A Recurrence Predictive Model for Thymic Tumors and Its Implication for Postoperative Management: a Chinese Alliance for Research in Thymomas Database Study

ObjectiveOur aim was to investigate appropriate postoperative management based on the risk of disease recurrence in thymic epithelial tumors after complete resection.MethodsThe Chinese Alliance for Research in Thymomas retrospective database was reviewed. Patients having stage I to IIIa tumors without pretreatment and with complete resection were included. Clinicopathologic variables with statistical significance in the multivariate Cox regression were incorporated into a nomogram for building a recurrence predictive model.ResultsA total of 907 cases, including 802 thymomas, 88 thymic carcinomas, and 17 neuroendocrine tumors, were retrieved between 1994 and 2012. With a median follow-up of 52 months, the 10-year overall survival rate was 89.5%. Distant and/or locoregional recurrences were noted in 53 patients (5.8%). The nomogram model revealed histologic type and T stage as independent predictive factors for recurrence, with a bootstrap-corrected C-index of 0.86. On the basis of this model, patients with T1 thymomas or T2 or T3 type A, AB, or B1 thymomas had a significantly lower incidence of recurrence (low-risk group) than those with T2 or T3 type B2 or B3 thymomas and all thymic carcinomas and neuroendocrine tumors (high-risk group) (2.7% versus 20.1% [p < 0.001]). In the high-risk group, more than half of the recurrences (55.2% [16 of 29]) were seen within the first 3 postoperative years, whereas all recurrences but one were recorded within 6 years after surgery. Recurrence occurred quite evenly over 10 postoperative years in the low-risk group.ConclusionsA 6-year active surveillance should be considered in high-risk patients regardless of adjuvant therapy. For low-risk patients, annual follow-up may be sufficient. Studies examining postoperative adjuvant therapies would be plausible in high-risk patients.     

Bariatric surgery in the elderly: a randomized prospective study comparing safety of sleeve gastrectomy and Roux-en-Y gastric bypass (BASE Trial)

BackgroundThe aging population along with the obesity epidemic has increased the number of older patients undergoing bariatric surgery. Nevertheless, there is still conflicting data regarding surgical safety in this population.ObjectivesThe aim of this study was to compare the surgical morbidity of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for older patients.SettingUniversity hospital, São Paulo, Brazil.MethodsWe performed a prospective randomized clinical trial from September 2017 to May 2019. Obese patients aged ≥65 years were randomized to LSG or LRYGB. Data collection included demographic information, body mass index (BMI), and co-morbidities. We assessed readmission, postoperative complications, and mortality. Complications were scored according to Clavien-Dindo classification.ResultsA total of 36 patients, with a BMI between 35.5 and 52.8 kg/m² were randomized to either LSG (18 patients) or LRYGB (18 patients). The overall complication rate was similar between LSG and LRYGB (3 versus 7, P = .13). Severe complication was more prevalent in LRYGB patients but had no statistically significant difference (0 versus 3, P = .07). Each group had 1 readmission and there was no mortality in 90-day follow-up.ConclusionsMorbidity and mortality rates of bariatric surgery are low in elderly obese patients. Despite not statistically significant, LSG had a lower rate of severe complications compared with LRYGB in this population setting.     

Circuitos postoperatorios en los pacientes sometidos a craneotomía programada. Revisión narrativa

In 2017, the Neurosciences section of the Spanish Society of Anaesthesiology, Critical Care and Pain Therapy published a national survey on postoperative care and treatment circuits in neurosurgery. The survey showed that practices vary widely, depending on the centre, the anaesthesiologist and the pathology of the patient. There is currently no standard postoperative circuit for cranial neurosurgical procedures in Spanish hospitals, and there is sufficient evidence to show that not all patients undergoing elective craniotomy should be routinely admitted to a postsurgical critical care unit. The aim of this study is to perform a narrative review of postoperative circuits in elective craniotomy in order to standardise clinical practice in the light of published studies. For this purpose, we searched MEDLINE (PubMed) to retrieve studies published in the last ten years, up to November 2019, using the keywords neurosurgery and postoperative care, craniotomy and postoperative care.     

