Laparoscopic Nissen Fundoplication Plus Mid-gastric Plication for Treatment of Obese Patients with Gastroesophageal Reflux Disease

Background

Gastroesophageal reflux disease (GERD) is commonly associated with obesity, and its surgical management is debatable.

Objective

The objective of this study was to prove the safety and feasibility of laparoscopic Nissen’s fundoplication (LNF) combined with mid-gastric plication (MGP) for treatment of obese patients with GERD.

Methods

LNF combined with MGP was done for 18 patients. All interventions were performed under general anesthesia. The follow-up protocol included body mass index (BMI), percentage of excess weight loss (%EWL), percentage of excess BMI loss (%EBMIL), and clinical assessment using the Gastro-esophageal Reflux Health-Related Quality-of-Life (GERD-HRQOL) scale at 6 and 12 months.

Results

The period of follow-up ranged from 12 to 33 months with a mean of 17.74 ± 3.73 months. The operation time was 1.40 ± 0.27 h. No serious procedure-related complications occurred. GERD-related symptoms resolved in all patients (p < 0.001). There was a significant improvment in endoscopic findings at 6 months compared to properatively (p = 0.001). There was a significant patient satisfaction score using GERD-HRQOL at 6 and 12 months (p = 0.000). The 1-year follow-up excess weight was significantly less than the baseline excess weight (p < 0.001). The average BMI decreased from 37.59 ± 1.89 kg/m² at baseline to 30.61 ± 1.57 kg/m² at 1 year (p < 0.001).

Conclusions

LNF combined with MGP for treatment of obese patients with GERD is technically safe, feasible, and promising with no serious procedure-related complications. The technique is effective in terms of weight loss and cure of GERD. However, future larger studies are required to demonstrate the safety, effectiveness, and long-term durability of the procedure.

     

Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: long-term 3-year results

Background

Electrical stimulation of the lower esophageal sphincter (LES) has been shown to improve outcomes in patients with gastroesophageal reflux disease (GERD) at 2 years. The aim of the study was to evaluate the safety and efficacy of LES stimulation in the same cohort at 3 years.

Methods

GERD patients with partial response to PPI, with % 24-h esophageal pH < 4.0 for >5 %, with hiatal hernia <3 cm and with esophagitis ≤LA grade C were treated with LES stimulation in an open-label 2-year trial. All patients were on fixed stimulation parameter of 20 Hz, 220 μs, 5 mA delivered in twelve, 30-min sessions. After completing the 2-year open-label study, they were offered enrollment into a multicenter registry trial and were evaluated using GERD-HRQL, symptom diaries and pH testing at their 3-year follow-up.

Results

Fifteen patients completed their 3-year evaluation [mean (SD) age = 56.1 (9.7) years; men = 8] on LES stimulation. At 3 years, there was a significant improvement in their median (IQR) GERD-HRQL on electrical stimulation compared to both their on PPI [9 (6–10) vs. 1 (0–2), p = 0.001] and off PPI [22 (21–24) vs. 1 (0–2), p < 0.001]. Median 24-h distal esophageal acid exposure was significantly reduced from [10.3 (7.5–11.6) % at baseline vs. 3 (1.9–4.5) %, p < 0.001] at 3 years. Seventy-three % (11/15) patients had normalized their distal esophageal acid exposure at 3 years. Remaining four patients had improved their distal esophageal acid exposure by 39–48 % from baseline. All but four patients reported cessation of regular PPI use (>50 % of days with PPI use); three had normal esophageal pH at 3 years. There were no unanticipated device- or stimulation-related adverse events or untoward sensation reported during the 2- to 3-year follow-up.

Conclusion

LES-EST is safe and effective for treating patients with GERD over long-term, 3-year duration. There was a significant and sustained improvement in esophageal acid exposure and reduction in GERD symptoms and PPI use. Further, no new GI side effects or adverse events were reported.

     

Feasibility of the liver-first approach for patients with initially unresectable and not optimally resectable synchronous colorectal liver metastases

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.

     

Increased Metabolic Benefit for Obese,Elderly Patients Undergoing Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy

Purpose

We sought to assess outcomes of laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB) in a cohort of morbidly obese, elderly patients.

Materials and Methods

Retrospective review was conducted of all patients age 60 years or greater undergoing LSG or LRYGB at our institution between 2007 and 2014.

