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1.
Satoru Kobayashi Yoko Karube Morimichi Nishihira Takashi Inoue Osamu Araki Tetsu Sado Masayuki Chida 《World journal of surgery》2016,40(7):1632-1637
Objectives
There is increasing evidence that Glasgow Prognostic Score (GPS), based on systemic inflammatory response and albumin level, is a useful predictor of overall survival in patients with various types of cancer.Methods
Patients with lung metastasis from colorectal carcinoma who underwent a lung metastasectomy from 2000 to 2015 were retrospectively investigated. Routine laboratory measurements including serum C-reactive protein (CRP), albumin, and the tumor marker carcinoembryonic antigen were performed before the metastasectomy.Results
Ninety-nine patients underwent 132 lung metastasectomy procedures during the study period. Kaplan–Meier analysis revealed that GPS (p = 0.017), number of metastases (p = 0.004), and the presence of liver metastasis (p = 0.010) were associated with overall survival, while univariate analysis selected GPS (p = 0.028), number of metastases (p = 0.005), and liver metastasis (p = 0.014) as predictive factors associated with overall survival. Multivariate analysis also indicated GPS (p = 0.004), number of metastases (p = 0.004), and liver metastasis (p = 0.013) as predictive factors associated with overall survival.Conclusion
In addition to number of metastases and liver metastasis, GPS is an important predictor of overall survival in colorectal cancer patients who undergo a lung metastasectomy.2.
Leigh White T. Stockwell N. Hartnell M. Hennessy J. Mullan 《Journal of orthopaedics and traumatology》2016,17(4):333-338
Background
Difficulties in kneeling, one of the poorest scoring functional outcomes post total knee arthroplasty (TKA),have been attributed to a lack of patient education. This is the first study to investigate specific factors affecting a patient’s perceived ability to kneel post TKA, following exposure to a preoperative kneeling education session.Materials and methods
A cross-sectional study was conducted following TKA with patients who had been educated about kneeling prior to the operation. Patients completed kneeling questionnaires at 6 (n = 115) and 12 (n = 82) months post TKA. In addition to the 12-month kneeling questionnaire, patients also completed the Oxford knee score (OKS) survey.Results
Seventy-two percent of patients perceived they could kneel at 12 months post TKA. Overall, pain and discomfort were the most common factors deterring patients from kneeling. Perceived kneeling ability was the poorest scored outcome on the OKS with patients reporting mild to moderate difficulty with this task. Kneeling scores were strongly correlated with overall knee function scores (R = 0.70), strongly correlated with pain scores (R = 0.45) and weakly correlated with knee stability scores (R = 0.29). When asked about other factors preventing kneeling other than pain or discomfort, 75 % had reasons unrelated to the knee or TKA. The most common reason was ‘problems with the other knee’ (n = 19).Conclusions
Patients in this study were provided with education regarding their kneeling ability post TKA, yet still experienced limitations in perceived kneeling ability postoperatively. Contrary to previous research, our study suggests that factors other than patient education affect a patient’s perceived kneeling ability post TKA.3.
Purpose
The purpose of this study was to determine the outcomes in patients treated with robotically assisted patello-femoral arthroplasty (PFA).Methods
This technique offers a safe, reliable, and reproducible way of obtaining correct implant positioning in patello-femoral arthroplasty, and as a result, reduces revision surgery due to implant malalignment. We evaluated 30 knees in 29 patients who underwent robotically assisted patello-femoral arthroplasty between June 2009 and May 2011. Mean follow-up was 15.9 months. This was a retrospective study that involved chart reviews and radiographic analysis. Radiographic analysis included pre-operative and postoperative plain films for implant positioning. Functional outcomes were evaluated using the Oxford Knee Score (OKS), range of motion, University of California at Los Angeles (UCLA) patient activity-level ratings, visual analog pain scale (VAS), and the Knee Society Score (KSS).Results
The patients had an average OKS of 21.7 pre-operatively and reached an average of 33.5 postoperatively (p = 0.0033). Pre-operative UCLA patient activity-level ratings was 3.1, compared with 4.8 postoperatively. Average VAS pre-operatively was 8 and postoperatively it decreased to 2.1 (p = 0.0033). The average KSS final score pre-operatively was 56 and postoperatively it increased to 68.3 while the functional score pre-operatively was 47.2 compared to 68.1 postoperatively (p = 0.011). As a result, patello-femoral arthroplasty is an emerging knee resurfacing technique that is an alternative to the total knee arthroplasty.Conclusions
The early retrospective data for robotically-assisted PFA show encouraging results. Advantages of this technique include a smaller incision, faster rehabilitation, preservation of bone stock, and implantation without malalignment.4.
