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Despite current evidence, the use of drains in liver surgery is still controversial. We conducted an international survey to investigate the clinical use of drains in the E-AHPBA, A-HPBA and A-PHPBA communities. An open survey of 30 questions was prepared on Google-Form and distributed by email to all members. One hundred and ninety-one HPB surgeons responded to the survey. One hundred and twelve surgeons (58.6%) reported routine use of abdominal drains after liver resections. Eighty-eight (46.1%) responded that removal was driven by low volume and low bilirubin levels in the drains. For minor liver resection, 97 (50.8%) surgeons reported using drains selectively; in contrast, 134 (70.2%) surgeons prefer to use a drain always after major procedures. Among patients with cirrhosis, 87 (45.5%) surgeons reported routine drains placement, while 84 (44.0%) considered drains selectively. A no-drain policy was most prevalent among surgeons from North America (80%) versus Asian-Pacific (70.0%), European and African (60.8%), and South American (61.5%) surgeons. Among minimally invasive surgeons, 74.2% reported drain use only in selected cases versus 35.0% among surgeons who performed open surgery. The practice of draining after liver surgery is still highly variable among centers and surgeons around the world, with a high variability according to the underlying liver condition and planned surgical approach.

Elderly patients with rectal tumor are often undertreated if compared to younger ones. The reasons for this attitude are not fully clear.The aim of this study was to determine the feasibility of radical treatments for rectal cancer in subjects with an age ≥ 75years (group 1) and to compare short- and long-term outcomes of these patients with patients with an age of less that 75years (group 2). 311 consecutive patients who underwent radical surgery for rectal cancer were evaluated. A propensity-matching analysis on short- and long-term outcomes was conducted to compare older and younger patients. Overall postoperative complication rate was 23.8% (19/80) in the group 2 and 33.8% (27/80) in group 1 (p = 0.162). OS at 1, 3 and 5years was 96.2%, 88.4% and 75.9% in under 75 and 92.5%, 64.3% and 50.6% in over 75 group, respectively (p = 0.001). However, TSS was considered, no significant difference was found. Major complications were comparable within groups: 10 (12.5%) versus 11 (13.8%) in groups 2 and 1, respectively (p = 0.633). This study suggests that major rectal cancer surgery with curative intent should not be denied to an elderly population on the basis of age alone. Specific oncologic features and comorbidities are better long-term mortality predictors than aging.

Background Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. Methods Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). Results During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank p = 0.041). Disease stage IV and III (HR 13.75; 95% CI 2.89–65.6; p < 0.001 and HR 4.72; 95% CI 1.06–21.1; p = 0.043, respectively) and sarcopenia (HR 2.62; 95% CI 1.22–5.6; p = 0.013) were independently associated with TSS. The other body composition indexes investigated showed no significant association with prognosis. Conclusions These results support the inclusion of body composition assessment for prognostic stratification of rectal cancer patients undergoing upfront resection.