Results

A total of 134 patients who underwent LSG (n = 65) or LRYGB (n = 69) were identified. Groups were similar with respect to age (64 years, range 60–75 years), BMI (44.0 ± 6.1), and ASA score (91% ≥ ASA 3). There were no differences in major post-operative complications (3, 4.7% LSG vs 4, 5.8% LRYGB, p = 0.75). Median follow-up was 39 months (IQR 14–64 months) with no patients lost to follow-up. Patients undergoing LRYGB had improvement in each of diabetes mellitus 2 (DM2), hypertension (HTN), hyperlipidemia (HL), and gastroesophageal reflux disease (GERD) as well as a significant decrease in insulin use (16/47, 34.0% pre-operatively vs 7/47, 15.2% post-operatively; p = 0.03). Patients undergoing LSG had improvement in DM2 and HTN but not in HL or GERD; there was no reduction in insulin dependence. Weight loss was not significantly different between groups; mean percent total weight loss at 36 months was 26.9 ± 9.0% in the LSG group and 23.9 ± 9.3% in the LRYGB group, p = 0.24.

Conclusions

Both LSG and RYGB can be safely performed on morbidly obese, elderly adults. At intermediate follow-up, there is an increased metabolic benefit for elderly patients undergoing LRYGB over LSG.

     

Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia

Purpose

The optimal analgesia following laparoscopic distal gastrectomy (LDG) has not been determined; moreover, it has been unclear whether epidural anesthesia has benefits for laparoscopic surgery. In this study, we evaluated the effectiveness of epidural analgesia after LDG.

Methods

This retrospective study included 84 patients who underwent LDG for gastric cancer. Patients received either combined thoracic epidural and general anesthesia (Epidural group, n = 34) or general anesthesia alone (No epidural group, n = 50). We recorded data on the patients, surgery, postoperative outcomes and anesthesia-related complications.

Results

In the Epidural group, the first day of flatus was significantly earlier (2.21 vs. 2.44 days, p = 0.045) and the number of additional doses of analgesics was significantly lower (2.85 vs. 4.86 doses, p = 0.007) than in the No epidural group. Postoperative urinary retention occurred at a significantly higher rate in the Epidural group (n = 7; 20.6 %) than in the No epidural group (p < 0.001).

Conclusion

Epidural anesthesia may reduce the need for additional analgesics after LDG, but increases the risk of urinary retention.

     

Small-Volume,Fast-Emptying Gastric Pouch Leads to Better Long-Term Weight Loss and Food Tolerance After Roux-en-Y Gastric Bypass

Introduction

Anatomical and functional influences on gastric bypass (GBP) results are often poorly evaluated and not yet fully understood.

Purpose

The purpose of this study is to evaluate the influence of the gastric pouch volume and its emptying rate on long-term weight loss and food tolerance after GBP.

Materials and Methods

Weight loss, food tolerance, pouch volumetry (V) by three-dimensional reconstruction, and pouch emptying rate by 4 h scintigraphy were evaluated in 67 patients. Cutoffs were identified for V and retention percentage (%Ret) at 1 h (%Ret1). From these parameters, the sample was categorized, looking for associations between V, %Ret, weight loss, and food tolerance, assessed by a questionnaire for quick assessment of food tolerance (SS).

Results

PO median follow-up time was 47 months; median V was 28 mL; %Ret at 1, 2, and 4 h were 8, 2, and 1%, respectively. There were associations between V ≤ 40 mL and higher emptying rates up to 2 h (V ≤ 40 mL: %Ret1 = 6, %Ret2 = 2, p = 0.009; V > 40 mL: %Ret1 = 44, %Ret2 = 13.5, p = 0.045). An association was found between higher emptying speed in 1 h and higher late weight loss (WL), represented by lower percentage of excess weight loss (%EWL) regain (p = 0.036) and higher %EWL (p = 0.033) in the group with %Ret1 ≤ 12%, compared to the group %Ret1 ≥ 25%. Better food tolerance (SS > 24), was associated with lower %Ret1 (p = 0.003).

Conclusion

Smaller pouch size is associated with a faster gastric emptying, greater WL maintenance, and better food tolerance. These data suggest that a small pouch with rapid emptying rate is an important technical parameter for good outcomes in GBP.

     

Comparative study of high tibial osteotomy using dynamic axial fixator and locked low-profile plate in medial osteoarthritis of knee

Purpose

The purpose of this study was to evaluate the role of medial opening wedge high tibial osteotomy (HTO) in medial unicompartmental osteoarthritis (MCOA) of knee and to compare between the two methods of osteotomy using either dynamic axial fixator (DAF) or locking compression plate (LCP).

