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The research is based on a literature review focused on early supplier involvement in new product development processes while working towards Lean production, especially for the automotive industry, where all actors must be fast and accurate. For practitioners, early supplier involvement is a topic that deserves serious attention since it impacts on decentralisation, promoting gains in quality, quantity, and execution time, as well as cost reduction and/or the acquisition of technical knowledge in developing products and production processes. The authors first introduce the key concepts, issues, and theoretical foundations concerning early supplier involvement challenges and new product development within organisations that affect their core processes and outsourcing strategies when seeking collaboration to develop more sophisticated technologies that a new product requires. The authors critically explore these issues, especially concerning earlier supplier involvement and its connection to the Lean philosophy, pursuing process tunning, considering production quantity, quality, and time, as well as avoiding penalising interruption within the automotive industry. The study provides the first critical review of potential challenges for a successful early supply involvement and, consequently, a successful new product development process decentralisation and the acquisition of technical knowledge in developing products and production processes needed to satisfy customers.

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Introduction: Personality is an internal factor, that is always present, independently of the particularly circumstances of the driver and the road context. Exploring the relationships between personality traits and the different driver behaviour dimensions is important to better understand who is more prone to risky driving behaviours. Objectives: The aim of this study is to explore the role of gender and personality traits on driver behaviour in a vast sample of Portuguese drivers, focusing on the mediation effects of certain variables. Methods: Participants answered an online survey including sociodemographic questions and the Portuguese validated version of the following questionnaires: Driver Behaviour Questionnaire (evaluates Infractions and aggressive driving/IAD, Non intentional errors/NIE, and Lapses), Impulsive Sensation Seeking Scale and NEO-FFI-20. The sample is composed of 747 participants [417 (55.8%) women; mean age=42.13±12.349 years; mean years of regular driving=20.33±11.328]. Hayes' PROCESS Macro for SPSS was used. Results: IAD significantly correlated with age (-.239), gender (.254), Agreeableness (-.142), Extraversion (.138), Impulsivity (.259) and Sensation seeking (.301); NIE with Neuroticism (.188), Consciousness (-.188) and Impulsivity (.212); Lapses with age (-.092), gender (-.133), Neuroticism (.166), Openness to experience (.113), Conscientiousness (-.157) and Impulsivity (.227) (p<.05). Sensation seeking was a mediator between gender and IAD; Impulsivity was a mediator between Consciousness/Neuroticism and NIE; even controlling the effect of gender and age, Impulsivity mediates the relationship between Neuroticism/Openness to experience/Conscientiousness and Lapses. Conclusions: Results emphasise that personality traits should be considered when developing profiles and models of driver behaviour to better understand and prevent risky behaviours on the road. [ABSTRACT FROM AUTHOR]

Background: The National Accreditation Program for Rectal Cancer (NAPRC) recommends definitive treatment of rectal cancer commence within 60 days from diagnosis. This study aimed to assess predictors of >60 days delay between diagnosis and definitive surgery of rectal cancer and the impact on survival and short-term outcomes., Methods: Retrospective cohort analysis of patients with stage I-III rectal adenocarcinoma who underwent proctectomy without preoperative neoadjuvant treatment from the National Cancer Database (2015-2019). Based on the time interval between diagnosis and definitive surgery, patients were divided into timely non-adherent (>60 days) and timely-adherent (≤60 days) groups. Multivariate analysis determined predictors of delayed definitive surgery., Results: 9479 patients (57.5 % males; mean age: 63.7 years) had a 41-day median time between diagnosis and definitive surgery. Non-adherence was noted in 27.9 % of patients. Independent predictors of non-adherence were male sex (Odds ratio [OR]: 1.25; p < 0.001), Black (OR: 1.65; p < 0.001) or Asian (OR: 1.33; p = 0.014) race, Charlson score 2 (OR: 1.33; p = 0.005) or 3 (OR: 1.55; p < 0.001), urban residence (OR: 1.21; p = 0.003), abdominoperineal resection (OR: 1.69; p < 0.001), pelvic exenteration (OR: 1.7; p = 0.002), and robotic-assisted surgery (OR: 1.22; p = 0.001). Medicare (OR: 0.725; p = 0.003) and private insurance (OR: 0.711; p < 0.001) were associated with better adherence. 30-day and 90-day mortality, unplanned readmission, and overall survival were similar., Conclusions: Male Black or Asian patients with high Charlson scores, and undergoing abdominoperineal resection, pelvic exenteration, and robotic-assisted surgery were more likely non-adherent with NAPRC standards with >60 days delay before definitive surgery for rectal cancer. Hopefully, recognition for these reasons for delay of definitive surgery will lead to an improvement in adherence to the standards., Competing Interests: Declaration of competing interest Dr. Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC. None of the rest of the authors reported any financial disclosures. Dr. Emile is a consultant for Becton, Dickinson & Co., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Introduction: Bibliometrics, a statistical method assessing the influence of scholarly works, was employed to analyze the evolution of endoscopic surgery for craniosynostosis., Methods: This comprehensive review followed PRISMA guidelines, sourcing data from PubMed, Embase, and Web of Science, focusing on clinical and surgical outcomes up to December 2023. We identified 1409 records, with 83 papers meeting inclusion criteria., Results: The majority of studies originated from the Americas (79%), predominantly from the United States (75.9%). The typical study design was retrospective cohort studies (62%), involving a total of 8,175 patients with median research duration of 8 years. Citation metrics indicated an average count of 38.9 per paper, with notable contributions from several key authors. A distinct increase in research was observed in recent years, particularly from 2011 onwards, peaking in 2022 and 2023. The top 10 most cited papers, largely emanating from the U.S., had a higher median patient number (103) compared to the overall median (53), suggesting their significant impact. These papers were primarily published in journals with higher impact factors and citation indicators. The most cited research was notably published in the Journal of Neurosurgery-Pediatrics., Conclusion: This analysis provides a comprehensive view of the field, highlighting the growing trend and clinical importance of endoscopic approaches in craniosynostosis, offering a valuable resource for future research and clinical practice., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Tumor deposits are a unique histologic feature of colorectal cancer that is associated with adverse survival outcomes. The present study aimed to assess the association between tumor deposits and liver and lung metastases and to describe the characteristics of colorectal cancer associated with tumor deposits., Methods: The Surveillance, Epidemiology, End Results (SEER) database was screened between 2010 and 2020 for patients with colorectal adenocarcinoma who underwent radical resection with data on tumor deposits. The primary outcome of the study was liver and lung metastases. The secondary outcome was the characteristics of patients with tumor deposits., Results: A total of 205,294 patients (52% male, mean age 66.5 years) were included in the study. Tumor deposits were detected in 20,059 (9.7%) patients. Patients with tumor deposits were younger and presented more often with larger tumors, T3/T4 tumors, N+ tumors, stage IV disease, left-sided and rectal cancers, signet-ring cell carcinomas, high-grade adenocarcinomas, and perineural invasion. Multivariable binary regression analyses showed that tumor deposits were associated with 72% higher odds of liver metastases (odds ratio 1.72, 95% confidence interval 1.62-1.82, P < .001) and 68% higher odds of lung metastases (1.68, 1.51-1.86, P < .001). The odds of liver metastases increased by 3% (odds ratio 1.03, 95% confidence interval 1.03-1.04, P < .001) and the odds of lung metastases increased by 2% (1.02, 1.01-1.03, P < .001) for each tumor deposit detected., Conclusions: Tumor deposit-positive colorectal cancers were larger, more often on the left side or in the rectum and presented with more advanced disease and unfavorable histology than tumor deposit-negative cancers. Tumor deposits were independently associated with 72% and 68% higher odds of liver and lung metastases, respectively., Competing Interests: Conflict of Interest/Disclosure Dr Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, and Virtual Ports; is a member of the data safety monitoring board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang; and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc, and Unique Surgical Solutions, LLC. Dr Emile is a consultant for Becton, Dickinson and Company., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Specific risk factors for suicide in patients with colorectal cancer have not been well established. Therefore, we aimed to assess factors associated with increased risk of suicide among patients with colorectal cancer., Methods: This was a retrospective cohort analysis of consecutive patients with colorectal cancer. Patients who survived were compared with patients for whom suicide was registered as their cause of death. Data were extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results Research Database 2000-2020. Primary outcome was risk factors for suicide., Results: In total, 309,561 patients were included in the analysis; 160,095 (51.7%) were male. Suicide was the cause of death in 1,052 (0.34%). The suicide rate among patients with colorectal cancer decreased over time from 1% between 2000 and 2010 to 0.05% between 2011 and 2020 (P < .001). Male sex (odds ratio, 6.44; P < .001), non-Hispanic ethnicity (odds ratio, 2.84; P = .014), household income between $50,000 and $74,999 (odds ratio, 1.79; P = .008) or <$50,000 (odds ratio, 1.84; P = .030), and metastatic disease (odds ratio, 2.89; P = .001) were independent risk factors for suicide. Colorectal cancer diagnosis in the second