1. Colorectal-vaginal fistula after rectal cancer resection : international comparative cohort study of characteristics and treatmentMila L. Van Lieshout, Jobbe M. G. Lemmens, Nynke G. Greijdanus, Kiedo Wienholts, 2025, izvirni znanstveni članek Povzetek: A colorectal-vaginal fistula (CRVF) can occur as a complication of rectal cancer surgery. They can cause discomfort, repeated infection, need for treatment/further surgery, and a permanent stoma (an opening in the abdomen to collect bowel contents). This study looked at how often CRVF happened after surgery complicated by a leak where bowels ends have been joined together, how they were treated, and how likely patients were to live without a stoma 1 year after surgery. Researchers collected data on women from around the world who had rectal cancer surgery between 2014 and 2018 and developed a bowel leak (called anastomotic leakage). They compared those with and without a CRVF. A total of 88 out of 694 patients (12.7%) developed a CRVF. These patients more often had major surgery involving removal of nearby organs, including part of the vagina. They were more likely to have ongoing problems and needed more surgeries to manage them. Most had a temporary stoma, but only 29.5% could live without it after 1 year, compared with 48.7% of women without CRVF. CRVF is a serious complication that makes recovery harder. These patients are less likely to live without a stoma and usually need more surgery. However, if the leak is small, the chances of recovery without a permanent stoma are better.
Ključne besede: rectal fistula, rectal cancer, rectal resections, postoperative complications, anastomotic leak
Objavljeno v DiRROS: 05.01.2026; Ogledov: 149; Prenosov: 57
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2. Association of preoperative smoking with the occurrence of postoperative pulmonary complications : a post hoc analysis of an observational study in 29 countriesGalina Dorland, W. Saadat, David M.P. van Meenen, Ary Serpa Neto, Michael Hiesmayr, 2025, izvirni znanstveni članek Povzetek: Introduction: While smoking has been consistently identified as a significant contributor to postoperative complications, the existing literature on its association with postoperative pulmonary complications remains conflicting. Aim: We examined the association of preoperative smoking with the occurrence of postoperative pulmonary complications (PPCs). Methods: Post hoc analysis of an observational study in 146 hospitals across 29 countries. We included patients at increased risk of PPCs, according to the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score (≥ 26 points). The primary endpoint was the occurrence of one or more predefined PPCs in the first five postoperative days, including unplanned postoperative need for supplementary oxygen, respiratory failure, unplanned need for invasive ventilation, ARDS, pneumonia and pneumothorax. Secondary endpoints included length of hospital stay and in–hospital mortality. We performed propensity score matching to correct for factors with a known association with postoperative outcomes. Results: Out of 2632 patients, 531 (20.2 %) patients were smokers and 2102 (79.8 %) non-smokers. At five days after surgery, 101 (19.0 %) smokers versus 404 (19.2) non–smokers had developed one or more PPCs (P = 0.95). Respiratory failure was more common in smokers (5.1 %) than non–smokers (3.0 %) (P = 0.02), while rates of other PPCs like need for supplementary oxygen, invasive ventilation, ARDS, pneumonia, or pneumothorax did not differ between the groups. Length of hospital stay and mortality was not different between groups. Propensity score matching did not change the findings. Conclusion: The occurrence of PPCs in smokers is not different from non–smokers.
Ključne besede: anaesthesia, intraoperative ventilation, smoking, postoperative outcome, postoperative pulmonary complications, PPCs, respiratory complications
Objavljeno v DiRROS: 23.12.2025; Ogledov: 245; Prenosov: 72
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3. Stomach cancer elective surgery morbidity and mortality at 90-Day (Hold Study) : a prospective, international collaborative cohort studyClaudia Neves-Marques, Mohamed Abulazayem, Geoffrey Yuet Mun Wong, Ricardo David Maldonado, Yirupaiahgari Viswanath, Jan Grosek, Jurij Aleš Košir, 2026, izvirni znanstveni članek Povzetek: Background: Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes among patients undergoing elective gastric cancer surgery, as in the GASTRODATA Registry, and to identify associated risk factors. Methods: We conducted an international prospective study on patients aged ≥ 18 years undergoing elective surgery for gastric cancer with curative intent from January 4 to September 30, 2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with the 90-day outcome. Results: 380 collaborators from 47 countries submitted data on 1538 patients. Median age was 65 years (IQR: 19–94), and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n = 587) and 2.9% (n = 45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss > 10%, positive specimen margin, and post-operative pathological IV staging (p value < 0.05) were significantly associated with clinically relevant complications and mortality. Conclusion: Elective gastric cancer surgery has a 90-day morbidity of 38.2% and a 90-day mortality of 2.9% globally. This study provided the most comprehensive international 90-day prospective data to date regarding gastric cancer surgery. Several factors associated with higher morbidity were identified, highlighting the importance of a unified language on surgical morbidity, prehabilitation, and ongoing audits to enhance patient outcomes.