Methods

A total of 20 patients with medial osteoarthritis of knee were enrolled in this prospective study who were divided into two groups of 10 each. First group comprising of two males and eight females were treated by HTO using DAF. Second group comprising of five males and five females were treated by HTO using LCP. We assessed various radiological parameters including hip knee ankle angle (HKA), tibiofemoral angle (TFA), weight-bearing line on tibia, Insall Salvati index and tibial slope. Functional outcome of knee at final follow-up was assessed by Oxford knee score (OKS) and visual analogue scale.

Results

In first group, mean HKA angle changed from 187° to 178.30° (p = 0.006), mean TFA from 182.40° to 172° (p = 0.003), average position of weight-bearing line from 11.24 to 59.54 % (p = 0.004), and mean OKS 43.3–16.9 (p = 0.004). In second group, mean HKA angle changed from 186° to 178.80° (p = 0.004), mean TFA from 180.90° to 173.60° (p = 0.004), average position of weight-bearing line from 14 to 61.3 % (p = 0.004), and mean OKS 43.2–16.5 (p = 0.002).

Conclusion

HTO is an established treatment for patients with symptomatic MCOA knee with significant improvement in the clinical and radiographic parameters. There is no significant difference between the two methods; however, external fixator has the complication of pin tract infections.

Level of evidence

II.

     

The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis

Purpose

We examined the impact of advanced age on left ventricular mass regression and the change in the diastolic function after aortic valve replacement in patients with aortic stenosis.

Methods

The present study included 129 patients who underwent either surgical or transcatheter aortic valve replacement and 1-year postoperative echocardiography. The patient characteristics and echocardiographic findings were compared between patients who were <80 years of age (group Y: n = 69) and those who were ≥80 years of age (group O: n = 60).

Results

Preoperative echocardiography revealed that although the left ventricular mass was similar between the groups, the patients in group O had more severe diastolic dysfunction in comparison to those in group Y. Postoperatively, left ventricular mass regression was significantly greater (p = 0.02) and diastolic dysfunction was less prevalent in group Y (p = 0.02) in comparison to group O. The change in E/e′ was significantly correlated with the left ventricular mass regression in group Y (p = 0.02), but not in Group O (p = 0.21).

Conclusions

The patients in group O were less susceptible to improvements in myocardial remodeling and the diastolic function in comparison to those in group Y. The altered physiological response to aortic valve replacement might help to determine the appropriate timing of surgery in elderly patients.

     

Charges,outcomes, and complications: a comparison of magnetic sphincter augmentation versus laparoscopic Nissen fundoplication for the treatment of GERD

Background

Magnetic sphincter augmentation (MSA) is approved for uncomplicated GERD. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. The MSA device itself, however, is an added cost to an anti-reflux surgery, and direct cost comparison studies have not been done between MSA and LNF. The aim of the study was to compare charges, complications, and outcome of MSA versus LNF at 1 year.

Methods

This is a retrospective analysis of all patients who underwent MSA or LNF for the treatment of GERD between January 2010 and June 2013. Patient charges were collected for the surgical admission. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use.

Results

There were 119 patients included in the study, 52 MSA and 67 LNF. There was no significant difference between the mean charges for MSA and LNF ($48,491 vs. $50,111, p = 0.506). There were significant differences in OR time (66 min MSA vs. 82 min LNF, p < 0.01) and LOS (17 h MSA vs. 38 h LNF, p < 0.01). At 1-year follow-up, mean GERD-HRQL was 4.3 for MSA versus 5.1 for LNF (p = 0.47) and 85 % of MSA patients versus 92 % of LNF patients were free from PPIs (p = 0.37). MSA patients reported less gas bloat symptoms (23 vs. 53 %, p ≤ 0.01) and inability to belch (10 vs. 36 %, p ≤ 0.01) and vomit (4 vs. 19 %, p ≤ 0.01).

Conclusion

The side effect profile of MSA is better than LNF as evidenced by less gas bloat and increase ability to belch and vomit. LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the MSA device is offset by less charges in other categories as a result of the shorter operative time and LOS.

     

C-reactive protein levels for early detection of early postoperative complications after proximal femoral fracture surgery

Introduction

We have studied the early C-reactive protein (CRP) kinetics after proximal femoral fracture (PFF) surgery and defined a chart of CRP threshold values beyond which early postoperative complications are likely.

