Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training.In this situation,virtual reality technology can help the new nurses.Despite its potential benefits,there are studies on patient satisfaction but there is limited information on the usability of virtual reality(VR)technology for new nurses in giving preoperative education to patients.AIM To investigate the impact on satisfaction,usability,and burnout of a system using VR technology in preoperative patient education.METHODS The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019.Each nurse taught four patients:Two using traditional verbal education and two using virtual reality.The System Usability Scale,After-Scenario Questionnaire,and Maslach Burnout Inventory(MBI)were employed to evaluate the impact of these education methods.RESULTS The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups.Among the three subscales of the MBI,emotional exhaustion and personal accomplishment improved statistically significantly.VR was also better in terms of usability.CONCLUSION This study suggests VR enhances usability and reduces burnout in nurses,but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Combined preoperative albumin bilirubin score and hepatectomy percentage for evaluate the liver regeneration after partial hepatectomy

Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.

Enhancing preoperative patient education through virtual reality:A leap forward in nursing practice

Integration of virtual reality(VR)technology into preoperative patient education has shown potential to improve nursing practice.The study by Kim et al examines the impact of VR on nurse satisfaction,usability,and burnout.A prospective study involving 20 nurses and 80 patients was conducted,comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital.Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses,while also reducing emotional exhaustion,a critical factor in nurse burnout.Consistency in education quality was also improved,ensuring uniform patient care.These results underscore the importance of VR in reducing the stress of repetitive tasks,improving job satisfaction,and potentially enhancing nurse retention.Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice.The study by Kim et al highlights VR’s transformative potential in preoperative education for both patients and healthcare providers.

Hepatic perivascular epithelioid cell tumors:The importance of preoperative diagnosis

Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the causes,properties and clinical manifestations of PEComas,we summarize the challenges and solutions in the diagnosis of PEComas.

Malnutrition Assessed Using the Geriatric Nutritional Risk Index Is Associated with Preoperative Incidence of Deep Vein Thrombosis in Japanese Patients Undergoing Total Knee Arthroplasty

Purpose: Few studies have evaluated the association between malnutrition and the risk of preoperative deep vein thrombosis (DVT) in patients undergoing primary total joint arthroplasty. This study aimed to investigate the prevalence of preoperative DVT in Japanese patients undergoing total knee arthroplasty (TKA) and the importance of malnutrition in the risk of preoperative DVT. Methods: We retrospectively analyzed 394 patients admitted for primary TKA at our institution between January 2019 and December 2023. All patients scheduled for TKA at our institution had serum D-dimer levels measured preoperatively. Lower-limb ultrasonography was examined to confirm the presence of DVT in patients with D-dimer levels ≥ 1.0 µg/mL or who were considered to be at high risk of DVT by the treating physician. Based on the results of lower-limb ultrasonography, all patients were divided into the non-DVT and DVT groups. The incidence of and risk factors for preoperative DVT were investigated, as well as the correlation of DVT with the patient’s nutritional parameters. We used two representative tools for nutritional assessment: the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status Score. Results: The mean age was 77.8 ± 6.9 years. Preoperative DVT was diagnosed in 57 of the 394 (14.5%) patients. Multivariate logistic regression analysis showed that advanced age and malnutrition status, assessed using the GNRI, were independent risk factors for preoperative DVT. Conclusion: A high incidence of preoperative DVT was observed in patients who underwent TKA. Malnutrition status, as assessed using the GNRI, increased the risk of preoperative DVT. Our findings suggest that clinicians should consider these factors when tailoring preventive strategies to mitigate DVT risk in patients undergoing TKA.