half of the study (2011-2020) was associated with lower risk of suicide compared with the first half (odds ratio, 0.338; P < .001)., Conclusion: Among patients with colorectal cancer, male patients of non-Hispanic ethnicity and income <$75,000 USD who presented with metastatic disease were at increased risk of suicide. This trend decreased in the last decade, especially compared with the suicide rate among all patients with cancer. On the basis of these findings, we recommend targeted screening of this group of patients with colorectal cancer for suicidality as part of routine oncologic care., Competing Interests: Conflict of Interest/Disclosure The authors do not report any relevant financial disclosures, except Dr Wexner, who is a consultant for Baxter, Becton, Dickinson and Co, GSK, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, and Virtual Ports; is a member of the Data Safety Monitoring Board of Applied Clinical Intelligence (chair), Polypoid (chair), and Boomerang; and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America, and Unique Surgical Solutions, LLC., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Esophageal cancer remains a significant global health challenge. Several treatment modalities were explored in randomized controlled trials (RCTs) in recent decades. This study evaluates the robustness of RCTs focusing on esophageal cancer treatment using the fragility index (FI) and reverse fragility index (RFI)., Methods: A systematic review of RCTs studying different treatment modalities for esophageal cancer from 2000 to 2023 was conducted. The FI and RFI were utilized to gauge the robustness of statistically significant and non-significant outcomes, respectively. The FI represents the minimal number of patient outcomes that would need to alter to overturn a trial's statistical significance, while RFI indicates the minimal changes required to achieve significance in non-significant results., Results: Out of 4028 studies retrieved, 21 RCTs were included for final analysis. The studies spanned 2001 to 2023 with a mean followup of 66 months (range, 29-108 months) and median number of patients of 194 (range, 45-802). The most common treatment modalities examined in these studies were neoadjuvant chemoradiotherapy (n = 7, 33.3%), neoadjuvant chemotherapy (n = 4, 19.0%), and neoadjuvant immunotherapy (n = 2, 9.5%). Only 5 studies (23.8%) had a statistically significant primary outcome result with a median FI of 6 (IQR, 2.5-8.5). Non-significant primary outcomes were seen in 16 studies (76.2%) with a median RFI of 4 (IQR 1-11) and lost to followup of 0 (IQR 0-4). In the study with the highest FI (10), the FI was lower than the number of patients lost to followup (13)., Conclusion: Our findings demonstrate that most RCTs on esophageal cancer treatments did not report significant primary outcomes. The few studies that reported significant results had a low fragility index, suggesting a vulnerability in their findings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Surgical treatments of refractory gastroparesis include pyloromyotomy and gastric electrical stimulator (GES). It is unclear if patients may benefit from a combined approach with concomitant GES and pyloromyotomy., Methods: Retrospective cohort analysis of all patients with refractory gastroparesis treated with GES implantation with and without concomitant pyloromyotomy at Cleveland Clinic Florida from January 2003 to January 2023. Primary endpoint was efficacy (clinical response duration and success rate) and secondary endpoints included safety (postoperative morbidity) and length of stay. Success rate was defined as the absence of one of the following reinterventions during follow-up: Roux-en-Y gastric bypass (RYGB), pyloromyotomy, GES removal., Results: During a period of 20 years, 134 patients were treated with GES implantation. Three patients with history of previous surgical pyloromyotomy or RYGB were excluded from the analysis. Median follow-up was 31 months (IQR 10, 72). Forty patients (30.5%) had GES with pyloromyotomy, whereas 91 (69.5%) did not have pyloromyotomy. Most of the patients had idiopathic (n = 68, 51.9%) or diabetic (n = 58, 43.3%) gastroparesis. Except for preoperative use of opioids (47.5 vs 14.3%; p < 0.001), patient's characteristics were similar in both groups. There were no significant differences between the two groups in terms of overall postoperative complications (17.5% vs 14.3%; p = 0.610), major postoperative complications (0% vs 2.2%; p = 1), and length of stay (2(IQR 1, 2) vs 2(IQR 1, 3) days; p = 0.068). At 5 years, success rate was higher in patients with than without pyloromyotomy however not statistically significant (82% versus 62%, p = 0.066). Especially patients with diabetic gastroparesis seemed to benefit from pyloromyotomy during GES (100% versus 67%, p = 0.053). In an adjusted Cox regression, GES implantation without pyloromyotomy was associated with a 2.66 times higher risk of treatment failure compared to GES implantation with pyloromyotomy (HR 2.66, 95% CI 1.03-6.94, p = 0.044)., Conclusion: Pyloromyotomy during GES implantation for gastroparesis seems to be associated with a longer clinical response with similar postoperative morbidity and length of hospital stay than GES without pyloromyotomy. Patient with diabetic gastroparesis might benefit from a combination of GES implantation and pyloromyotomy., (© 2024. The Author(s).)