Materials and methods

We have prospectively followed up a 42-patient cohort for surgical treatment by osteosynthesis or hip arthroplasty, and CRP was dosed at admission, on day 1, day 3, day 5 and then twice weekly for 30 days at the same time as a platelet count control of low molecular weight heparins. Then, we identified postoperative complications (medical complications like infections other than the surgical site, thromboembolic complications, death and surgical complications like surgical site infections, dislocation, haematoma) and established the evolutive profile of CRP in a ‘complication’ group and a ‘no complication’ group. We developed a threshold value model for complications detection from our results and compared with Chapman’s 500/d formula (d being the postoperative day).

Results

CRP in the ‘complication’ group (20 patients) is on average 19 points higher than the ‘no complication’ group (22 patients) (p = 0.007). Our model, which corresponds to the formula CRP(d) = e^{(4.71 ? 0.06*d)}, is valid from day 1 to day 30 and has a threshold value of 105 mg/L at day 1. From day 5, the correlation between our chart and the 500/d chart is 0.84 (p < 10^?5). Two successive CRP values strictly above our chart at a 48-h interval have a sensitivity of 65% and a specificity of 85% to detect a postoperative complication while only one CRP value above the chart has a sensitivity and a specificity of 48%.

Discussion/conclusion

Early postoperative CRP kinetics of PFF surgical patients can be modelled as a threshold value scale valid between day 1 and day 30. This can be an additional tool in the early detection of postoperative complications, if two CRP values are above the threshold values, without replacing the clinical examination, which remains the ‘gold standard’.

Level of evidence

Prospective observational study.

     

Results of the treatment of first carpometacarpal joint osteoarthritis: trapeziectomy alone versus trapeziectomy associated with suspensionplasty

Backgrounds

The goal of this study was to compare trapeziectomy alone to trapeziectomy associated with a technique of suspensionplasty using the abductor pollicis longus with a minimum of 6 years of follow-up in the treatment of osteoarthritis of the first carpometacarpal joint.

Methods

Our series included 46 trapeziectomies in 35 patients, aged 69 years in average, among which 27 were women. In 27 cases group I, a trapeziectomy alone was performed, and in 19 cases group II, a trapeziectomy associated with an abductor pollicis longus suspensionplasty was performed.

Results

At the last follow-up, the difference between pre- and postoperative Quick DASH was ??36.104 in average in group I and ??38.877 in average in group II p?=?0.7717. The difference between pre- and postoperative pain was ??3.926 in average in group I and ??4.368 in average in group II p?=?0.35. The difference of pre- and postoperative thumb opposition was 0.630 in group I and 0.421 in group II p?=?0.3033. The average difference of pre- and postoperative key pinch was 0.389 in group I and 0.842 in group II p?=?0.3303. No complication was reported.

Conclusions

Our results suggest that it is unnecessary to perform a ligamentoplasty when a trapeziectomy is indicated.

     

Correlation between pelvic tilt and the sacro-femoral-pubic angle in patients with adolescent idiopathic scoliosis,patients with congenital scoliosis,and healthy individuals

Purpose

To examine whether the sacro-femoral-pubic (SFP) angle could estimate pelvic tilt (PT) in scoliotic and normal subjects.

Methods

One hundred nine subjects including 38 patients with adolescent idiopathic scoliosis (AIS), 35 patients with congenital scoliosis (CS), and 36 healthy individuals were studied. PT, as the angle between the lines connecting the midpoint of the sacral plate to the centroid of one acetabulum and the vertical plane, and the SFP angle, as the angle between the midpoint of the upper sacral endplate, the centroid of one acetabulum, and the upper midpoint of the pubic symphysis, were calculated on full-length lateral and anteroposterior radiographs, respectively. Correlations between PT and the SFP angle were investigated in each group.

Results

The three groups were comparable in terms of age, sex, and the mean SFP angle. The mean PT, however, was significantly lower in healthy subjects compared to that in patients with AIS and CS. Significant and reverse correlations were present between PT and the SFP angle in all three groups (AIS: r = ?0.32, p = 0.04, PT = 82.5???average SFP angle; CS: r = ?0.48, p = 0.003, PT = 95.41???average SFP angle; healthy: r = ?0.33, p = 0.04, PT = 88.95???average SFP angle).

Conclusions

Unlike two previous reports, the SFP angle correlated poorly to PT in this study, limiting its use as a suitable surrogate for PT in scoliotic and healthy subjects.