Tumour response following preoperative chemotherapy is affected by body mass index in patients with colorectal liver metastases

BACKGROUND Colorectal cancer is the third most prevalent malignancy globally and ranks second in cancer-related mortality,with the liver being the primary organ of metastasis.Preoperative chemotherapy is widely recommended for initially or potentially resectable colorectal liver metastases(CRLMs).Tumour pathological response serves as the most important and intuitive indicator for assessing the efficacy of chemotherapy.However,the postoperative pathological results reveal that a considerable number of patients exhibit a poor response to preoperative chemotherapy.Body mass index(BMI)is one of the factors affecting the tumori-genesis and progression of colorectal cancer as well as prognosis after various antitumour therapies.Several studies have indicated that overweight and obese patients with metastatic colorectal cancer experience worse prognoses than those with normal weight,particularly when receiving first-line chemotherapy regimens in combination with bevacizumab.AIM To explore the predictive value of BMI regarding the pathologic response following preoperative chemotherapy for CRLMs.METHODS A retrospective analysis was performed in 126 consecutive patients with CRLM who underwent hepatectomy following preoperative chemotherapy at four different hospitals from October 2019 to July 2023.Univariate and multivariate logistic regression models were applied to analyse potential predictors of tumour pathological response.The Kaplan-Meier method with log rank test was used to compare progression-free survival(PFS)between patients with high and low BMI.BMI<24.0 kg/m^(2) was defined as low BMI,and tumour regression grade 1-2 was defined as complete tumour response.RESULTS Low BMI was observed in 74(58.7%)patients and complete tumour response was found in 27(21.4%)patients.The rate of complete tumour response was significantly higher in patients with low BMI(29.7%vs 9.6%,P=0.007).Multivariate analysis revealed that low BMI[odds ratio(OR)=4.56,95%confidence interval(CI):1.42-14.63,P=0.011],targeted therapy with bevacizumab(OR=3.02,95%CI:1.10-8.33,P=0.033),preoperative carcinoembryonic antigen level<10 ng/mL(OR=3.84,95%CI:1.19-12.44,P=0.025)and severe sinusoidal dilatation(OR=0.17,95%CI:0.03-0.90,P=0.037)were independent predictive factors for complete tumour response.The low BMI group exhibited a significantly longer median PFS than the high BMI group(10.7 mo vs 4.7 mo,P=0.011).CONCLUSION In CRLM patients receiving preoperative chemotherapy,a low BMI may be associated with better tumour response and longer PFS.

Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy:A singlecenter retrospective study

BACKGROUND The population of elderly patients with gastric cancer is increasing,which is a major public health issue in China.Malnutrition is one of the greatest risk factors for adverse clinical outcomes in elderly patients with gastric cancer.AIM To investigate the preoperative nutritional status and its association with delayed discharge of elderly gastric cancer patients following radical gastrectomy.METHODS A total of 783 patients aged 65 years and older harboring gastric adenocarcinoma and following radical gastrectomy were retrospectively analyzed from the prospectively collected database of Zhongshan Hospital of Fudan University between January 2018 and May 2020.RESULTS The overall rate of malnutrition was 31.8%.The incidence of postoperative complications was significantly higher in the malnourished group compared to the well-nourished group(P<0.001).Nutritional characteristics in the malnourished group,including body mass index,prognostic nutritional index(PNI),albumin,prealbumin,and hemoglobin,were all significantly lower than those in the well-nourished group.The percentage of patients who received postoperative total nutrient admixture was lower in the malnourished group compared to the wellnourished group(22.1%vs 33.5%,P=0.001).Age≥70 years(HR=1.216,95%CI:1.048-1.411),PNI<44.5(HR=1.792,95%CI:1.058-3.032),operation time≥160 minutes(HR=1.431,95%CI:1.237-1.656),and postoperative complications grade III or higher(HR=2.191,95%CI:1.604-2.991)were all recognized as independent risk factors associated with delayed discharge.CONCLUSION Malnutrition is relatively common in elderly patients undergoing gastrectomy.Low PNI is an independent risk factor associated with delay discharge.More strategies are needed to improve the clinical outcome of these patients.

