Feasibility of transperineal minimal invasive surgery when performing sacrectomy for advanced primary and recurrent pelvic malignancies.

BACKGROUND: This study aimed to clarify the efficacy and safety of minimally invasive transabdominal surgery (MIS) with transperineal minimal invasive surgery (tpMIS) for sacrectomy in advanced primary and recurrent pelvic malignancies. METHODS: Using a prospectively collected database, we retrospectively analyzed the clinical, surgical, and pathological outcomes of MIS with tpMIS for sacrectomies. Surgery was performed between February 2019 and May 2023. The median follow-up period was 27 months (5-46 months). RESULTS: Fifteen consecutive patients were included in this analysis. The diagnoses were as follows: recurrent rectal cancer, n = 11 (73%); primary rectal cancer, n = 3 (20%); and recurrent ovarian cancer, n = 1 (7%). Seven patients (47%) underwent pelvic exenteration with sacrectomy, six patients (40%) underwent abdominoperineal resection (APR) with sacrectomy, and two patients (13%) underwent tumor resection with sacrectomy. The median intraoperative blood loss was 235 ml (range 45-1320 ml). The postoperative complications (Clavien-Dindo grade ≥ 3a) were graded as follows: 3a, n = 6 (40%); 3b, n = 1 (7%); and ≥ 4, n = 0 (0%). Pathological examinations demonstrated that R0 was achieved in 13 patients (87%). During the follow-up period, two patients (13%) developed local re-recurrence due to recurrent cancer. The remaining 13 patients (87%) had no local disease. Fourteen patients (93%) survived. CONCLUSIONS: Although the patient cohort in this study is heterogeneous, MIS with tpMIS was associated with a very small amount of blood loss, a low incidence of severe postoperative complications, and an acceptable R0 resection rate. Further studies are needed to clarify the long-term oncological feasibility.

Peritonite bacteriana espontânea associado a cirrose hepática. Relato de caso

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Improvement of cardiac function by short atrioventricular delay and diastolic mitral regurgitation in patients implanted with DDD pacemakers

Efficacy of short atrioventricular (AV) delay and diastolic mitral regurgitation (MR) were studied in 16 patients (70.2 mais ou menos 10.5 SD years old) with implanted DDD pacemakers. AV delay was set at 0.215 and 0.115 sec. In 10 of the 16 patients, diastolic MR was not observed when the AV delay was set at both 0.215 and 0.115 sec. Cardiac output (CO) and pulmonary capilary wedge pressure (PCWP) did not change.In 6 of the 16 patients, diastolic MR was observed when the AV delay was set a 0.215 se However, diastolic MR was not observed when the AV delay was set at 0.115 sec. CO increased from 3.6 mais ou menos 0.7 to 3.9 mais ou menos 0.8 I/min (p menor que 0.05). PCWP was decreased in 5 of the 6 patients (83 por cento, p menor que 0.05 vs. 10 por cento in patients without diastolic MR at 0.215 sec of AV delay). Cardiac function may be improved by shortening AV delay when the diastolic MR was observed. On the other hand, short AV delay may not be effective for patients in whom diastolic MR was ntobserved.