Few internal iliac artery aneurysms rupture under 4 cm

Objective

This study investigated the diameter of internal iliac artery (IIA) aneurysms (IIAAs) at the time of rupture to evaluate whether the current threshold diameter for elective repair of 3 cm is reasonable. The prevalence of concomitant aneurysms and results of surgical treatment were also investigated.

Under-grading of <4 cm renal masses on renal biopsy

Study Type – Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? It is well documented that biopsy of small renal masses is inaccurate and tends to under‐estimate tumour grade compared with surgical specimens. To our knowledge there has not been a study showing grading discrepancy between biopsy and surgical excision in a large population‐based cohort.

OBJECTIVE

• ? To determine whether differences exist in tumour grade between patients who undergo partial nephrectomy (PN) and those who undergo ablation for renal tumours.

PATIENTS AND METHODS

• ? Data was obtained using the Surveillance, Epidemiology and End Results database. Patients with solitary renal tumours of <4 cm treated with ablation or PN and with renal cell carcinoma (RCC) histopathology were identified.
• ? Tissue diagnosis in the ablation specimens was obtained from biopsy reports, whereas tissue from PN specimens was determined from surgical pathology.
• ? Variables analysed included: year of diagnosis, age, sex, race/ethnicity, marital status, population density, education, poverty level, and tumour size.
• ? Stacked bar graphs were created to compare the distributions of grade and histology between the groups. Multinomial logistic regression was used to determine factors independently associated with grade.

RESULTS

• ? In all, 7704 (87.4%) patients underwent PN and 1114 (12.6%) underwent either radiofrequency ablation or cryoablation.
• ? The PN patients were younger at diagnosis (59 vs 68 years, P < 0.001), more likely to be married (70% vs 64%, P < 0.001), and had smaller tumours (2.4 vs 2.6 cm, P < 0.001).
• ? There were no differences in the distribution of histology between the PN and ablation groups.
• ? Tumour grade was significantly lower in tumours treated with ablation.
• ? Compared with grade 1 disease, those undergoing ablation were 30% less likely to have grade 2 (P < 0.001), 30% less likely to have grade 3 (P < 0.001), and 92% less likely to have grade 4 disease (P < 0.01) than those having PN.

CONCLUSIONS

• ? There is a strong association between grade and treatment type in patients with small renal masses after controlling for baseline characteristics.
• ? As grade is determined by different methods, we think that this shows systematic under‐grading in biopsy of small renal masses.

     

输尿管软镜下钬激光治疗2～4cm肾结石的新进展

对于直径为2~4cm的肾结石,各国家指南均推荐行经皮肾镜取石术(PCNL),但随着输尿管软镜(FURS)设备的不断改进及手术者操作水平的提高,输尿管软镜下钬激光通过分期治疗肾结石清除率可达93%左右,且并发症发生率较低,主要并发症石街的发生率为3.2%左右。本文将简述FURS的发展,对输尿管软镜下钬激光碎石术治疗2~4cm肾结石的应用进展及相关经验归纳总结,以供各位同道参考。     

微波消融治疗直径大于4 cm的混合型良性甲状腺结节疗效分析

目的观察微波消融对直径大于4 cm的混合型良性甲状腺结节的治疗效果。 方法回顾性分析2018年1月至6月中山大学孙逸仙纪念医院采用微波消融治疗68例混合型良性甲状腺结节患者的临床资料,统计治疗后甲状腺结节的体积变化及相关并发症的发生情况。 结果68例患者（68个结节）进行了微波消融治疗。超声造影显示,术后第1、3和6个月,达到完全消融效果的患者分别为63例（92.65%）、62例（91.18%）和61例（89.71%）,肿块体积分别缩小68.75%、84.88%和91.29%,患者消融效果满意。 结论微波消融治疗混合型良性甲状腺结节效果良好、安全可靠,可作为大于4 cm的混合性甲状腺结节的治疗首选。     

2cm～3cm小切口开腹胆囊切除术465例报告

目的 探讨2cm～3cm小切口开腹胆囊切除术的技术及适应证。方法 选择465例作一右上腹肋缘下2cm～3cm长切口开腹，直视下行胆囊切除术。结果 435例(93．5％)成功，术中操作困难延长切口30例，术后胆漏1例，引流3周自愈。全组无胆道损伤、术后出血及死亡病例。结论 经严格选择适应证后，2cm～3cm小切口开腹胆囊切除术是一安全有效的术式。     

