Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

INTRODUCTIONA scientific congress is an environment in which physicians with the same specialty and other health staff participate in, the results of which is shared as abstracts, and in which ideas are exchanged with one another. The abstracts presented in scientific congresses (oral/poster) are evaluated by the commissions that are assigned by the congress scientific committee during the preparation period of the congress and it is decided if the studies will be accepted in the congress or not.The publication of abstracts in national/international peer-reviewed journals after the congress is one of the indicators of the scientific value of the congress. In a Cochrane meta-analysis published in 2007, it was stated that the publication rate of the abstracts presented in a congress was 44.5% (1). Articles evaluating the conversion rate of the abstracts presented in international congresses into publications are limited. Similarly, the number of studies that are conducted in order to reveal the scientific efficiency of national congresses held in our country is also low. In these studies, it is reported that the conversion rate of the abstracts presented in the congresses to publications is very limited (between 5.7% and 28.6%) (2-7).Turkish Society of Colorectal Surgery (TSCRS) organizes periodic scientific activities in order to develop the professional, scientific and social relationships between its members in accordance with its aims. The congresses of TSCRS, which are organized once in two years, are one of the important scientific activities. In our study, we aimed to define the conversion rate of the abstracts presented in the congresses organized in 2003, 2007, 2009 and 2011 to articles in peer-reviewed journals, to determine the factors (presentation type, study type, congress year etc.) effecting publication rate. MATERIAL AND METHODSThe abstracts of oral presentations (OP) and poster presentations (PP) presented at the TSCRS congresses in

Pneumoperitoneum is often caused by visceral perforation, and usually manifests with symptoms of peritonitis requiring surgical intervention. Non-surgical spontaneous pneumoperitoneum (ie. not associated with organ perforation) is a rare entity due to intrathoracic, intra-abdominal, gynecologic, iatrogenic or other reasons, and is usually treated conservatively. Idiopathic spontaneous pneumoperitoneum is even rarer than visceral perforation or other causes of free intra-abdominal air. In this report, we present a case of idiopathic spontaneous pneumoperitoneum. A seventy-five-year-old female patient presented with acute abdominal pain, low-grade fever, and nausea. Her abdominal examination findings were vague, and she did not have leukocytosis. Free intra-abdominal air was detected on plain X-ray, she was followed-up with cessation of oral intake, nasogastric tube, fluid resuscitation and prophylactic antibiotics for one day. There were no signs of acute abdomen except diffuse abdominal tenderness by deep palpation on the first day examination. There was a mild leukocytosis with a shift to the left in leukocytes, and pneumoperitoneum on abdominal X-ray. The abdominal computed tomography revealed free intra-abdominal air and minimal free fluid in Douglas pouch. Her past medical history revealed cholecystectomy (10 years ago) with no chronic diseases, regular medications, smoking, or alcohol consumption. The patient underwent emergency laparotomy. Despite lack of an identifiable cause and uncertainty of etiology, the patient was discharged on postoperative day 5. A thorough medical history, appropriate laboratory tests and radiological techniques and physical examination should be combined for identification of patients with non-surgical pneumoperitoneum, and avoid unnecessary laparotomy, while minimally invasive techniques such as laparoscopy should be considered as part of evaluation.