Hasil untuk "Surgery"

E. Monsell, T. Balkany, G. Gates et al.

A. Kingsnorth, K. LeBlanc

F. Carli, Guillaume Bousquet-Dion, Rashami Awasthi et al.

Importance Research supports use of prehabilitation to optimize physical status before and after colorectal cancer resection, but its effect on postoperative complications remains unclear. Frail patients are a target for prehabilitation interventions owing to increased risk for poor postoperative outcomes. Objective To assess the extent to which a prehabilitation program affects 30-day postoperative complications in frail patients undergoing colorectal cancer resection compared with postoperative rehabilitation. Design, Setting, and Participants This single-blind, parallel-arm, superiority randomized clinical trial recruited patients undergoing colorectal cancer resection from September 7, 2015, through June 19, 2019. Patients were followed up for 4 weeks before surgery and 4 weeks after surgery at 2 university-affiliated tertiary hospitals. A total of 418 patients 65 years or older were assessed for eligibility. Of these, 298 patients were excluded (not frail [n = 290], unable to exercise [n = 3], and planned neoadjuvant treatment [n = 5]), and 120 frail patients (Fried Frailty Index,≥2) were randomized. Ten patients were excluded after randomization because they refused surgery (n = 3), died before surgery (n = 3), had no cancer (n = 1), had surgery without bowel resection (n = 1), or were switched to palliative care (n = 2). Hence, 110 patients were included in the intention-to-treat analysis (55 in the prehabilitation [Prehab] and 55 in the rehabilitation [Rehab] groups). Data were analyzed from July 25 through August 21, 2019. Interventions Multimodal program involving exercise, nutritional, and psychological interventions initiated before (Prehab group) or after (Rehab group) surgery. All patients were treated within a standardized enhanced recovery pathway. Main Outcomes and Measures The primary outcome included the Comprehensive Complications Index measured at 30 days after surgery. Secondary outcomes were 30-day overall and severe complications, primary and total length of hospital stay, 30-day emergency department visits and hospital readmissions, recovery of walking capacity, and patient-reported outcome measures. Results Of 110 patients randomized, mean (SD) age was 78 (7) years; 52 (47.3%) were men and 58 (52.7%) were women; 31 (28.2%) had rectal cancer; and 87 (79.1%) underwent minimally invasive surgery. There was no between-group difference in the primary outcome measure, 30-day Comprehensive Complications Index (adjusted mean difference, -3.2; 95% CI, -11.8 to 5.3; P = .45). Secondary outcome measures were also not different between groups. Conclusions and Relevance In frail patients undergoing colorectal cancer resection (predominantly minimally invasive) within an enhanced recovery pathway, a multimodal prehabilitation program did not affect postoperative outcomes. Alternative strategies should be considered to optimize treatment of frail patients preoperatively. Trial Registration ClinicalTrials.gov identifier: NCT02502760.

A. Currie, J. Burch, J. Jenkins et al.

B. Green, H. Marshall, F. Collinson et al.

Alexis C. Colvin, N. Egorova, A. Harrison et al.

D. de Ziegler, B. Borghese, C. Chapron

V. Garimella, C. Cellini

C. D. de Virgilio

1. A 55-year-old man presents with a mass in the left groin that is intermittently painful. The mass protrudes upon straining and reduces when he is in the supine position. With the patient standing, there is an obvious mass in his left scrotum that protrudes from the internal ring and becomes more prominent when the patient coughs. Elective surgery is recommended. At surgery, the posterior wall of the hernia sac feels very thickened and is consistent with a possible sliding hernia. Which of the following is true regarding this type of hernia?