唇裂Ⅱ期鼻畸形修复术后患者佩戴硅胶鼻模初始时间的探讨

目的探索唇裂Ⅱ期鼻畸形修复术后患者佩戴硅胶鼻模适宜的初始时间。方法选取我科唇部整形门诊2016年3月-2018年1月收治的鼻修复手术的47例唇裂Ⅱ期鼻畸形患者,根据患者门诊号的奇偶数分为观察组(25例)和对照组(22例),观察组于术后拆线日起佩戴硅胶鼻模,对照组于术后即刻佩戴硅胶鼻模。比较两组术后即刻、术后6个月患者和手术医生对鼻部外型满意度;比较两组术后拆线日切口愈合恢复情况及患者自我清洁能力和舒适度。结果术后即刻、术后6个月患者和手术医生对鼻部外型满意度比较两组差异无统计学意义(P>0.05)。伤口愈合率、患者自我清洁能力和舒适度观察组明显优于对照组,差异有统计学意义(P<0.05)。结论术后拆线日开始佩戴硅胶鼻模,既不影响术后鼻部外型的巩固与维持,又有利于患者的自我护理和观察,改善术后早期舒适度的体验,有利于伤口愈合,增加手术成功率。     

腮腺切除术中沿面神经总干顺行解剖面神经的效果及安全性

目的探讨腮腺切除术中应用沿面神经总干顺行解剖面神经的治疗效果及安全性。方法选取我院2016年2月至2019年3月收治的60例择期行腮腺切除术的患者,随机分为观察组与对照组各30例。对照组沿面神经总干逆行解剖面神经,观察组沿面神经总干顺行解剖面神经,观察两组患者术后1个月面神经功能及术后并发症发生情况。结果术后1个月,两组患者的面神经功能分级比较无统计学差异(P>0.05);观察组的术后并发症发生率为10.00%,明显低于对照组的33.33%(P <0.05)。结论临床行腮腺切除术中,沿面神经总干顺行解剖面神经可降低术后并发症发生率,值得推广。     

血流导向装置治疗颅内大型未破裂动脉瘤的临床疗效分析

目的探讨血流导向装置(FD)治疗颅内大型未破裂动脉瘤的安全性及疗效。方法回顾性分析郑州大学人民医院(河南省人民医院)脑血管介入科2015年2月至2019年7月应用FD(Pipeline+Tubridge)治疗的颅内大型(最大径≥10 mm)未破裂动脉瘤患者的临床资料,共92例(95个动脉瘤)。采用改良Rankin量表评分(mRS)标准评价临床预后,采用O′Kelly-Marotta(OKM)分级标准评估动脉瘤闭塞情况;采用多因素logistic回归分析方法分析影响术后6个月动脉瘤完全闭塞的相关因素。结果92例患者95个动脉瘤共置入101枚FD,手术成功率为100%。术后神经系统并发症发生率为4.3%(4/92),其中缺血性1例,出血性2例(死亡1例),术后出现烦躁等症状1例。77例患者获临床随访,中位随访时间为12(1~51)个月。至末次随访,mRS 0分70例,1分5例,2分、3分各1例。55例患者(56个动脉瘤)行影像学随访,末次中位随访时间为6(3~29)个月,动脉瘤完全闭塞(OKM分级D级)40个(71.4%,40/56),支架内狭窄的发生率为7.1%(4/56)。52例患者(53个动脉瘤)6个月随访时动脉瘤完全闭塞34个(64.2%,34/53),支架内狭窄的发生率为7.5%(4/53)。多因素logistic回归分析显示,联合弹簧圈填塞是术后6个月时动脉瘤完全闭塞的独立影响因素(OR=8.98,95%CI:1.87~43.22,P=0.006)。结论FD治疗颅内大型未破裂动脉瘤的手术成功率高,安全性好,但应警惕严重并发症的发生;联合弹簧圈填塞可促进动脉瘤完全闭塞。     

Significance of the simultaneous combined transcranial and endoscopic endonasal approach for prevention of postoperative CSF leak after surgery for lateral skull base meningioma

Lateral skull base meningiomas, particularly sphenoorbital meningiomas, sometimes extend extremely widely into adjacent structures including the paranasal sinuses. For endonasal skull base reconstruction using a vascularized nasoseptal flap for prevention of postoperative cerebrospinal fluid (CSF) leak, the simultaneous combined transcranial and endoscopic endonasal approach was applied for resection of these extensive tumors. We performed a retrospective review of four patients treated with the simultaneous combined transcranial and endoscopic endonasal approach for resection of lateral skull base meningiomas. Preoperative characteristics, tumor extent, extent of resection, complications, and postoperative outcomes were analyzed. The tumor extended into the paranasal sinus, infratemporal fossa, and pterygopalatine fossa in all patients. Extracranial extension into the cavernous sinus or superior orbital fissure was detected in two and three patients, respectively. In one patient without extension into the cavernous sinus and superior orbital fissure, gross total resection was achieved, whereas in the other three patients, subtotal resection was performed, and small residual masses of the tumor remained in the cavernous sinus or superior orbital fissure to minimize the risk of postoperative ocular nerve damage. No patients experienced postoperative CSF leak. The simultaneous combined transcranial and endoscopic endonasal approach is useful for a subgroup of patients with lateral skull base meningiomas for prevention of postoperative CSF leak. Particularly in recurrent cases in which vascularized flaps from the transcranial side are likely unavailable due to prior tumor resection, this combined approach is worth considering depending on tumor extension into the paranasal sinus.