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1.
Piardi T Gheza F Ellero B Woehl-Jaegle ML Ntourakis D Cantu M Marzano E Audet M Wolf P Pessaux P 《Annals of surgical oncology》2012,19(6):2020-2026
Background
Hepatocellular carcinoma (HCC) is an indication for liver resection or transplantation (LT). In most centers, patients whose HCC meets the Milan criteria are considered for LT. The first objective of this study was to analyze whether there is a correlation between the pathologic characteristics of the tumor, survival and recurrence rate. Second, we focused our attention on vascular invasion (VI).Methods
From January 1997 to December 2007, a total of 196 patients who had a preoperative diagnosis of HCC were included. The selection criteria for LT satisfied both the Milan and the San Francisco criteria (UCSF). Demographic, clinical, and pathologic information were recorded.Results
HCC was confirmed in 168 patients (85.7%). The median follow-up was 74?months. The pathologic findings showed that 106 patients (54.1%) satisfied the Milan criteria, 134 (68.4%) the UCSF criteria of whom 28 (14.3%) were beyond the Milan criteria but within the UCSF criteria, and 34 (17.3%) beyond the UCSF criteria. VI was detected in 41 patients (24%). The 1-, 3-, and 5-year overall survival rates were 90%, 85%, and 77%, respectively, according to the Milan criteria and 90%, 83%, and 76%, respectively, according to the UCSF criteria (P?=?NS). In univariate and multivariate analyses, tumor size and VI were significant prognostic factors affecting survival (P?0.001). Two factors were significantly associated with VI: alfa-fetoprotein level of >400?ng/ml and tumor grade G3.Conclusions
Tumor size and VI were the only significant prognostic factors affecting survival of HCC patients. Primary liver resection could be a potential selection treatment before LT. 相似文献2.
Hung-Hsu Hung Hao-Jan Lei Gar-Yang Chau Chien-Wei Su Cheng-Yuan Hsia Wei-Yu Kao Wing-Yiu Lui Wen-Chieh Wu Han-Chieh Lin Jaw-Ching Wu 《Journal of gastrointestinal surgery》2013,17(4):702-711
Aims
This study aims to evaluate the risk factors for tumor recurrence beyond the Milan criteria (MC) for patients with hepatocellular carcinoma (HCC) after surgical resection (SR) in which salvage liver transplantation is relatively contraindicated.Methods
A total of 447 patients who underwent SR for HCC were enrolled consecutively. Among them, 248 and 199 patients were within the Milan criteria and beyond the Milan criteria (BMC group), respectively. Overall survival, recurrence, and disease-free survival were analyzed by multivariate analysis.Results
After a median follow-up of 34.4 months, 130 patients died. Microvascular invasion, higher Edmondson stage of tumor cell differentiation, BMC group, and no anti-viral therapy were associated with poor overall survival. Multi-nodularity, higher Edmondson stage, BMC group, and no anti-viral therapy were independent risk factors for tumor recurrence, while BMC group and no anti-viral therapy were independent risk factors for disease-free survival. The Milan criteria, multi-nodularity, and microvascular invasion were used to stratify the patients into low-, medium-, and high-risk groups for tumor recurrence outside the MC and showed statistical significance (low vs. medium, p?=?0.011; low vs. high, p?<?0.001; medium vs. high, p?=?0.009).Conclusions
The combination of the MC, multi-nodularity, and microvascular invasion predict the post-operative recurrence of HCC and may provide a roadmap for further treatment. 相似文献3.
E. J. T. Belt H. B. A. C. Stockmann G. S. A. Abis J. M. de Boer E. S. M. de Lange-de Klerk M. van Egmond G. A. Meijer S. J. Oosterling 《Journal of gastrointestinal surgery》2012,16(12):2260-2266
Background
The presence of an inflammatory response resulting from bowel perforation or anastomotic leakage has been suggested to enhance recurrence rates in colorectal cancer patients. Currently, it is unknown if bowel perforation or anastomotic leakage has prognostic significance in early stage colon cancer patients. In this study, the impact of peri-operative bowel perforation including anastomotic leakage on disease-free survival of stage I/II colon cancer patients was investigated.Methods
Prospective follow up data of 448 patients with stages I/II colon cancer that underwent resection were included. Patients who died within 3?months after initial surgery were excluded.Results
Median follow up was 56.0?months. Patients with peri-operative bowel perforation (n?=?25) had a higher recurrence rate compared to patients without perforation (n?=?423), 36.0?% vs. 16.1?% (p?=?0.01). Disease-free survival was significantly worse for the perforation group compared to patients without perforation (p?=?0.004). Multivariate analysis including T-stage, histological grade, and adjuvant chemotherapy showed peri-operative bowel perforation to be an independent factor significantly associated with disease recurrence (odds ratio, 2.7; 95?% CI, 1.1?C6.7).Conclusion
Peri-operative bowel perforation is associated with increased recurrence rates and impaired disease-free survival in early-stage colon cancer patients. 相似文献4.