F. Doglietto, M. Vezzoli, F. Gheza et al.

Importance There are limited data on mortality and complications rates in patients with coronavirus disease 2019 (COVID-19) who undergo surgery. Objective To evaluate early surgical outcomes of patients with COVID-19 in different subspecialties. Design, Setting, and Participants This matched cohort study conducted in the general, vascular and thoracic surgery, orthopedic, and neurosurgery units of Spedali Civili Hospital (Brescia, Italy) included patients who underwent surgical treatment from February 23 to April 1, 2020, and had positive test results for COVID-19 either before or within 1 week after surgery. Gynecological and minor surgical procedures were excluded. Patients with COVID-19 were matched with patients without COVID-19 with a 1:2 ratio for sex, age group, American Society of Anesthesiologists score, and comorbidities recorded in the surgical risk calculator of the American College of Surgeons National Surgical Quality Improvement Program. Patients older than 65 years were also matched for the Clinical Frailty Scale score. Exposures Patients with positive results for COVID-19 and undergoing surgery vs matched surgical patients without infection. Screening for COVID-19 was performed with reverse transcriptase-polymerase chain reaction assay in nasopharyngeal swabs, chest radiography, and/or computed tomography. Diagnosis of COVID-19 was based on positivity of at least 1 of these investigations. Main Outcomes and Measures The primary end point was early surgical mortality and complications in patients with COVID-19; secondary end points were the modeling of complications to determine the importance of COVID-19 compared with other surgical risk factors. Results Of 41 patients (of 333 who underwent operation during the same period) who underwent mainly urgent surgery, 33 (80.5%) had positive results for COVID-19 preoperatively and 8 (19.5%) had positive results within 5 days from surgery. Of the 123 patients of the combined cohorts (78 women [63.4%]; mean [SD] age, 76.6 [14.4] years), 30-day mortality was significantly higher for those with COVID-19 compared with control patients without COVID-19 (odds ratio [OR], 9.5; 95% CI, 1.77-96.53). Complications were also significantly higher (OR, 4.98; 95% CI, 1.81-16.07); pulmonary complications were the most common (OR, 35.62; 95% CI, 9.34-205.55), but thrombotic complications were also significantly associated with COVID-19 (OR, 13.2; 95% CI, 1.48-∞). Different models (cumulative link model and classification tree) identified COVID-19 as the main variable associated with complications. Conclusions and Relevance In this matched cohort study, surgical mortality and complications were higher in patients with COVID-19 compared with patients without COVID-19. These data suggest that, whenever possible, surgery should be postponed in patients with COVID-19.

Sang Lin, Sheng Tan, Yonglin Peng et al.

Abstract Neurotransmitter serotonin (5-hydroxytryptamine [5-HT]) has emerged to play parallel roles in both neurobiology and oncology. Apart from receptor-mediated signaling transduction pattern, serotonin can be covalently integrated into histone (the post-translational modification known as histone serotonylation) and serve as an epigenetic mark associated with permissive gene expression. However, how histone serotonylation influences tumorigenesis is yet to be understood. In this study, we observe the higher levels of histone serotonylation (H3K4me3Q5ser) and transglutaminases 2 (TGM2, the enzyme catalyzing serotonylation) in both pancreatic ductal adenocarcinoma (PDAC) tissues and cell lines in comparison with their normal counterparts, and inhibition of histone serotonylation suppresses PDAC development. Mechanistically, we demonstrate that TGM2-mediated histone serotonylation at promoter of the gene encoding stearoyl-CoA desaturase (SCD) up-regulates its expression and drives PDAC development by lipid metabolism remodeling. Collectively, this study reveals histone serotonylation as an important driver of PDAC tumorigenesis.

Cristina Cravana, Pietro Medica, Esterina Fazio et al.

The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system involved in the coping response to stressful challenges during exercise stimuli. Exercise represents a significant disruptor of homeostasis, inducing an ACTH-cortisol co-secretion, based on different characteristics of exercise in sport horses. Based on this statement, the aim of this study is to evaluate the circulating adrenocorticotropin and cortisol changes in Standardbred trotters, after training and racing sessions, considering the different age and sex. In particular, the aim is to determine to what extent the level of ACTH and cortisol increases during maximum effort in competition conditions (racing), and to compare two exercise conditions of different intensity, training and racing sessions, and effects on ACTH and cortisol responses. Ten Standardbreds, three females and seven males, clinically healthy, were enrolled and subjected to two exercise conditions: a non-competitive session (training) and then a competitive event (racing). Four of them were 2-year-olds and a further six were 3-year-olds. Training and racing effects on both ACTH (<i>p</i> < 0.01) and cortisol (<i>p</i> < 0.01) values were obtained. Compared to the training session, horses showed greater ACTH concentrations at rest (<i>p</i> < 0.001), at 5 (<i>p</i> < 0.01) and 30 min (<i>p</i> < 0.001), and lower cortisol concentrations only at rest (<i>p</i> < 0.01) after racing; 2- and 3-year-old horses showed the greater ACTH concentrations at 5 and 30 min (<i>p</i> < 0.01) post-racing; males showed the greater ACTH concentrations at 5 min and 30 min (<i>p</i> < 0.01) post-racing. The different stimuli of the two contexts, and differences in exercise intensity, such as training and competitive event, may have affected the direction of hypothalamic-pituitary-adrenal (HPA) axis response, both as an ability to adapt to physical stress of different intensity and as a preparatory activity for coping with stimuli. In conclusion, training and racing events induced a different HPA axis response in which both emotional experience and physical maturity could induce a significant adaptive response. As ACTH and cortisol concentrations in adult equids are extremely heterogeneous, further investigation is required to explore how different variables can influence the hormonal dynamics and their role as expressions of adaptive strategies to stress in horses.

