Psychometric validation of the Moroccan version of the EORTC QLQ-C30 in colorectal Cancer patients: cross-sectional study and systematic literature review.

BACKGROUND: Health-related quality of life is mainly impacted by colorectal cancer which justified the major importance addressed to the development and validation of assessment questionnaires. We aimed to assess the validity and reliability of the Moroccan Arabic Dialectal version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) in patients with colorectal cancer. METHODS: We conducted a cross-sectional study using the Moroccan version of the EORTC QLQ-C30 on colorectal cancer patients from the National Oncology Institute of Rabat, in the period from February 2015 to June 2017. The QLQ-C30 was administered to 120 patients. Statistical analysis included reliability, convergent, and discriminant validity as well as known-groups comparisons. RESULTS: In total, 120 patients with colorectal cancer were included in the study with 38 (32%) patients diagnosed with colon cancers. Eighty-two patients (68%) had rectal cancer, among which 29 (24%) patients with a stoma. The mean age of diagnosis was 54 years (+/- 13.3). The reliability and validity of the Arabic dialectal Moroccan version of the EORTC QLQ-C30 were satisfactory. [Cronbach's alpha (α =0.74)]. All items accomplished the criteria for convergent and discriminant validity except for question number 5, which did not complete the minimum required correlation with its own scale (physical functioning). Patients with rectal cancer presented with bad Global health status and quality of life (GHS/QOL), emotional functioning as well as higher fatigue symptoms compared to patients with colon cancer. The difference between patients with and without stoma was significant for diarrhea and financial difficulty. CONCLUSIONS: The Moroccan Arabic Dialectal version of the QLQ-C30 is a valid and reliable measure of health-related quality of life (HRQOL) in patients with colorectal cancer.

Predictive factors of disease-free survival after complete pathological response to neoadjuvant radiotherapy for rectal adenocarcinoma: retrospective case series.

BACKGROUND: Many data suggest that patients with low rectal adenocarcinoma who achieved ypT0N0 status have improved survival and disease-free survival (DFS) compared to all other stages however only few data are available regarding the specific prognosis factors of this subgroup. This study aimed to evaluate predictive factors for disease free survival after complete pathological response (CPR) in cases of low rectal adenocarcinoma. MATERIALS AND METHODS: From January 2005 to December 2013, all patients with low rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by total mesorectal excision and achieved CPR were included at 7 Moroccan and 1 Algerian centres. Predictive factors for disease-free survival were analysed by uni and multivariate analysis. RESULTS: Eigthy-four (12.1%) patients achieved a CPR (ypT0N0). Multivariate analysis revealed that both poorly differentiated tumors (OR, 9.23; 95 CI 1.35-62.82; P = 0.023) and the occurrence of perineal sepsis (OR, 13.51; 95 CI 1.96-93.12; P = 0.008) were independently associated with impaired DFS. CONCLUSIONS: Patients with low rectal cancer who exhibited a CPR after neoadjuvant therapy have good prognoses; however, the occurrence of perineal sepsis and/or poor initial differentiation may be associated with impaired DFS in these patients. TRIAL REGISTRATION: The study was retrospectively registered the 28th July 2018 in ClinicalTrials.gov register with the reference NCT03601689.

Impact of seniority on operative time and short-term outcome in laparoscopic cholecystectomy: Experience of an academic Surgical Department in a developing country.

INTRODUCTION: Resident participation in laparoscopic cholecystectomy (LC) is one of the first steps of laparoscopic training. The impact of this training is not well-defined, especially in developing countries. However, this training is of critical importance to monitor surgical teaching programmes. OBJECTIVE: The aim of this study was to determine the impact of seniority on operative time and short-term outcome of LC. DESIGNS AND SETTINGS: We performed a retrospective study of all consecutive laparoscopic cholecystectomies for gallbladder lithiasis performed over 2 academic years in an academic Surgical Department in Morocco. PARTICIPANTS: These operations were performed by junior residents (post-graduate year [PGY] 4-5) or senior residents (PGY 6), or attending surgeons assisted by junior residents, none of whom had any advanced training in laparoscopy. All data concerning demographics (American Society of Anesthesiologists, body mass index and indications), surgeons, operative time (from skin incision to closure), conversion rate and operative complications (Clavien-Dindo classification) were recorded and analysed. One-way analysis of variance, Student's t-test and Chi-square tests were used as appropriate with statistical significance attributed to P < 0.05. RESULTS: One hundred thirty-eight LC were performed. No differences were found on univariate analysis between groups in demographics or diagnosis category. The overall rate of operative complications or conversions and hospital stay were not significantly different between the three groups. However, mean operative time was significantly longer for junior residents (n = 27; 115 ± 24 min) compared to senior residents (n = 37; 77 ± 35 min) and attending surgeons (n = 66; 55 ± 17 min) (P < 0.001). CONCLUSION: LC performed by residents appears to be safe without a significant difference in complication rate; however, seniority influences operative time. This information supports early resident involvement in laparoscopic procedures and also the need to develop cost-effective laboratory training programmes.