Effects of fluid therapy combined with a preoperative glucose load regimen on postoperative recovery in patients with rectal cancer

BACKGROUND Patients with rectal cancer undergoing radical resection often have poor post-operative recovery due to preoperative fasting and water deprivation and the removal of diseased tissue,and have a high risk of complications.Therefore,it is of great significance to apply appropriate rehydration regimens to patients un-dergoing radical resection of rectal cancer during the perioperative period to improve the postoperative outcomes of patients.AIM To analyze the effects of goal-directed fluid therapy(GDFT)with a preoperative glucose load regimen on postoperative recovery and complications in patients undergoing radical resection for rectal cancer.METHODS Patients with rectal cancer who underwent radical resection(n=184)between January 2021 and December 2023 at our hospital were randomly divided into either a control group or an observation group(n=92 in each group).Both groups received a preoperative glucose load regimen,and routine fluid replacement and GDFT were additionally implements in the control and observation groups,res-pectively.The operative conditions,blood levels of lactic acid and inflammatory markers,postoperative recovery,cognitive status,hemodynamic indicators,brain oxygen metabolism,and complication rates were compared between the groups.RESULTS The colloidal fluid dosage,total infusion,and urine volume,as well as time to first exhaust,time to food intake,and postoperative length of hospital stay,were lower in the observation group(P<0.05).No significant differences were observed between the two groups in terms of operation time,bleeding volume,crystalloid liquid consumption,time to tracheal extubation,complication rate,heart rate,or mean arterial pressure(P>0.05).Compared with the control group,in the ob-servation group the lactic acid level was lower immediately after the surgery(P<0.05);the Mini-Mental State Examination score was higher on postoperative day 3(P<0.05);the pulse pressure variability(PPV)was lower at 30 min after pneumoperitoneum(P<0.05),though the differences in the PPV of the two groups was not significant at the remaining time points(P>0.05);tumor necrosis factor-αand interleukin-6 levels were lower on postoperative day 3(P<0.05);and the left and right regional cerebral oxygen saturation was higher immediately after the surgery and 30 min after pneumoperitoneum(P<0.05).CONCLUSION GDFT combined with the preoperative glucose load regimen is a safe and effective treatment strategy for im-proving postoperative recovery and risk of complications in patients with rectal cancer undergoing radical re-section.

Three-dimensional printing for preoperative rehearsal and intraoperative navigation during laparoscopic rectal cancer surgery with left colic artery preservation

BACKGROUND Prior studies have shown that preserving the left colic artery(LCA)during laparo-scopic radical resection for rectal cancer(RC)can reduce the occurrence of anasto-motic leakage(AL),without compromising oncological outcomes.However,anatomical variations in the branches of the inferior mesenteric artery(IMA)and LCA present significant surgical challenges.In this study,we present our novel three dimensional(3D)printed IMA model designed to facilitate preoperative rehearsal and intraoperative navigation to analyze its impact on surgical safety.AIM To investigate the effect of 3D IMA models on preserving the LCA during RC surgery.METHODS We retrospectively collected clinical dates from patients with RC who underwent laparoscopic radical resection from January 2022 to May 2024 at Fuyang People’s Hospital.Patients were divided into the 3D printing and control groups for sta-tistical analysis of perioperative characteristics.RESULTS The 3D printing observation group comprised of 72 patients,while the control group comprised 68 patients.The operation time(174.5±38.2 minutes vs 198.5±49.6 minutes,P=0.002),intraoperative blood loss(43.9±31.3 mL vs 58.2±30.8 mL,P=0.005),duration of hospitalization(13.1±3.1 days vs 15.9±5.6 days,P<0.001),postoperative recovery time(8.6±2.6 days vs 10.5±4.9 days,P=0.007),and the postoperative complication rate(P<0.05)were all significantly lower in the observation group.CONCLUSION Utilization of a 3D-printed IMA model in laparoscopic radical resection of RC can assist surgeons in understanding the LCA anatomy preoperatively,thereby reducing intraoperative bleeding and shortening operating time,demonstrating better clinical application potential.

