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Surgical site events (SSE), including surgical wound complications and surgical site infections, are a major concern in patients undergoing general surgery operations. These increase the costs of care, and can lead to prolonged hospital stay and need for further treatments, ultimately resulting in poor quality of life. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSE, but little is known on the topic, and particularly in geriatric population. Our primary aim was to assess the efficacy of NPWT by means of a pocket device (PICO, Smith & Nephew, London, UK) in preventing SSE compared with conventional dressings in patients undergoing surgery with primary wound closure for breast and for colorectal diseases in our Unit. Our secondary aims were to assess the efficacy and safety of PICO in elderly patients, and to seek for differences between breast and abdominal results. All consecutive patients undergoing breast and colorectal surgery in our Unit between September 2012 and May 2014 were prospectively enrolled in this open label controlled study. Breast patients receiving NPWT were assigned to group B1, those receiving conventional dressings were assigned to group B2. Colorectal patients were assigned to group C1 (NPWT) and C2 (conventional dressings) in similar fashion. Each group included 25 patients, and at least 10 (40%) patients aged over 65 years to allow sub-analyses. NPWT significantly reduced SSE in both breast and colorectal patients compared with controls. No significant differences were observed according to age. Similar benefits were observed in breast and colorectal patients. Our results suggest that PICO is an effective tool to prevent SSE in patients undergoing general surgery, irrespective of age. Its use is recommended in frail, elderly patients at risk of SSE.

A higher rate of patients suffering from inflammatory bowel diseases (IBD) are reported to experience the symptom of fatigue compared with general population. Fatigue can impair quality of life of IBD patients by limiting their daily functioning. However, this problem is poorly understood and addressed. Our aim was to investigate the impact of fatigue in IBD patients compared with controls, and to seek for relation between age and disease activity. IBD patients aged between 16 and 75 years observed at our Unit from June 2011 through June 2012 were evaluated for fatigue. Patients were asked to fill the fatigue impact scale (FIS) questionnaire. A cohort of age- and sex-matched patients observed for other-than-IBD diseases were prospectively enrolled to act as controls. Patients diagnosed with malignancies were excluded from evaluation. Each group included 16 patients, of whom half aged over 65 years. Fatigue was more severe in IBD patients than in controls (p = 0.02), irrespective of age and disease activity. IBD patients with moderate to severe disease activity showed worse fatigue compared with controls at any age (p < 0.0001). Young IBD patients with low disease activity showed a trend toward worse FIS score when compared with old IBD counterparts (p = 0.06). IBD significantly impacted on fatigue in our series. Considering IBD patients in remission, younger patients may experience worse fatigue. Further studies are needed to explore the effects of fatigue on quality of life and the potential of appropriate intervention strategies.

Purpose of investigation:the aim of this study is to demostrate if cytoreductive surgery in patients with ovarian carcinoma increases overall survival

Background: Colorectal Cancer (CRC) in the elderly is being diagnosed and treated more frequently, as a consequence of longer life expectancy. However, patients aged over 80 years are diagnosed late and surgical treatment is often difficult or aimed to palliate symptoms. Aim of the present study was to report on the characteristics of elderly patients referred to the endoscopy of our surgical Unit and outcomes of surgical treatment compared with younger patients. Materials and Methods: We prospectively gathered data of all patients referred to our Unit between January 2011 and January 2013 for suspicion of CRC, confirmed during endoscopy. We collected baseline characteristics, management, survival and quality of life (QoL). Patients who received radical surgery were compared with a sex- and disease cohort of younger patients undergoing surgery for CRC in the same period. Presentation and outcomes were compared, as well as survival and QoL. QoL was evaluated in all patients 3 months after endoscopy by means of EORTC QLQ-C30. Results: Twenty patients aged over 80 years received CRC diagnosis during endoscopy. Most patients were referred to endoscopy because of rectal bleeding (35%). Cancers were mainly located below the splenic flexure (75%), but the rate of right localizations was not negligible. Three (15%) patients received palliative surgery while 4 (20%) refused to undergo surgery or did not meet surgical criteria. At a mean follow-up of 14 ± 6 months survival rate was significantly higher in patients receiving radical surgery (p=0.04). Thirty patients aged < 80 years served as controls. No differences were observed in terms of cancer localization and stage, although elderly patients were more often found with node-positive CRC. Elderly patients more frequently suffered from minor perioperative complications (46.1 vs 6.7% p=0.006), but perioperative mortality and overall survival did not differ between groups. Concerning QoL, radical surgery conferred optimal results when compared with palliative/no surgery, irrespective of age. Conclusions: Referral of elderly patients to endoscopic examination is often delayed, and may result in suboptimal treatment. Pancolonoscopy and radical surgery should be encouraged, as a timely approach offers excellent results in terms of survival and QoL.

The aim of this study was to compare disease features and surgical complications of patients undergoing surgery under or over 65 years of age. We performed a retrospective review of patients undergoing thyroidectomy or lobectomy from January 1990 through January 2012 in our Institution. Patients aged over 65 years of age were compared with younger patients on a 1:1 ratio. A total of 2012 patients were operated on during the study period. Two-hundred patients aged > 65 years were compared with 200 patients < 65 years old. In this series, no significant differences were observed concerning surgical complications between groups. At multivariate analysis, masses causing compression, extended approaches and malignant lesions were significant predictors of complications, irrespective of age. Due to longer life expectancy, elderly patients are being operated on more frequently. Safety of thyroid surgery in this population is still debated. We observed no difference in surgical outcomes between elderly and younger patients; however, some features of the diseases impair survival in the former. Age did not increase likeliness of worse outcomes in patients receiving thyroid surgery.

the aim of this study is to demonstrate if Cytoreductive surgery in patients with ovarian carcinoma increases overall survival.during the period between 1998 and 2008, 60 patients with a relapse of ovarian cancer, were evaluated in order to undergo a cytoreductive surgery.an optimal cytoreduction (residual disease1 cm maximum diameter) was obtained in over half of patients.surgery remains the best therapeutic approach in ovarian cancer since it is associated with an increase in survival in all patients undergoing cytoreduction especially in the advanced stages of the disease. These results and those of other studies allow us to determine which patients may benefit from the cytoreductive surgery, improving their survival rate. A disease-free interval12 months is the best predictive factor of improved survival rate after surgery.