Publications by authors named "Nicolas Demartines"

368 Publications

Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass: Incidence, Risk Factors, and Management - a 21-Year Experience.

Obes Surg 2022 Aug 6. Epub 2022 Aug 6.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.

Purpose: Morbidity and mortality associated with bariatric surgery are considered low. The aim of this study is to assess the incidence, clinical presentation, risk factors, and management of early postoperative bleeding (POB) after laparoscopic Roux-en-Y gastric by-pass (RYGB).

Materials And Methods: Retrospective analysis of prospectively collected data of consecutive patients who underwent RYGB in 2 expert bariatric centers between January 1999 and April 2020, with a common bariatric surgeon.

Results: A total of 2639 patients underwent RYGB and were included in the study. POB occurred in 72 patients (2.7%). Intraluminal bleeding (ILB) was present in 52 (72%) patients and extra-luminal bleeding (ELB) in 20 (28%) patients. POB took place within the first 3 postoperative days in 79% of patients. The most frequent symptom was tachycardia (63%). Abdominal pain was more regularly seen with ILB, compared to ELB (50% vs. 20%, respectively, p = 0.02). Male sex was an independent risk factor of POB on multivariate analysis (p < 0.01). LOS was significantly longer in patients who developed POB (8.3 vs. 3.8 days, p < 0.01). Management was conservative for most cases (68%). Eighteen patients with ILB (35%) and 5 patients with ELB (25%) required reoperation. One patient died from multiorgan failure after staple-line dehiscence of the excluded stomach (mortality 0.04%).

Conclusion: The incidence of POB is low, yet it is the most frequent postoperative complication after RYGB. Most POB can be managed conservatively while surgical treatment is required for patients with hemodynamic instability or signs of intestinal obstruction due to an intraluminal clot.
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http://dx.doi.org/10.1007/s11695-022-06173-yDOI Listing
August 2022

Early enteral vs. oral nutrition after Whipple procedure: Study protocol for a multicentric randomized controlled trial (NUTRIWHI trial).

Front Oncol 2022 28;12:855784. Epub 2022 Jun 28.

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.

Background: Malnutrition has been shown to be a risk factor for postoperative complications after pancreatoduodenectomy (PD). In addition, patients needing a PD, such as patients with pancreatic cancer or chronic pancreatitis, often are malnourished. The best route of postoperative nutrition after PD remains unknown. The aim of this randomized controlled trial is to evaluate if early postoperative enteral nutrition can decrease complications after PD compared to oral nutrition.

Methods: This multicenter, open-label, randomized controlled trial will include 128 patients undergoing PD with a nutritional risk screening ≥3. Patients will be randomized 1:1 using variable block randomization stratified by center to receive either early enteral nutrition (intervention group) or oral nutrition (control group) after PD. Patients in the intervention group will receive enteral nutrition since the first night of the operation (250 ml/12 h), and enteral nutrition will be increased daily if tolerated until 1000 ml/12 h. The primary outcome will be the Comprehensive Complication Index (CCI) at 90 days after PD.

Discussion: This study with its multicentric and randomized design will permit to establish if early postoperative enteral nutrition after PD improves postoperative outcomes compared to oral nutrition in malnourished patients.

Clinical Trial Registration: https://clinicaltrials.gov/(NCT05042882) Registration date: September 2021.
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http://dx.doi.org/10.3389/fonc.2022.855784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296100PMC
June 2022

Principles of enhanced recovery in gastrointestinal surgery.

Langenbecks Arch Surg 2022 Jul 21. Epub 2022 Jul 21.

Department of Visceral Surgery, Lausanne University Hospital CHUV and University of Lausanne UNIL, Lausanne, 1011, Switzerland.

Background: To reduce the impact of surgery-related stress, enhanced recovery after surgery (ERAS) pathways have been developed since over 15 years with subsequent improved postoperative outcome. This multimodal and evidence-based perioperative approach has spread to all fields of gastrointestinal surgery, from esophagus, stomach, duodenum and pancreas, liver, small intestine and colon, and rectum, as well as for other specialties like vascular and cardia surgeries or neurosurgery, among others.

Purpose: The aim of this state-of-the-art article is to assess current state of evidence on perioperative management specifically in gastrointestinal surgery, with a focus on surgery-related aspects, outcome benefit, and future directions.

Conclusion: The surgical team must promote continuous improvement of the patient's ERAS compliance to ensure optimal perioperative care. Everyday clinical practice should be performed according to latest evidence-based medicine and challenging surgical dogma. Moreover, the surgeon must lead and support a multidisciplinary and collaborative teamwork tailored to patient's need especially with anesthetists and nursing staff.
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http://dx.doi.org/10.1007/s00423-022-02602-9DOI Listing
July 2022

Reply to: Deep insight into lymph node metastasis in pancreatic ductal adenocarcinoma.

