Featured Articles in Apr 2019

Relative Value of Adapted Novel Bibliometrics in Evaluating Surgical Academic Impact and Reach

 

 

Author list David B. T. Robinson, Luke Hopkins, Chris Brown, Tarig Abdelrahman, Arfon G. Powell, Richard J. Egan, Wyn G. Lewis

 

Abstract

 

Background

The Hirsch index, often used to assess research impact, suffers from questionable validity within the context of General Surgery, and consequently adapted bibliometrics and altmetrics have emerged, including the r-index, m-index, g-index and i10-index. This study aimed to assess the relative value of these novel bibliometrics in a single UK Deanery General Surgical Consultant cohort.

 

Method

Five indices (h, r, m, g and i10) and altmetric scores (AS) were calculated for 151 general surgical consultants in a UK Deanery. Indices and AS were calculated from publication data via the Scopus search engine with assessment of construct validity and reliability.

 

Results

The median number of publications, h-index, r-index, m-index, g-index and i10-index were 13 (range 0–389), 5 (range 0–63), 5.2 (range 0–64.8), 0.33 (range 0–1.5), 10 (range 0–125) and 4 (range 0–245), respectively. Correlation coefficients of r-index, m-index, g-index and i10-index with h-index were 0.913 (p < 0.001), 0.716 (p < 0.001), 0.961 (p < 0.001) and 0.939 (p < 0.001), respectively. Significant variance was observed when the cohort was ranked by individual bibliometric measures; the median ranking shifts were: r-index − 2 (− 46 to + 23); m-index − 6.5 (− 53 to + 22); g-index − 0.5 (− 24 to + 13); and i10-index 0 (− 8 to + 11), respectively (p < 0.001). The median altmetric score and AS index were 0 (range 0–225.5) and 1 (range 0–10), respectively; AS index correlated strongly with h-index (correlation coefficient 0.390, p < 0.001).

 

Conclusions

Adapted bibliometric indices appear to be equally valid measures of evaluating academic productivity, impact and reach.

 

URL https://rdcu.be/bpQtH

 


Robotic Versus Conventional Laparoscopic Surgery for Colorectal Cancer: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

 

 

Author list Ka Ting Ng, Azlan Kok Vui Tsia, Vanessa Yu Ling Chong

 

Abstract

 

Background

Minimally invasive surgery has been considered as an alternative to open surgery by surgeons for colorectal cancer. However, the efficacy and safety profiles of robotic and conventional laparoscopic surgery for colorectal cancer remain unclear in the literature. The primary aim of this review was to determine whether robotic-assisted laparoscopic surgery (RAS) has better clinical outcomes for colorectal cancer patients than conventional laparoscopic surgery (CLS).

 

Methods

All randomized clinical trials (RCTs) and observational studies were systematically searched in the databases of CENTRAL, EMBASE and PubMed from their inception until January 2018. Case reports, case series and non-systematic reviews were excluded.

 

Results

Seventy-three studies (6 RCTs and 67 observational studies) were eligible (n = 169,236) for inclusion in the data synthesis. In comparison with the CLS arm, RAS cohort was associated with a significant reduction in the incidence of conversion to open surgery (ρ < 0.001, I2 = 65%; REM: OR 0.40; 95% CI 0.30,0.53), all-cause mortality (ρ < 0.001, I2 = 7%; FEM: OR 0.48; 95% CI 0.36,0.64) and wound infection (ρ < 0.001, I2 = 0%; FEM: OR 1.24; 95% CI 1.11,1.39). Patients who received RAS had a significantly shorter duration of hospitalization (ρ < 0.001, I2 = 94%; REM: MD − 0.77; 95% CI 1.12, − 0.41; day), time to oral diet (ρ < 0.001, I2 = 60%; REM: MD − 0.43; 95% CI − 0.64, − 0.21; day) and lesser intraoperative blood loss (ρ = 0.01, I2 = 88%; REM: MD − 18.05; 95% CI − 32.24, − 3.85; ml). However, RAS cohort was noted to require a significant longer duration of operative time (ρ < 0.001, I2 = 93%; REM: MD 38.19; 95% CI 28.78,47.60; min).

 

Conclusions

This meta-analysis suggests that RAS provides better clinical outcomes for colorectal cancer patients as compared to the CLS at the expense of longer duration of operative time. However, the inconclusive trial sequential analysis and an overall low level of evidence in this review warrant future adequately powered RCTs to draw firm conclusion.