Fang WL Chang SC Lan YT Huang KH Chen JH Lo SS Hsieh MC Li AF Wu CW Chiou SH 《World journal of surgery》2012,36(9):2131-2138
Background
Microsatellite instability (MSI) is one of the leading mechanisms for the carcinogenesis of gastric cancer. Its prognostic value is controversial.Methods
Between May 1988 and Oct 2003, a total of 214 gastric cancer patients undergoing curative surgery were enrolled, and their MSI statuses were classified as MSI-H (high) or MSI-L/S (low/stable). The clinicopathologic characteristics of MSI-H and MSI-L/S gastric cancers were compared.Results
The MSI-H tumors accounted for 11.7?% (n?=?25) of the 214 total gastric cancers. Although not statistically significant, the MSI-H gastric cancers were more frequently located in the lower third of the stomach (64?% vs. 49.2?%) and were more often the intestinal type (72?% vs. 61.4?%) compared to the MSI-L/S gastric cancers. The MSI-H gastric cancers had a significantly better 5-year overall survival (OS) rate (68?% vs. 47.6?%, p?=?0.030) and a trend of a better 3-year disease-free survival rate (71.8?% vs. 55.2?%, p?=?0.076) compared to the MSI-L/S gastric cancers. A multivariate analysis revealed that pathologic TNM stage and MSI status were the independent prognostic factors for OS after curative surgery.Conclusions
Compared to MSI-L/S tumors, MSI-H tumors are associated with a better OS rate for gastric cancer patients after R0 resection. 相似文献5.
Fumitoshi Hirokawa Michihiro Hayashi Yoshiharu Miyamoto Mitsuhiro Asakuma Tetsunosuke Shimizu Koji Komeda Yoshihiro Inoue Atsushi Takeshita Yuro Shibayama Kazuhisa Uchiyama 《Journal of gastrointestinal surgery》2013,17(11):1929-1937
Background
The aim of this study was to investigate the clinical characteristics and outcomes of elderly patients (≥70 years old) undergoing curative hepatectomy for hepatocellular carcinoma (HCC).Methods
Clinicopathological data and treatment outcomes in 100 elderly patients (≥70 years old) and 120 control patients (≤70 years old) with HCC who underwent curative hepatectomy between 2000 and 2011 were retrospectively collected and compared.Results
The overall survival rate was similar between the two groups, but the disease-free survival rate was worse in the elderly group when compared with the control group. Prognostic factors for overall and disease-free survival were the same when comparing the two groups. The elderly group had higher rate of females (p?=?0.0230), higher hepatitis C virus infection rate (p?=?0.0090), higher postoperative pulmonary complication rate (p?=?0.0484), lower rate of response to interferon (IFN) therapy (p?=?0.0203) and shorter surgical time (p?=?0.0337) when compared with the control group. The overall recurrence rate was higher in the elderly group than in the control group (p?=?0.0346), but the rate of recurrence within 2 years after the operation was similar when comparing the two groups.Conclusion
The survival of elderly patients with HCC was similar to that of younger patients. However, the disease-free survival was worse in elderly patients than in younger patients. Aggressive antiviral therapy (e.g. IFN therapy) may be necessary to improve the disease-free survival, even in elderly patients. Additionally, clinicians should be aware of the risk of pulmonary complications in elderly patients after hepatectomy. 相似文献6.