Eur J Surg Oncol 2022 Jun 25. Epub 2022 Jun 25.

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland.

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http://dx.doi.org/10.1016/j.ejso.2022.06.026DOI Listing
June 2022

[ERAS: perioperative care for the benefit of the patient].

Rev Med Suisse 2022 Jun;18(786):1218-1222

Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne.

During surgical procedures, surgery, and anesthesia lead to pathophysiological stress on the human body. The goal of perioperative medicine is to prepare patients and take all possible measures to reduce this pathophysiological stress. The emergence of ERAS over the past 15 years has made it possible to set up a multimodal program based on scientific evidence, showing that the adequate application of an improved rehabilitation program after surgery, ERAS-type, is possible in all surgical specialties, including gynecology, cardiac surgery, and neurosurgery. ERAS improves the quality of life of patients, reduces postoperative complications and lengths of stay, and finally, reduces costs. The purpose of this article is to show the most important elements of such an ERAS program by taking the example of digestive surgery.
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http://dx.doi.org/10.53738/REVMED.2022.18.786.1218DOI Listing
June 2022

[Convalescence after groin hernia surgery].

Rev Med Suisse 2022 Jun;18(786):1205-1207

Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne.

Inguinal hernia repair represents one of the most common operations in general surgery worldwide. It is performed either as open surgery using a transinguinal approach or as minimal invasive procedure using a preperitoneal (endoscopic) or transabdominal (laparoscopic) approach, respectively. A mesh is always placed to reinforce the abdominal wall of the groin. Most interventions are nowadays performed in an ambulatory setting, and a short convalescence with early return to daily activities and work is possible. However, postoperative care is not yet widely standardized, and subsequently, off work periods are still often prolonged up to several weeks. This article provides simple recommendations to shorten postoperative convalescence.
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http://dx.doi.org/10.53738/REVMED.2022.18.786.1205DOI Listing
June 2022

[Obstructed colon cancer: which strategy in 2022?]

Rev Med Suisse 2022 Jun;18(786):1192-1199

Service de chirurgie viscérale, Département de chirurgie, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne.

The key priority for obstructed colon cancer (OCC) is urgent resolution of the large bowel obstruction with ideally no compromise of oncological outcomes and low initial and permanent ostomy rates. Proactive management is pivotal to decrease the risk of perforation and septic shock. Staged procedures have an important place to provide optimal treatment and offer similar treatment and outcomes as in the elective setting. The approach is tailored to the patient's condition, the oncological situation and expertise of the available surgical team. This overview concludes by proposing a comprehensive treatment algorithm for individualized treatment of OCC.
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http://dx.doi.org/10.53738/REVMED.2022.18.786.1192DOI Listing
June 2022

Enhanced recovery in elderly patients undergoing pancreatic resection: A retrospective monocentric study.

Medicine (Baltimore) 2022 Jun 10;101(23):e29494. Epub 2022 Jun 10.

Department of Visceral Surgery, University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.

Abstract: Enhanced recovery after surgery (ERAS) pathway for pancreas has demonstrated its value in clinical practice. However, there is a lack of specific evidence about its application in elderly patients. The aim of the present study was to assess the impact of age on compliance and postoperative outcomes. Patients ≥70 years old that underwent pancreatic resection within an ERAS pathway between 2012 and 2018 were included, and divided into three groups: 70-74, 75-79, and ≥80 years old. Compliance with ERAS items, length of stay, mortality, and complications were analyzed. 114 patients were included: 49, 37, and 28 patients aged 70-74, 75-79, and ≥80 years, respectively. Overall compliance to ERAS items between groups was not different (66%, 66%, and 62%, P = .201). No significant difference was observed in terms of median length of stay (14, 17, and 17 days, P = .717), overall complications (67%, 78%, and 71%, P = .529), major complications (26%, 32%, and 39%, P = .507), or mortality (0%, 3%, and 4%, P = .448) with increasing age. Application of an ERAS pathway is feasible in elderly patients with pancreatic resection. Increasing age was neither associated with poorer compliance nor worse postoperative outcomes.
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http://dx.doi.org/10.1097/MD.0000000000029494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9276327PMC
June 2022

Basic Science with Preclinical Models to Investigate and Develop Liquid Biopsy: What Are the Available Data and Is It a Fruitful Approach?

Int J Mol Sci 2022 May 10;23(10). Epub 2022 May 10.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), CH-1011 Lausanne, Switzerland.