Laparoscopic liver resection: initial experience in a North-African single center.

BACKGROUND: Over past decades laparoscopic liver resection (LLR) has gained wide acceptance among hepatobiliary surgeons community. To date, few data are available concerning LLR programs in developing countries. This study aimed to assess feasibility and safety of LLR in a Moroccan surgical unit. METHODS: From June 2010 to February 2013, patients that received LLR were identified from a prospective "liver resection" database and included in this study. Parenchymal transection was performed using Harmonic scalpel and bipolar clamp with no Intraoperative ultrasound use or systematic pedicle clamping. LLR difficulty was categorized into 3 categories according to Louisville-statement (I-III). Demographic informations, liver lesion informations, operative details, pathological tumor-margin and 1-months postoperative morbidity according to Clavien-Dindo(C-D) classification were analyzed. RESULTS: Among 104 patients who underwent liver resection 13(12,5%) had LLR. There were 7 females and 6 males with mean age of 57,5 ± 17 years. LLR was performed for benign lesions in 3 cases and malignant ones in 10 (77%) patients: hepatocarcinoma in 7 patients and synchronous rectal-liver metastasis in 3 patients. Lesions were solitary in 12 (92%) patients with median size of 50mm (15 mm-150 mm). Patients with liver metastasis received combined laparoscopic rectal and liver resection. We used pure laparoscopic approach in 12 (92%) patients and hybrid one in 1 patient. LLR difficulty was category I, II and II in respectively 3(23%), 6(46%) and 4(31%)patients. Conversion rate to open liver resection was 15%. Mean blood loss was 395 min ± 270 min with no hepatic pedicle clamping or peroperative blood transfusion. All resections were tumor free margin. Mortality rate was nil and morbidity occurred in 4(30%) patients: ascites (C-D 2) and pelvic sepsis in combined resections (CD 3b). Median hospital stay was 6 days. CONCLUSION: Laparoscopic liver resection in our context is safe in selected patients, since no operative mortality, blood transfusion requirement or palliative resection was recorded and liver related morbidity rate was low. Intraoperative ultrasound liver examination capacities are mandatory to improve laparoscopic liver resection program's quality and extend indications.

Mesenteric inflammatory pseudotumor: A rare case report and review of the literature.

Inflammatory pseudotumor (IP) is a rare type of benign tumor. Although initially identified in the lung, it has now been identified in a number of somatic and visceral sites, but mesenteric presentation is uncommon and has a variable clinical presentation. As inflammatory pseudotumor mimic malignancy both clinically and radiologically, the radiologist should be familiar with this entity. The only effective treatment is complete surgical resection. We present the case of a 55-year-old woman who presented with chronic abdominal pain and was diagnosed with a mesenteric inflammatory pseudotumor, in an attempt to illustrate the different imaging aspects of this benign condition in ultrasound, computed tomography and magnetic resonance imaging, and to simplify the description of these tumors.

Synchronous retroperitoneal liposarcoma and gastric adenocarcinoma: A rare case report.

Multiple primary malignancies can occur as either synchronous or metachronous tumors, particularly in adults. Retroperitoneal liposarcoma is a rare malignancy arising from adipose tissue, while gastric adenocarcinoma is one of the most common neoplasms worldwide. The simultaneous occurrence of these 2 malignancies is extremely rare, with only 1 case reported worldwide. Here, we present the case of a 52-year-old man diagnosed with both retroperitoneal liposarcoma and gastric adenocarcinoma, marking the second reported case in the world.