Meng FY Ko JY Lou PJ Wang CP Yang TL Chang CH Chang YL Chen TC 《Annals of surgical oncology》2012,19(6):2003-2010
Background
The determining risk factors for patients with squamous cell carcinoma of the hard palate are not well verified.Methods
Medical records from our facility of all patients with squamous cell carcinoma of the hard palate receiving curative surgery between March 2003 and May 2009 were reviewed.Results
Seventy-eight patients were enrolled in the study. The 5?year disease-free and overall survival rates were 49.8 and 49.7%, respectively. The 5?year disease-free and overall survival rates were statistically different between positive/close margins and negative margins (24.6% vs. 65.4%, P?=?0.02; 20.1% vs. 63.1%, P?=?0.001, respectively), with and without soft palate invasion (38.8% vs. 68.9%, P?=?0.02; 27.4% vs. 77.5%, P?=?0.001, respectively), and soft palate invasion patients with and without perineural invasion (10.4% vs. 52.8%, P?=?0.02; 0% vs. 38.1%, P?=?0.008, respectively). The rate of positive nodal metastasis for T3 and T4 tumors was 44%. For the tumor with soft palate invasion, the rate of positive nodal metastasis was 29%. After multivariate analyses, soft palate invasion and positive/close margins were the determining risk factors for disease-free and overall survival.Conclusions
Soft palate invasion and positive/close margins were the determining risk factors for disease-free and overall survival in patients with squamous cell carcinoma of the hard palate. Elective neck dissection is suggested for advanced primary tumors (T3 or T4) or tumors with soft palate invasion. 相似文献7.
Cheng-Maw Ho MD Chao-Ying Wu MD Po-Huang Lee MD PhD Hong-Shiee Lai MD PhD Ming-Chih Ho MD PhD Yao-Ming Wu MD Rey-Heng Hu MD PhD 《Annals of surgical oncology》2013,20(8):2526-2533
Purpose
To determine the prognostic factors that predict recurrence of hepatocellular carcinoma (HCC) exceeding the University of California at San Francisco (UCSF) criteria after primary resection.Methods
HCC patients who underwent curative liver resections between 2001 and 2007 and who were within the UCSF criteria (n = 716) were examined. Independent prognostic factors were examined by the Cox proportional hazard model.Results
A total of 285 patients (39.8 %) developed recurrences. Of the patients who developed recurrences, 180 had HCC still within the UCSF criteria (63.2 %), and 105 developed HCC beyond this criteria (36.8 %). Among the population with primary transplantable HCC, patients with larger primary tumor sizes, serum α-fetoprotein (AFP) levels over 400 ng/mL, satellite nodules, vascular invasion, or undifferentiated HCC had a risk of untransplantable recurrence, as shown by univariate analysis. In multivariate analysis, undifferentiated HCC and vascular invasion were identified as the significant predictors with adjusted hazard ratios of 9.25 [95 % confidence interval (CI) 2.13–40.21] and 2.19 (95 % CI 1.34–3.58), respectively. When only preoperative factors were considered in multivariate analysis, primary tumor size and serum AFP levels over 400 ng/mL were identified as significant predictors with adjusted hazard ratios of 1.24 (95 % CI 1.07–1.45) and 1.72 (95 % CI 1.05–2.82), respectively.Conclusions
For primary HCC patients within the UCSF criteria, larger tumor sizes and AFP levels over 400 ng/mL were associated with postresection recurrence of HCC exceeding the UCSF criteria. Because these are clearly markers for aggressive tumor biology, whether early primary transplant will alter the aggressive tumor behaviors warrant further investigation. 相似文献8.