Hao Wang, Xuan Wang, Yusheng Du et al.

Objectives: This study aimed to develop a predictive model for lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) patients by deep learning radiomic (DLRad) and clinical features. Methods: This study included 271 thyroid lobes from 228 PTC patients who underwent preoperative neck non-contrast CT at Center 1 (May 2021–April 2024). LNM status was confirmed via postoperative pathology, with each thyroid lobe labeled accordingly. The cohort was divided into training (n = 189) and validation (n = 82) cohorts, with additional temporal (n = 59 lobes, Center 1, May–August 2024) and external (n = 66 lobes, Center 2) test cohorts. Thyroid lobes were manually segmented from the isthmus midline, ensuring interobserver consistency (ICC ≥ 0.8). Deep learning and radiomics features were selected using LASSO algorithms to compute DLRad scores. Logistic regression identified independent predictors, forming DLRad, clinical, and combined models. Model performance was evaluated using AUC, calibration, decision curves, and the DeLong test, compared against radiologists' assessments. Results: Independent predictors of LNM included age, gender, multiple nodules, tumor size group, and DLRad. The combined model demonstrated superior diagnostic performance with AUCs of 0.830 (training), 0.799 (validation), 0.819 (temporal test), and 0.756 (external test), outperforming the DLRad model (AUCs: 0.786, 0.730, 0.753, 0.642), clinical model (AUCs: 0.723, 0.745, 0.671, 0.660), and radiologist evaluations (AUCs: 0.529, 0.606, 0.620, 0.503). It also achieved the lowest Brier scores (0.167, 0.184, 0.175, 0.201) and the highest net benefit in decision-curve analysis at threshold probabilities > 20 %. Conclusions: The combined model integrating DLRad and clinical features exhibits good performance in predicting LNM in PTC patients.

Lihui ZHANG, Shuo XIE, Mingfa LUO et al.

