Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
The objective of this study is to evaluate the efficacy of the Harmonic ACE, Harmonic FOCUS and harmonic scalpel with 5-mm curved blade in head and neck surgery. During a 15-month period, we performed 295 thyroidectomies, 23 parotidectomies and 45 tonsillectomies using the harmonic scalpel. Control group consisted of 106 thyroidectomies, 9 parotidectomies and 30 tonsillectomies performed with the use of conventional hemostatic techniques. The use of both Harmonic ACE and Harmonic FOCUS scalpel reduced the time of thyroid and parotid surgery by 20-25%. The use of Harmonic ACE reduced the mean time of tonsillectomy, while the use of 5-mm curved blade had no significant effect. Postoperative pain and complication rate were comparable for both the groups. In conclusion, the use of both Harmonic ACE and Harmonic FOCUS devices significantly reduces operative time in the head and neck procedures and enables a smaller neck skin incision in thyroidectomy.
Objective: To investigate the role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of cervical metastases in papillary thyroid cancer. Our hypothesis is that level of expression of MMPs and TIMPs is associated with the development of cervical metastases and the pattern of metastatic process in papillary thyroid cancer.Design: This research retrospectively investigates the expression of MMP-1, -2 and -9 as well as TIMP-1 and -2 in papillary thyroid carcinoma tissue. Tissue specimens were immunohistochemically treated with primary monoclonal antibodies against MMP-1, MMP-2, MMP-9, TIMP-1 and TIMP-2.Setting: Single-centre study.Participants: In total, samples of 159 patients were analysed. In all patients, total thyroidectomy was performed, whereas 102 patients underwent selective neck dissection of either central (level VI) or lateral neck (level II-V). Subjects were divided into four groups. Main outcome measures: Matrix metalloproteinases and TIMPs expression valueswere analysed in each group, and groups were compared to each other.Results: Total number of patients was 159, of which 125 were women and 34 men.Comparing expression levels of MMPs and TIMPs in metastatic (study groups) and non-metastatic (control group), papillary thyroid carcinomas yielded significant differences in MMP-1 and TIMP-1 expression levels, where the highest expression values were found in the group with metastasis in lateral neck. Expression levels of MMP-2, MMP-9 and TIMP-2 did not differ statistically significant among the groups. Conclusion:Elevated expression of MMP-1 and TIMP-1 in tumour tissue can be considered a predictive factor for the development of metastases.
OBJECTIVE:Although PET-CT has been shown to have diagnostic and staging value for the head and neck carcinoma, it still has deficiencies to give an optimal level of sensitivity and specificity. High levels of false positivity continue to be the biggest clinical challenge. This study evaluates the impact of major clinicopathologic factors on PET-CT findings in the primary and lymph node metastatic head and neck carcinoma. METHOD: Retrospective chart review of a case series at Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute: 243 oral cavity (OC) and laryngopharyngeal carcinoma patients who underwent PET CT and neck dissections in the 3 consecutive years were included in the study. Major primary site was OC followed by oropharynx (OP), larynx and hypoharynx (HP) and carcinoma of unknown primary (CUP). RESULTS: Oral cavity and OP were the two major primary sites (70.3%, nϭ171), followed by larynx, CUP, and HP. 111 patients (45.6 %) were determined to be clinically Nϩ at the time of preoperative evaluation, while pathological Nϩ was detected in 36.2% of patients. Correlation of the PET CT SUV value and the clinicopathologic factors like the size of the largest lymph node, number of positive lymph nodes, extracapsular spread, tumor grade, primary site, size and depth of infiltration of the primary tumor, lymphatic and perineural invasion are all compared; correlation was found with the size and depth of infiltration of the tumor, and number of positive lymph node. Perineural (pϭ0.013) and lymphatic invasion (pϭ0.0093), and extracapsular spread (pϽ0.0001) was significantly altering the SUV value. CONCLUSION: Most of the adverse features of the current pathologic staging system are shown to have significant impact on the PET CT findings. Complication Rates in Stapled vs Suture Closure LaryngectomyLarry Myers, MD (presenter); Deborah Larrison, MD OBJECTIVE: Surgical technique, or fear of increased risk of complications including infection and fistula. The purpose of this study was to examine complication rates with the use of the linear stapling device compared with traditional suture techniques during laryngectomy in a matched cohort of patients. METHOD: This investigation was a retrospective, matched cohort design. The records of all patients undergoing total laryngectomy by the senior author were reviewed from 2002 to 2007. Criteria for inclusion in the study were as follows: Patients must have undergone total laryngectomy within the study period. Only patients with endolaryngeal disease or disease amenable to primary closure were included in the study cohort. This resulted in a total of 42 patients being included in the study. Of these, 26 patients underwent traditional suture closure of the pharynx and 16 patients underwent closure with the linear stapling device. Demographic data, clinical data, treatment data, and outcome data were retrospectively collected and stored in an Excel v12.2 database (Microsoft). Data were analyzed using SPSS v16.0 statistical softwa...
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