Ključne besede: gastric cancer, elective surgery, morbidity, mortality, 90-day postoperative outcomes, multinational audit, surgical complications, anastomotic leaks, patient safety
Objavljeno v DiRROS: 16.12.2025; Ogledov: 225; Prenosov: 74
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4. Epidemiological and Clinical Data from the European lipodystrophy (ECLip) registryGiovanni Ceccarini, Camille Vatier, Baris Akinci, Ines Belalem, Marjoleine Broekema, Eva Csajbok, Iztok Štotl, 2025, izvirni znanstveni članek Povzetek: Objective: Lipodystrophy syndromes comprise a group of rare diseases characterized by loss of adipose tissue without nutritional or catabolic causes. As the rarity of these conditions necessitates collaboration, the European Consortium of Lipodystrophies (ECLip) established an international, longitudinal registry for patients with all forms of lipodystrophy (excluding HIV-associated cases). Methods: From December 2017 to November 2023, 19 centres from 13 countries recruited 631 patients into the ECLip registry. Cross-sectional data were analysed using descriptive statistics. Results: Prospective data was available for 467 patients (82.7%, female; 86.5% adults; median age 44.0 years). Familial partial lipodystrophy (FPLD) was the most common subtype (57.4%), especially FPLD2 (37.9%). However, in men congenital generalized lipodystrophy was nearly as common as FPLD (33.3% vs. 35.8%). Symptoms at onset varied by subtype, with loss of adipose tissue being the most frequent. More than 70% of the patients suffered from metabolic complications, particularly dyslipidaemia (59.0%) and diabetes (48.4%) but prevalence and severity varied between subtypes (prevalence of diabetes for example 76.9% in patients with acquired partial lipodystrophy vs 8.7% in acquired localized lipodystrophy). Metreleptin, the only disease-specific treatment, was used by 11.6% of all patients. 34 deaths were documented, primarily due to cardiovascular events and cancer. Patients with generalized forms of lipodystrophy died earlier compared to patients with partial forms (median age at death 27.0 vs. 72.0 years). Conclusion: This study describes the largest cohort of patients with lipodystrophy reported to date. The dataset offers a comprehensive view of the epidemiology, clinical presentation, and associated comorbidities of lipodystrophy.
Ključne besede: lipodystrophy, registry, metabolic diseases, chronic complications, adipose tissue, leptin
Objavljeno v DiRROS: 12.12.2025; Ogledov: 170; Prenosov: 83
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5. Complications on the feeding artery after an arterio-venous fistula closure in patients after kidney transplantation : a national cohort studyMatej Zrimšek, Barbara Vajdič Trampuž, Matija Jelenc, Juš Kšela, Jakob Gubenšek, 2025, izvirni znanstveni članek Povzetek: Background: Arteriovenous fistulas (AVFs) in kidney transplant recipients are sometimes closed, either as a policy or due to complications. We collected data on the incidence of complications after AVF closure in a national cohort of transplanted patients. Methods: Patients who received a kidney transplant between 2000 and 2015 and had a functional AVF that was later ligated or extirpated were included. Medical records were searched for arterial complications on the arm with the closed AVF. Furthermore, all patients who were still alive in January 2023 were invited for a follow-up arterial ultrasound exam. Results: Sixty patients were included; mean follow-up was 9.3 ± 3.8 years. There were five (8% cumulative incidence) patients with symptomatic arterial thrombosis and three (5% incidence) with a symptomatic feeding artery aneurysm. Prospective ultrasound exams were performed in 50 patients; the mean diameter of the brachial artery was almost doubled on the arm with the closed AVF (8.1 ± 3.2 versus 4.7 ± 0.7 mm; P < .001). Additional asymptomatic complications were found in nine patients (18% incidence): seven cases (14% incidence) of arterial thrombosis, some extending up to the axillary artery, and three (6% incidence) brachial artery aneurysms. All patients in whom the thrombosis spread to the brachial artery had large brachial arteries (>10 mm) or an aneurysm. Conclusion: We observed a high cumulative incidence of arterial thrombosis (20%) and brachial artery aneurysms (10%), sometimes developing several years after AVF closure. These complications should be taken into account when contemplating closure of a well-developed AVF and an AVF-preserving approach with flow reduction surgery might be preferred in some cases.
