operative time of 77.5 (110e65) vs. 122.5 (140e94) minutes, p < 0.001. T-tubes were placed only in 13 (11.5%) patients. Complete clearance of the bile duct was achieved in 91.1% leading to a conversion rate of 2.7%; in 6.2% of cases additional postoperative ERCP was performed. Readmission and ERCP for missed stones was needed in 3.6% of all cases. The overall postoperative complication rate reached 6.3%. The median IQR overall hospital stay was 9 (14e7) days. Conclusions: One-stage surgical approach is rational in the management of patients with a high risk of CBD stones.
Pancreatic cancer is one of the most aggressive malignancies nowadays. 1 It accounts for 3% of new cases per annum, 2 and it is fourth leading cause of deaths in the west due to malignancy. Pancreatic cancer has a poor prognosis with 5 years survival <5%, 3 despite active surgical treatment. With newer modalities of treat-ment, outcomes of pancreatic cancer still remain poor and has changed very little in the last three decades. Surgery is the mainstay of treatment; but adjuvant chemotherapy is essential for long term survival. Risk factors for pancreatic cancer are smoking, 4 alcohol, chronic pancreatitis and diabetes mellitus, 5 however exact cause remains unknown.With the advancement of cross-sectional imaging technology, more pancreatic and periampullary tumors are being diagnosed, thus leading to more pancreatic resections. 6,7 Pancreaticoduodenectomy is the surgical procedure of choice for benign and malignant periampullary and pancreatic head tumors. 8 It is a complex surgical procedure associated with major complications including pancreatic fistula, delayed gastric emptying,
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