The molecular analysis of circulating analytes (circulating tumor-DNA (ctDNA), -cells (CTCs) and -RNA (ctRNA)/exosomes) deriving from solid tumors and detected in the bloodstream-referred as liquid biopsy-has emerged as one of the most promising concepts in cancer management. Compelling data have evidenced its pivotal contribution and unique polyvalence through multiple applications. These data essentially derived from translational research. Therewith, data on liquid biopsy in basic research with preclinical models are scarce, a concerning lack that has been widely acknowledged in the field. This report aimed to comprehensively review the available data on the topic, for each analyte. Only 17, 17 and 2 studies in basic research investigated ctDNA, CTCs and ctRNA/exosomes, respectively. Albeit rare, these studies displayed noteworthy relevance, demonstrating the capacity to investigate questions related to the biology underlying analytes release that could not be explored via translational research with human samples. Translational, clinical and technological sectors of liquid biopsy may benefit from basic research and should take note of some important findings generated by these studies. Overall, results underscored the need to intensify the efforts to conduct future studies on liquid biopsy in basic research with new preclinical models.
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http://dx.doi.org/10.3390/ijms23105343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9141279PMC
May 2022

External validation of three lymph node ratio-based nomograms predicting survival using an international cohort of patients with resected pancreatic head ductal adenocarcinoma.

Eur J Surg Oncol 2022 May 15. Epub 2022 May 15.

Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland.

Introduction: Lymph node ratio (LNR) is an important prognostic factor of survival in patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to validate three LNR-based nomograms using an international cohort.

Materials And Methods: Consecutive PDAC patients who underwent upfront pancreatoduodenectomy from six centers (Europe/USA) were collected (2000-2017). Patients with metastases, R2 resection, missing LNR data, and who died within 90 postoperative days were excluded. The updated Amsterdam nomogram, the nomogram by Pu et al., and the nomogram by Li et al. were selected. For the validation, calibration, discrimination capacity, and clinical utility were assessed.

Results: After exclusion of 176 patients, 1'113 patients were included. Median overall survival (OS) of the cohort was 23 months (95% CI: 21-25). For the three nomograms, Kaplan-Meier curves showed significant OS diminution with increasing scores (p < 0.01). All nomograms showed good calibration (non-significant Hosmer-Lemeshow tests). For the Amsterdam nomogram, area under the ROC curve (AUROC) for 3-year OS was 0.64 and 0.67 for 5-year OS. Sensitivity and specificity for 3-year OS prediction were 65% and 59%. Regarding the nomogram by Pu et al., AUROC for 3- and 5-year OS were 0.66 and 0.70. Sensitivity and specificity for 3-year OS prediction were 68% and 53%. For the Li nomogram, AUROC for 3- and 5-year OS were 0.67 and 0.71, while sensitivity and specificity for 3-year OS prediction were 63% and 60%.

Conclusion: The three nomograms were validated using an international cohort. Those nomograms can be used in clinical practice to evaluate survival after pancreatoduodenectomy for PDAC.
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http://dx.doi.org/10.1016/j.ejso.2022.05.002DOI Listing
May 2022

Impact of an Operating Room Nurse Preoperative Dialogue on Anxiety, Satisfaction and Early Postoperative Outcomes in Patients Undergoing Major Visceral Surgery-A Single Center, Open-Label, Randomized Controlled Trial.

J Clin Med 2022 Mar 29;11(7). Epub 2022 Mar 29.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), 1011 Lausanne, Switzerland.

Background: Anxiety is common before surgery and known to negatively impact recovery from surgery. The aim of this study was to evaluate the impact of a preoperative nurse dialogue on a patient's anxiety, satisfaction and early postoperative outcomes.

Method: This 1:1 randomized controlled trial compared patients undergoing major visceral surgery after a semistructured preoperative nurse dialogue (interventional group: IG) to a control group (CG) without nursing intervention prior to surgery. Anxiety was measured with the autoevaluation scale State-Trait Anxiety Inventory (STAI, Y-form) pre and postoperatively. The European Organization for Research and Treatment of Cancer (EORTC) In-Patsat32 questionnaire was used to assess patient satisfaction at discharge. Further outcomes included postoperative pain (visual analogue scale: VAS 0-10), postoperative nausea and vomiting (PONV), opiate consumption and length of stay (LOS).

Results: Over a period of 6 months, 35 participants were randomized to either group with no drop-out or loss to follow-up (total = 70). The median score of preoperative anxiety was 40 (IQR 33-55) in the IG vs. 61 (IQR 52-68) in the CG ( < 0.001). Postoperative anxiety levels were comparable 34 (IQR 25-46) vs. 32 (IQR 25-44) for IG and CG, respectively ( = 0.579). The IG did not present higher overall satisfaction (90 ± 15 vs. 82.9 ± 16, = 0.057), and pain at Day 2 was similar (1.3 ± 1.7 vs. 2 ± 1.9, = 0.077), while opiate consumption, PONV levels and LOS were comparable.