Background: This umbrella review aimed to summarize the findings and conclusions of published systematic reviews on the prophylactic role of mesh against parastomal hernias in colorectal surgery., Methods: PRISMA-compliant umbrella overview of systematic reviews on the role of mesh in prevention of parastomal hernias was conducted. PubMed and Scopus were searched through November 2023. Main outcomes were efficacy and safety of mesh. Efficacy was assessed by the rates of clinically and radiologically detected hernias and the need for surgical repair, while safety was assessed by the rates of overall complications., Results: 19 systematic reviews were assessed; 7 included only patients with end colostomy and 12 included patients with either ileostomy or colostomy. The use of mesh significantly reduced the risk of clinically detected parastomal hernias in all reviews except one. Seven reviews reported a significantly lower risk of radiologically detected parastomal hernias with the use of mesh. The pooled hazards ratio of clinically detected and radiologically detected parastomal hernias was 0.33 (95%CI: 0.26-0.41) and 0.55 (95%CI: 0.45-0.68), respectively. Six reviews reported a significant reduction in the need for surgical repair when a mesh was used whereas six reviews found a similar need for hernia repair. The pooled hazards ratio for surgical hernia repair was 0.46 (95%CI: 0.35-0.62). Eight reviews reported similar complications in the two groups. The pooled hazard ratio of complications was 0.81 (95%CI: 0.66-1)., Conclusions: The use of surgical mesh is likely effective and safe in the prevention of parastomal hernias without an increased risk of overall complications., (© 2024. The Author(s).)

Background: This study aimed to assess concordance between clinical and pathologic assessment of colon cancer., Patients and Methods: A retrospective cohort analysis of patients with stage I-III colon cancer in the National Cancer Database (2010-2019) was conducted. Concordance between clinical and pathologic assessment of colon cancer was calculated using Kappa coefficients and 95% confidence intervals (CIs)., Results: A total of 125,473 patients (51.2% female; mean age 68.2 years) were included. There was moderate concordance between clinical and pathologic T stage (Kappa = 0.606, 95%CI: 0.602-0.609) and between clinical and pathologic N stage (Kappa = 0.506, 95%CI: 0.501-0.511). For right-sided colon cancer, there was moderate agreement between clinical and pathologic T stage (Kappa = 0.594, 95%CI: 0.589-0.599) and N stage (Kappa = 0.530, 95%CI: 0.523-0.537). For left-sided colon cancer, there was substantial agreement between clinical and pathologic T stage (Kappa = 0.624, 95%CI: 0.619-0.630) and moderate agreement between N stage (Kappa 0.472, 95%CI: 0.463-0.480). Sensitivity of clinical assessment of T and N stage ranged from 64.3% to 77.2% and 41.6% to 54.5%, respectively. Specificity ranged from 96.7% to 97.7% for T stage and 95.7% to 97.3% for N stage., Conclusions: Clinical assessment of T and N stages of colon cancer had good diagnostic accuracy with moderate concordance with the final pathologic stage. While clinical assessment was highly specific with < 3% of patients being over-staged, it had modest sensitivity, especially for detection of nodal involvement. Diagnostic accuracy of clinical assessment of right and left colon cancers was similar, except for higher sensitivity and accuracy of assessment of nodal involvement in right than left colon cancers., (© 2024. The Author(s).)

