August 22, 2023
Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the ACS Brief editorial board.
Huang EY, Zhao B, Llaneras J, et al. Autologous Fat Grafting: An Emerging Treatment Option for Complex Anal Fistulas. J Gastrointest Surg. 2023;27(7): 1445-1453.
Complex anal fistula is an important challenge in surgical practice. This article presented a retrospective review of a prospectively maintained database that sought to determine the value of autologous fat grafting as a means of improving outcomes for patients with complex anal fistula.
Not surprisingly, the majority (65.4%) of the study cohort (n = 52) were patients with Crohn’s disease. Fat graft harvesting and placement techniques are described clearly in the article. Fat graft harvest sites were mostly in the abdominal wall and extremities. Symptom improvement was documented in 80.4% of patients and complete fistula closure occurred in 64.4%; complications (mostly postoperative abscess), occurred in 15.4% of patients.
The authors concluded that autologous fat grafting has potential value as a means of controlling complex anal fistulas.
Kim D, Woodham BL, Chen K, Koganathan V, Edye MB. Rapid MRI Abdomen for Assessment of Clinically Suspected Acute Appendicitis in the General Adult Population: A Systematic Review. J Gastrointest Surg 2023;27(7): 1473-1485.
Medical imaging is used for diagnosing appendicitis in 99% of patients in the US, according to data cited in this article.
Computed tomography (CT) imaging is usually chosen because of its high sensitivity for diagnosing acute appendicitis (95%); however, the complications of CT imaging are significant including renal damage due to contrast agents and increased long-term risk of radiation-related malignancy. Ultrasound is an alternative diagnostic procedure but has a significantly lower sensitivity.
The authors conducted a systematic review of the literature to determine usage patterns and outcomes of magnetic resonance imaging (MRI) for diagnosis acute appendicitis. A total of 33 studies from 8 countries were included in the systematic review. The duration of the MRI examination ranged from 2.5 to 30 minutes. The sensitivity for diagnosis of acute appendicitis was 96%.
Of interest was the observation that the sensitivity of MRI for diagnosis of complicated appendicitis was variable, ranging from 28% to 95%. Since availability of MRI during nights and weekends is variable, data on the frequency of using MRI in these time periods would be valuable; this issue was not addressed in the article.
The authors concluded that MRI has potential value for diagnosis of acute appendicitis, reducing imaging-related complications, and achieving overall cost savings.
Wysong A. Squamous-Cell Carcinoma of the Skin. N Engl J Med. 2023;388(24): 2262-2273.
This article provided a thorough, easily readable review of the biology, diagnosis, grading, and treatment of squamous cell carcinoma of the skin.
Skin cancer is the most diagnosed malignancy worldwide; more than 1 million new cases of squamous cell carcinoma of the skin are diagnosed annually, outnumbering all other reportable malignancies. Squamous cell skin cancer is especially dangerous in immunocompromised patients; the risk of metastasis and death are increased up to 15% in this patient group.
Squamous cell cancer of the skin contributes significantly to the increasing death rate due to cancer in the US, with the number of annual deaths exceeding the number of deaths from melanoma.
The authors noted that sun exposure is the most common underlying cause of squamous cell skin cancer. Grading of lesions is mostly accomplished using the American Joint Cancer Commission system; data cited in the review confirmed that other grading systems, such as the Brigham and Women’s and Salamanca systems, have improved the accuracy of the AJCC system especially for T3 tumors.
Surgical excision is the most common treatment; obtaining wider margins and more precise tumor grading using Moh’s micrographic surgery technique is the recommended surgical approach. Risk reduction for recurrent squamous cell cancer of the skin can be achieved with nicotinamide according to data presented in the review. Surgeons are encouraged to read the entire review article.