Intraperitoneal chronic expanding hematoma mimicking an ovarian tumor: A case report.

Chronic expanding hematoma of soft tissue is a rare lesion and often misdiagnosed as neoplastic mass. It is mostly related to trauma or surgery, leading to blood-filled cysts surrounded by fibrous tissues. Symptoms may include abdominal pain, nausea or bowel obstruction. Diagnosis is often difficult, and imaging tests such as CT scans or MRIs can be inconclusive. Treatment may require complete surgical removal to prevent postoperative recurrence. We present a case of a 27-year-old woman with history of recent abdominal trauma presented with an abdominal mass, along with chronic pain and vomiting. CT scan revealed a large pelvic cystic mass, suggesting an ovarian origin which was ruled out by the MRI. Surgery was performed and histopathology revealed an intraperitoneal chronic expanding hematoma. In this case report, we review the epidemiological, clinical, and paraclinical aspects of the disease, as well as the treatment modalities.

Risk factors of poor functional results at 1-year after pseudocontinent perineal colostomy for ultralow rectal adenocarcinoma.

BACKGROUND: Pseudocontinent perineal colostomy is one of the techniques that helps recover the body image of patients undergoing abdominoperineal resection. This technique is rarely used internationally given its unknown functional results. OBJECTIVE: The study aimed to evaluate 1-year functional outcomes of perineal pseudocontinent colostomy and to determine the risk factors for "poor" functional results. DESIGN: This study is a retrospective interventional case series. SETTINGS: This study was conducted at a tertiary care university hospital and oncological center in Morocco. PATIENTS: From January 1993 to December 2007, 149 patients underwent pseudocontinent perineal colostomy after abdominoperineal resection for low rectal adenocarcinoma. INTERVENTION: Pseudocontinent perineal colostomy was performed with the use of the Schmidt technique after abdominoperineal resection. MAIN OUTCOME MEASURES: One-year functional results were assessed according to the Kirwan classification system. Functional results were considered "poor" when the Kirwan score was C, D, or E. Univariable and multivariable analyses were used to evaluate the impact of age, sex, type of surgery, irrigation frequency, palpable muscular ring, concomitant chemoradiotherapy, stage, and perineal complications on functional results. RESULTS: One hundred forty-six patients were analyzed. According to the Kirwan system, the scores showed that 100 (68.5%) patients had "good" continence results (stage A-B) and 46 (31.5%) patients had altered functional results (stage C-D-E). With the exception of pelvic recurrences, no conversions from a perineal colostomy to an abdominal colostomy were performed for dissatisfactory functional results. In multivariate analysis, the only independent predictive factors of poor functional results were the occurrence of perineal complications (OR, 3.923; 95% CI, 1.461-10.35; p = 0.007) and extended resection (OR, 3.03; 95% CI, 1.183-7.750; p = 0.021) LIMITATION OF THE STUDY:: This study is an observational retrospective study on selected patients (mainly a young population). CONCLUSIONS: This study showed that perineal complications and extended resection are associated with poor functional results after pseudocontinent perineal colostomy. These data can help clinicians to better inform patients about the outcomes of this technique and to assist them in choosing the right reconstruction technique after abdominoperineal resection.

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study.

BACKGROUND: Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. METHODS: In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. FINDINGS: Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). INTERPRETATION: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. FUNDING: None.

Thyroid metastasis revealing a lung adenocarcinoma: A case report and review of the literature.

INTRODUCTION: Metastatic lung adenocarcinoma in the thyroid is very rare. The clinical presentation and the radiological findings for metastasis carcinoma are nonspecific and do not allow the distinction between metastatic lung carcinoma and primary thyroid tumor. CASE PRESENTATION: We report the case of a pulmonary papillary adenocarcinoma revealed by a thyroid metastasis in a 62-year-old and non-smoker patient with no history of cancer. DISCUSSION: Thyroid metastasis revealing a primary adenocarcinoma of lung is extremely rare. In the absence of a history of lung cancer, the histological appearance of a papillary adenocarcinoma localized in the thyroid can be misdiagnosed as a primary thyroid cancer given the non-specificity of the clinical, radiological and histological presentations. Immunohistochemical analysis and molecular studies are the gold standards for establishing the diagnosis of the primary site. CONCLUSION: In this report we aim to discuss the histological and immunohistochemical features of lung adenocarcinoma metastazing in thyroid gland through a literature review. We are also targeting to highlight the essential role of immunohistochemistry and molecular study for the confirmation of the primary pulmonary origin and to discuss therapy for patients with lung cancer metastatic in the thyroid [17].

