The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery.

OBJECTIVE: To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovarian cancer surgery and to evaluate the prognostic implication of AL on overall survival in these patients. METHODS: We analyzed our institutional database for primary EOC and included all consecutive patients treated by debulking surgery including any type of full circumferential bowel resection beyond appendectomy between 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival. RESULTS: AL occurred in 36/800 (4.5%; 95% confidence interval [3%-6%]) of all patients with advanced ovarian cancer and 36/518 (6.9% [5%-9%]) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% [5%-13%]) than in patients with rectosigmoid resection only (6.9% [4%-10%]), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associated with shortened overall survival (HR 1.9 [1.2-3.4], p=0.01). CONCLUSION: In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections.

Evaluation of postoperative pain after minimally invasive video-assisted and conventional thyroidectomy: results of a prospective study. ESES Vienna presentation.

BACKGROUND: One of the advocated benefits of minimally invasive video-assisted thyroidectomy (MIVAT) is reduction of postoperative pain. We compared in a prospective study pain after video-assisted and conventional thyroidectomy (CT). METHODS: One hundred sixty-nine patients (56 men, 113 women, mean age: 50 ± 14 years) operated between November 2007 and February 2008 were included. MIVAT was performed if thyroid volume was <30 ml or the nodule diameter < 35 mm. Postoperative pain scores were documented on a visual analog scale (VAS; 0 = no and 100 = unbearable pain) at 8, 24, 36, and 48 h after surgery. Additionally, postoperative analgesic consumption was registered. RESULTS: Seventy-five patients (17 men, 58 women, mean age: 45 ± 15 years) underwent MIVAT and 94 (39 men, 55 women, mean age: 54 ± 15 years) CT. The mean overall VAS score at 8, 24, 36 and 48 h did not significantly differ between the groups (26 ± 21 vs. 26 ± 19 at 8 h, 17 ± 15 vs. 21 ± 18 at 24 h, 11 ± 13 vs. 10 ± 11 at 36 h and 7 ± 12 vs. 6 ± 8 at 48 h in MIVAT and CT group, respectively) [p = ns]. Twelve vs. 13 patients (16% vs. 14%) required opioid administration on the day of the operation [p = ns]. CONCLUSIONS: The length of the skin incision seems not to influence the perception of pain after thyroid surgery.