Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA).

BACKGROUND: International register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents. MATERIAL AND METHODS: A prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). TRIAL REGISTRATION: NCT02382770. RESULTS: 1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49-74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2-7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001). CONCLUSION: There is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome.

Use of electrochemotherapy in a voluminous chest wall recurrence of triple-negative breast cancer: case report.

Breast cancer is the most common cause of chest wall recurrence, skin, and subcutaneous tissue metastases which mainly occur as multiple nodes in the skin and subcutaneous tissue. When it occurs, surgery (re-excision or totalization) is the treatment of choice. Unfortunately, it is not possible in rare cases for example after multiple plastic reconstructions and particular anatomical sites not eligible for resection. Moreover, in some cases where radiation therapy has already been used, and systemic therapy is ineffective or contraindicated, electrochemotherapy could represent a choice of palliation treatment. The principle of electrochemotherapy is based on a physical approach to permeabilize cells in the tissue exposed to electric pulses with increased cellular uptake of hydrophilic chemotherapeutics as bleomycin. We present a case of a 62-year-old woman suffering from chest wall recurrence of triple-negative breast cancer, previously treated with chemotherapy, surgery, and radiotherapy. The persistence of the tumor disease with abundant losses of blood serum material led the patient to a progressive decay of the general physical conditions. For this reason, we performed an electrochemotherapy session with an improvement in pain management and partial necrosis of the tumor tissue and devascularization that reduced bleeding and serum production leading to a better quality of life.