Audit of laparoscopic surgery for colon cancer in Morocco: A report of the results of a prospective multicentre cohort study.

Background: Little data is available about colon laparoscopic surgery in low mid-income countries. The aim of this study was to audit the status and results of laparoscopic colon cancer surgery in Morocco. Patients and methods: This was a prospective study performed at 4 academic departments in Morocco between January 1, 2018, and March 31, 2020. All adult patients who underwent elective right or left colonic resection for colon adenocarcinoma were included. The main outcomes were the rate of laparoscopic surgery (LS) and the comparison of its short-term outcomes with open surgery (OS). Results: Among 121 patients included, 52 (43%) underwent laparoscopic resection (0-49.3%). Five surgeons (29%) performed at least one laparoscopic resection. There were more left colectomies in the laparoscopic group (71.2% vs. 39.1%. p = 0.0004), and more extended resections (23.1% vs. 40.6%. p = 0.043) and T4 stage (19% vs. 37.5%. p = 0.037) in the open group. There were no differences in 90-days overall and serious complications. OS patients had significantly more harvested lymph nodes (14 vs. 18. P = 0.007) and higher median surgical margins (6 cm vs. 9 cm. P = 0.003) than LS patients. Conclusions: LS for colon cancer in Morocco is performed by few surgeons, who apply strict patient selection for laparoscopic cases. It was associated with lower quality resections compared to open surgery. There are still many challenges requiring more focus on training, certification, centralization and standardisation of care across the nation.

Predictive model of biliocystic communication in liver hydatid cysts using classification and regression tree analysis.

BACKGROUND: Incidence of liver hydatid cyst (LHC) rupture ranged 15%-40% of all cases and most of them concern the bile duct tree. Patients with biliocystic communication (BCC) had specific clinic and therapeutic aspect. The purpose of this study was to determine witch patients with LHC may develop BCC using classification and regression tree (CART) analysis METHODS: A retrospective study of 672 patients with liver hydatid cyst treated at the surgery department "A" at Ibn Sina University Hospital, Rabat Morocco. Four-teen risk factors for BCC occurrence were entered into CART analysis to build an algorithm that can predict at the best way the occurrence of BCC. RESULTS: Incidence of BCC was 24.5%. Subgroups with high risk were patients with jaundice and thick pericyst risk at 73.2% and patients with thick pericyst, with no jaundice 36.5 years and younger with no past history of LHC risk at 40.5%. Our developed CART model has sensitivity at 39.6%, specificity at 93.3%, positive predictive value at 65.6%, a negative predictive value at 82.6% and accuracy of good classification at 80.1%. Discriminating ability of the model was good 82%. CONCLUSION: we developed a simple classification tool to identify LHC patients with high risk BCC during a routine clinic visit (only on clinical history and examination followed by an ultrasonography). Predictive factors were based on pericyst aspect, jaundice, age, past history of liver hydatidosis and morphological Gharbi cyst aspect. We think that this classification can be useful with efficacy to direct patients at appropriated medical struct's.

[Surgical management of bilateral pheochromocytoma]. / La prise en charge chirurgicale du phéochromocytome bilatéral.