M. Sgroi M. Faschingbauer H. Reichel T. Kappe 《Journal of orthopaedics and traumatology》2016,17(4):339-343
Background
The aim of total knee arthroplasty is, amongst others, the reconstruction of a physiological axis of the leg with a tibiofemoral angle in the frontal plane of an average of 6°. The aim of this study is to clarify how much of the bone length on the femur and tibia has to be reproduced on anteroposterior (AP) knee radiographs in order to determine the leg’s alignment after a total knee arthroplasty.Materials and methods
We analyzed the postoperative hip-to-ankle (HTA) radiographs of 100 patients who had undergone a total knee arthroplasty at our institution.Results
There were strong correlations between the measured values on HTA and 20 cm bone length [lateral distal femur angle (LDFA) r = 0.887, medial proximal tibial angle (MPTA) r = 0.874, tibiofemoral angle (TFA) r = 0.888], but not between the measurements on HTA and 10 cm (LDFA r = 0.267, MPTA r = 0.102, TFA r = 0.161). There were significant differences between all measurements both on HTA and 20 cm and on HTA and 10 cm, with the exception of the LDFA between HTA and 10 cm (p = 0.085) and of the MPTA between HTA and 20 cm (p = 0.227). The intra- and inter-observer correlations were both high.Conclusion
If preoperatively crude axis deviations are excluded, the tibiofemoral angle on AP knee radiographs can be determined with an accuracy of ±2.6° if at least 20 cm length of bone is reproduced (measured from the femoral and tibial joint line). Due to the high 95 % confidence intervals and bearing in mind that deviations greater than 3° may lead to inferior clinical results, however, it appears inappropriate to determine lower limb alignment with anteroposterior radiographs.Level of evidence
Level 2.5.
Kevin A. Reinard Diana M. Cook Hesham M. Zakaria Azam M. Basheer Victor W. Chang Muwaffak M. Abdulhak 《European spine journal》2016,25(7):2068-2077
Purpose
To identify risk factors that may lead to the development of dysphagia after combined anterior and posterior (360°) cervical fusion surgery.Methods
A single center, retrospective analysis of patients who had same-day, 360° fusion at Henry Ford Hospital between 2008 and 2012 was performed. Variables analyzed included demographics, medical co-morbidities, levels fused, and degree of dysphagia.Results
The overall dysphagia rate was 37.7 %. Patients with dysphagia had a longer mean length of stay (p < 0.001), longer mean operative time (p < 0.001), greater intraoperative blood loss (p = 0.002), and fusion above the fourth cervical vertebra, C4, (p = 0.007). There were no differences in the rates of dysphagia when comparing patients undergoing primary or revision surgery (p = 0.554).Conclusion
Prolonged surgery and fusion above C4 lead to higher rates of dysphagia after 360° fusions. Prior anterior cervical fusion does not increase the risk of dysphagia development.6.