Thomas RM Truty MJ Nogueras-Gonzalez GM Fleming JB Vauthey JN Pisters PW Lee JE Rice DC Hofstetter WL Wolff RA Varadhachary GR Wang H Katz MH 《Journal of gastrointestinal surgery》2012,16(9):1696-1704
Background
Resection of certain recurrent malignancies can prolong survival, but resection of recurrent pancreatic ductal adenocarcinoma is typically contraindicated because of poor outcomes.Methods
All patients from 1992 to 2010 with recurrent pancreatic cancer after intended surgical cure were retrospectively evaluated. Clinicopathologic features were compared from patients who did and did not undergo subsequent reoperation with curative intent to identify factors associated with prolonged survival.Results
Twenty-one of 426 patients (5?%) with recurrent pancreatic cancer underwent potentially curative reoperation for solitary local-regional (n?=?7) or distant (n?=?14) recurrence. The median disease-free interval after initial resection among reoperative patients was longer for those with lung or local-regional recurrence (52.4 and 41.1?months, respectively) than for those with liver recurrence (7.6?months, p?=?0.006). The median interval between reoperation and second recurrence was longer in patients with lung recurrence (median not reached) than with liver or local-regional recurrence (6 and 9?months, respectively, p?=?0.023). Reoperative patients with an initial disease-free interval >20?months had a longer median survival than those who did not (92.3 versus 31.3?months, respectively; p?=?0.033).Conclusion
Patients with a solitary pulmonary recurrence of pancreatic cancer after a prolonged disease-free interval should be considered for reoperation, as they are more likely to benefit from resection versus other sites of solitary recurrence. 相似文献9.
Tseng-Cheng Chen MD Cheng-Ping Wang MD Jeng-Yuh Ko MD PhD Tsung-Lin Yang MD PhD Chun-Wei Hsu MD Kuo-An Yeh MD Yih-Leong Chang MD PhD Pei-Jen Lou MD PhD 《Annals of surgical oncology》2013,20(7):2388-2395
Background
For early-stage oral squamous cell carcinoma (OSCC) patients, the impact of perineural invasion (PNI) and lymphovascular invasion (LVI) on disease control and survival has not been clarified.Methods
The medical records of all early-stage OSCC patients who underwent curative surgery between 2004 and 2009 were reviewed.Results
A total of 442 early stage patients were included in this study. There were 360 patients in group A (without PNI or LVI) and 82 patients in group B (with PNI and/or LVI). Between groups A and B patients, there were no significant differences in the 5-year disease-free survival (73.8 vs 68.7 %, p = 0.48) and overall survival (90.9 vs 86.1 %, p = 0.25). Between groups A and B patients without postoperative radiotherapy (PORT), there were no significant differences in the 5-year disease-free survival (73.8 vs 70.2 %, p = 0.51) and overall survival (90.9 vs 85.2 %, p = 0.18). Between group B patients with and without PORT, there was no significant difference in either the disease-free survival (61.1 vs 70.2 %, p = 0.98) and overall survival (88.9 vs 85.2 %, p = 0.64). Multivariate analyses revealed that PNI, LVI, and PORT could not provide significant effect on treatment outcome.Conclusions
PNI and LVI were not significant risk factors for the disease control and overall survival for early stage OSCC patients. Furthermore, PORT could not provide an additional benefit for the disease control and overall survival for stages I and II OSCC patients with PNI and/or LVI. 相似文献10.
Min Soo Cho Sung Hoon Kim Seung Woo Park Jin Hong Lim Gi Hong Choi Joon Seong Park Jae Bock Chung Kyung Sik Kim 《Journal of gastrointestinal surgery》2012,16(9):1672-1679
Background
The surgical resection of hilar cholangiocarcinoma is extremely challenging because the tumor is closely related with the complicated hilar structures. We investigated to identify the outcomes for patients who underwent surgical resection and to identify the parameters that influenced radical resection.Methods
From January 2000 to December 2009, 105 patients underwent surgical resection for hilar cholangiocarcinoma. The clinicopathological parameters and surgical outcomes were retrospectively analyzed.Results
There were 15 operative mortalities (14.3%). Seventy-four patients underwent curative resection (70.5%). The median overall survival time for R0, R1, and R2 were 58, 28, and 19?months, respectively. Caudate lobectomy (p?=?0.044; odds ratio [OR], 4.386) and perineural invasion (p?=?0.01; OR, 0.062) were correlated with curative resection. Total bilirubin levels of more than 3?g/dl just before the operation (p?=?0.042; hazard ratio [HR], 2.109) and extent of resection (R1 and 2 vs R0; p?=?0.05; HR, 2.309) were selected as significantly negative factors affecting overall survival on the multivariate analysis.Conclusions
Caudate lobectomy and neurectomy may be thought of as adjustable territories by the surgeon??s efforts to achieve curative resection. R0 resection achieved through those efforts and liver optimization using preoperative biliary drainage may offer the patients a chance of cure. 相似文献11.