     

Backflow prevention mechanism of laparoscopic Toupet fundoplication using high-resolution manometry

Background

The use of multichannel intraluminal impedance pH (MII-pH) and high-resolution manometry (HRM), which are new devices used to examine the esophageal function, has recently become common in Europe and the USA, thus garnering much attention. There have not been enough studies as of yet, however, on the esophageal motor function and the benefits of treatment after these devices have been used in laparoscopic fundoplication.

Objective

To use MII-pH and HRM to study the treatment effectiveness of laparoscopic fundoplication and consider a backflow prevention mechanism for laparoscopic Toupet fundoplication.

Materials and methods

The study looked at 27 of a total of 60 patients undergoing laparoscopic fundoplication due to reasons of either gastroesophageal reflux disease or esophageal hiatal hernia between October 2012 and February 2014, who underwent a postsurgical HRM examination. Of these, 25 patients whose symptoms disappeared following surgery and who were not orally administered gastric secretion inhibitor (of whom nine were male, average age 55.9 ± 14.9 years, and of whom 76 % underwent MII-pH) were taken as the subjects of the study. The postsurgical evaluation was conducted 3 months after the operation.

Results

Using HRM, although no change was noted in the lower esophageal sphincter pressure (LESP) (p = 0.943), an increase in lower esophageal sphincter pressure integral (p = 0.024) and extensions in both overall length and abdominal length were noted (both p < 0.001), while a significant improvement was noted in the lower esophageal sphincter (LES). Furthermore, the cases subjected to MII-pH demonstrated a reduced gastroesophageal reflux time, total number of liquid reflux episodes, and total number of reflux episodes (p < 0.001, p = 0.008, p = 0.009).

Conclusions

Backflow prevention mechanism of laparoscopic Toupet fundoplication is thus considered to improve the overall LES function without elevating LESP.

     

Risk Factors for Early Recurrence of Single Lesion Hepatocellular Carcinoma After Curative Resection

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.

     

Preoperative Needs-Based Education to Reduce Anxiety,Increase Satisfaction,and Decrease Time Spent in Day Surgery: A Randomized Controlled Trial

Background

Too much or too little information during patient education can increase patient anxiety. Needs-based patient education helps to determine the appropriate amount of information required to provide education based on patient needs. This study aimed to compare needs-based patient education with traditional patient education in reducing preoperative anxiety.

Methods

This was a prospective, multicenter, single-blind, randomized controlled trial with a 1:1 allocation ratio. Patients undergoing day surgery were randomized into a study group (needs-based education) or a control group (traditional education). The primary outcome was patient anxiety. Secondary outcomes were patient satisfaction and time spent in patient education. Patients completed questionnaires to evaluate their anxiety and satisfaction before patient education, after patient education, and after surgery.

Results

In total, 450 patients were randomized and analyzed (study group n = 225, control group n = 225). Comparisons before education, after education, and after surgery showed that there was a significant decrease in patient anxiety and an increase in satisfaction in both groups (p < 0.001). The comparison between needs-based education and traditional education showed a greater decrease in anxiety (7.09 ± 7.02 vs. 5.33 ± 7.70, p = 0.001) and greater increase in satisfaction (21.1 ± 16.0 vs. 16.0 ± 21.6, p < 0.001) in the needs-based group. The needs-based group also had significantly less education time than the traditional group (171.8 ± 87.59 vs. 236.32 ± 101.27 s, p < 0.001).

Conclusion

Needs-based patient education is more effective in decreasing anxiety, increasing patient satisfaction, and reducing time spent in education compared with traditional patient education.

Trial registration

ClinicalTrials.gov, number NCT03003091

     

The feasibility of laparoscopic extended pelvic surgery for rectal cancer

Purpose

The present study aimed to assess the safety and feasibility of laparoscopic extended pelvic surgery for primary or recurrent rectal cancer.

Methods

The data on 77 patients, who underwent extended pelvic surgery between February 2008 and June 2014, were retrospectively analyzed. The patients were divided, based on their treatment history, into an open surgery (OS) group (n = 41) and a laparoscopic surgery (LS) group (n = 36).

Results

The operative time in the LS group was significantly longer than that in the OS group (766 vs. 561 min; p < 0.001). In contrast, the LS group was associated with a significantly lower volume of intraoperative blood loss (195 vs. 923 ml; p < 0.001), fluid balance (5.38 vs. 8.23 ml/kg/h; p < 0.001) and rate of complications (40.0 vs. 68.3 %; p = 0.035), and a significantly shorter postoperative hospital stay. The postoperative levels of colloid osmotic pressure and albumin were significantly higher in the LS group.