 

URL https://rdcu.be/bpQxi

 


Hurdles to Take for Adequate Treatment of Morbidly Obese Children and Adolescents: Attitudes of General Practitioners Towards Conservative and Surgical Treatment of Paediatric Morbid Obesity

 

 

Author list Yvonne G. M. Roebroek, Ali Talib, Jean W. M. Muris, Francois M. H. van Dielen, Nicole D. Bouvy, L. W. Ernest van Heurn

Abstract

 

Background

Bariatric surgery is regarded as the most effective treatment of morbid obesity in adults. Referral patterns for bariatric surgery in adults differ among general practitioners (GPs), partially due to restricted knowledge of the available treatment options. Reluctance in referral might be present even stronger in the treatment of morbidly obese children.

 

Objectives

The aim of this study was to investigate the current practice of GPs regarding treatment of paediatric morbid obesity and their attitudes towards the emergent phenomenon of paediatric weight loss surgery.

 

Methods

All GPs enlisted in the local registries of two medical centres were invited for a 15-question anonymous online survey.

 

Results

Among 534 invited GPs, 184 (34.5%) completed the survey. Only 102 (55.4%) reported providing or referring morbidly obese children for combined lifestyle interventions. A majority (n = 175, 95.1%) estimated that conservative treatment is effective in a maximum of 50% of children. Although 123 (66.8%) expect that bariatric surgery may be effective in therapy-resistant morbid obesity, only 76 (41.3%) would consider referral for surgery. Important reasons for reluctance were uncertainty about long-term efficacy and safety. The opinion that surgery is only treatment of symptoms and therefore not appropriate was significantly more prevalent amongst GPs who would not refer (58.3% vs. 27.6%, p < 0.001).

 

Conclusion

There is a potential for undertreatment of morbidly obese adolescents, due to suboptimal knowledge regarding guidelines and bariatric surgery, as well as negative attitudes towards surgery. This should be addressed by improving communication between surgeons and GPs and providing educational resources on bariatric surgery.

 

URL https://rdcu.be/bpRgb

 


Surgical Resection for Recurrent Intrahepatic Cholangiocarcinoma

 

 

Author list Fabian Bartsch, Markus Paschold, Janine Baumgart, Maria Hoppe-Lotichius, Stefan Heinrich, Hauke Lang

 

Abstract

 

Background

Although after R0 resection of intrahepatic cholangiocarcinoma (ICC) recurrence is frequent, most guidelines do not address strategies for this. The aim of this study was to analyze the outcome of repeated resection and to determine criteria when repeated resection is reasonable.

 

Methods

Between 2008 and 2016, we consecutively collected all cases of ICC (n = 176) in a prospective database and further analyzed them with a focus on tumor recurrence, its surgical treatment, overall survival and recurrence-free survival.

 

Results

Overall, a total of 22 explorations were performed for recurrent ICC in 17 patients. Resection rate was 18 repeated resections in 13 patients. Three patients underwent repeated resection twice and one patient three times. Recurrence was solitary in 7 patients and multifocal in 11 re-resected cases. Median overall survival (OS) of patients who underwent repeated resection was 65.2 months (interquartile range 37–126.5) with a 5-year OS rate of 62%, calculated from primary resection. Patients who underwent repeated resections had a significant better OS compared to those receiving chemotherapy, transarterial chemoembolization, selective internal radiotherapy, radiofrequency ablation or best supportive care (p < 0.001).

 

Conclusion

Repeated resection of recurrent ICC is reasonable and associated with an improved survival. Re-exploration should be considered as long as resection is technically possible.

 

URL https://rdcu.be/bpRgT

 


Surgical Management of the Axilla in Breast Cancer Patients with Negative Sentinel Lymph Node: A Method to Reduce False-Negative Rate

 

 

Author list Qianqian Yuan, Gaosong Wu, Shu-Yuan Xiao, Yukun He, Kun Wang, Dan Zhang

 

Abstract

 

Background

False-negative rate (FNR) of sentinel lymph node dissection (SLND) has not been eliminated. The study was conducted to optimize the surgical resection of axilla in patients with negative sentinel lymph node (SLN) for the purpose of eradicating false-negative (FN) events of SLND.

 

Methods

A total of 312 clinically node-negative patients without neoadjuvant therapy underwent SLND with indocyanine green (ICG), methylene blue and the combination of ICG and methylene blue. Axillary dissection was performed subsequently regardless of the status of SLN. Lymph nodes were sent for pathological examination separately by serial resection every 0.5 cm away from marginally visualized SLNs.