Objectives: Bone tissue grinding is one of the common and basic applications in orthopedic surgery clinics. The grinding process is energy-intensive and generates a lot of grinding heat. The accumulation of this heat may cause thermal damage to biological tissues. This paper presents experimental research to investigate the bone-grinding heat and the cooling method. Methods: The combined influence of nozzle position and feed direction on the cooling effect of bone grinding under cryogenic spray cooling conditions is experimentally investigated. A bone grinding platform with three-dimensional motion, as well as a cryogenic spray generation device, is designed and constructed. A spherical diamond grinding head with a diameter of 4 mm and a grit size of #150 is utilized. Fresh bovine cortical bone is used as the processing sample. The temperature at the nozzle outlet is 13 ℃, and the flow rate valve regulates the coolant flow rate to 400 mL/h. A three-dimensional force transducer (DJSW-40, China) is connected to a data acquisition system, which captures the forces applied to the bone sample along the X, Y, and Z directions at a frequency of 100 Hz. Simultaneously, a 0.1 mm diameter type K thermocouple (Omega Inc., TT-K-36) is embedded inside the bone sample to measure the grinding temperature in real-time. Three different nozzle arrangements were designed: above, in front of, and to the side of the abrasive tool, with the nozzles 10 mm away from the spray surface. Six sets of experiments (3×2) were designed using three nozzle orientations and two feeding directions. Each set of experiments was repeated three times to study the cooling effect of the spray under the combined influence of nozzle orientation and feed direction. Results: (1) During bone grinding, the abrasive tool is subjected to three orthogonal directional forces, namely FX (the tangential grinding force used for removing material), FY (the axial grinding force, representing the resistance of the abrasive tool during its feed), and FZ (the normal grinding force, which serves as the support force of the workpiece on the abrasive tool). For forward feed, the average values of the individual forces are: FX = 0.37 N, FY = -0.72 N, FZ = 1.38 N. For backward feed, FX = 0.46 N, FY = 0.78 N, FZ = 1.67 N. Since the grinding tool remains in the same rotational direction, the tangential force FX is consistently positive. For forward/backward feed, the axial force FY is in the -Y and +Y directions respectively, thus the sign of the FY value changes. When feeding forward/backward, the tangential force (FX) is 0.37 N and 0.46 N, respectively, which are relatively similar to each other, in accordance with the grinding theory. The power consumed for grinding is approximately 1.6 W and 1.9 W for forward and backward feed, respectively. (2) The nerve tissue is more heat-sensitive than bone tissue. Taking the human body's 37 ℃ as the base temperature, the threshold for the occurrence of thermal injury is 43 ℃, so the temperature rise threshold for thermal injury of nerve tissue is 6 ℃. In our experiment, the maximum temperature rise of bone under low-temperature spray cooling was lower than 4 ℃, indicating that the cooling method is effective. The effect of the nozzle arrangement was investigated under a fixed forward or backward feeding direction. When the abrasive tool is fed forward, the cooling of the thermocouple under the front nozzle is obvious. This is because, in addition to the contact arc area between the abrasive tool and the bone sample, a portion of the coolant from the front nozzle is sprayed onto the bone sample surface, resulting in a pre-cooling effect within the bone. When the abrasive tool is fed backward, the grinding temperature is lowest when the nozzle is placed above. For the different nozzle orientations, the side nozzles are in a perpendicular plane to the feed direction (Y-direction) of the grinding tool, so the feed direction has the least influence on the grinding temperature. The upper and front nozzles are in the same plane as the feed direction of the abrasive tool, so the influence of the feed direction is more significant. Conclusions: (1) The average tangential grinding force is 0.42 N, axial grinding force is 0.75 N, normal grinding force is 1.53 N, and the average power consumed by grinding is approximately 1.75 W when bone grinding is performed at a depth of 0.5 mm using a spherical diamond abrasive tool with a diameter of 4 mm. (2) Under the cooling effect of the cryogenic spray, the maximum temperature rise of grinding is less than 4 ℃, which can effectively prevent the occurrence of thermal damage in biological tissues. The temperatures of the two thermocouples in the same set of experiments were more consistent when the nozzle was placed above or side, while there was a significant difference in the temperatures of the two thermocouples when the nozzle was placed in front. This indicates that the cooling effect is more uniform when the nozzle is placed above and to the side. (3) The coupling of the nozzle arrangement and the feeding mode has a greater impact on the grinding temperature. When the nozzle is placed on top, it is favorable to backward feeding; when the nozzle is placed in front, it is conducive to forward feeding; and when the nozzle is placed on the side, there is no significant difference in the temperature between forward and backward feeding.

Jiu-Ling Chen, Chuang-Yan Wu, Xiang-Yu Luo et al.

Abstract Killer cell lectin-like receptor B1 (KLRB1) is implicated in cancer progression and immunity. In this study, we aimed to evaluate the expression levels of KLRB1 in lung adenocarcinoma (LUAD) and analyze the relationship between KLRB1 expression levels, LUAD progression, and the tumor immune microenvironment. KLRB1 levels in LUAD were analyzed using data from the TCGA and XENA databases. Additionally, the diagnostic values of KLRB1 were analyzed in patients with LUAD. Survival and meta-analyses were employed to investigate the relationship between KLRB1 levels and other prognostic factors in patients with LUAD. Bioinformatics and cellular experiments were used to understand the functions and mechanisms of KLRB1. In addition, correlation analysis was used to investigate the relationship between KLRB1 levels and the immune microenvironment in LUAD. Reduced KLRB1 expression in LUAD was found to positively correlate with tumor size, distant metastasis, pathological stage, age, overall survival, diagnostic value, and disease-specific survival in patients with LUAD (P < 0.05). Conversely, increased KLRB1 expression was found to positively correlate with the overall survival and disease-specific survival in patients with LUAD (P < 0.05). We also found that the overexpression of KLRB1 can inhibit the proliferation, migration, and invasion of LUAD cells and promote apoptosis. KLRB1 was involved in immune cell differentiation, NF-kB, PD-L1, and PD-1 checkpoint pathways and others. Additionally, KLRB1 expression was linked to tumor purity, stromal, immune, and estimate scores, the levels of immune cells including B cells, CD8+ T cells, and CD4+ T cells, and immune cell markers in LUAD. Reduced KLRB1 expression has a significant positive correlation with diagnosis, poor prognosis, and immunity to cancer in patients with LUAD. KLRB1 inhibited cell proliferation and migration in patients with LUAD. These results suggest that KLRB1 may serve as a potential therapeutic target in patients with LUAD.