AIM: the aim of this retrospective study was to assess our experience in surgical management of bilateral pheochromocytoma (BP) and to report diagnosis methods and therapeutic results of a series of 10 patients treated in "surgical clinique A" department. METHODS: from 1986 to 2005, we studied all cases of histological confirmed BP in their clinical, biochemical and radiological aspects. We analyzed all of therapeutic attitudes suggested and their results. RESULTS: Ten patients underwent adrenalectomy for BP: 6 men and 4 women with age average of 37.1 (13-60). Eight of them were synchronous BP versus two metachronous ones. Eight patients were symptomatic. One of them had a Von Hippel Lindeau syndrome and 2 others had a familial form of BP. For the two asymptomatic cases: the first one was an incidentaloma and the second one was discovered in a MEN IIb screening. As a primary biochemical diagnostic measure, the determination of the excretion rate of cathecholamine in the 24h urine was high among 6 patients. The ultrasonic imaging and CT scanning were done to localize the tumor site. The surgical treatment consisted in a bilateral adrenalectomy in one phase for 5 patients and in two phases for the 5 others (one double laparoscopy). An enucleating of a pancreatic nodule was an associated act practiced on a patient. Perioperative incidents were related in heart rythme dysfunctions, crises of hypertension among 6 patients and a cardiac arrest rehabilitated. In postoperative phase we assess a death case of sepsis chock, an acute adrenal insufficiency, an acute pancreatitis and a liver metastasis one year after the adrenalectomy. All patients were under hydrocortisone (30 mg) for life. CONCLUSION: Bilateral adrenalectomy is the basic treatment of a BP. A familial screening must be systematically carried out. Laparoscopic adrenalectomy has good results.

[Isolated tuberculosis of pancreas and peripancreatic lymph nodes: diagnostic challenge]. / Tuberculose isolée du pancréas et des ganglions péripancréatiques: challenge diagnostique.

BACKGROUND: Isolated tuberculosis of pancreas and peripancreatic lymph nodes is very rare and difficult to recognise. It may mimic pseudocyst, cystic tumor or carcinoma of pancreas and lead to unuseful and potentially morbid surgery. AIM: We report 3 cases diagnosed in peropeative and postoperative situations. CASES: Thirty four-year-old and 50-year-old women presented with obstructive jaundice. Abdominal CT scan showed resectable head of pancreas tumour. In first patient, peroperative biopsies suggested tuberculosis and resection was avoided. The second patient underwent Whipple procedure. Third case was a 48-year-old alcoholic man who presented with recent history of painful mass of left hypochondre. Cystic tumor of pancreas tail and pseudocyst were suggested in CT scan. En bloc resection of tumor, pancreas tail and spleen was performed. The three patients had antitubercular therapy after histological confirmation of pancreatic tuberculosis. Follow-up is respectively 3 years, 5 months and 2 years free of recurrence. CONCLUSION: Radio or echoendoscopical fine needle punction can contribute to the diagnosis. Surgery remains the main treatment of complications (fistulas, bleedings, obstructions) and the last diagnosis option. Tuberculous origin of an isolated pancreatic mass may be suspected in young people and immunocompromised especially in endemic areas.

[Hydatid cyst of the psoas muscle]. / Kyste hydatique du muscle psoas.

While hydatid cysts may occur in any area of the body, isolated muscular localizations are rare. Only some thirty-odd such cases have been reported. The authors report the case of a 38-year-old man who consulted for isolated abdominal pain in the left iliac region. Radiographic study showed a simple hydatid cyst of the left psoas muscle. The cyst was removed by extraperitoneal transverse laparotomy. Crural nerve palsy occurred but regressed after 2 months and had not recurred after 24 months. Ultrasonography is the preferred method for detecting muscular hydatid cysts. No other diagnostic tool is needed. Surgical treatment remains best. We recommend the unroofing technique over pericystectomy. Other cyst localizations must be sought before any therapeutic decision, since they determine the initial surgical management and allow consideration of other therapeutic methods to be combined with surgery.

[Intraperitoneal perforation of hepatic hydatid cyst]. / Rupture intrapéritonéale du kyste hydatique du foie.

The incidence of the rupture of hydatid cyst of the liver is about 15 to 40% of the cases. In 2 to 7% of the cases the cyst can perforate into the peritoneum. The occurrence of a sclerosing peritonitis secondary to the rupture of the hydatid cyst of the liver was described, to our knowledge, only once. We report the observation of a 43 year-old woman in whom the diagnostis of peritoneal rupture of a liver hydatid cyst was made after 3 months. The patient was treated by albendazole (10 mg/kg/d). Two months after the beginning of this treatment, the patient was operated. A sclerosing peritonitis was discovered. The parasitologic studies of the different specimens were negative. The surgical treatment consisted of a good washing with H2O2 of the fibrous hull of the sclerosing peritonitis and drainage without any dissection. The evolution was satisfactory with albendazole treatment for 14 months. Currently, she is in good health without recurrence and without any abnormalities with a 2 years follow-up. We think that albendazole in the treatment of the hydatid disease is very effective in condition to give a continuous treatment for a long time. The occurrence of a sclerosing peritonitis is fortunately an exceptional situation whose surgical management is very delicate.