Purpose
Although several studies have compared the clinical efficacy of an adductor canal block (ACB) to that of a femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA), disputes mainly exist in the recovery of quadriceps strength and mobilization ability between the two methods. The aim of the present study was to compare, in a systematic review and meta-analysis, the clinical efficacy of ACB with that of FNB.Methods
We systematically searched randomized controlled trials comparing FNB with ACB for analgesia after TKA in Pubmed and the Cochrane Library from inception to April 30th 2015. There was no limitation of publication language. Trial quality was assessed using the modified Jadad scale, and eligible data were pooled for meta-analysis.Results
Five studies of 348 patients were included. Outcomes showed that patients who received ACB had similar or better recovery of quadriceps strength and mobilization ability than those that underwent FNB. Similar efficacy was found between the two strategies regarding adductor strength, pain scores [at rest (p = 0.86), at or after knee flexion (p = 0.31)], opioid consumption (p = 0.99), opioid-associated adverse effects (p = 0.60), length of hospital stay (p = 0.42), patient satisfaction (p = 0.57), and success rate of blockade (p = 0.20).Conclusions
The present study suggests that TKA patients who receive ACB can achieve similar or even better recovery of quadriceps strength and mobilization ability than those treated with FNB. Taken as a whole, ACB may be a better analgesia strategy after TKA at present.7.
S. Pesenti B. Blondel E. Peltier E. Choufani G. Bollini J. L. Jouve 《European spine journal》2016,25(2):424-429
Purpose
In the last few years several reports stressed the importance of sagittal alignment in adolescent idiopathic scoliosis (AIS) patients. It was recently reported that T1 slope, defined as the angle between the superior endplate of T1 and the horizontal, correlates strongly with overall sagittal parameters. The aim of this study was to assess the impact of T1 parameters (T1-slope and T1-tilt) on sagittal alignment of AIS hypokyphotic patients preoperatively and postoperatively.Methods
Twenty-nine AIS patients with <20° preoperative hypokyphosis were included in a retrospective study. Surgery systematically comprised hybrid construct with screws below T11, sublaminar bands at thoracic level and a lamino-laminar claw on the upper instrumented vertebra. Preoperative, postoperative and 2-year follow-up radiological assessment included Cobb angle, T1 slope, T1 sagittal tilt, regional sagittal parameters and pelvic parameters.Results
In the series as a whole, coronal Cobb angle was significantly reduced postoperatively (58° vs. 17°; p < 0.001), thoracic kyphosis significantly improved (12.4° vs. 25.6°; p < 0.001) and cervical lordosis significantly restored (6.2° kyphosis vs. 4.1° lordosis; p < 0.001). There was a significant modification in T1-slope (10.2° vs. 18.2°; p < 0.001). Preoperatively, T1 slope was significantly correlated with T1 tilt (r = 0.427; p = 0.029). Postoperatively, T1 slope was significantly correlated with T1 tilt (r = 0.549; p = 0.002), thoracic kyphosis (r = 0.535, p = 0.005) and cervical lordosis (r = ?0.444, p = 0.03). Restoration of cervical lordosis was significantly correlated to changes of T1-slope (r = ?0.393, p = 0.032), which was significantly correlated to postoperative thoracic kyphosis.Conclusion
According to these results, T1 seems to be of major interest in postoperative modifications of sagittal alignment. T1 slope and sagittal tilt are good indicators of postoperative changes for regional (cervical lordosis and thoracic kyphosis) and global parameters. We therefore consider these parameters as essential in the assessment of AIS patients. Further studies and correlation with clinical scores will, however, be necessary in order to confirm the present findings.8.