Background: This study aimed to investigate factors associated with prolonged operative time in laparoscopic right hemicolectomy for colon cancer., Methods: This was a retrospective review of patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Linear and binary logistic regression analyses were performed to determine factors associated with prolonged operative time. The association between longer operative times and complications and hospital stay was assessed., Results: One hundred and ninety-seven patients (52.3% female; mean age: 68.8 ± 14.1 years) were included. Factors independently associated with operative time were male sex (β = 17.3, 95% CI: 2, 32.5; p = 0.026) and extended hemicolectomy (β = 67.7, 95% CI: 27.6, 107.9; p = 0.001). American Society of Anesthesiologists (ASA) IV classification had a borderline significant association with operative time (β = 100.4, 95% CI: -2.05, 202.9; p = 0.055). Male sex (r = 0.158; p = 0.026), body mass index (r = 0.205; p = 0.004), ASA classification (r = 0.232; p = 0.001), extended hemicolectomy (r = 0.256; p < 0.001), and intracorporeal vessel control (r = 0.161; p = 0.025) had significant positive correlation with operative times. Patients with operative times ≥ 160 min had significantly longer hospital stays (5 vs. 4 days; p = 0.043) and similar complication rates to patients with shorter operative times., Conclusions: Male sex, advanced ASA classification, and extended hemicolectomy were independently and significantly associated with longer operative times in laparoscopic right hemicolectomy. Longer operative times were associated with longer hospital stays and similar complication rates., (© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)

Background: Robotic surgery is becoming increasingly popular in bariatric-metabolic surgery. However, its superiority regarding postoperative outcomes compared with conventional laparoscopy has not been clearly proven. With growing adoption of robotic surgery and improved technologies, benefits should become more evident., Objectives: Evaluate readmission and reoperation rates after bariatric-metabolic surgery performed by conventional laparoscopy versus robotic-assisted from 2015 to 2021., Setting: Academic institution., Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was reviewed for primary bariatric operations performed with conventional laparoscopy versus robotic-assisted. Postoperative outcomes were compared in a propensity score-matched sample., Results: Of 1,059,348 cases meeting inclusion criteria, 921,322 (87%) were conventional laparoscopic bariatric-metabolic surgeries, which were matched 1:1 with robotic-assisted cases (138,026). Reoperation (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.00-1.15, P = .0463), postoperative morbidity (OR 1.07; 95% CI 1.01-1.12, P = .0193), readmission (OR 1.14; 95% CI 1.09-1.18, P < .0001), and emergency department visits (OR 1.06; 95% CI 1.03-1.09, P = .0003) at 30 days postoperatively were significantly greater for robotic-assisted cases. Robotic-assisted cases had a similar mortality rate at 30 days postoperatively and length of stay >3 days when compared with conventional laparoscopic cases. Similar results were observed in cases from 2020 to 2021, except for reoperation and emergency department visits, which showed no difference between groups and length of stay >3 days, which was greater in robotic-assisted cases., Conclusions: Our results show a greater readmission and reoperation rate and greater morbidity at 30 days postoperatively in robotic-assisted bariatric-metabolic surgery compared with conventional laparoscopy. Analyzing only cases performed between 2020 and 2021, robotic surgery also does not show superiority over conventional laparoscopy., (Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Thermal ablation has recently become a key therapy for the treatment of colorectal liver metastasis (CLM). However, the role of ablation in combination with resection has not yet been firmly established. We hypothesize that in patients with CLM, those who undergo liver resection with ablation (RA) have similar outcomes compared with those who undergo liver resection only., Methods: We reviewed a multicenter international database of 906 surgical procedures for CLM from 5 high volume hepatobiliary surgical units. Patients undergoing RA (n = 63) were matched based on the number of lesions and tumor size using a 1:1 balanced propensity score analysis with those having resection only (n = 63). Our primary outcomes were overall survival (OS) and disease-free survival (DFS)., Results: The mean age of our cohort was 58 ± 11 years, with 43% females. With a median follow-up of 70.8 months, patients in the resection and RA group had a median OS of 45.1 and 54.8 months (p = 0.71), respectively. The median DFS was 22.7 and 14.2 months (p = 0.045), respectively. Using a multivariate Cox proportional hazards regression model, the treatment approach was not associated with OS (p = 0.94) or DFS (p = 0.059). A higher number of lesions is independently associated with worse DFS (hazard ratio: 1.12, p < 0.01). When there was disease recurrence, the region of recurrence was similar between the RA versus resection only groups (p = 0.27), but there was a shorter time to recurrence in the RA group (p = 0.002)., Conclusion: For CLM, the treatment approach was not significantly associated with OS or DFS, while tumor biology likely played an important role. Prospective research on the quality and effectiveness of thermal ablation combined with hepatic resection is warranted., (© 2024 Wiley Periodicals LLC.)