Preoperative malnutrition in elderly gastric cancer patients and adverse postoperative outcomes of radical gastrectomy

Malnutrition is not only a prevalent condition among the elderly but also a common comorbidity in elderly people with gastric cancer(GC).Malnutrition is closely linked to high rates of postoperative complications and poor wound healing in elderly GC patients,which may lead to a higher incidence and mor-tality rate of GC.Malnutrition decreases the physical function of elderly GC patients after surgery,severely affecting their postoperative life quality and hindering subsequent treatments.This retrospective study was conducted by Zhao et al,focusing on the clinical baseline data,postoperative complications,and hospitalization times of elderly GC patients who underwent curative gastrectomy.Additionally,the underlying causes of poor outcomes for patients were discussed.This study may provide a solid basis for the clinical treatment of elderly GC patients in the future.Therefore,malnutrition can serve as a negative prognostic factor for curative surgery in GC patients.Addressing malnutrition and its adverse effects can benefit elderly GC patients from surgical treatment.

Influence of static cartoons combined with dynamic virtual environments on preoperative anxiety of preschool-aged children undergoing surgery

BACKGROUND Preschoolers become anxious when they are about to undergo anesthesia and surgery,warranting the development of more appropriate and effective interventions.AIM To explore the effect of static cartoons combined with dynamic virtual environments on preoperative anxiety and anesthesia induction compliance in preschool-aged children undergoing surgery.METHODS One hundred and sixteen preschool-aged children were selected and assigned to the drug(n=37),intervention(n=40),and control(n=39)groups.All the children received routine preoperative checkups and nursing before being transferred to the preoperative preparation room on the day of the operation.The drug group received 0.5 mg/kg midazolam and the intervention group treatment consisting of static cartoons combined with dynamic virtual environments.The control group received no intervention.The modified Yale Preoperative Anxiety Scale was used to evaluate the children’s anxiety level on the day before surgery(T0),before leaving the preoperative preparation room(T1),when entering the operating room(T2),and at anesthesia induction(T3).Compliance during anesthesia induction(T3)was evaluated using the Induction Compliance Checklist(ICC).Changes in mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)were also recorded at each time point.RESULTS The anxiety scores of the three groups increased variously at T1 and T2.At T3,both the drug and intervention groups had similar anxiety scores,both of which were lower than those in the control group.At T1 and T2,MAP,HR,and RR of the three groups increased.The drug and control groups had significantly higher MAP and RR than the intervention group at T2.At T3,the MAP,HR,and RR of the drug group decreased and were significantly lower than those in the control group but were comparable to those in the intervention group.Both the drug and intervention groups had similar ICC scores and duration of anesthesia induction(T3),both of which were higher than those of the control group.CONCLUSION Combining static cartoons with dynamic virtual environments as effective as medication,specifically midazolam,in reducing preoperative anxiety and fear in preschool-aged children.This approach also improve their compliance during anesthesia induction and helped maintain their stable vital signs.

Association of preoperative antiviral treatment with incidences of post-hepatectomy liver failure in hepatitis B virus-related hepatocellular carcinoma

BACKGROUND Post-hepatectomy liver failure(PHLF)is a common consequence of radical partial hepatectomy in hepatocellular carcinoma(HCC).AIMS To investigate the relationship between preoperative antiviral therapy and PHLF,as well as assess the potential efficacy of hepatitis B virus(HBV)DNA level in predicting PHLF.METHODS A retrospective study was performed involving 1301 HCC patients with HBV who underwent radical hepatectomy.Receiver operating characteristic(ROC)analysis was used to assess the capacity of HBV DNA to predict PHLF and establish the optimal cutoff value for subsequent analyses.Logistic regression analyses were performed to assess the independent risk factors of PHLF.The increase in the area under the ROC curve,categorical net reclassification improvement(NRI),and integrated discrimination improvement(IDI)were used to quantify the efficacy of HBV DNA level for predicting PHLF.The P<0.05 was considered statistically significant.RESULTS Logistic regression analyses showed that preoperative antiviral therapy was independently associated with a reduced risk of PHLF(P<0.05).HBV DNA level with an optimal cutoff value of 269 IU/mL(P<0.001)was an independent risk factor of PHLF.All the reference models by adding the variable of HBV DNA level had an improvement in area under the curve,categorical NRI,and IDI,particularly for the fibrosis-4 model,with values of 0.729(95%CI:0.705-0.754),1.382(95%CI:1.341-1.423),and 0.112(95%CI:0.110-0.114),respectively.All the above findings were statistically significant.CONCLUSION In summary,preoperative antiviral treatment can reduce the incidence of PHLF,whereas an increased preoperative HBV DNA level has a correlative relationship with an increased susceptibility to PHLF.