Conclusion: A preoperative dialogue with a patient-centered approach helped to reduce preoperative anxiety in patients undergoing major visceral surgery.
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http://dx.doi.org/10.3390/jcm11071895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999599PMC
March 2022

Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness.

BMC Sports Sci Med Rehabil 2022 Apr 7;14(1):61. Epub 2022 Apr 7.

Department of Sports Medicine, Swiss Olympic Medical Center, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.

Background: Prehabilitation may improve postoperative clinical outcomes among patients undergoing major abdominal surgery. This study evaluated the potential effects of a high-intensity interval training (HIIT) program performed before major abdominal surgery on patients' cardiorespiratory fitness and functional ability (secondary outcomes of pilot trial NCT02953119).

Methods: Patients were included before surgery to engage in a low-volume HIIT program with 3 sessions per week for 3 weeks. Cardiopulmonary exercise and 6-min walk (6MWT) testing were performed pre- and post-prehabilitation.

Results: Fourteen patients completed an average of 8.6 ± 2.2 (mean ± SD) sessions during a period of 27.9 ± 6.1 days. After the program, [Formula: see text]O peak (+ 2.4 ml min kg, 95% CI 0.8-3.9, p = 0.006), maximal aerobic power (+ 16.8 W, 95% CI 8.2-25.3, p = 0.001), [Formula: see text]O at anaerobic threshold (+ 1.2 ml min kg, 95%CI 0.4-2.1, p = 0.009) and power at anaerobic threshold (+ 12.4 W, 95%CI 4.8-20, p = 0.004) were improved. These changes were not accompanied by improved functional capacity (6MWT: + 2.6 m, 95% CI (- 19.6) to 24.8, p = 0.800).

Conclusion: A short low-volume HIIT program increases cardiorespiratory fitness but not walking capacity in patients scheduled for major abdominal surgery. These results need to be confirmed by larger studies.
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http://dx.doi.org/10.1186/s13102-022-00454-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8991597PMC
April 2022

Early postoperative outcomes of staging laparoscopy for peritoneal metastases with or without pressurized intra-peritoneal aerosol chemotherapy (PIPAC).

BMC Surg 2022 Mar 30;22(1):122. Epub 2022 Mar 30.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon, 46, 1005, Lausanne, Switzerland.

Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been introduced for palliative treatment of peritoneal surface malignancies (PSM) and is currently tested also in the neoadjuvant and prophylactic setting. The aim was therefore to compare safety and tolerance of staging laparoscopy with or without PIPAC.

Methods: This retrospective analysis compared consecutive patients undergoing staging laparoscopy alone for oesogastric cancer with patients having PIPAC for suspected PSM of various origins from January 2015 until January 2020. Safety was assessed by use of the Clavien classification for complications and CTCAE for capturing of adverse events. Pain and nausea were documented by use of a visual analogue scale (VAS: 0-10: maximal intensity).

Results: Overall, 25 PIPAC procedures were compared to 24 staging laparoscopies. PIPAC procedures took a median of 35 min (IQR: 25-67) longer. Four patients experienced at least one complication in either group (p = 0.741). No differences were noted for postoperative nausea (p = 0.961) and pain levels (p = 0.156). Median hospital stay was 2 (IQR: 1-3) for PIPAC and 1 (IQR: 1-2) for the laparoscopy group (p = 0.104).

Conclusions: The addition of PIPAC did not jeopardize safety and postoperative outcomes of staging laparoscopy alone. Further studies need to clarify its oncological benefits.
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http://dx.doi.org/10.1186/s12893-022-01572-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8969273PMC
March 2022

Simple Clinical Screening Underestimates Malnutrition in Surgical Patients with Inflammatory Bowel Disease-An ACS NSQIP Analysis.

Nutrients 2022 Feb 22;14(5). Epub 2022 Feb 22.

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Bugnon 46, 1011 Lausanne, Switzerland.