A. Russo R. Capasso C. Varelli A. Laporta M. Carbone G. D’Agosto S. Giovine M. Zappia A. Reginelli 《Musculoskeletal surgery》2017,101(1):37-43
Introduction
This retrospective study examined the relationship between the mechanical axis throughout a functional arc of motion and functional outcome scores in patients undergoing computer-assisted navigation-based total knee arthroplasty (CAN-TKA) at 6-year follow-up.Materials and methods
The Stryker eNact Precision Knee Navigation System was utilized to obtain pre- and postoperative alignment measurements throughout the functional arc of motion. Patients were contacted via telephone and asked to complete the Short Form-12 and Western Ontario and McMaster Universities, which have been demonstrated to be reliable, valid, and sensitive assessment tools in this patient population. Statistical analysis was performed to determine the correlation between arc alignment and patient-reported functional outcome measures.Results
A total of 47 patients at a mean of 76.1 (±6.3)-month follow-up and mean age of 65.9 (±7.9) years were surveyed. No correlation was found between the postoperative alignment or degree of intraoperative correction and the functional outcome scores. In a planned subgroup analysis of patients with a mean functional arc alignment greater than 3° from neutral, mean intraoperative degree of correction correlated with decreasing physical function (Spearman’s ρ = 0.772, p = 0.04) and mean postoperative arc alignment positively correlated with increasing stiffness (ρ = 0.798, p = 0.03).Conclusion
This study suggests that patients undergoing CAN-TKA with mean functional arc range of motion greater than 3° may be at increased risk for suboptimal patient-reported functional outcomes. This study also illustrates the ability of CAN-TKA to measure the varus or valgus alignment of the knee throughout the entire range of motion.10.
Tyler Barker Victoria E. Rogers Vanessa T. Henriksen Kimberly B. Brown Roy H. Trawick Nathan G. Momberger G. Lynn Rasmussen 《Journal of orthopaedics and traumatology》2016,17(2):163-168
Background
This study aimed to identify (1) if the postoperative increase in the neutrophil-to-lymphocyte ratio (NLR) is different between contrasting knee arthroplasty procedures, and (2) if the NLR predicts venous thromboembolism (VTE) after total knee arthroplasty (TKA).Materials and methods
To address the first objective, we retrospectively studied patients who underwent primary unilateral TKA (n = 111) or unicompartmental knee arthroplasty (UKA; n = 74) between 2009 and 2012. Patients who required a blood transfusion, underwent autologous blood salvage, experienced any postoperative complication (such as VTE), or were re-admitted >90 days were excluded from analysis. For the second objective, we retrospectively identified patients (cases, n = 10) who underwent primary unilateral TKA between 2010 and 2012 and developed postoperative VTE (deep venous thrombosis, pulmonary embolism, or both) during inpatient care (postoperative day 1 or day 2). Cases were matched to surgeon, gender, body mass index, age, and date of surgery controls (n = 20) who underwent primary unilateral TKA without developing VTE before patient discharge. The NLR was calculated from the neutrophil and lymphocyte counts extracted from pre- and postoperative (day 1 and day 2) blood chemistry records.Results
On postoperative day 1, the NLR increase was exacerbated (p = 0.02) following TKA compared to UKA and predicted (p = 0.02) the occurrence of VTE in TKA patients prior to hospital discharge.Conclusion
We conclude that the NLR increase is greater following TKA compared to UKA and could serve as a matrix to predict or identify a patient susceptible of sustaining VTE after TKA.Level of evidence
3.11.
Tina Schubert Tilman Todenhöfer Johannes Mischinger Christian Schwentner Markus Renninger Arnulf Stenzl Georgios Gakis 《World journal of urology》2016,34(6):829-834
Purpose
To determine whether pre-treatment hemoglobin (Hb) levels in patients with bladder cancer impact on oncological outcomes after radical cystectomy (RC).Methods
A consecutive, contemporary series of 246 patients undergoing RC and pelvic lymph node dissection for bladder cancer. Decreased Hb level was defined as ≤12 g/dL. The Kaplan–Meier method was used to estimate recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS). The Fisher exact/Chi-square test was used to investigate differences between both groups. Uni- and multivariable Cox regression analysis addressed risk factors for recurrence, cancer-specific death and overall death. The median follow-up was 30 months (2–116).Results
Of the 246 patients, 182 (74 %) had normal (>12 g/dL) and 64 decreased (≤12 g/dL) preoperative Hb (26 %). In univariable analysis, decreased Hb was associated with increased age, extravesical disease, hydronephrosis (all p < 0.001), node-positive disease and positive resection margins (both p = 0.01). Subanalyzed for patients with organ-confined disease (defined as ≤pT2bN0R0; N = 109), the 3-year RFS, CSS and OS was significantly lower in patients with decreased (34.9, 35.5 and 19.8 %) compared to normal Hb level (69.7, 86.3 and 77.6 %; p = 0.01/p = 0.002/p < 0.001). In multivariable analysis, RFS, CSS and OS were significantly lower in patients with decreased Hb (p = 0.007, p = 0.001 and p = 0.002), pathologically locally advanced tumor (≥pT3a; p = 0.023, p = 0.036 and p = 0.065) and nodal stage (p < 0.001, p = 0.006 and p = 0.001) and positive soft tissue surgical margins (p = 0.040, p = 0.004 and 0.012).Conclusions
Pre-cystectomy Hb levels are associated with adverse histopathologic characteristics and provide additional prognostic information especially for patients with pathologically localized bladder cancer.12.