Impact of preoperative therapy on surgical outcomes of laparoscopic total gastrectomy for gastric/gastroesophageal junction cancer

Objective: As laparoscopic surgery is widely applied for primarily treated gastric cancer(GC)/gastroesophageal junction cancer(GEJC) and gains many advantages, the feasibility of laparoscopic total gastrectomy(LTG) for GC/GEJC patients who have received preoperative therapy(PT) has come to the fore. This study aims to analyze the safety and feasibility of LTG after PT for GC/GEJC patients.Methods: We retrospectively analyzed the data of 511 patients with GC/GEJC undergoing LTG, of which 405received LTG(LTG group) and 106 received PT+LTG(PT-LTG group) at Nanfang Hospital between June 2018and September 2022. The surgical outcomes were compared between the two groups.Results: The surgical duration was significantly longer in the PT-LTG group(P<0.001), while the incidence of intraoperative complications(P=1.000), postoperative complications(LTG group vs. PT-LTG group: 26.2% vs.23.6%, P=0.587), the classification of complication severity(P=0.271), and postoperative recovery was similar between two groups. Notably, the incidence of anastomotic complications of esophagojejunostomy was also comparable between the two groups(LTG group vs. PT-LTG group: 5.9% vs. 5.7%, P=0.918). The univariate and multivariate analysis confirmed that positive proximal margin [positive vs. negative: odds ratio(OR)=14.094, 95%confidence interval(95% CI): 2.639-75.260, P=0.002], rather than PT, has an impact on anastomotic complications after LTG(OR=0.945, 95% CI: 0.371-2.408, P=0.905).Conclusions: PT did not increase the surgical risk of LTG for GC/GEJC. Therefore, considering the positive effect of PT on long-term survival, the broader application of PT and LTG for GC/GEJC is supported by our findings.

Efficacy and safety of preoperative immunotherapy in patients with mismatch repair-deficient or microsatellite instability-high gastrointestinal malignancies

BACKGROUND Programmed death protein(PD)-1 blockade immunotherapy significantly prolongs survival in patients with metastatic mismatch repair-deficient(dMMR)/microsatellite instability-high(MSI-H)gastrointestinal malignancies such gastric and colorectal cancer.However,the data on preoperative immunotherapy are limited.AIM To evaluate the short-term efficacy and toxicity of preoperative PD-1 blockade immunotherapy.METHODS In this retrospective study,we enrolled 36 patients with dMMR/MSI-H gastrointestinal malignancies.All the patients received PD-1 blockade with or without chemotherapy of CapOx regime preoperatively.PD1 blockade 200 mg was given intravenously over 30 min on day 1 of each 21-d cycle.RESULTS Three patients with locally advanced gastric cancer achieved pathological complete response(pCR).Three patients with locally advanced duodenal carcinoma achieved clinical complete response(cCR),followed by watch and wait.Eight of 16 patients with locally advanced colon cancer achieved pCR.All four patients with liver metastasis from colon cancer reached CR,including three with pCR and one with cCR.pCR was achieved in two of five patients with nonliver metastatic colorectal cancer.CR was achieved in four of five patients with low rectal cancer,including three with cCR and one with pCR.cCR was achieved in seven of 36 cases,among which,six were selected for watch and wait strategy.No cCR was observed in gastric or colon cancer.CONCLUSION Preoperative PD-1 blockade immunotherapy in dMMR/MSI-H gastrointestinal malignancies can achieve a high CR,especially in patients with duodenal or low rectal cancer,and can achieve high organ function protection.