The present large scale study aimed to assess the prevalence and consequences of malnutrition, based on clinical assessment (body mass index and preoperative weight loss) and severe hypoalbuminemia (<3.1 g/L), in a representative US cohort undergoing IBD surgery. The American College of Surgeons National Quality improvement program (ACS-NSQIP) Public User Files (PUF) between 2005 and 2018 were assessed. A total of 25,431 patients were identified. Of those, 6560 (25.8%) patients had severe hypoalbuminemia, 380 (1.5%) patients met ESPEN 2 criteria (≥10% weight loss over 6 months PLUS BMI < 20 kg/m in patients <70 years OR BMI < 22 kg/m in patients ≥70 years), and 671 (2.6%) patients met both criteria (severe hypoalbuminemia and ESPEN 2). Patients who presented with malnutrition according to any of the three definitions had higher rates of overall, minor, major, surgical, and medical complications, longer LOS, higher mortality and higher rates of readmission and reoperation. The simple clinical assessment of malnutrition based on BMI and weight loss only, considerably underestimates its true prevalence of up to 50% in surgical IBD patients and calls for dedicated nutritional assessment.
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http://dx.doi.org/10.3390/nu14050932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8912602PMC
February 2022

Implementing a surgical site infection prevention bundle for emergency appendectomy: Worth the effort or waste of time?

Surgery 2022 07 24;172(1):11-15. Epub 2022 Feb 24.

Department of Visceral Surgery, Lausanne University Hospital CHUV, Switzerland.

Background: The aim of this study was to evaluate feasibility and impact of an intraoperative surgical site infection prevention bundle for emergency appendectomy.

Methods: Consecutive adult patients undergoing emergency appendectomy were prospectively included during a 10-year study period (2011-2020). The care bundle was implemented as of November 1, 2018, and focused on 4 intraoperative items (disinfection, antibiotic prophylaxis, induction temperature control >36.5°C, and intracavity lavage). The primary outcome was the compliance to bundle items. Thirty-day surgical site infections were assessed by the independent Swiss National SSI Surveillance Program (2011 to October 2018) and by an institutional audit (November 2018-2020). Independent risk factors for surgical site infection were identified through multinominal logistic regression analysis.

Results: Of 1,901 patients, 449 (23.6%) were included after bundle implementation. Overall surgical site infection rate was 111 (5.8%). In 42 patients with surgical site infection (37.8%), antibiotic treatment alone was done, and additional surgical management was necessary in 31 patients (27.9%), computed tomography-guided drainage in 30 patients (27%), and bedside wound opening in 9 cases (8.1%). Overall compliance to the bundle was 79.9%. Overall surgical site infection rates were decreased after bundle implementation (17/449 [3.8%] vs 94/1,452 [6.5%], P = .038), mainly due to a decrease in superficial incisional infections (P = .014). Independent risk factors for surgical site infection were surgical duration ≥60 minutes (odds ratio: 1.66, P = .018), contamination class IV (odds ratio: 2.64, P < .001), and open or converted approach (odds ratio: 4.0, P < .001), and the bundle was an independent protective factor (odds ratio: 0.58, P = .048).

Conclusion: Implementation of an intraoperative surgical site infection prevention bundle was feasible and might have a beneficial impact on surgical site infection rates after emergency appendectomy.
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http://dx.doi.org/10.1016/j.surg.2022.01.027DOI Listing
July 2022

Postoperative decrease of albumin (ΔAlb) as early predictor of complications after gastrointestinal surgery: a systematic review.

Perioper Med (Lond) 2022 Feb 15;11(1). Epub 2022 Feb 15.

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.

Background: Postoperative complications are frequent after gastrointestinal surgery and early prediction remains an unmet need. Serum albumin shows a rapid decrease after surgery, and this decline (ΔAlb) may reflect the intensity of the surgical stress response and thereby be a predictor of postoperative complications. This study aimed to comprehensively review the available data on ΔAlb in gastrointestinal surgery.

Methods: PRISMA guidelines were followed to conduct a systematic review of the literature in MEDLINE and Embase. Studies assessing the role of ΔAlb to predict complications after gastrointestinal surgery were included.

Results: A total of 1256 articles were screened, and 16 studies were included in the final analysis: 7 prospective and 9 retrospective trials. Sensitivity of ΔAlb to predict postoperative complications ranged from 63 to 84%, whereas specificity ranged from 61 to 86%. Nine out of the 16 included studies established a threshold of ΔAlb to predict morbidity (range: 5-11 g/l or 14-27%).

Conclusion: ΔAlb appeared as a valuable and promising biomarker to anticipate complications after gastrointestinal surgery. Future efforts are needed to determine whether and how ΔAlb may be integrated in clinical practice to guide clinicians in the perioperative management of patients.
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http://dx.doi.org/10.1186/s13741-022-00238-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8845214PMC
February 2022

Patient Perspectives in Cancer Surgery.

J Clin Med 2022 Jan 31;11(3). Epub 2022 Jan 31.

Department of Visceral Surgery, University Hospital CHUV, University of Lausanne (UNIL), 1011 Lausanne, Switzerland.

Cancer patients frequently misunderstand essential information, incorrectly state the extent of their disease, are unclear about the treatment goal, and overestimate their prognosis [...].
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http://dx.doi.org/10.3390/jcm11030789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8837181PMC
January 2022

Immunotherapy for Esophageal Cancer: State-of-the Art in 2021.