Yakup Tomak Basar Erdivanli Ahmet Sen Habib Bostan Ersel Tan Budak Ahmet Pergel 《Journal of anesthesia》2016,30(1):26-30
Purpose
We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications.Methods
A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution.Results
The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001).Conclusions
Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.13.
Risk Factors for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection
Mitsugi Shimoda Kazuma Tago Takayuki Shiraki Shozo Mori Masato Kato Taku Aoki Keiichi Kubota 《World journal of surgery》2016,40(10):2466-2471
Background and objectives
Hepatic resection is established as the treatment for HCC. However, patients sometimes experience early recurrence of HCC (ER HCC) after curative resection.Methods
A retrospective analysis was conducted for 193 patients with single HCC who underwent curative liver resection in our medical center between April 2000 and March 2013. We divided the cohort into two groups; early recurrence group (ER G) which experienced recurrence within 6 months after resection, and non-early recurrence group (NER G). Risk factors for ER HCC were analyzed.Results
Thirty-nine out of 193 (20.2 %) patients had ER HCC. Univariate analysis showed Glasgow prognostic score (GPS, p = 0.036), neutrophil to lymphocyte ratio (NLR, p = 0.001), level of PIVKA-II (p = 0.0001), level of AFP (p = 0.0001), amounts of blood loss (p = 0.001), operating time (p = 0.002), tumor size (p = 0.0001), stage III and IV (p = 0.0001), and microvascular invasions (portal vein: p = 0.0001 and hepatic vein: p = 0.001) to be associated with ER HCC. By multivariate analysis, there were significant differences in high NLR (p = 0.029) and high AFP (p = 0.0001) in patients with ER HCC.Conclusions
Preoperative high AFP (more than 250 ng/ml) and high NLR (more than 1.829) were independent risk factors for ER HCC.14.
Johannes Breyer Michael Gierth Sanzhar Shalekenov Atiqullah Aziz Julius Schäfer Maximilian Burger Stefan Denzinger Ferdinand Hofstädter Christian Giedl Wolfgang Otto 《World journal of urology》2016,34(5):709-716
Purpose
To determine whether the immunohistochemical markers survivin and E-cadherin can predict progress at initially diagnosed Ta bladder cancer.Methods
We retrospectively searched for every initially diagnosed pTa urothelial bladder carcinoma having been treated at our single-center hospital in Germany from January 1992 up to December 2004. Follow-up was recorded up to June 2010, with recurrence or progress being the endpoints. Immunohistochemical staining and analysis of survivin and E-cadherin of the TURB specimens were performed. Outcome dependency of progression and no progression with immunohistochemical staining was analyzed using uni- and multivariate regression analysis, Kaplan–Meier analysis and uni- and multivariate Cox regression analysis.Results
Overall, 233 patients were included. Forty-two percent of those were tumor free in their follow-up TURBs, 46 % had at least one pTa recurrence and 12 % even showed progress to at least pT1 bladder cancer. Aberrant staining of E-cadherin was found within 71 % of patients with progression in contrast to only 40 % in cases without progression (p = 0.004). Of all progressed patients, 92 % showed overexpression of survivin in their initial pTa specimen compared to 61 % without progression (p = 0.001). Kaplan–Meier analysis revealed aberrant E-cadherin staining to be associated with worse progression-free survival (PFS) (p = 0.005) as well as overexpression of survivin (p = 0.003). In multivariate Cox regression analysis, strong E-cadherin staining was an independent prognosticator for better PFS (p = 0.033) and multifocality (p = 0.046) and tumor size over 3 cm (p = 0.042) were prognosticators for worse PFS.Conclusion
Adding the immunohistochemical markers survivin and E-cadherin could help to identify patients at risk of developing a progressive disease in initial stage pTa bladder cancer.15.