Ključne besede: kidney transplantation, arterial thrombosis, arteriovenous fistula, complications, true brachial artery aneurysm, ultrasound exam
Objavljeno v DiRROS: 01.12.2025; Ogledov: 486; Prenosov: 94
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6. Influence of pancreas transection with cavitron ultrasonic surgical aspirator (CUSA) on incidence of postoperative pancreatic fistula after pancreatoduodenectomy (PANCUT) : study protocol for a randomised controlled trialBenjamin Hadžialjević, Hana Zavrtanik Čarni, Miha Petrič, Mihajlo Djokić, Blaž Trotovšek, Aleš Tomažič, David Badovinac, 2025, izvirni znanstveni članek Povzetek: Background: Complications after pancreatoduodenectomy occur in up to 40% of patients. Postoperative pancreatic fistula (POPF) remains the most common complication after pancreatoduodenectomy and is associated with increased postoperative mortality. The cavitron ultrasonic surgical aspirator (CUSA) is a surgical instrument commonly used in liver and neurosurgery. The CUSA selectively dissects tissue parenchyma, leaving blood vessels and bile ducts undamaged, which are then selectively ligated or clipped. Only a few studies have investigated the relationship between the transection of pancreatic tissue with CUSA and the formation of POPF. The results were inconsistent and were published before the updated ISGPS consensus on the definition of POPF. Methods: The PANCUT study is a randomised controlled trial initiated at the Department of Abdominal Surgery, University Medical Centre Ljubljana. The aim of the study is to determine whether precise dissection of the pancreatic tissue with CUSA reduces the incidence of POPF. Patients scheduled for pancreatoduodenectomy will be randomly assigned to either the experimental group, in which the pancreatic tissue will be dissected with CUSA, or the control group, in which pancreas will be conventionally transected with scalpel. A total of 180 patients will be included in the study. The primary endpoint is the formation of POPF. Secondary endpoints include operation time, amount of intraoperative blood loss, postoperative infectious complications, postoperative bleeding, length of hospital stay and mortality. Discussion: To our knowledge, the PANCUT study is the first randomized controlled trial to investigate the role of CUSA in the transection of pancreatic tissue during pancreatoduodenectomy. Trial registration: ClinicalTrials.gov NCT06135012. Registered on 18 November 2023.
Ključne besede: pancreatic fistula, postoperative complications, pancreas resection, cusa, pancreatoduodenectomy, pancreatic ducts
Objavljeno v DiRROS: 26.11.2025; Ogledov: 464; Prenosov: 143
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7. Enhanced oral glucose tolerance test for early detection of insulin resistance and metabolic complications in children with obesityUrh Grošelj, Jan Kafol, Jaka Šikonja, Matej Mlinarič, Robert Šket, Žiga Iztok Remec, Jernej Kovač, Ana Drole Torkar, Jasna Šuput Omladič, Barbka Repič-Lampret, Tadej Battelino, Primož Kotnik, 2025, izvirni znanstveni članek Povzetek: Background and aims: Early detection of insulin resistance (IR) and obesity-related complications is crucial for preventing type 2 diabetes. This study aimed to identify dynamic metabolic biomarkers for more precise early detection of IR and metabolic abnormalities. Methods: This cross-sectional cohort study evaluated IR and metabolic biomarkers in 403 children with obesity (median age 13.18 years, 51.3 % female, 98.5 % with obesity) using an enhanced oral glucose tolerance test (eOGTT). IR was assessed via four indices, with the Matsuda Insulin Sensitivity Index (ISI-M) used as the primary measure. Participants were stratified into quartiles based on ISI-M. Results: Participants with the highest IR (Q1) were older (p = 0.002), had a higher body mass index, were in a more advanced pubertal stage (p < 0.001), and had significantly elevated glucose and insulin levels (p < 0.001 for both) compared to the most insulin sensitive (Q4), with significant differences observed across all quartiles (p < 0.050 for all). Insulin at 120 min demonstrated excellent diagnostic accuracy for IR (AUC=0.958). Triglyceride levels in Q1 showed minimal decline during the eOGTT, while greater declines were observed with increasing insulin sensitivity (p = 0.002 across quartiles), suggesting that a lack of decline in triglycerides may help identify IR. High-sensitivity C-reactive protein levels increased with IR (p = 0.024). Baseline beta-hydroxybutyrate levels were highest in the Q4 and showed the greatest absolute decrease during the eOGTT, compared to Q1 (p < 0.001 for both). Conclusions: We validated established IR markers in children with obesity, while demonstrating that eOGTT may offer improved characterization and earlier identification of those at risk for metabolic complications.