Vidya Baiju, Akshitha J, Namasiyava Naveen S

Brain tumours are caused by the abnormal growth of cells in the brain. This occurs mainly due to genetic changes or exposure to X-ray radiation. When the tumours are detected early, they can be removed via surgery. The tumour can be removed through radiotherapy and chemotherapy if the removal of the tumour through surgery affects the survival rate. There are two main classifications of tumours: malignant or cancerous and benign or non-cancerous. Deep learning techniques are considered as they require more minimal human intervention than machine learning; they are built to accommodate huge amounts of unstructured data, while machine learning uses traditional algorithms. Though deep learning takes time to set up, the results are generated instantaneously. In this review, the authors focus on the various deep learning techniques and approaches that could detect brain tumours that were analysed and compared. The different types of deep learning approaches investigated are convolutional neural network (CNN), cascaded CNN (C-CNN), fully CNN and dual multiscale dilated fusion network, fully CNN and conditional random field, U-net convolutional network, fully automatic heterogeneous segmentation using support vector machine, residual neural network, and stacked denoising autoencoder for brain tumour segmentation and classification. After reviewing the algorithms, the authors have listed them based on their best accuracy (U-net convolutional network), dice score (residual neural network), and sensitivity score (cascaded CNN).

Eiji Nomura, Takatoshi Seki, Kentaro Yatabe et al.

Abstract Background Elderly gastric cancer patients (EGCPs) require treatment according to not just the stage of their cancer, but also to their general condition and organ function, and rather than full treatment, the appropriate amount of treatment is necessary. Methods A total of 425 patients who underwent gastrectomy for primary gastric cancer in our institution between April 2013 and March 2020 were classified by age into two groups: elderly patients (EP, age ≥ 80 years, n = 89); and younger patients (YP, age < 80 years, n = 336). The preoperative, intraoperative, and postoperative conditions of the two groups were then compared. Propensity score matching (PSM) was performed, and factors affecting complications and survival outcomes were examined in detail. In addition, the necessary treatment strategy for EGCPs in the preoperative, intraoperative, and postoperative periods was investigated. Results Of the preoperative factors, American Society of Anesthesiologists physical status (ASA-PS) was significantly higher, and respiratory function was significantly lower in the EP group than in the YP group, and the prognostic nutritional index (PNI) also tended to be lower. Of the intraoperative factors, there was no difference in the level of lymph node dissection. However, the EP group had significantly higher rates of postoperative pneumonia and anastomotic leakage. Of the postoperative factors, on simple comparison, postoperative long-term outcomes of the EP group were significantly worse (63.8% vs. 85.4%, p < 0.001), but there was no significant difference in disease-specific survival (DSS), and the DSS survival curves after PSM were almost identical, indicating that the survival rate in the EP group was decreased by death from other disease. Though the survival rate of laparoscopic surgery was significantly better than that of open surgery in the YP group, there was a significantly lower rate of postoperative complications in the EP group after PSM. Conclusions In EGCPs, one needs to be aware of short-term complications such as pneumonia and anastomotic leakage due to respiratory dysfunction and malnutrition that are present before surgery. Furthermore, to suppress deaths from other diseases that reduce postoperative survival rates, prevention of postoperative complications (particularly pneumonia) through minimally invasive surgery can be effective.

Hao Cui, Yu-Yue Zhao, Qiong Wu et al.