 

Results

SLND was successfully conducted in 98.1% (306/312) of patients using methylene blue, ICG, and its combination. Further examination revealed 97 true-positive, 189 true-negative, and 13 FN results. The overall FNR was 11.8% (13/110). A horizontal line 1.5 cm away from the superior vSLN and a vertical line 1.5 cm away from the medial vSLN formed a zone of lower outer quadrant (LOQ) in axilla. Surgical resection of LOQ ‘en bloc’ showed a FNR of zero.

 

Conclusions

The surgical management of axilla may benefit negative SLN patients with potential nodal involvement, reducing the FNR of SLND to zero.

 

 

URL https://rdcu.be/bpRhO

 


Transoral Robotic Thyroidectomy for Papillary Thyroid Carcinoma: Perioperative Outcomes of 100 Consecutive Patients

 

 

Author list Hong Kyu Kim, Young Jun Chai, Gianlorenzo Dionigi, Eren Berber, Ralph P. Tufano, Hoon Yub Kim

 

Abstract

 

Background

Endoscopic transoral thyroidectomy is a recently introduced technique of remote access thyroidectomy. We previously reported the feasibility of the robotic approach (TORT). Nevertheless, experience to date is limited, with scant data on outcomes in patients with papillary thyroid carcinoma (PTC).

 

Methods

This was a retrospective analysis of prospectively collected data. Patients with PTC, who underwent TORT at a single center between March 2016 and February 2017, were analyzed.

 

Results

There were a total of 100 patients (85 women, 15 men) with a mean age of 40.7 ± 9.8 years, and a mean tumor size of 0.8 ± 0.5 cm. Nine patients underwent a total thyroidectomy, and 91 underwent a lobectomy. The operative time for a total thyroidectomy and lobectomy was 270.0 ± 9.3 and 210.8 ± 32.9 min, respectively. Ipsilateral prophylactic central neck compartment dissection was performed routinely with retrieval of 5.0 ± 3.6 lymph nodes. Perioperative morbidity was present in nine patients including transient recurrent laryngeal nerve palsy (n = 1), postoperative bleeding requiring surgical intervention (n = 1), zygomatic bruising (n = 2), chin flap perforation (n = 1), oral commissure tearing (n = 2), and chin dimpling (n = 2). There was no conversion to endoscopic or conventional open thyroid surgery.

 

Conclusion

In this study, TORT could be safely performed in a large series of patients with PTC without serious complications. In selected patients, TORT by experienced surgeons could be considered an alternative approach for remote access thyroidectomy.

 

URL https://rdcu.be/bpRiU

 


Early Laparoscopic Washout may Resolve Persistent Intra-abdominal Infection Post-appendicectomy

 

 

Author list Matthew G. R. Allaway, Kristenne Clement, Guy D. Eslick, Michael R. Cox

 

Abstract

 

Background

Intra-abdominal abscess (IAA) complicates 2–3% of patients having an appendicectomy. The usual management is prolonged antibiotics and drainage of the IAA. From 2006, our unit chose to use early re-laparoscopy and washout in patients with persistent sepsis following appendicectomy. The aims of this study were to assess the outcomes of early laparoscopic washout in patients with features of persistent intra-abdominal sepsis and compare those with percutaneous drainage and open drainage of post-appendicectomy IAA.

 

Methods

A retrospective case note review was performed for all patients having a laparoscopic washout, percutaneous drainage or open drainage following appendicectomy between January 2006 and December 2017.

 

Results

During the period, 4901 appendicectomies occurred. Forty-one (0.8%) patients had a laparoscopic washout, 16 (0.3%) had percutaneous drainage, and 6 (0.1%) had an open drainage. The demographics, ASA grade and pathology at initial appendicectomy were similar. The mean time after appendicectomy was significantly shorter for laparoscopic washout (4.1 days vs. 10.1 and 9.0 days, p = <0.003). The mean time for resolution of SIRS was significantly shorter (2.0 days vs. 3.3 and 5.2 days, p <0.02). The morbidity and length of stay were similar.

 

Conclusion

Early laparoscopic washout for persistent intra-abdominal sepsis may be an alternative to non-operative management and delayed intervention for IAA and may have better outcomes than either percutaneous drainage or open drainage. A prospective randomised comparison is required to further evaluate the indications and role of early laparoscopic washout post-appendicectomy.

 

URL https://rdcu.be/bpRjB

 


 

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