腹腔镜联合结肠镜手术治疗直径≤4cm结直肠肿瘤的疗效及安全性

目的探讨腹腔镜联合结肠镜(双镜联合)手术治疗直径≤4 cm结直肠肿瘤的效果及安全性。方法随机将64例结直肠肿瘤患者分为2组,各32例。对照组实施开腹手术,观察组行双镜联合手术。比较2组的疗效。结果观察组手术时间、术中出血量及术后肛门排气时间、下床活动时间、并发症发生率及住院时间均显著低于对照组,差异有统计学意义(P0.05)。结论双镜联合手术治疗直径≤4 cm结直肠肿瘤,能准确定位肿瘤部位,手术时间短、术后并发症发生率低,有利于促进患者术后恢复。     

Thyroid Nodules (≥4 cm): Can Ultrasound and Cytology Reliably Exclude Cancer?

Background

Whether a threshold nodule size should prompt diagnostic thyroidectomy remains controversial. We examined a consecutive series of patients who all had thyroidectomy for a ≥4 cm nodule to determine (1) the incidence of thyroid cancer (TC) and (2) if malignant nodules could accurately be diagnosed preoperatively by ultrasound (US), fine needle aspiration biopsy (FNAB) cytology and molecular testing.

Methods

As a prospective management strategy, 361 patients with 382 nodules ≥4 cm by preoperative US had thyroidectomy from 1/07 to 3/12.

Results

The incidence of a clinically significant TC within the ≥4 cm nodule was 22 % (83/382 nodules). The presence of suspicious US features did not discriminate malignant from benign nodules. Moreover, in 86 nodules ≥4 cm with no suspicious US features, the risk of TC within the nodule was 20 %. US-guided FNAB was performed for 290 nodules, and the risk of malignancy increased stepwise from 10.4 % for cytologically benign nodules, 29.6 % for cytologically indeterminate nodules and 100 % for malignant FNAB results. Molecular testing was positive in 9.3 % (10/107) of tested FNAB specimens, and all ten were histologic TC.

Conclusions

In a large consecutive series in which all ≥4 cm nodules had histology and were systematically evaluated by preoperative US and US-guided FNAB, the incidence of TC within the nodule was 22 %. The false negative rate of benign cytology was 10.4 %, and the absence of suspicious US features did not reliably exclude malignancy. At minimum, thyroid lobectomy should be strongly considered for all nodules ≥4 cm.     

超微经皮肾镜碎石术治疗2～4cm肾结石的疗效研究

目的研究超微经皮肾镜碎石术(UPCNL)治疗2～4cm肾结石的疗效及对机体应激反应的影响。方法选择本院于2017年3月至2020年3月期间收治的68例肾结石手术患者为研究对象,其中选用UPCNL治疗的34例患者为UPCNL组,选用输尿管软镜碎石术(URSL)治疗的34例患者为URSL组,比较分析两组患者的手术相关情况、手术后机体应激反应及并发症发生情况。结果 UPCNL组手术时间、住院时间比URSL组更短,术中出血量比URSL组更少,术后1周结石清除率比URSL组更高(P0.05);手术后UPCNL组丙二醛(MDA)比URSL组更低,超氧化物岐化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)水平比URSL组更高(P0.05)。两组患者术后并发症发生率比较不明显(P0.05)。结论针对2～4cm肾结石患者实施UPCNL治疗效果显著,能够获得较为理想的结石清除率,减轻机体应激反应,加快身体康复,值得临床应用。     

5cm的边缘究竟多长

结直肠癌手术一直沿用肿瘤远端肠管需切除5cm的标准作法。这一传统的长度对肿瘤位于肛管附近者尤显重要。近代研究发现,直肠癌远端切除<5 cm和>5 cm,局部复发率和长期生存率相仿。然而,研     