Cancers (Basel) 2022 Jan 22;14(3). Epub 2022 Jan 22.

Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.

The management of esophageal cancer (EC) has experienced manifold changes during the last decades. Centralization of EC treatment has been introduced in many countries, subsequently allowing the development of specialized high-volume centers. Minimal invasive surgery has replaced open surgery in many centers, whereas more potent systemic treatments have been introduced in clinical practice. Newer chemotherapy regimens increase long-term survival. Nevertheless, the overall survival of EC patients remains dismal for advanced tumor stages. In this direction, a wide range of targeted biologic agents (immunotherapy) is currently under assessment. Anti- Human Epidermal Growth Factor Receptor-2 (HER-2) monoclonal antibodies are used in HER2 (+) tumors, predominantly well-differentiated adenocarcinomas, and are currently assessed in the neoadjuvant setting (TRAP, INNOVATION trials). Immune checkpoint inhibitors Nivolumab (ATTRACTION-03) and pembrolizumab (KEYNOTE-181), have demonstrated a survival benefit compared with conventional chemotherapy in heavily pre-treated progressive disease. More recently, CheckMate-577 showed very promising results for nivolumab in a curative adjuvant setting, improving disease-free survival mainly for esophageal squamous cell carcinoma. Several ongoing trials are investigating novel targeted agents in the preoperative setting of locally advanced EC. In addition, other immunomodulatory approaches such as peptide vaccines and tumor infiltrating lymphocytes (TILs) are currently under development and should be increasingly integrated into clinical practice.
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http://dx.doi.org/10.3390/cancers14030554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8833794PMC
January 2022

[Surgery Sustainability in surgical practice : the "green surgery" concept and its innovations].

Rev Med Suisse 2022 Feb;18(767):152-155

Service de chirurgie viscérale, Centre hospitalier universitaire vaudois, 1011 Lausanne.

Awareness of climate change grows in the population and people develop eco-responsible habits in their daily and professional life. The health care system is nowadays responsible for 4.6% of global greenhouse gases emissions, and most of them comes from hospital activity. The operating room is one of the greatest contributors of the overall energetic cost and generates a large amount of hospital waste. As an example, all laparoscopic procedures in the US has an energy cost similar to an 80'000 inhabitants city during one year. A better understanding of the environmental impact of surgery is necessary to identify what can be done to limit the ecological impact of surgery without compromising standards of care.
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http://dx.doi.org/10.53738/REVMED.2022.18.767.152DOI Listing
February 2022

The role of disruptive technologies and approaches in ERAS®: erupting change through disruptive means.

Langenbecks Arch Surg 2022 Feb 27;407(1):437-441. Epub 2022 Jan 27.

Division of Hepatobiliary Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.

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http://dx.doi.org/10.1007/s00423-022-02450-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791806PMC
February 2022

Author's Reply: Cost-Benefit Analysis of an Enhanced Recovery Program for Gastrectomy: A Retrospective Controlled Analysis.

World J Surg 2022 04 22;46(4):971-972. Epub 2022 Jan 22.

Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.

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http://dx.doi.org/10.1007/s00268-021-06423-7DOI Listing
April 2022

Association between CT-Based Preoperative Sarcopenia and Outcomes in Patients That Underwent Liver Resections.

Cancers (Basel) 2022 Jan 5;14(1). Epub 2022 Jan 5.

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, 1011 Lausanne, Switzerland.

This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m) than patients without sarcopenia (59.3 years, < 0.01, and 27.7 kg/m, < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.
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http://dx.doi.org/10.3390/cancers14010261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8750804PMC
January 2022

Management of a Late-Term Hiatal Hernia with Intrathoracic Pouch Migration After Roux-en-Y Gastric Bypass.

Obes Surg 2022 03 6;32(3):957-958. Epub 2022 Jan 6.

Department of Visceral Surgery, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Vaud, Switzerland.

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http://dx.doi.org/10.1007/s11695-021-05881-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866366PMC
March 2022

EUS-guided radiofrequency ablation for pancreatic insulinoma: experience in 2 tertiary centers.

Gastrointest Endosc 2022 06 10;95(6):1256-1263. Epub 2021 Dec 10.

Division of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland.

Background And Aims: Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, and preserving surgery is the treatment of choice. EUS-guided radiofrequency ablation (EUS-RFA) is a novel and promising technique that induces tissue necrosis of localized lesions. This article presents a preliminary clinical experience in treating pancreatic insulinomas <2 cm by EUS-RFA, focusing on safety and efficacy.