Kim HS Choi CH Lim MC Chang SJ Kim YB Kim MA Kim TJ Park SY Kim BG Song YS Bae DS Kim JW 《Annals of surgical oncology》2012,19(6):1973-1979
Background
To determine the safe criteria for less radical trachelectomy to treat patients with early-stage cervical cancer.Methods
We reviewed medical records and pathologic slides of 65 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA?CIB1 cervical cancer. The safe criteria for less radical trachelectomy were determined by using three factors such as tumor size ??1?cm, stromal invasion ??5?mm, and no lymphovascular space invasion (LVSI) for minimizing parametrial involvement, lymph node metastasis (LNM), and the need of adjuvant radiotherapy. The diagnostic values were investigated by calculating specificity, negative predictive value for no parametrial involvement, no LNM, and no need of adjuvant radiotherapy.Results
The median age was 32?years (range 22?C44?years), and the median duration of follow-up was 26?months (range 2?C103?months). Among seven single or combined factors for the safe criteria, (1) tumor size ??1?cm, (2) tumor size ??1?cm and stromal invasion ??5?mm, (3) tumor size ??1?cm and no LVSI, (4) tumor size ??1?cm, stromal invasion ??5?mm, and no LVSI did not show parametrial involvement, LNM, and the need of adjuvant radiotherapy. In particular, tumor size ??1?cm showed the highest specificity (28.1?C29.5%) and negative predictive value (100%). In spite of no difference in progression-free survival (PFS) between tumor size ??1?cm and >1?cm (P?=?0.22), tumor size ??1?cm showed better PFS without disease recurrence than tumor size >1?cm (2-year PFS, 100% vs. 90%).Conclusions
Less radical trachelectomy may be safe in patients with early-stage cervical cancer who have tumor size ??1?cm. 相似文献12.
Background and Aims
Various downstaging therapies were introduced to liver recipients who could not meet the relative criteria for liver transplantation, and many endpoints were reported. The most common criteria used were the Milan criteria and the University of California, San Francisco (UCSF) criteria. However, no comparison was made between them, and we attempted to find possible differences between the living donor liver transplantation (LDLT) patients who met the Milan criteria and those who met the UCSF criteria after accepting preoperative downstaging therapies.Materials and Methods
We performed a retrospective study of all 72 patients at our center from January 2003 to March 2009 who were diagnosed with advanced hepatocellular carcinoma but accepted various downstaging therapies. Some patients met the Milan criteria (group 1), and some met the UCSF criteria (group 2) but not the Milan criteria. We collected the data from the two groups and then compared the preoperative demographic data, downstaging therapies, intraoperative data from LDLT, and the recovery and complications after LDLT. Survival rates were compared using Kaplan?CMeier analysis.Results
Only 44 patients (61.1?%) met the criteria for liver transplantation, 21 cases met the Milan criteria (group 1), and 23 cases met the UCSF criteria (group 2) but not the Milan criteria. All of the 44 patients accepted right lobe living liver donor liver transplantation in our center. The difference in the baseline characteristics between the two groups did not reach statistical significance. The mean number of downstaging treatments per patient was 1.81?±?0.35 in group 1 and 1.83?±?0.41 in group 2 (P?=?0.928). Most of the patients received only one downstaging treatment, and transcatheter arterial chemoembolization (TACE) was the most common downstaging therapy. Four patients suffered complications after downstaging therapies: intra-abdominal hemorrhage after right hepatectomy, upper gastrointestinal hemorrhage after TACE, biliary fistula after resection, and hand?Cfoot syndrome after taking sorafenib. All complications after LDLT, classified according to the Clavien?CDindo system, were compared within the two groups, and the calculated score of the complications in group 1 was 1.48?±?1.63, which was greater than that of group 2 (1.39?±?1.64), but this difference did not reach statistical significance (P?=?0.865). The 1-, 3-, and 5-year survival rates were 90.4, 76.2, and 71.4?% in group 1 and 91.3, 73.9, and 69.6?% in group 2, respectively (P?>?0.05). Seven patients (three in group 1 and four in group 2) had tumor recurrence after a median follow-up period of 72?months. The pathology findings were not different between the two groups.Conclusion
Recipients who meet the Milan or UCSF criteria after accepting successful preoperative downstaging therapy in LDLT can achieve the same result. 相似文献13.