Preoperative Fasting of More Than 14 Hours Increases the Risk of Time-to-Death after Cardiothoracic Surgery in Children:A Retrospective Cohort Study

Background:Prolonged preoperative fasting can cause hypoglycemia,hyperglycemia,and intravascular volume depletion in children.We aimed to examine whether prolonged preoperative fasting is associated with in-hospital mortality and other morbidities in pediatric cardiothoracic surgery.Methods:This retrospective cohort study included children aged 0–3 years who underwent cardiac surgery between July 2014 and October 2020.The patient demographic data,surgery-related and anesthesia-related factors,and postoperative outcomes,including hypoglycemia,hyperglycemia,sepsis,length of intensive care unit stay,and in-hospital mortality,were recorded.The main exposure and outcome variables were prolonged fasting and time-to-death after surgery,respectively.The associations between prolonged fasting and perioperative death were analyzed using multivariate Cox regression analysis.Results:In total,402 patients were recruited.The incidence of perioperative mortality was 21%(85/402).The proportion of perioperative deaths was significantly higher in the prolonged fasting group than that in the normal fasting group.The proportion of postoperative bacteremia and hypoglycemia was significantly higher in the very prolonged fasting group than that in the prolonged fasting group.After adjusting for preoperative conditions and anesthesia-and surgery-related factors,preoperative prolonged fasting>14.4 h was significantly associated with time-to-death(HR[95%CI]:2.2[1.2,3.9],p=0.036).The 30-day survival rates of fasting time>14.4 h,9.25–14.4 h,and<9.25 h were 0.67(0.55,0.81),0.79(0.72,0.87),and 0.85(0.79,0.91),respectively.Conclusions:Preoperative fasting of more than 14.4 h was associated with a two-fold increase in the hazard rate of time-to-death in children who underwent cardiac surgery.

Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors

Objective To investigate the clinical symptoms experienced by patients with thoracic spinal tumors and verify the associated symptoms that are predictive of a decline in muscle strength in the lower limbs.Methods A single-center,retrospective cross-sectional study was conducted on in-patients diagnosed with epidural thoracic spinal tumors between January 2011 and May 2021.The study involved a review of electronic medical records and radiographs and the collection of clinical data.The differences in clinical manifestations between patients with constipation and those without constipation were analyzed.Binary logistic regression analyses were performed to identify risk factors associated with a decline in muscle strength in the lower limbs.Results A total of 227 patients were enrolled,including 131 patients with constipation and 96 without constipation.The constipation group had a significantly higher proportion of patients who experienced difficulty walking or paralysis compared to those without constipation prior to surgery(83.2%vs.17.7%,χ~2=99.035,P 0.001).Constipation(OR=9.522,95%CI:4.150±21.849,P 0.001)and urinary retention(OR=14.490,95%CI:4.543±46.213,P 0.001)were independent risk factors for muscle strength decline in the lower limbs.Conclusions The study observed that patients with thoracic spinal tumors who experienced constipation symptoms had a higher incidence of lower limb weakness.Moreover,the analysis revealed that constipation and urinary retention were independent risk factors associated with a preoperative decline in muscle strength of lower limbs.

