Dr. Sreejith P. S

Table of Contents
DR. SREEJITH P. S
Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer
Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017
Preoperative Risk Factors for Conversion of

Laparoscopic Cholecystectomy to Open Surgery –
A Systematic Review and Meta-Analysis of
Observational Studies . Journal of digestive surgery Dig Surg 2016;33:414–423
Excision of both pre treatment marked positive nodes and

sentinel nodes improves axillary staging after neoadjuvant
systemic therapy in breast cancer BJS 2019; 106: 1632–1639
Meta-analysis of the effect of extending the interval after

long-course chemoradiotherapy before surgery in locally
advanced rectal cancer BJS DOI: 10.1002/bjs.11220
Evaluation of The New ISGLS Definitions of Typical

Posthepatectomy Complications .
DOI: 10.1177/1457496918798202
journals.sagepub.com/home/sjs
Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

tumours after treatment with imatinib R. Tielen et al. / EJSO 39 (2013) 150e155
EARLY vs LATE STOMA
CLOSURE
The objective was to study morbidity and mortality associated with early
closure (8–13 days) of a temporary stoma compared with standard procedure
(closure after > 12 weeks) after rectal resection for cancer.
Methods: Early closure (8–13 days after stoma creation) of a temporary

ileostomy was compared with late closure (>12 weeks) in a multicenter
randomized controlled trial, EASY (www.clinicaltrials.gov, NCT01287637)
including patients undergoing rectal resection for cancer. Patients with a
temporary ileostomy without signs of postoperative complications were
randomized to closure at 8 to 13 days or late closure (>12 weeks after index
surgery). Clinical data were collected up to 12 months. Complications were
registered according to the Clavien-Dindo Classification of Surgical
Complications, and Comprehensive Complication Index was calculated.
Results: The trial included 127 patients in eight Danish and Swedish surgical
departments, and 112 patients were available for analysis. The mean number
of complications after index surgery up to 12 months follow up was
significantly lower in the intervention group (1.2) compared with the control
group (2.9), P < 0.0001.
Conclusions: It is safe to close a temporary ileostomy 8 to 13 days after

Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017




DOI: 10.1177/1457496918798202

PREDICTORS OF DIFFICULT

CHOLECYSTECTOMY/CONVERSIO
N
PubMed and Embasewere searched systematically in March 2014. Observational studies evaluating
preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery in patients with
gallstone disease were included. The outcome variables extracted were patient demographics, medical
history, severity of gallstone disease, and preoperative laboratory values.
Results: A total of 1,393 studies were screened for eligibility.We found 32 studies, including 460,995
patients operated with laparoscopic cholecystectomy, eligible for the systematic review. Of these, 10
studies were suitable for 7 meta-analyses on age, gender, body mass index, previous abdominal surgery,
severity of disease, white blood cellcount, and gallbladder wall thickness.
Conclusions: A gallbladder wall thicker than 4–5 mm, a contracted gallbladder, age above 60 or 65,
male gender, and acute cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy
to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell
count and conversion to open surgery
Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017




DOI: 10.1177/1457496918798202

POST NACT NODE NEGATIVE AXILLA
This was a multicentre retrospective analysis of patients with clinically node-positive

breast cancer undergoing neo-adjuvant systemic therapy and the combination
procedure (with or without axillary lymph node dissection). The identification rate and
detection of axillary residual disease were calculated for the combination procedure,
and for MLNs and SLNs separately.
Results: At least one MLN and/or SLN(s) were identified by the combination
procedure in 138 of 139 patients (identification rate 99 ⋅3 per cent). The identification
rate was 92⋅8 per cent for MLNs alone and 87⋅8 per cent for SLNs alone. In 88 of 139
patients (63⋅3 per cent) residual axillary disease was detected by the combination
procedure. Residual disease was shown only in the MLN in 20 of 88 patients (23
percent) and only in the SLN in ten of 88 (11 per cent), whereas both the MLN and SLN
contained residual disease in the remainder (58 of 88, 66 per cent).
Conclusion: Excision of the pre-treatment-positive MLN together with SLNs after

neo-adjuvant systemic therapy in patients with clinically node-positive disease resulted
in a higher identification rate and improved detection of residual axillary disease
Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017