[Digestive actinomycosis: three cases and review]. / Actinomycose digestive. Trois cas et revue de la littérature.

Actinomycosis is a chronic suppurative disease. It is caused by an anaerobic bacterium, generally Actinomyces israelii. Cervical and thoracic localizations are most frequent. Digestive actinomycosis is rare and can simulate cancer leading to resection. We report 3 cases of surgical abdominal actinomycosis. Localization was colic in 2 cases and hepatic in 1 case. The diagnosis of actinomycosis was made after resection in the 3 cases. The evolution was favourable under medical treatment. These observations illustrate the difficulty of diagnosing this rare and unrecognised disease which can be cured by long term penicillin therapy.

Changing paradigms in the surgical management of cystic liver hydatidosis improve the postoperative outcomes.

AIM OF THE STUDY: Our aim was to propose and examine the outcomes of a comprehensive strategy for the management of cystic liver hydatidosis (CLH) based on extensive intraoperative assessments and optimal management of cystobiliary communications. BACKGROUND DATA: Although operative intervention remains the preferred treatment for CLH, and the presence of a cystobiliary communication remains a well-established predictive factor for postoperative complications, no internationally accepted management strategy integrates the specific management of cystobiliary communication into the choice of surgical approach. METHODS: Early postoperative outcomes were compared before (1990-2004; P1 group; n = 664) and after (2005-2013; P2 group; n = 156) the implementation of a CLH surgical management strategy for CLH in our overall group of patients in subgroups selected by risk factors (as determined by multivariate analysis), and in 2 propensity score-matched groups. RESULTS: Specific complications related to the hepatic procedure (intraabdominal complications) were independently associated with the presence of ≥ 3 cysts (P = .013), a fibrotic pericyst (P = .005), a cystobiliary communication (P < .001), and the P1 treatment period (P = .002). Between P1 and P2 groups, the rate of specific complications decreased in the overall group of patients with CLH (18.3% vs 4.5%; P < .001). The rate also decreased in risk factor-based subgroups: patients with ≥ 3 cysts (31.0% vs 4.0%; P = .005), a fibrotic pericyst (23.1% vs 9.2%; P = .011), and a cystobiliary communication (33.0% vs 13.2%; P = .006). After propensity score matching among 123 well-balanced matched pairs of patients, the overall complication rate, specific hepatic surgery-related complication rate, and median duration of hospital stay decreased between the P1 and P2 groups: 23.6% vs 12.2% (P = .02), 21.1% vs 4.9% (P < .001), and 7 vs 5 days (P < .001), respectively. CONCLUSION: Implementation of a CLH surgical management strategy based on specific intraoperative assessment and optimal management of cystobiliary communications improved early postoperative outcomes.

Feasibility and safety of laparoscopic adrenalectomy for large tumours.

OBJECTIVE: To verify the feasibility and safety of laparoscopic adrenalectomy for large tumours, as since it was described, the laparoscopic approach for adrenalectomy has become the 'gold standard' for small tumours and for large and non-malignant adrenal tumours many studies have reported acceptable results. PATIENTS AND METHODS: This is a retrospective study from a general surgery department from January 2006 to December 2013 including 45 patients (56 laparoscopic adrenalectomies). We divided patients into two groups according to tumour size: <5 or ⩾5 cm, we compared demographic data and peri- and postoperative outcomes. RESULTS: There was no statistical difference between the two groups for conversion rate (3.7% vs 11.7% P = 0.32), postoperative complications (14% vs 12%, P = 0.4), postoperative length of hospital stay (5 vs 6 days P = 0.43) or mortality (3.5% vs 0% P = 0.99). The only statistical difference was the operating time, at a mean (SD) 155 (60) vs 247 (71) min (P < 0.001). CONCLUSION: Laparoscopic adrenalectomy for large tumours needs more time but appears to be safe and feasible when performed by experienced surgeons.