Similar Rates of Symptomatic Marginal Ulcers After One-Anastomosis-Gastric Bypass Compared to Roux-en-Y Gastric Bypass.

PURPOSE: One-anastomosis-gastric-bypass (OAGB) has become a common bariatric procedure worldwide. Marginal ulcers (MU) are a significant non-immediate complication of gastric bypass surgeries. There seems to be concern among surgeons that MU are more common after OAGB compared with Roux-en-Y gastric bypass (RYGB) due to the constant and extensive exposure of the anastomosis to bile. The aim of this study was to compare the incidence, presentation, and management of MU between the two surgeries. MATERIALS AND METHODS: A retrospective study of prospectively collected data was performed to include all consecutive patients between 2010 and 2020, who underwent elective OAGB or RYGB at our institution. Patients diagnosed with symptomatic MU were identified. Factors associated with this complication were assessed and compared between the two surgeries. RESULTS: Symptomatic MU were identified in 23/372 OAGB patients (6.2%) and 35/491 RYGB patients (7.1%) (p = 0.58). Time to ulcer diagnosis was shorter in OAGB patients (12 ± 11 vs. 22 ± 17 months, p < 0.01). Epigastric pain was the common symptom (78% OAGB vs. 88.5% RYGB, p = 0.7) and approximately 15% of ulcers presented with perforation upon admission (17% vs.11.4%, p = 0.7). Re-operation was required in 5/23 OAGB (21.7%) and 6/36 RYGB (17%) patients (p = 0.11) while the rest of the patients were managed non-operatively. CONCLUSIONS: The risk of developing a marginal ulcer is similar between patients who underwent OAGB and RYGB. Patients diagnosed with MU following OAGB tend to present earlier; however, the clinical presentation is similar to RYGB patients. The management of this serious complication seems to be associated with acceptable outcomes with comparable operative and non-operative approaches.

CDC25C Protein Expression Correlates with Tumor Differentiation and Clinical Outcomes in Lung Adenocarcinoma.

Given that, even after multimodal therapy, early-stage lung cancer (LC) often recurs, novel prognostic markers to help guide therapy are highly desired. The mRNA levels of cell division cycle 25C (CDC25C), a phosphatase that regulates G2/M cell cycle transition in malignant cells, correlate with poor clinical outcomes in lung adenocarcinoma (LUAD). However, whether CDC25C protein detected by immunohistochemistry can serve as a prognostic marker in LUAD is yet unknown. We stained an LC tissue array and a cohort of 61 LUAD tissue sections for CDC25C and searched for correlations between CDC25C staining score and the pathological characteristics of the tumors and the patients' clinical outcomes. Clinical data were retrieved from our prospectively maintained departmental database. We found that high expression of CDC25C was predominant among poorly differentiated LUAD (p < 0.001) and in LUAD > 1cm (p < 0.05). Further, high expression of CDC25C was associated with reduced disease-free survival (p = 0.03, median follow-up of 39 months) and with a trend for reduced overall survival (p = 0.08). Therefore, high expression of CDC25C protein in LUAD is associated with aggressive histological features and with poor outcomes. Larger studies are required to further validate CDC25C as a prognostic marker in LUAD.

Existing Scores Fail to Predict Bowel Ischemia in Patients With Adhesive Small Bowel Obstruction.

INTRODUCTION: Early recognition of bowel ischemia is critical in patients suffering from acute adhesive small bowel obstruction (ASBO). Recent studies attempted to propose a score combining clinical and radiological factors to predict the risk of bowel ischemia in patients with ASBO. This study aimed to compare and validate the existing clinical scores with a cohort of surgical patients. METHODS: We conducted a retrospective study including all ASBO cases admitted to our institution between January 1, 2005 and December 31, 2019. Based on three existing clinical scores, we calculated the risk of bowel ischemia for each patient. We then divided the cohort into groups based on the risk for bowel ischemia. For each risk-based category, the proportion of patients who underwent surgical resection and were found to have evidence of ischemic bowel was calculated. RESULTS: A total of 160 patients presenting with 217 episodes of acute ASBO were included. One hundred seventy-one (78.8%) cases were managed nonoperatively while 46 cases (21.2%) required surgery. Sixteen patients (7.3%) were eventually found to have ischemic bowel while 13 required small bowel resection (5.9%). All three clinical scores showed correlation between the calculated risk of ischemia and the intraoperative finding of ischemia. However, all three scores overestimated ischemia rates in the high-risk groups, yielding a PPV of 8.3%-28.5% and a NPV of 93.3%-94.7%. CONCLUSIONS: Current clinical scores for predicting bowel ischemia in patients with ASBO are of high value in ruling out ischemia, yet are of extremely low sensitivity, warranting an overly aggressive and unnecessary surgical approach.