Preoperative risk modelling for oesophagectomy: A systematic review

BACKGROUND Oesophageal cancer is a frequently observed and lethal malignancy worldwide.Surgical resection remains a realistic option for curative intent in the early stages of the disease.However,the decision to undertake oesophagectomy is significant as it exposes the patient to a substantial risk of morbidity and mortality.Therefore,appropriate patient selection,counselling and resource allocation is important.Many tools have been developed to aid surgeons in appropriate decision-making.AIM To examine all multivariate risk models that use preoperative and intraoperative information and establish which have the most clinical utility.METHODS A systematic review of the MEDLINE,EMBASE and Cochrane databases was conducted from 2000-2020.The search terms applied were((Oesophagectomy)AND(Risk OR predict OR model OR score)AND(Outcomes OR complications OR morbidity OR mortality OR length of stay OR anastomotic leak)).The applied inclusion criteria were articles assessing multivariate based tools using exclusively preoperatively available data to predict perioperative patient outcomes following oesophagectomy.The exclusion criteria were publications that described models requiring intra-operative or post-operative data and articles appraising only univariate predictors such as American Society of Anesthesiologists score,cardiopulmonary fitness or pre-operative sarcopenia.Articles that exclusively assessed distant outcomes such as long-term survival were excluded as were publications using cohorts mixed with other surgical procedures.The articles generated from each search were collated,processed and then reported in accordance with PRISMA guidelines.All risk models were appraised for clinical credibility,methodological quality,performance,validation,and clinical effectiveness.RESULTS The initial search of composite databases yielded 8715 articles which reduced to 5827 following the deduplication process.After title and abstract screening,197 potentially relevant texts were retrieved for detailed review.Twenty-seven published studies were ultimately included which examined twenty-one multivariate risk models utilising exclusively preoperative data.Most models examined were clinically credible and were constructed with sound methodological quality,but model performance was often insufficient to prognosticate patient outcomes.Three risk models were identified as being promising in predicting perioperative mortality,including the National Quality Improvement Project surgical risk calculator,revised STS score and the Takeuchi model.Two studies predicted perioperative major morbidity,including the predicting postoperative complications score and prognostic nutritional index-multivariate models.Many of these models require external validation and demonstration of clinical effectiveness.CONCLUSION Whilst there are several promising models in predicting perioperative oesophagectomy outcomes,more research is needed to confirm their validity and demonstrate improved clinical outcomes with the adoption of these models.

Summary of the Best Evidence for Preoperative Pre-Rehabilitation in Patients with Lung Cancer Complicated with COPD

Objective: To search, evaluate and integrate the best domestic and foreign evidence on the preoperative pre-rehabilitation of lung cancer patients with COPD, and summarize the best evidence. Methods: Cochrane Library, BMJ Best Practice, JBI Center for International Cooperation in Evidence-Based Health Care Library, and Up to were searched by computer system Date, Embase, CINAHL, PubMed, Evidence-Based Health Care Center Database (JBI), American Guidenet, Global Guidenet, CNKI, CMBM, Wanfang, and VIP databases on preoperative pre-rehabilitation of patients with lung cancer and COPD. Literature screening and quality evaluation were conducted independently by two researchers, and evidence was extracted, summarized and summarized according to the theme. Results: A total of 13 kinds of literature were included, including 4 guidelines, 4 systematic reviews, 3 evidence summaries, and 2 expert consensus articles. This paper summarizes 44 best evidence on pre-rehabilitation of lung cancer patients with COPD, including 8 aspects: pre-rehabilitation content and principle, pre-rehabilitation assessment, exercise rehabilitation, nutrition management, psychological guidance, health education, multidisciplinary cooperation, quality control and follow-up. Conclusion: The best evidence of preoperative pre-rehabilitation for patients with lung cancer complicated with COPD is rich in content, and needs to be selected according to the characteristics of the hospital and the clinical environment. Some of the evidence still needs to be confirmed by higher-quality studies. .