Background: Colon cancer pathological and clinical staging may be disoncordant. This study assessed patients with colon cancer in whom the nodal status was clinically understaged., Methods: Patients with stage I-III clinical node-negative colon cancer from the National Cancer Database were included. Regression analyses were conducted to elucidate risk factors for clinical nodal understaging and a scoring system was developed to identify high-risk patients., Results: The study included 94,945 patients with 78.4 ​% of patients correctly staged and 21.6 ​% clinically understaged. The predictors of nodal positivity in clinically understaged patients were age <65 (OR 1.43), left-sided tumors (OR 1.41), elevated CEA (OR 2.03), moderately (OR 1.81) or poorly/undifferentiated tumors (OR 3.76), T1 tumors (OR 1.29), signet-ring cell histology (OR 2.26), and microsatellite-stable tumors (OR 1.4)., Conclusion: Patients with colon cancer and the above factors are more likely to have their nodal status clinically understaged. A scoring system has been developed to identify high-risk patients., Competing Interests: Declaration of competing interest None of the authors has any relevant financial disclosures. Dr. Wexner is a consultant for Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The pterional craniotomy, described by Yasargil and Fox in 1975, constitutes the most traditional and important surgical access in vascular neurosurgery. Minimally invasive alternatives include the minipterional (MP) and lateral supraorbital (LSO) craniotomies, which avoid complications such as injury to the frontal branch of the facial nerve, temporal muscle dysfunction, depression of the craniotomy site, frontal sinus opening, and cosmetically unacceptable outcomes. We evaluated and compared the exposures provided by MP and LSO craniotomies through quantitative measurements of the surgical exposure area around the circle of Willis and parasellar regions, as well as angular and linear exposures of the internal carotid artery (ICA) bifurcation, middle cerebral artery (MCA), midpoint of the anterior communicating artery, and tip of the basilar artery (BA)., Methods: Seven fresh cadavers were dissected at the São Paulo Medical Examiner's Office, SP, and three at the skull base laboratory of Weill Cornell Medical College, New York, USA. The craniotomies were performed sequentially, initially with the LSO craniotomy followed by the MP. After the craniotomy, the surgical exposure area, craniotomy area, and angular exposures in the horizontal and vertical axes were determined., Results: The MP craniotomy provided better angular exposure for the ipsilateral MCA, while the LSO craniotomy and BA provided better vertical axis exposures. The LSO craniotomy provided better angular exposure in the vertical axis for the midpoint of the anterior communicating artery and contralateral ICA bifurcation. Regarding surgical exposure and craniotomy area, there were no statistically significant differences., Conclusion: The MP craniotomy offers a significantly larger surgical exposure compared to the LSO craniotomy, with specific advantages regarding angular exposure to important neurovascular structures. This study provides important quantitative data to guide the choice between these minimally invasive access techniques in vascular neurosurgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Background: Treatment of elderly patients with cancer is challenging as they can be overtreated with respect to frailty or undertreated because of advanced age. Maintaining a good quality of life is essential for this population. This study aimed to assess the difference in overall survival and short-term outcomes according to the extent of rectal cancer resection in patients aged ≥80 years., Methods: In this retrospective cohort study, very elderly patients with stage I-III rectal cancer aged ≥80 years were identified from the National Cancer Database (2004-2019). Patients were divided into 2 groups: radical resection and local excision. The groups were matched using exact matched analysis for clinical T and N stage, tumor size, and neoadjuvant treatment. The main outcome measures were overall survival, hospital stay, 30-day unplanned readmissions, and short-term mortality., Results: A total of 9634 patients were included (local excision = 2710; radical resection = 6924). After matching, 1106 patients were included in each group with a median follow-up of 49.9 and 51.7 months, respectively. The radical resection group had statistically significantly longer overall survival than did the local excision group (60 vs 57.2 months, P = .026). Local excision was associated with shorter length of stay (1 vs 7 days. P < .001), lower 30-day mortality (odds ratio: 0.43; 95% CI: 0.25-0.75, P = .003), lower 90-day mortality (odds ratio: 0.47, 95% CI: 0.32-0.68, P < .001), and lower 30-day readmission (odds ratio: 0.49, 95% CI: 0.33-0.74, P < .001). A subgroup analysis of matched patients with cTis-T2 and N0 tumors who underwent curative surgery revealed similar results., Conclusion: Radical resection of rectal cancer in very elderly patients has a modest survival benefit, whereas local excision has lower odds of readmission and short-term mortality., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Background: Obesity and its