Laparoscopic right hemicolectomy: a SICE (Società Italiana di Chirurgia Endoscopica e Nuove tecnologie) network prospective study on the approach to right colon lymphadenectomy in Italy: is there a standard?-CoDIG 2 (ColonDx Italian Group).

BACKGROUND: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). METHODS: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. RESULTS: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). CONCLUSIONS: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951.

Interimplant femoral fracture: analysis of risk factors.

Interimplant fractures present a significant challenge for orthopedic surgeons. Despite a noticeable rise in these cases in recent years, our understanding of this specific fracture type remains limited. This study aims to analyze and identify the primary risk factors associated with interimplant femoral fractures. We conducted a retrospective analysis involving 20 patients with interimplant femoral fracture (case group) and 18 patients who had both proximal and distal femoral implants but did not experience interimplant fractures (control group). Our analysis focused on demographic factors (age, sex, BMI) and radiographic parameters (implant types, gap between implants, cortical thickness, femoral canal area) to identify potential risk factors. In the case group, all patients were females, whereas in the control group, 16 patients were female and 2 were males. The mean age in the case group was 88 [Formula: see text] 9 years and in the control group was 87 [Formula: see text] 12 years. None of the demographic differences reached statistical significance. The mean cortical thickness in the case group was 6 [Formula: see text] 2.25 mm, whereas in the control group, it was 9 [Formula: see text] 1.75 mm (p-value < 0.001). The median gap between the proximal and distal tips of the implants measured 194 [Formula: see text] 126 mm in the case group and 66 [Formula: see text] 78 mm in the control group (p-value < 0.001). Additionally, the mean femoral canal area was 284 [Formula: see text] 102 mm2 in the case group and 227 [Formula: see text] 26 mm2 in the control group (p-value < 0.010). Our data indicate that a small cortical thickness, a wide femoral canal area, and having a hip arthroplasty despite a gap between the implants exceeding 110 mm are factors that elevate the risk of interimplant femoral fracture. Notably, osteoporosis therapy emerges as a protective factor against these fractures.

A systematic review and meta-analysis of germline BRCA mutations in pancreatic cancer patients identifies global and racial disparities in access to genetic testing.

BACKGROUND: Germline BRCA1 and BRCA2 mutations (gBRCAm) can inform pancreatic cancer (PC) risk and treatment but most of the available information is derived from white patients. The ethnic and geographic variability of gBRCAm prevalence and of germline BRCA (gBRCA) testing uptake in PC globally is largely unknown. MATERIALS AND METHODS: We carried out a systematic review and prevalence meta-analysis of gBRCA testing and gBRCAm prevalence in PC patients stratified by ethnicity. The main outcome was the distribution of gBRCA testing uptake across diverse populations worldwide. Secondary outcomes included: geographic distribution of gBRCA testing uptake, temporal analysis of gBRCA testing uptake in ethnic groups, and pooled proportion of gBRCAm stratified by ethnicity. The study is listed under PROSPERO registration number #CRD42022311769. RESULTS: A total of 51 studies with 16 621 patients were included. Twelve of the studies (23.5%) enrolled white patients only, 10 Asians only (19.6%), and 29 (56.9%) included mixed populations. The pooled prevalence of white, Asian, African American, and Hispanic patients tested per study was 88.7%, 34.8%, 3.6%, and 5.2%, respectively. The majority of included studies were from high-income countries (HICs) (64; 91.2%). Temporal analysis showed a significant increase only in white and Asians patients tested from 2000 to present (P < 0.001). The pooled prevalence of gBRCAm was: 3.3% in white, 1.7% in Asian, and negligible (<0.3%) in African American and Hispanic patients. CONCLUSIONS: Data on gBRCA testing and gBRCAm in PC derive mostly from white patients and from HICs. This limits the interpretation of gBRCAm for treating PC across diverse populations and implies substantial global and racial disparities in access to BRCA testing in PC.

Incidence of heart failure in patients with type 1 diabetes: a systematic review of observational studies.

BACKGROUND: Heart failure (HF) is considered an important contributor to cardiovascular morbidity and mortality in diabetes mellitus. However, a precise identification of hyperglycemia as contributor for HF is missing. OBJECTIVES: We performed a review and a meta-regression of the available observational studies on the incidence of HF in type 1 diabetes (T1D). DATA SOURCE AND ANALYSIS: We conducted a systematic search of the literature on the incidence of HF in patients with T1D identifying suitable studies published between January 1970 and June 2018 using the following search string: "type 1 diabetes" AND, "heart failure" OR "cardiac failure" OR "congestive heart failure" AND "incidence" NOT "type 2 diabetes" OR "diabetes type 2". Six observational studies were included. A random effect meta-regression model has been estimated to evaluate the incidence rate ratio (IRR) of HF in T1D compared to healthy controls. RESULTS: The mean ± SD age of patients with T1D was 42 ± 11 years, the mean HbA1c was 8.4 ± 0.3%, and average follow-up was 11 ± 3 years. The age-adjusted model shows an incidence rate ratio (IRR) effect of 3.18 (p < 0.001), in correspondence of the mean age at enrollment of studies involved in the analysis. A negative correlation was observed between IRR and average age. CONCLUSIONS: This review shows that the incidence rate of HF is three times higher in patients with T1D than in controls. A careful surveillance of the risk factors for this condition should be included, since the onset of T1D may be important to reduce HF risk in these patients.