New trends in the surgical management of soft tissue sarcoma: The role of preoperative biopsy

Soft tissue sarcoma(STS)accounts for 1%of all malignant neoplasms in adults.Their diagnosis and management constitute a challenging target.They originate from the mesenchyme,and 50 subtypes with various cytogenetic profiles concerning soft tissue and bones have been recognized.These tumors mainly affect middle-aged adults but may be present at any age.Half of the patients have metastatic disease at the time of diagnosis and require systemic therapy.Tumors above 3-5 cm in size must be suspected of potential malignancy.A thorough history,clinical examination and imaging that must precede biopsy are necessary.Modern imaging techniques include ultrasound,computed tomography(CT),new magnetic resonance imaging(MRI),and positron emission tomography/CT.MRI findings may distinguish low-grade from high-grade STS based on a diagnostic score(tumor heterogeneity,intratumoral and peritumoral enhancement).A score≥2 indicates a high-grade lesion,and a score≤1 indicates a lowgrade lesion.For disease staging,abdominal imaging is recommended to detect early abdominal or retroperitoneal metastases.Liquid biopsy by detecting genomic material in serum is a novel diagnostic tool.A preoperative biopsy is necessary for diagnosis,prognosis and optimal planning of surgical intervention.Core needle biopsy is the most indicative and effective.Its correct performance influences surgical management.An unsuccessful biopsy means the dissemination of cancer cells into healthy anatomical structures that ultimately affect resectability and survival.Complete therapeutic excision(R0)with an acceptable resection margin of 1 cm is the method of choice.However,near significant structures,i.e.,vessels,nerves,an R2 resection(macroscopic margin involvement)preserving functionality but having a risk of local recurrence can be an acceptable choice,after informing the patient,to prevent an unavoidable amputation.For borderline resectability of the tumor,neoadjuvant chemo/radiotherapy has a place.Likewise,after surgical excision,adjuvant therapy is indicated,but chemotherapy in nonmetastatic disease is still debatable.The five-year survival rate reaches up to 55%.Reresection is considered after positive or uncertain resection margins.Current strategies are based on novel chemotherapeutic agents,improved radiotherapy applications to limit local side effects and targeted biological therapy or immunotherapy,including vaccines.Young age is a risk factor for distant metastasis within 6 mo following primary tumor resection.Neoadjuvant radiotherapy lasting 5-6 wk and surgical resection are indicated for highgrade STS(grade 2 or 3).Wide surgical excision alone may be acceptable for patients older than 70 years.However,locally advanced disease requires a multidisciplinary task of decision-making for amputation or limb salvage.

Preoperative carbohydrate load to reduce perioperative glycemic variability and improve surgical outcomes:A scoping review

The detrimental effects of both diabetes mellitus(DM)and hyperglycemia in the perioperative period are well established and have driven extensive efforts to control blood glucose concentration(BGC)in a variety of clinical settings.It is now appreciated that acute BGC spikes,hypoglycemia,and high glycemic variability(GV)lead to more endothelial dysfunction and oxidative stress than uncomplicated,chronically elevated BGC.In the perioperative setting,fasting is the primary approach to reducing the risk for pulmonary aspiration;however,prolonged fasting drives the body into a catabolic state and therefore may increase GV.Elevated GV in the perioperative period is associated with an increased risk for postoperative complications,including morbidity and mortality.These challenges pose a conundrum for the management of patients typically instructed to fast for at least 8 h before surgery.Preliminary evidence suggests that the administration of an oral preoperative carbohydrate load(PCL)to stimulate endogenous insulin production and reduce GV in the perioperative period may attenuate BGC spikes and ultimately decrease postoperative morbidity,without significantly increasing the risk of pulmonary aspiration.The aim of this scoping review is to summarize the available evidence on the impact of PCL on perioperative GV and surgical outcomes,with an emphasis on evidence pertaining to patients with DM.The clinical relevance of GV will be summarized,the relationship between GV and postoperative course will be explored,and the impact of PCL on GV and surgical outcomes will be presented.A total of 13 articles,presented in three sections,were chosen for inclusion.This scoping review concludes that the benefits of a PCL outweigh the risks in most patients,even in those with well controlled type 2 DM.The administration of a PCL might effectively minimize metabolic derangements such as GV and ultimately result in reduced postoperative morbidity and mortality,but this remains to be proven.Future efforts to standardize the content and timing of a PCL are needed.Ultimately,a rigorous data-driven consensus opinion regarding PCL administration that identifies optimal carbohydrate content,volume,and timing of ingestion should be established.