associated lifestyle are known risk factors for early-onset colorectal cancer and are associated with poor postoperative and survival outcomes in older patients. We aimed to investigate the impact of obesity on the outcomes of early-onset colorectal cancers., Methods: Retrospective review of all patients undergoing primary resection of colon or rectal adenocarcinoma at our institution between 2015-2022. Patients who had palliative resections, resections performed at another institution, appendiceal tumors, and were underweight were excluded. The primary endpoint was survival according to the patient's body mass index: normal weight (18-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), and obesity (≥30 kg/m 2 ). Patient and tumor characteristics and survival were compared between the three groups., Results: A total of 279 patients aged <50 years with colorectal cancer were treated at our hospital; 120 were excluded from the analysis for the following reasons: main treatment or primary resection performed at another hospital (n = 97), no resection/palliative resection (n = 23), or body mass index <18 kg/m 2 (n = 2). Of these, 157 patients were included in the analysis; 61 (38.9%) were overweight and 45 (28.7%) had obesity. Except for a higher frequency of hypertension in the overweight (P = .062) and obese (P = .001) groups, no differences in patient or tumor characteristics were observed. Mean overall survival was 89 months with normal weight, 92 months with overweight, and 65 months with obesity (P = .032). Mean cancer-specific survival was 95 months with normal weight, 94 months with overweight, and 68 months with obesity (P = .018). No statistically significant difference in disease-free survival (75 vs 70 vs 59 months, P = .844) was seen., Conclusion: Individuals with early-onset colorectal cancer who are overweight or obese present with similar tumor characteristics and postoperative morbidity to patients with normal weight. However, obesity may have a detrimental impact on their survival. Addressing obesity as a modifiable risk factor might improve early-onset colorectal cancer prognosis., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Available platforms for local excision (LE) of early rectal cancer are rigid or flexible [trans‑anal minimally invasive surgery (TAMIS)]. We systematically searched the literature to compare outcomes between platforms., Methods: PRISMA-compliant search of PubMed and Scopus databases until September 2022 was undertaken in this random-effect meta-analysis. Statistical heterogeneity was assessed using I 2 statistic. Studies comparing TAMIS versus rigid platforms for LE for early rectal cancer were included. Main outcome measures were intraoperative and short-term postoperative outcomes and specimen quality., Results: 7 studies were published between 2015 and 2022, including 931 patients (423 females); 402 underwent TAMIS and 529 underwent LE with rigid platforms. Techniques were similar for operative time (WMD 11.1, 95%CI - 2.6 to 25, p = 0.11), percentage of defect closure (OR 0.7, 95%CI 0.06-8.22, p = 0.78), and peritoneal violation (OR 0.41, 95%CI 0.12-1.43, p = 0.16). Rigid platforms had higher rates of short-term complications (19.1% vs 14.2, OR 1.6, 95%CI 1.07-2.4, p = 0.02), although no significant differences were seen for major complications (OR 1.41, 95%CI 0.61-3.23, p = 0.41). Patients in the rigid platforms group were 3-times more likely to be re-admitted within 30 days compared to the TAMIS group (OR 3.1, 95%CI 1.07-9.4, p = 0.03). Rates of positive resection margins (rigid platforms: 7.6% vs TAMIS: 9.34%, OR 0.81, 95%CI 0.42-1.55, p = 0.53) and specimen fragmentation (rigid platforms: 3.3% vs TAMIS: 4.4%, OR 0.74, 95%CI 0.33-1.64, p = 0.46) were similar between the groups. Salvage surgery was required in 5.5% of rigid platform patients and 6.2% of TAMIS patients (OR 0.8, 95%CI 0.4-1.8, p = 0.7)., Conclusion: TAMIS or rigid platforms for LE seem to have similar operative outcomes and specimen quality. The TAMIS group demonstrated lower readmission and overall complication rates but did not significantly differ for major complications. The choice of platform should be based on availability, cost, and surgeon's preference., (© 2024. The Author(s).)

Background: We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery., Methods: A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE., Results: Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, P  =   0.004, I 2   =   0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, P  =   0.024, I 2   =   0%). Meta-regression showed that age [standard error (SE): 0.036, P  <   0.001], male sex (SE: 0.006, P  <   0.001), and operative time (SE: 0.002, P  =   0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay., Conclusions: LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications., Competing Interests: S.D.W. reports receiving consulting fees from Baxter, Becton, Dickinson and Co, Glaxo Smith Kline, Intuitive Surgical, Livsmed, Medtronic, OstomyCure, Stryker, Takeda, Virtual Ports, is a member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang and receives royalties from Intuitive Surgical, Karl Storz Endoscopy America Inc., and Unique Surgical Solutions, LLC., (© The Author(s) 2024. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-sen University.)