Mathew D. Schur Christopher Lee Alexandre Arkader Anthony Catalano Paul D. Choi 《Journal of children's orthopaedics》2016,10(3):185-192
Purpose
The purpose of this study was to identify and evaluate risk factors of avascular necrosis (AVN) after closed treatment for developmental dysplasia of the hip (DDH).Methods
A retrospective review of children diagnosed with DDH at a tertiary-care children’s hospital between 1986 and 2009 was performed. The presence of AVN was assessed according to Salter’s classification system.Results
Eighty-two affected hips in 70 children with an average age of 10 months at closed reduction (range 1–31 months) and 5 years (range 2–19 years) of follow-up met the inclusion criteria. Twenty-nine (of 82, 35 %) affected hips developed AVN. The use of pre-reduction traction (p = 0.019) increased the risk of AVN, while preoperative Pavlik harness or brace trial (p = 0.28), presence of ossific nucleus at the time of closed reduction (p = 0.16), and adductor tenotomy (p = 0.37) were not significant factors. Laterality (right vs. left) was also not a significant risk factor (p = 0.75), but patients who underwent closed reduction for bilateral DDH were less likely to develop AVN (p = 0.027). Overall, the degree of abduction did not affect the rate of AVN (p = 0.87). However, in patients treated with closed reduction younger than 6 months of age, the rate of AVN was increased with abduction ≥50° (9/15, 60 %) compared to abduction <50° (0/8, 0 %) (p = 0.007). Patients who developed AVN were more likely to require subsequent surgery (p = 0.034) and more likely to report a fair/poor clinical outcome (p = 0.049).Conclusions
The risk of AVN (35 %) following closed reduction and spica casting for DDH is high. The degree of abduction in spica casts appears to be a risk factor in patients ≤6 months old. The authors recommend that abduction in spica casts should be limited to <50° in children younger than 6 months of age.Level of evidence
IV.16.
Introduction
Despite its clinical relevance, particularly in septic knee surgery, the volume of the human knee joint has not been established to date. Therefore, the objective of this study was to determine knee joint volume and whether or not it is dependent on sex or body height.Methods
Sixty-one consecutive patients (joints) who were due to undergo endoprosthetic joint replacement were enrolled in this prospective study. During the operation, the joint volume was determined by injecting saline solution until a pressure of 200 mmHg was achieved in the joint.Results
The average volume of all knee joints was 131 ± 53 (40–290) ml. The volume was not found to be dependent on sex, but it was dependent on the patients’ height (R = 0.312, p = 0.014). This enabled an estimation of the joint volume according to V = 1.6 height ? 135.Conclusions
The considerable inter-individual variance of the knee joint volume would suggest that it should be determined or at least estimated according to body height if the joint volume has consequences for the diagnostics or therapy of knee disorders.17.