Ključne besede: insulin resistance, oral glucose tolerance test, OGTT, metabolic complications, screening, children, adolescents, obesity
Objavljeno v DiRROS: 11.11.2025; Ogledov: 275; Prenosov: 123
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8. The association of KEAP1 and NFE2L2 polymorphisms with glycemic control and late complications in patients with type 2 diabetesZala Vraničar, Katja Goričar, Tanja Blagus, Vita Dolžan, Jasna Klen, 2025, izvirni znanstveni članek Povzetek: To investigate the association of KEAP1 rs1048290, rs9676881 and NFE2L2 rs6706649, rs6721961, rs35652124 polymorphisms with glycemic control and development of late complications in patients with type 2 diabetes mellitus (T2DM), a total of 316 T2DM patients were included in the retrospective genetic association study. Genotyping was performed using competitive allele-specific PCR. Data on HbA1c levels as a measure of glycemic control, and information on late complications, including ischemic heart disease, retinopathy, and nephropathy, was obtained from the medical records. Logistic regression analysis was used to assess the association between selected genetic polymorphisms and patients outcomes. Significant associations were observed between KEAP1 rs9676881 (p < 0.001) and NFE2L2 rs6721961 (p = 0.006) polymorphisms and elevated HbA1c levels. Additionally, NFE2L2 rs35652124 polymorphism was linked to a nominally higher risk of late complications, including ischemic heart disease (p = 0.036), retinopathy (p = 0.032), and nephropathy (p = 0.026). Results indicate that polymorphisms in the KEAP1 and NFE2L2 genes may influence glycemic control and the development of late complications in T2DM patients. These findings provide valuable insights into the genetic factors underlying T2DM progression and its complications in European populations, highlighting the potential role of genetic markers in optimizing personalized treatment strategies.
Ključne besede: diabetes mellitus type 2, oxidative pathway, genetic polymorphism, microvascular complications, macrovascular complications, personalized medicine
Objavljeno v DiRROS: 11.11.2025; Ogledov: 285; Prenosov: 144
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9. Phase angle as a prognostic indicator of surgical outcomes in patients with gastrointestinal cancerJana Gulin, Ester Ipavic, Denis Mlakar-Mastnak, Erik Brecelj, Ibrahim Edhemović, Nada Rotovnik-Kozjek, 2023, izvirni znanstveni članek Ključne besede: phase angle, colorectal cancer, postoperative complications, malnutrition
Objavljeno v DiRROS: 26.07.2024; Ogledov: 1350; Prenosov: 327
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10. High rate of complications in patients with carcinoma of the cervix surgically treated after radical radiotherapyAlbert-Peter Fras, 1995, izvirni znanstveni članek Povzetek: With the aim to improve the results of treatment of patients who had advanced carcinoma of the uterine cervix and were radically irradiated, a group of 49 patients underwent hysterectomy two to 24 months after completion of radiotherapy, among whom for only 43 patients data were available. Radiotherapy consisted of 40 Gy external beam irradiation to true pelvis, low dose intracavitary treatment to a total dose 40 Gy to point A, and parametrial irradiation 16 to 20 Gy, shielding the place where radioactive sources were positioned during intracavitary therapy. Necrosis, persistent cervical carcinoma, recurrent carcinoma, and in patients younger than 50 years no evidence of disease (NED) with dysplasia were indications for the surgical treatment. Hysterectomy with bilateral oophorectomy was as conservative as possible but severe complications, such as ureteral stenosis (five cases), recto-vaginal fistula (three cases), vesico-vaginal fistula (two cases), recto-vesico-vaginal fistula (one case) occurred. Asymptomatic frozen pelvs as a mild complication occurered in 10 cases. One patient died postoperatively because of dehiscence and abdominal wall necrosis. In 17 (39.5%) of 43 patients complications occurred, although asymtomatic frozen pelvic was not taken in account. We believe that such a combined treatment is only for selected cases.
Ključne besede: Complications
Objavljeno v DiRROS: 15.01.2024; Ogledov: 861; Prenosov: 248
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