经皮肾镜与输尿管软镜治疗2～4cm肾结石的临床疗效比较

目的 比较经皮肾镜与输尿管软镜治疗2～4cm肾结石的临床效果.方法 收集2009年9月至2011年1月34例输尿管软镜和36例经皮肾镜手术治疗直径范围为2-4cm肾结石,比较两者结石清除率、手术时间、住院时间及并发症.结果 输尿管软镜和经皮肾镜手术一期结石清除率分别为73.5％和88.9％(P＜0.05).经二期治疗后输尿管软镜清除率提高到88.2％.3个月后随访,清除率分别达94.1％或94.4％(P＞0.05).输尿管软镜平均手术时间为58.2±13.4(30～85)min,经皮肾镜为38.7±11.6(14～60) min(P＜0.001).经皮肾镜组总体并发症发生率较高,与输尿管镜组比较差异没有统计学意义.住院时间输尿管软镜组30.0±37.4h,经皮肾镜组61.4±34.0h,P＜0.001,比较差异有统计学意义.结论 多期输尿管软镜治疗2～4cm的肾结石可以达到令人满意的结果,可以替代经皮肾镜治疗较大肾结石.     

Preoperative Chemotherapy Decreases the Need for Re-Excision of Breast Cancers Between 2 and 4 cm Diameter

Introduction  It is accepted that preoperative chemotherapy can result in increased breast preservation for breast cancers greater than 4 cm. The benefits of preoperative chemotherapy are less clear, however, for patients who present with smaller tumors and are already candidates for breast-preserving surgery. The goal of this study is to assess the effect of preoperative chemotherapy on breast cancers between 2 and 4 cm diameter. Methods  A retrospective chart review was conducted of patients diagnosed with new breast cancer at the Yale-New Haven Breast Center for the years 2002–2007. Patients were included in the study if their breast cancer was between 2 and 4 cm and their initial surgical treatment had been completed. Patients with distant metastases were excluded. Results  There were 156 new cancers that met study requirements. Forty-seven patients underwent preoperative chemotherapy, and 109 patients had their surgery first, usually followed by chemotherapy. Initial surgery was lumpectomy for 31 out of 47 patients (66%) in the preoperative chemotherapy group compared with 62 out of 109 patients (57%) in the surgery group. For patients with lumpectomies, 2 out of 31 patients (6%) in the preoperative group had positive margins and required re-excision compared with 20 out of 62 patients (37%) in the surgery-first group (P < 0.01). Conclusions  We conclude that, for tumors between 2 and 4 cm, preoperative chemotherapy is associated with a significantly decreased rate of re-excision following lumpectomy. This not only results in fewer mastectomies, but also avoids the morbidity and inferior cosmetic results associated with a re-excision lumpectomy. Presented at the 61st Meeting of the Society of Surgical Oncology, March 13–16, 2008, Chicago, IL. Carla J. Christy is a Norma Lies Mitchell Interdisciplinary Breast Fellow funded by the Breast Cancer Alliance, Greenwich, CT.     

Should elective partial nephrectomy be performed for renal cell carcinoma >4 cm in size?

This Practice Point discusses the study of Pahernik and colleagues, which compared outcomes of partial nephrectomy between 102 patients with renal cell carcinoma >4 cm in size and 372 patients with tumors 相似文献   

Laparoscopic partial nephrectomy for tumours >4 cm compared with smaller tumours: perioperative results

Objective  

The use of laparoscopic partial nephrectomy (LPN) in patients with tumours >4 cm remains to be further evaluated. We report our experience with LPN in tumours >4 cm compared with tumours ≤4 cm.     

射频消融治疗5cm以下肝癌

自1993年ROSSis等[1]首先采用射频消融(radio-frequency ablation,RFA)治疗肝癌以来,因其安全微创、简单实用、疗效显著而备受关注,现已成为肝癌治疗领域的一个重要手段和热点[2],是当今小肝癌治疗的研究重点之一.湖南省肿瘤医院从1999年9月至2006年12月采用RFA治疗首诊5 cm以下肝癌78例,取得了比较好的效果,总结分析如下.     