DOI: 10.1177/1457496918798202


REASONABLE GAP BETWEEN NCRT TO TME
 A systematic search was performed for studies reporting oncological results that
compared the classical interval (less than 8weeks) from the end of nCRT to TME with a
minimum 8-week interval in patients with LARC. The primary endpoint was the rate of
pathological complete response (pCR). Secondary endpoints were recurrence-free
survival, local recurrence and distant metastasis rates, R0 resection rates,
completeness of TME, margin positivity, sphincter preservation, stoma formation,
anastomotic leak and other complications. A meta-analysis was performed using the
Mantel–Haenszel method.
 Results: Twenty-six publications, including four RCTs, with 25 445 patients were
identified. A minimum 8-week interval was associated with increased odds of pCR
(odds ratio (OR) 1⋅41, 95 per cent c.i. 1⋅30 to 1⋅52; P <0⋅001) and tumour downstaging
(OR 1⋅18, 1⋅05 to 1⋅32; P = 0⋅004). R0 resection rates, TME completeness, lymph node
yield, sphincter preservation, stoma formation and complication rates were similar
between the two groups. The increased rate of pCR translated to reduced distant
metastasis(OR 0⋅71, 0⋅54 to 0⋅93; P = 0⋅01) and overall recurrence (OR 0⋅76, 0⋅58 to
0⋅98; P = 0⋅04), but not local recurrence (OR 0⋅83, 0⋅49 to 1⋅42; P = 0⋅50).
 Conclusion: A minimum 8-week interval from the end of nCRT to TME increases
pCR and downstaging rates, and improves recurrence-free survival without
compromising surgical morbidity.
Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017




Post hepatectomy Complications .
DOI: 10.1177/1457496918798202

ISGLS DEFENITION- SIMPLE BUT DEPENDABLE
A total of 415 patients underwent hepatic surgery between 2004 and 2014. Uni and
multivariate analyses were made for correlations of post hepatectomy hemorrhage, post
hepatectomy liver failure, and bile leakage with perioperative parameters and mortality.
Results: Of the total, 25 (6.1%) patients developed a post hepatectomy hemorrhage Grade
A, 3 (0.7%) patients a post hepatectomy hemorrhage Grade B, and 1 (0.2%) patient a
posthepatectomy hemorrhage Grade C;
23 (5.5%) patients had a post hepatectomy liver failure Grade A, 24 (5.8%) patients a
posthepatectomy liver failure Grade B, and 7 patients (1.6%) a posthepatectomy liver
failure Grade C.
 Bile leakage Grade A occurred in 10 (2.4%) patients, bile leakage Grade B in 24 (5.8%)
patients, and bile leakage Grade C in 7 (1.6%) patients.
Mortality was significantly increased in patients with posthepatectomy hemorrhage
Grades B and C and in patients with posthepatectomy liver failure Grades A,B, and C.
Three (42.9%) patients with bile leakage Grade C died.
Conclusion: Our data indicate that the new definitions correlate well with mortality and
duration of hospital stay.
Annals of Surgery
DOI:10.1097/SLA.0000000000001829
2017




Post hepatectomy Complications .
DOI: 10.1177/1457496918798202

NEOADJUVANT IMATINIB – DELAYING THE SURGERY
IS ACCEPTED
Patients with locally advanced gastrointestinal stromal tumours (GISTs) have a high risk of tumour
perforation, incomplete tumour resections and often require multivisceral resections. Long-term
disease-free and overall survival is usually impaired in this group of patients. Induction therapy
with imatinib followed by surgery seems to be beneficial in terms of improved surgical results and
long-term outcome. We report on a large cohort of locally advanced GIST patients who have been
treated in four centres in the Netherlands specialized in the treatment of sarcomas.
Methods: Between August 2001 and June 2011, 57 patients underwent surgery for locally
advanced GISTs after imatinib treatment. Data of all patients were retrospectively collected.
Endpoints were progression-free and overall survival.
Results: The patients underwent surgery after a median of 8 (range 1e55) months of imatinib
treatment. Median tumour size before treatment was 12.2 (range 5.2e30) cm and reduced to 6.2
(range 1e20) cm before surgery. No tumour perforation occurred and a surgical complete (R0)
resection was achieved in 48 (84%) patients. Five-year PFS and OS were 77% and 88%. Eight
patients had recurrent/metastatic disease.
Conclusions: Imatinib in locally advanced GIST is feasible and enables a high complete resection
rate without tumour rupture. The combination of imatinib and surgery in patients with locally
advanced GIST seems to improve PFS and OS.

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Table of Contents

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

Methods: Early closure (8–13 days after stoma creation) of a temporary

Conclusions: It is safe to close a temporary ileostomy 8 to 13 days after

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

This was a multicentre retrospective analysis of patients with clinically node-positive

Conclusion: Excision of the pre-treatment-positive MLN together with SLNs after

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

Preoperative Risk Factors for Conversion of

Excision of both pre treatment marked positive nodes and

Meta-analysis of the effect of extending the interval after

Evaluation of The New ISGLS Definitions of Typical

Surgical treatment of locally advanced, non-metastatic, gastrointestinal stromal

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