Background and Objectives: Pathological nodal staging is relevant to postoperative decision-making and a prognostic marker of cancer survival. This study aimed to assess the effect of different total neoadjuvant therapy (TNT) regimens on lymph node status following total mesorectal excision (TME) for locally advanced rectal cancer (LARC)., Methods: A retrospective cohort study of patients treated for node-positive clinical stage 3 LARC with TNT between January 2015 and August 2022. Patients were stratified into induction therapy and consolidation therapy groups. Variables collated included patient demographics, clinical and radiological characteristics of the tumor, and pathology of the resected specimen. Primary outcome was total harvested lymph nodes., Results: Ninety-seven patients were included (57 [58.8%] males; mean age of 58.5 ± 11.4 years). The induction therapy group included 85 (87.6%) patients while 12 (12.4%) patients received consolidation therapy. A median interquartile range value of 22.00 (5.00-72.00) harvested lymph nodes was recorded for the induction therapy group in comparison to 16.00 (16.00-47.00) in the consolidation therapy arm (p = 0.487). Overall pathological complete response rate was 34%., Conclusion: Total harvested nodes from resected specimens were marginally lower in the consolidation therapy group. Induction therapy may be preferrable to optimize postoperative specimen staging., (© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.)

Aim: Splenic flexure mobilization (SFM) is commonly performed during left-sided colon and rectal resections. The aim of the present systematic review was to assess the outcomes of SFM in left-sided colon and rectal resections and the risk factors for complications and anastomotic leak (AL)., Method: This study was a PRISMA-compliant systematic review. PubMed, Scopus and Web of Science were searched for studies that assessed the outcomes of sigmoid and rectal resections with or without SFM. The primary outcomes were AL and total complications, and the secondary outcomes were individual complications, operating time, conversion to open surgery, length of hospital stay (LOS) and pathological and oncological outcomes., Results: Nineteen studies including data on 81 116 patients (49.1% male) were reviewed. SFM was undertaken in 40.7% of patients. SFM was associated with a longer operating time (weighted mean difference 24.50, 95% CI 14.47-34.52, p < 0.0001) and higher odds of AL (OR 1.19, 95% CI 1.06-1.33, p = 0.002). Both groups had similar odds of total complications, splenic injury, anastomotic stricture, conversion to open surgery, (LOS), local recurrence, and overall survival. A secondary analysis of rectal cancer cases only showed similar outcomes for SFM and the control group., Conclusions: SFM was associated with a longer operating time and higher odds of AL, yet a similar likelihood of total complications, splenic injury, anastomotic stricture, conversion to open surgery, LOS, local recurrence, and overall survival. These conclusions must be cautiously interpreted considering the numerous study limitations. SFM may have only been selectively undertaken in cases in which anastomotic tension was suspected. Therefore, the suboptimal anastomoses may have been the reason for SFM rather than the SFM being causative of the anastomotic insufficiencies., (© 2024 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Background: This study assessed trends in treatment and outcomes of anal melanomas over a 17-year period., Methods: NCDB was searched for patients with anal melanoma (2004-2020). Receiver-operating characteristic curve analysis was used to determine cutoff year marking increased overall survival (OS) of anal melanoma. Characteristics, treatments, and outcomes in consecutive time periods were compared., Results: A total of 815 patients (mean age: 67.2 years; 59.4% female) were included: 354 in Period 1 (2004-2012) and 461 in Period 2 (2013-2020). Period 2 included fewer abdominoperineal resections (18% vs. 28%, p = 0.002), more local tumor excisions (61.1% vs. 55%, p = 0.002), more often immunotherapy (odds ratio [OR]: 3.41, 95% confidence interval [CI]: 2.22-5.22, p < 0.001) and less often chemotherapy (OR: 0.516, 95% CI: 0.352-0.755, p < 0.001) administered and longer median OS (25.2 vs. 19.8 months, p = 0.006). Independent predictors of worse OS were older age (hazard ratio [HR]: 1.02, p = 0.012), higher Charlson score (HR: 2.32, p = 0.02), and greater number of positive lymph nodes (HR: 1.15, p < 0.001); conversely private insurance (HR: 0.385, p = 0.008) was predictive of increased OS., Conclusions: Anal melanoma patients diagnosed between 2013 and 2020 underwent fewer abdominoperineal resections and more local excisions than patients diagnosed between 2004 and 2013. Increased immunotherapy and longer median OS were noted in period two. Age and private insurance were significant predictors of OS, remaining constant across time periods., (© 2024 Wiley Periodicals LLC.)