Dumitrascu T Dima S Herlea V Tomulescu V Ionescu M Popescu I 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2012,397(6):933-943
Background/aims
Neuroendocrine tumours occur very rarely in the ampulla of Vater and their clinical behaviour is unknown. The aim of this study is to assess the clinico-pathological features, surgical approach and prognosis of these patients.Methods
Six patients with neuroendocrine tumours of the ampulla of Vater treated with curative intent surgery at a single centre were retrospectively analysed. A univariate analysis of potential prognostic factors was also performed (data provided from the present study and literature review).Results
Pancreaticoduodenectomy was curative in all the patients. Overall and disease-free survival rates were significantly better for G1/G2 tumours (p?=?0.006 and p?=?0.004, respectively). Although frequent, lymph node metastases did not influenced both overall (p?=?0.760) and disease-free survival rates (p?=?0.745). No significant differences of survival were observed in patients with ENETS stage I/II disease, as compared to ENETS stage III disease (p?=?0.169 and p?=?0.137, respectively). No differences were observed according to UICC staging system (p?=?0.073 and p?=?0.177, respectively). Tumours that are less than 2?cm or limited to the ampulla appear to have a better prognosis.Conclusion
The WHO 2010 classification appear to accurately predict patient prognosis, while the ENETS or UICC staging systems have a limited value (especially in regard to lymph node metastases). Radical surgery (i.e. pancreaticoduodenectomy with lymphadenectomy) should be the standard approach in most patients with NET of the ampulla of Vater because this procedure removes all the potential tumour-bearing tissue. 相似文献14.
R. C. W. Martin MBBS K. F. Shannon MBBS M. J. Quinn MBBS R. P. M. Saw MS A. J. Spillane MD J. R. Stretch Dphil M. H. Colman BSc K. Gao B Eng J. F. Thompson MD 《Annals of surgical oncology》2012,19(12):3926-3932
Background
The aim of this study was to review the management of cervical lymph nodes in patients with cutaneous melanoma and to analyze factors influencing prognosis.Methods
This was a retrospective cohort study of patients who had cervical node surgery at the Sydney Melanoma Unit from 1990 to 2004.Results
Of 716 patients who met the study criteria, 339 had a sentinel node biopsy (SNB) and 396 had a neck dissection. Locoregional recurrence occurred in 27.6?% of those undergoing therapeutic neck dissection and 60?% eventually developed distant metastases. Radiotherapy was given as adjuvant treatment in 110 of the patients who had a therapeutic neck dissection (41?%), but this was not associated with improved regional control (p?=?.322). Multivariate analysis showed that nodal positivity (p?<?.001) and primary tumor ulceration (p?=?<?.027) were the most important predictors of locoregional recurrence and that primary tumor Breslow thickness (p?=?.009) and node positivity (p?=?.046) were the most important factors predicting survival. SNB-positive patients who underwent immediate completion lymphadenectomy had a 5-year survival advantage over those who had a therapeutic neck dissection for macroscopic disease (54?% vs 47?%, p?=?.028).Conclusions
Nodal status was the most important factor predicting disease-free and overall survival in patients with melanoma of the head and neck. Adjuvant radiotherapy was not associated with better locoregional control in the non-randomized cohorts of patients in this study. 相似文献15.