The clinical application of cancer immunotherapy is unsatisfied due to low response rates and systemic immune-related adverse events. Microwave hyperthermia can be used as a synergistic immunotherapy to amplify the antitumor effect. Herein, we designed a Gd-based metal-organic framework (Gd-MOF) nanosystem for MRI-guided thermotherapy and synergistic immunotherapy, which featured high performance in drug loading and tumor tissue penetration. The PD-1 inhibitor (aPD-1) was initially loaded in the porous Gd-MOF (Gd/M) nanosystem. Then, the phase change material (PCM) and the cancer cell membrane were further sequentially modified on the surface of Gd/MP to obtain Gd-MOF@aPD-1@CM (Gd/MPC). When entering the tumor microenvironment (TME), Gd/MPC induces immunogenic death of tumor cells through microwave thermal responsiveness, improves tumor suppressive immune microenvironment and further enhances anti-tumor ability of T cells by releasing aPD-1. Meanwhile, Gd/MPC can be used for contrast-enhanced MRI. Transcriptomics data revealed that the downregulation of MSK2 in cancer cells leads to the downregulation of c-fos and c-jun, and ultimately leads to the apoptosis of cancer cells after treatment. In general, Gd/MPC nanosystem not only solves the problem of system side effect, but also achieves the controlled drug release via PCM, providing a promising theranostic nanoplatform for development of cancer combination immunotherapy.

Fan Ren MD, Feng Chen MM, Xiaoqian Xu MM et al.

Background: Lung cancer screening is not limited to low dose computed tomography (LDCT). Recently, molecular biomarkers have been shown to have the potential to improve the current state of early lung cancer detection. The current study determined the efficiency of seven autoantibodies against tumor-associated antigens (7-AABs) and tumor markers in patients with lung cancer. Materials and Methods: An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of 7-AABs and tumor markers in 354 patients with lung cancer and 108 patients with benign pulmonary disease under care at Ethics Committee of Tianjin Medical University General Hospital. Results: The sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curve of 7-AABs were 30.0%, 84.3%, 86.3%, and 0.61, respectively. When combining the 7-AABs and tumor markers, the sensitivity was 68.6%, the specificity was 52.8%, and the area under the ROC curve was 0.72. The 7-AABs positive expression rate in lung cancer patients was significantly higher than patients with benign pulmonary diseases (30.1% vs 15.7%); however, the 7-AABs positive expression rate was affected by clinical features and pathologic stages. When combining 7-AABs and tumor markers, the combined 7-AABs and tumor marker positive expression rate increased to 68.6%. Conclusion: Based on this study and previous literature, the supplemental diagnostic value of 7-AABs has been confirmed; however, due to the low sensitivity, the value of 7-AABs alone in lung cancer screening is limited. The combination of 7-AABs and tumor markers has improved sensitivity and positivity, but decreased specificity, which makes their performance in cancer screening and early detection worthy of further research.

Matthias M Mauschitz, Bettina Wabbels, Maja Ehlers

Background Strabismus can have a great negative impact on the quality of life and the well-being of affected patients. In the past, these aspects were often neglected and, compared with somatic functioning, placed in the background. The aim of our study is to elicit factors influencing satisfaction with strabismus surgery, quality of life and expectations of surgery in order to better predict who will benefit the most and who may need further support.Methods We made a selection of suitable questionnaires to assess psychosocial aspects of strabismus and decided for Adult Strabismus 20 Questionnaire, Amblyopia and Strabismus Questionnaire, Diplopia Questionnaire, Expectations of Strabismus Surgery Questionnaire and Hospital Anxiety and Depression Scale. We then translated these measures (if not available in German). The patients filled out these forms as part of their preoperative orthoptic and ophthalmological assessment as well as approximately 3 months after strabismus surgery.Results We enrolled 59 patients in this study. Postoperative strabismus-related quality of life was higher after surgery and anxiety and depression levels were lower. Satisfaction with surgery was lower with higher postoperative angle and diplopia; the latter was also a determinant of lower postoperative quality of life. Higher expectations of strabismus surgery were present with higher depression levels and higher preoperative strabismus angle.Conclusion Our data indicate that strabismus surgery may cause a significant improvement in several psychosocial domains. There is evidence that psychosocial factors can have significant impact on expectations with surgery. Hence, it is important to consider mental health aspects of this disease in order to treat patients in the best possible way.