1～4 cm分化良好的甲状腺癌选择单侧甲状腺腺叶切除术的效益和风险分析

目的 研究和分析初次手术选择单侧甲状腺腺叶切除术对1～4 cm甲状腺癌患者带来的效益和风险.方法 系统性回顾郑州大学第一附属医院甲状腺外科在2014年5月-2015年6月间因分化良好的甲状腺癌行甲状腺全切除术的病例,依据最新修订后的美国甲状腺协会(American Thyroid Association,ATA)指南,选取符合行单侧甲状腺腺叶切除术,1～4 cm分化良好的甲状腺癌患者171例,依据原发灶的病理结果特点,评估病例中如果初次手术选择了单侧甲状腺腺叶切除术,则最终可能需要二次行甲状腺全切除术的患者比例.结果 本组患者中,49％面临行二次手术的风险.结论 术前诊断为1～4 cm分化良好的甲状腺癌患者如果行单侧甲状腺腺叶切除术,则面临行二次手术的风险,甲状腺医师及患者在选择手术方式时,应权衡甲状腺全切除术和单侧甲状腺腺叶切除术可能带来的获益和风险.     

2cm与3cm切缘宽度在乳腺癌保乳手术中的疗效及美容效果比较

目的:探讨2cm与3cm切缘宽度在乳腺癌保乳手术中的疗效及美容效果的比较。方法:入选我院2008年5月至2012年11月收治的64例进行保乳的乳腺癌患者为观察对象,随机分为两组,分别采用2cm和3cm切缘长度,观察两组患者的手术疗效,并对两组患者美容效果评分进行比较。结果:2cm切缘组的危险因素阳性的比例明显高于3cm切缘组(P0.05),差异具有统计学意义;两组在局部复发率、远处转移率及3年以上生存率方面差异无统计学意义(P0.05);2cm切缘组的乳房美容优良率明显高于3cm切缘组(P0.05),差异具有统计学意义。结论:乳腺癌保乳手术行局部扩大切除时,2cm切缘宽度的临床疗效与3cm切缘宽度的效果接近,且术后乳房美容效果更佳,因此切缘2cm宽度已经基本足够,无需进一步扩大切缘宽度。     

Breast conservation therapy versus mastectomy in the surgical management of invasive lobular carcinoma measuring 4 cm or greater

BackgroundThe safety of breast conservation therapy (BCT) has not been demonstrated in large ILC tumors, potentially contributing to the higher mastectomy rates seen in ILC.MethodsWe queried a prospectively maintained database to identify patients with ILC measuring ≥4 cm and evaluated difference in recurrence free survival (RFS) between those treated with BCT versus mastectomy using a multivariate model.ResultsOf 180 patients, 30 (16.7%) underwent BCT and 150 (83.3%) underwent mastectomy. Patients undergoing mastectomy were younger (56.6 vs. 64.3 years, p = 0.003) and had larger tumors (7.2 vs. 5.4 cm, p < 0.001). While tumor size, nodal stage, receptor subtype, and margin status were significantly associated with RFS, there was no difference in RFS at 5 (p = 0.88) or 10 (p = 0.65) years for individuals undergoing BCT versus mastectomy.ConclusionsFor patients with ILC ≥4 cm, BCT provides similar tumor control as mastectomy, provided that negative margins are achieved.     

Is patient age associated with risk of malignancy in a ≥4 cm cytologically benign thyroid nodule?

BackgroundCurrent data regarding the risk of malignancy in a large thyroid nodule with benign fine-needle aspiration biopsy(FNAB) is conflicting. We investigated the impact of patient age on the risk of malignancy in nodules≥4 cm with benign cytology.MethodsWe performed a single-institution retrospective review of patients who underwent surgery from 07/2008–08/2019 for a cytologically benign thyroid nodule ≥4 cm. The relationship between malignant histopathology and patient and ultrasound features was assessed with multivariable logistic regression.ResultsOf 474 nodules identified, 25(5.3%) were malignant on final pathology. In patients <55 years old, 21/273(7.7%) nodules were malignant, compared to 4/201(2.0%) in patients ≥55. Patient age ≥55 was independently associated with significantly lower risk of malignancy(OR:0.2,95%CI:0.1–0.7,p = 0.011). Increasing nodule size >4 cm and high-risk ultrasound features were not associated with risk of malignancy(OR:1.0,95%CI:0.7–1.4,p = 0.980, and OR:9.6,95%CI:0.9–107.8,p = 0.066, respectively).ConclusionsPatients <55 years old are 3.7-fold more likely to have a falsely benign FNA biopsy in a nodule≥4 cm.