Ana Ramos-Levi Andres Sanchez-Pernaute Pilar Matia Lucio Cabrerizo Ana Barabash Carmen Hernandez Alfonso Calle-Pascual Antonio Torres Miguel Rubio 《Obesity surgery》2013,23(10):1520-1526
Background
Controversy exists regarding type 2 diabetes (T2D) remission rates after bariatric surgery (BS) due to heterogeneity in its definition and patients' baseline features. We evaluate T2D remission using recent criteria, according to preoperative characteristics and insulin therapy (IT).Methods
We performed a retrospective study from a cohort of 657 BS from a single center (2006–2011), of which 141 (57.4 % women) had T2D. We evaluated anthropometric and glucose metabolism parameters before surgery and at 1-year follow-up. T2D remission was defined according to 2009 consensus criteria: HbA1c <6 %, fasting glucose (FG) <100 mg/dL, and absence of pharmacologic treatment. We analyzed diabetes remission according to previous treatment.Results
Preoperative characteristic were (mean?±?SD): age 53.9?±?9.8 years, BMI 43.7?±?5.6 kg/m2, T2D duration 7.4?±?7.6 years, FG 160.0?±?54.6 mg/dL, HbA1c 7.6?±?1.6 %. Fifty-six (39.7 %) individuals had IT. At 1-year follow-up, 74 patients (52.5 %) had diabetes remission. Percentage weight loss (%WL) and percentage excess weight loss (%EWL) were associated to remission (35.5?±?8.1 vs. 30.2?±?9.5 %, p?=?0.001; 73.6?±?18.4 vs. 66.3?±?22.8 %, p?=?0.037, respectively). Duration of diabetes, age, and female sex were associated to nonremission: 10.3?±?9.4 vs. 4.7?±?3.8 years, p?<?0.001; 55.1?±?9.3 vs. 51.2?±?9.9 years, p?=?0.017; 58.9 vs. 33.3 %, p?=?0.004, respectively. Prior treatment revealed differences in remission rates: 67.1 % in case of oral therapy (OT) vs. 30.4 % in IT, p?<?0.001. OR for T2D remission in patients with previous IT, compared to those with only OT, were 0.157–0.327 (p?<?0.05), adjusting by different models.Conclusions
Consensus criteria reveal lower T2D remission rates after BS than previously reported. Prior insulin use is a main setback for remission. 相似文献16.
Background
As a consequence of the increase in life expectancy, hepatobiliary surgeons have to deal with an emerging aged population. We aimed to analyze the liver function and outcome after right hepatectomy (RH) in patients over 70?years of age.Methods
From January 2006 to December 2009, we prospectively collected data of 207 consecutive elective hepatectomies. In patients who had RH, cardiac risk was assessed by a dedicated preoperative workup. Liver failure (LF) was defined by the “fifty–fifty” criteria at postoperative day 5 (POD) and morbidity by the Clavien–Dindo classification. Liver function tests (LFTs) and short-term outcome were retrospectively analyzed in patients over (elderly group, EG) and younger (young group, YG) than 70?years of age.Results
Eighty-seven consecutive RH were performed during the study period. Indication for surgery included 90?% malignancy in 47?% of patients requiring preoperative chemotherapy. ASA grade?>?2 (44 vs. 16?%, p?=?0.027), ischemic heart disease (17 vs. 5?%, p?=?0.076), and preoperative cardiac failure (26 vs. 2?%, p?0.001) were more frequent in the EG (n?=?23) than in the YG (n?=?64). Both groups were similar regarding rates of normal liver parenchyma, chemotherapy and intraoperative parameters. The overall morbidity rates were comparable, but the serious complication (grades III–V) rate was relatively higher in the EG (39 vs. 25?%, p?=?0.199), particularly in patients with diabetes mellitus (100 vs. 29?%, p?=?0.04) and those who had additional nonhepatic surgery (67 vs. 35?%, p?=?0.110) and transfusions (44 vs. 30?%, p?=?0.523). The 90-day mortality rate was similar (9?% in the EG vs. 3?% in the YG, p?=?0.28) and was related to heart failure in the EG. LFTs showed a similar trend from POD 1 to 8, and patients ≥70?years of age had no liver failure.Conclusions
Age ≥70?years alone is not a contraindication to RH. However, major morbidity is particularly higher in the elderly with diabetes. This high-risk group should be closely monitored in the postoperative course. Liver function is not altered in the elderly patient after RH. 相似文献17.