Conclusion

The operative time of the LS group was longer than that of the OS group; however, the LS group experienced less blood loss and fewer complications. Moreover, LS was associated with a reduction in intraoperative infusions and a reduced fluid balance, which maintained homeostasis.

     

Comparison of perioperative and oncologic outcomes between open and laparoscopic liver resection for intrahepatic cholangiocarcinoma

Background

Laparoscopic liver resection (LLR) has become an essential method for treating malignant liver tumors. Although the perioperative and oncologic outcomes of LLR in patients with hepatocellular carcinoma have been reported, there are few reports of LLR for intrahepatic cholangiocarcinoma (IHCC).

Methods

Patients who underwent liver resection for T1 or T2 IHCC between March 2010 and March 2015 in Gyeongsang National University Hospital were enrolled. They were divided into open (n = 23) and laparoscopic (n = 14) approaches, and the perioperative and oncologic outcomes were compared.

Results

The Pringle maneuver was less frequently used (p = 0.015) and estimated blood loss was lesser (p = 0.006) in the laparoscopic group. There were no significant differences in complication rate (p = 1.000), hospital stay (p = 0.371), tumor size (p = 0.159), lymph node metastasis (p = 0.127), and the number of retrieved lymph nodes (p = 0.553). The patients were followed up for a median of 21 months. The 3-year overall survival (OS) and recurrence-free survival (RFS) rates were 74.7 and 55.2 %, respectively. No differences were observed in the 3-year OS (75.7 vs 84.6 %, p = 0.672) and RFS (56.7 vs 76.9 %, p = 0.456) rates between the open and laparoscopic groups, even after the groups were divided into patients that received liver resection with or without lymph node dissection.

Conclusion

LLR for IHCC is a treatment modality that should be considered as an option alongside open liver resection in selected patients.

     

Coexistent Loss of the Expressions of BRCA1 and p53 Predicts Poor Prognosis in Triple-Negative Breast Cancer

Background

To investigate the prognostic significance of altered breast cancer susceptibility gene 1 (BRCA1) and p53 expression in triple-negative breast cancer (TNBC).

Methods

Immunohistochemical expression of BRCA1 and p53 was examined in the tumor tissues of 465 TNBC cases and relations were sought with clinicopathological features and patient survival.

Results

Loss of BRCA1 expression was found in 29.5% (137/465) of TNBCs. Positive expression of p53 was observed in 49.9% (232/465). Patients with loss of BRCA1 expression had a tendency to have higher rate of lymph node metastasis (p = 0.075). An association between p53 expression and high histological grade was observed (p = 0.039). TNBC patients with loss of BRCA1 expression had a tendency to have poorer overall survival (OS) than those positive for BRCA1 (p = 0.09). TNBC patients with positive p53 expression showed better OS than those with p53 negativity (p = 0.001). In terms of combined expression patterns, significantly poorer overall survival (OS) was observed for BRCA1-negative/p53-negative TNBCs and best OS for BRCA1-positive/p53-positive TNBCs (p = 0.005).

Conclusions

Combined expression patterns of BRCA1 and p53 could serve as useful prognostic markers in TNBC.

     

A systematic review on the efficacy and safety of PA21 versus sevelamer in dialysis patients

Aim

To evaluate the efficacy and safety of PA21 versus sevelamer in dialysis patients.

Methods

We searched Medline, Embase, Science Citation Index, Cochrane Central Register of Controlled Trials, and Clinical Trial Registries for randomized controlled trials comparing PA21 and sevelamer in dialysis patients.

Results

Four studies were included. Compared with sevelamer group, PA21 needed fewer mean daily number of tablets (WMD, ? 7.97 pill; 95% CI, ? 11.28 to ? 4.65, p < 0.00001), developed fewer all adverse events (RR = 1.05; 95% CI, 1.00 to 1.11, p = 0.05), and developed fewer gastrointestinal adverse events (RR = 1.32; 95% CI, 1.15 to 1.53, p = 0.0001). There was no significant difference in serum phosphorus between two groups (WMD, ? 0.07 mmol/L; 95% CI, ? 0.15 to 0.02, p = 0.12). As for serum calcium, there was also no significant difference between two groups (WMD, 0.27 mmol/L; 95% CI, ? 0.63 to 1.17, p = 0.55).

Conclusion

PA21 can effectively control serum phosphorus with lower pill burden and less side effects than sevelamer. PA21 might be another valuable choice for dialysis patients with hyperphosphatemia when patients are unable to tolerate sevelamer.