Methods: The clinical course of patients with pancreatic insulinoma treated by EUS-RFA at 2 tertiary referral centers was analyzed.

Results: Between November 2017 and December 2020, 7 patients were included (6 women; mean age, 66 years). EUS-RFA was feasible in all patients with immediate hypoglycemia relief after only 1 single treatment session; 6 of 7 achieved complete response by cross-sectional imaging and remained asymptomatic (median follow-up, 21 months; range, 3-38). Three patients had minor adverse events. One elderly patient developed a large retrogastric collection 15 days after treatment and died 1 month after EUS-RFA.

Conclusions: Management of pancreatic neuroendocrine tumors <2 cm by EUS-RFA seems to be effective with an acceptable safety profile. However, further evidence focusing on long-term survival and recurrence is needed.
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http://dx.doi.org/10.1016/j.gie.2021.11.045DOI Listing
June 2022

Preoperative patients' quality of life and outcomes after colorectal surgery: A prospective study.

Medicine (Baltimore) 2021 Nov;100(44):e27665

Department of Visceral Surgery, University Hospital CHUV and University of Lausanne, Lausanne, Switzerland.

Abstract: The aim of this prospective study was to assess the influence of preoperative life satisfaction on objective and subjective outcomes after elective colorectal surgery. Preoperative life satisfaction was assessed using a validated questionnaire (Échelle de Mesure des Manifestations du Bien-Être Psychologique). Postoperative quality of life was assessed by the Cleveland Global Quality of Life and QLQ-C30. Number of footsteps was recorded from preoperative day 5 to postoperative day 3. Physical activity, length of stay, and complications were compared between patients with low and high preoperative life satisfaction. Fifty patients were included. There was no difference between the 2 groups concerning postoperative objective (length of stay, complications, and number of footsteps) and subjective (Cleveland Global Quality of Life and QLQ-C30) recovery. In conclusion, preoperative life satisfaction of colorectal surgery patients had no influence on outcomes and physical activity in colorectal surgery.
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http://dx.doi.org/10.1097/MD.0000000000027665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568351PMC
November 2021

Feasibility of a prehabilitation program before major abdominal surgery: a pilot prospective study.

J Int Med Res 2021 Nov;49(11):3000605211060196

Department of Visceral Surgery, University Hospital CHUV and University of Lausanne (UNIL), Lausanne, Switzerland.

Objective: To assess the feasibility of a prehabilitation program and its effects on physical performance and outcomes after major abdominal surgery.

Methods: In this prospective pilot study, patients underwent prehabilitation involving three training sessions per week for 3 weeks preoperatively. The feasibility of delivering the intervention was assessed based on recruitment and adherence to the program. Its impacts on fitness (oxygen uptake (VO)) and physical performance (Timed Up and Go Test, 6-Minute Walk Test) were evaluated.

Results: From May 2017 to January 2020, 980 patients were identified and 44 (4.5%) were invited to participate. The main obstacles to patient recruitment were insufficient time (<3 weeks) prior to scheduled surgery (n = 276, 28%) and screening failure (n = 312, 32%). Of the 44 patients, 24 (55%) declined to participate, and 20 (23%) were included. Of these, six (30%) were not adherent to the program. Among the remaining 14 patients, VO at ventilatory threshold significantly increased from 9.7 to 10.9 mL/min/kg. No significant difference in physical performance was observed before and after prehabilitation.

Conclusion: Although prehabilitation seemed to have positive effects on exercise capacity, logistic and patient-related difficulties were encountered. The program is not feasible in its current form for all-comers.
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http://dx.doi.org/10.1177/03000605211060196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649915PMC
November 2021

Effects of structured intraoperative briefings on patient outcomes: multicentre before-and-after study.

Br J Surg 2021 12;109(1):136-144

Department of Visceral Surgery and Medicine, Berne University Hospital, University of Berne, Berne, Switzerland.

Background: Operations require collaboration between surgeons, anaesthetia professionals, and nurses. The aim of this study was to determine whether intraoperative briefings influence patient outcomes.

Methods: In a before-and-after controlled trial (9 months baseline; 9 months intervention), intraoperative briefings were introduced in four general surgery centres between 2015 and 2018. During the operation, the responsible surgeon (most senior surgeon present) briefed the surgical team using the StOP? protocol about: progress of the operation (Status), next steps (Objectives), possible problems (Problems), and encouraged asking questions (?). Differences between baseline and intervention were analysed regarding surgical-site infections (primary outcome), mortality, unplanned reoperations, and duration of hospital stay (secondary outcomes), using inverse probability of treatment (IPT) weighting based on propensity scores.