Chia-Yang Hsu MD Yun-Hsuan Lee MD Cheng-Yuan Hsia MD Yi-Hsiang Huang MD PhD Chien-Wei Su MD Han-Chieh Lin MD Yi-You Chiou MD Fa-Yauh Lee MD Teh-Ia Huo MD 《Annals of surgical oncology》2013,20(6):2035-2042
Background
Performance status (PS) is closely linked with survival in patients with hepatocellular carcinoma (HCC). We investigated its impact on treatment strategy for small HCC(s).Methods
A total of 360 and 362 HCC patients within the Milan criteria undergoing surgical resection (SR) and radiofrequency ablation (RFA), respectively, were prospectively enrolled. Patients were classified into PS 0 (n = 558) and PS ≥1 (n = 164) groups. Propensity score analysis was performed, and 168 and 35 matched pairs were selected from patients with PS 0 and ≥1, respectively.Results
The SR group was younger and had a higher male-to-female ratio, higher prevalence of hepatitis B, lower prevalence of hepatitis C, better PS, better liver functional reserve, and larger tumor burden than the RFA group (all p < 0.05). Among patients with PS 0, the SR group was consistently younger, less cirrhotic, and had larger tumor burden (all p < 0.05). The long-term survival was comparable between SR and RFA group in patients with PS 0. After propensity score matching, SR provided significantly better long-term survival than RFA for patients within the Milan criteria classified as PS 0 (p = 0.016); the Cox proportional hazards model showed consistent results. There was no significant difference of overall survival between the SR and RFA group in patients with PS ≥1 before or after propensity score matching (both p > 0.05).Conclusions
For HCC patients within the Milan criteria and classified as PS 0, SR provides a better long-term survival compared with RFA. Performance status may enhance treatment selection and stratify the risk of survival in these patients. 相似文献18.
Liying Zhao Yanan Wang Hao Liu Hao Chen Haijun Deng Jiang Yu Qi Xue Guoxin Li 《Journal of gastrointestinal surgery》2014,18(5):1003-1009
Background
The role of laparoscopic surgery for advanced transverse colon cancer (TCC) remains controversial, especially in terms of long-term oncologic outcomes.Methods
This retrospective cohort study enrolled 157 consecutive patients who underwent curable resections for advanced TCC between January 2002 and June 2011 (laparoscopic-assisted colectomy (LAC), n?=?74; open colectomy (OC), n?=?83). Short-term outcomes and oncologic long-term outcomes were compared between the two groups.Results
Compared to the OC group, patients in the LAC group had less blood loss (LAC vs. OC, 79.6?±?70.3 vs. 158.4?±?89.3 ml, p?<?0.001), faster return of bowel function (2.6?±?0.7 vs. 3.8?±?0.8 days, p?<?0.001), and shorter postoperative hospital stay (10.3?±?3.7 vs. 12.6?±?6.0 days, p?=?0.007). Conversions were required in four (5.4 %) patients. Rates of short-term complication, mortality, and long-term complication were comparable between the two groups. The median follow-up time was 54 (26–106) months in the LAC group and 58 (29–113) months in the OC group (p?=?0.407). There were no statistical differences in the rates of 5-year overall survival (73.6 vs. 71.1 %, p?=?0.397) and 5-year disease-free survival (70.5 vs. 66.7 %, p?=?0.501) between the two groups.Conclusions
Laparoscopic surgery for advanced TCC yield short-term benefits while achieving equivalent long-term oncologic outcomes. 相似文献19.
Chang Ming Shen MS Guang Cai Niu MS Wei Cui MD Hui Kai Li PhD Qiang Li MD PhD 《Journal of gastrointestinal surgery》2012,16(12):2239-2246
Objectives
The aim of this study was to determine if there has been improvement in survival for patients with gallbladder cancer treated with surgical procedures.Methods
A retrospective review of all patients with gallbladder cancer admitted during the past 11?years was conducted. The patients were categorized into two periods: period 1, from 1 January 2000 to 31 December 2005 (group 1, n?=?77); and period 2, from 1 January 2006 to 31 December 2010 (group 2, n?=?131).Results
The two groups have similar age, sex distribution, and symptoms. There were more patients with advanced stage in group 2 (P?=?0.001). And patients in group 2 were treated with more aggressive surgical procedures compared with group 1. Patients of group 2 had a better surgical outcomes and longer 5-year overall survival (9?% vs. 19?%, P?=?0.040) and disease-free survival (P?=?0.017). Median survival in group 1 was 14.7?months, while in group 2 it was 22.3?months. Patients underwent R0 resection in group 2 had better survival than that in group 1 (P?=?0.009), while they had similar survival for those who underwent non-R0 resection in both periods (P?=?0.108).Conclusions
A significant improvement of disease-free survival and long-term survival results was observed in the past decade. 相似文献20.
CS Lim D Whalley LE Haydu R Murali J Tippett JF Thompson G Hruby RA Scolyer 《Annals of surgical oncology》2012,19(11):3325-3334