Purpose
To compare an inflammation score and collagen morphometry after incisional hernia repair with four different meshes at two time points.Methods
Four types of mesh were used to repair an abdominal wall incisional defect in Wistar rats: high-density polypropylene (HW/PP); low-density polypropylene (LW/PP); polypropylene mesh encapsulated with polydioxanone coated with oxidized cellulose (PP/CE); and expanded polytetrafluoroethylene (ePTFE). An inflammation score based on histological analysis and collagen morphometry was performed after 7 and 28 days after operation (POD).Results
Compared to LW/PP group at 7 POD, HW/PP group had lower (p = 0.014) and PP/CE group had higher inflammation scores (p = 0.001). At 28 POD, higher scores were seen in all the other groups compared to the LW/PP group (HW/PP, p = 0.046; PP/CE, p < 0.001; ePTFE, p = 0.027). Comparing groups individually at 7 and 28 PODs, all demonstrated lower inflammation score values at 28 POD (HW/PP, p < 0.001; LW/PP, p < 0.001; PP/CE, p = 0.002; ePTFE, p = 0.001). At 7 POD, higher amounts of collagen were detected in ePTFE compared to HW/PP (p < 0.001) and LW/PP (p = 0.004) and in PPCE group compared to HW/PP (p = 0.022). At 28 POD, no statistically significant difference was found. Comparing groups individually at 7 and 28 PODs, HW/PP and LW/PP showed larger amounts of collagen at the 28th POD, without any statistically significant differences for the PP/CE and ePTFE groups.Conclusions
Inflammation scores decreased in all groups at 28 POD. Collagen deposition was higher for non-composite meshes at 28 POD.18.
Purpose
To investigate the outcomes of patients with colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated using the liver-first approach in the era of modern chemotherapy in Japan.Methods
We analyzed and compared data retrospectively on patients with asymptomatic resectable colorectal cancer and initially unresectable or not optimally resectable liver metastases, who were treated either using the liver-first approach (n = 12, LF group) or the primary-first approach (n = 13, PF group).Results
Both groups of patients completed their therapeutic plan and there was no mortality. Postoperative morbidity rates after primary resection and hepatectomy, and post-hepatectomy liver failure rate were comparable between the groups (p = 1.00, p = 0.91, and p = 0.55, respectively). Recurrence rates, median recurrence-free survival since the last operation, and 3-year overall survival rates from diagnosis were also comparable between the LF and PF groups (58.3 vs. 61.5 %, p = 0.87; 10.5 vs. 18.6 months, p = 0.57; and 87.5 vs. 82.5 %, p = 0.46, respectively).Conclusions
The liver-first approach may be an appropriate treatment sequence without adversely affecting perioperative or survival outcomes for selected patients.19.
Background
Laparoscopic total extraperitoneal repair (TEP) of inguinal hernia has been associated with higher rates of recurrence compared to open methods. The aim of the present study was to determine independent risk factors for recurrence within 2 years after TEP.Methods
This was a single-centre prospective cohort study with consecutive inclusion of patients undergoing inguinal hernia repair from 2010 to 2014. Systematic follow-up was conducted 6 months and 2 years postoperatively. Risk factors for recurrence after 2 years were analysed in univariate and multivariate analyses.Results
A total of 1194 patients underwent TEP for inguinal or femoral hernia in the study period, of which 1047 were eligible for analyses. After 2 years, 56 (5.3%) patients had presented with recurrence. The following factors were associated with recurrence in univariate analyses: body mass index (BMI) >30 (HR 3.64; p = 0.011), medial vs. lateral hernia (HR 2.37; p = 0.004), repair of recurrent hernia vs. primary repair (HR 2.12; p = 0.049), and length of stay >1 day (HR 1.77; p = 0.043). In multivariate analyses, factors independently associated with recurrence after 2 years were BMI >30 (HR 3.74; p = 0.026) and medial vs. lateral hernia (HR 2.39; p = 0.004).Conclusion
The recurrence rate after TEP is higher than reported after open hernia repair. Attempts to decrease the rate should be persuaded. Good surgical technique with precise dissection and correct placement of the mesh, especially in medial hernias and obese patients, may be key points to improve outcomes after TEP.20.