Results: In total, 8256 patients underwent surgery in the study. Endpoint data were available for 7745 patients (93.8 per cent). IPT-weighted and adjusted intention-to-treat analyses showed no differences in surgical-site infections between baseline and intervention (9.8 versus 9.6 per cent respectively; adjusted difference (AD) -0.15 (95 per cent c.i. -1.45 to 1.14) per cent; odds ratio (OR) 0.92, 95 per cent c.i. 0.83 to 1.15; P = 0.797), but there were reductions in mortality (1.6 versus 1.1 per cent; AD -0.54 (-1.04 to -0.03) per cent; OR 0.60, 0.39 to 0.92; P = 0.018), unplanned reoperations (6.4 versus 4.8 per cent; AD -1.66 (-2.69 to -0.62) per cent; OR 0.72, 0.59 to 0.89; P = 0.002), and fewer prolonged hospital stays (21.6 versus 19.8 per cent; AD -1.82 (-3.48 to -0.15) per cent; OR 0.87, 0.77 to 0.98; P = 0.024).

Conclusion: Short intraoperative briefings improve patient outcomes and should be performed routinely.
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http://dx.doi.org/10.1093/bjs/znab384DOI Listing
December 2021

Rate of stoma formation following damage-control surgery for severe intra-abdominal sepsis: a single-centre consecutive case series.

BJS Open 2021 11;5(6)

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.

Background: Severe intra-abdominal sepsis (IAS) is associated with high mortality and stoma rates. A two-stage approach with initial damage-control surgery (DCS) and subsequent reconstruction might decrease stoma and mortality rates but requires standardization.

Methods: A standardized two-stage damage-control algorithm for IAS was implemented in April 2016 and applied systematically.

Results: Some 203 consecutive patients (median age 70 years, 62 per cent ASA score greater than 3) had DCS for severe IAS. Median operation time was 82 minutes, 60 per cent performed during night-time. Median intraoperative noradrenaline doses were 20 (i.q.r. 26) µg/min and blood gas analysis (ABG) was abnormal (metabolic acidosis) in 90 per cent of patients. The second-stage operation allowed definitive surgery in 76 per cent of patients, 24 per cent had up to four re-DCSs until definitive surgery. The in-hospital mortality rate was 26 per cent. At hospital discharge, 65 per cent of patients were stoma free. Risk factors for in-hospital death were noradrenaline (odds ratio 4.25 (95 per cent c.i. 1.72 to 12.83)), abnormal ABG (pH: odds ratio 2.72 (1.24 to 6.65); lactate: odds ratio 6.77 (3.20 to 15.78)), male gender (odds ratio 2.40 (1.24 to 4.85)), ASA score greater than 3 (odds ratio 5.75 (2.58 to 14.68)), mesenteric ischaemia (odds ratio 3.27 (1.71 to 6.46)) and type of resection (odds ratio 2.95 (1.24 to 8.21)). Risk factors for stoma at discharge were ASA score greater than 3 (odds ratio 2.76 (95 per cent c.i. 1.38 to 5.73)), type of resection (odds ratio 30.91 (6.29 to 559.3)) and longer operation time (odds ratio 2.441 (1.22 to 5.06)).

Conclusion: Initial DCS followed by secondary reconstruction of bowel continuity for IAS within 48 hours in a tertiary teaching hospital was feasible and safe, following a clear algorithm.
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http://dx.doi.org/10.1093/bjsopen/zrab106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576255PMC
November 2021

Economic considerations of a connected tracking device after colorectal surgery.

Br J Surg 2021 12;108(12):e407-e408

Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.

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http://dx.doi.org/10.1093/bjs/znab377DOI Listing
December 2021

Elective Surgery for Diverticulitis in Swiss Hospitals.

Front Surg 2021 12;8:717228. Epub 2021 Oct 12.

Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland.

To assess current management of diverticulitis in Switzerland. Prospective observational study of diverticulitis management and outcomes in surgical departments over a 3-month time period. Hospital category was graded according to the Swiss Medical Association (FMH) as: U: University; A: Cantonal; B: Regional; P: Private. 75 participating hospitals treated 1,015 patients, among whom 214 patients (21%) had elective sigmoid resections in 49 hospitals. Indication for elective resection were recurrent diverticulitis, previous complicated diverticulitis, fistulas, and stenosis. Surgeries were performed completely laparoscopically in 185 cases (86%) and required conversion to open in 19 cases (9%). Overall postoperative complication rate was 18% ( = 39) and no mortality was observed. Operation time, surgeons experience and hospital stay differed considerably between hospital categories. Elective sigmoid resection for diverticulitis in Switzerland was mainly performed laparoscopically with low postoperative morbidity. Different practices and outcomes between institutions were observed.
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http://dx.doi.org/10.3389/fsurg.2021.717228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547539PMC
October 2021
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