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1.
Luca Viganò MD Serena Langella MD Alessandro Ferrero MD Nadia Russolillo MD Elisa Sperti MD Lorenzo Capussotti MD 《Annals of surgical oncology》2013,20(3):938-945
Background
Management of patients with synchronous colorectal liver metastases (SCRLM) should be individually tailored. This study compares patients managed by hepatobiliary centers from diagnosis with those referred for liver resection (LR).Methods
Between 1998 and 2010, a total of 284 patients with SCRLM underwent resection; 106 resectable patients (1–3 unilobar metastases, diameter <100 mm, liver-only disease) were divided into two groups: 66 managed from diagnosis (group A) and 40 referred for LR (group B).Results
Group A contained a greater proportion of multiple metastases (55.0 vs. 34.8 %, P = 0.042). Group B always received colorectal surgery as up-front treatment (vs. 18.2 %, P < 0.0001). In group B, chemotherapy before LR was more common (72.5 vs. 33.3 %, P = 0.0001) and lasted longer (P = 0.010). More patients in group B exhibited disease progression before LR (17.5 vs. 3.0 %, P = 0.025). Group A underwent fewer surgical procedures (80.3 % simultaneous resection vs. 0 %, P < 0.00001), with similar short-term outcomes. After a median follow-up of 42.0 months, group A exhibited higher 5 year disease-free survival (DFS, 64.8 vs. 30.8 %, P = 0.005) and fewer extrahepatic recurrences (21.5 vs. 47.5 %, P = 0.005). The late-referral group (>6 months, n = 24) had shorter median overall survival (OS) and DFS than group A (49.1 and 25.3 months vs. not achieved and not achieved, P < 0.05). The early-referral group exhibited OS and DFS similar to group A. Multivariate analysis confirmed late referral as a negative predictive factor of OS and DFS.Conclusions
Monocentric management of SCRLM in hepatobiliary centers is associated with shorter preoperative chemotherapy, better disease control, fewer surgical procedures (simultaneous resection), and, compared with late-referred patients, better survival. 相似文献2.
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Hamed Kargozaran MD Vu Vu BS Partha Ray MD Sanjay Bagaria MD Shawn Steen MD Xing Ye MS Singh Gagandeep MD 《Annals of surgical oncology》2011,18(2):345-351
Background
The efficacy of surgery for invasive mucinous neoplasms is unclear. We examined the natural history of invasive mucinous cystic neoplasms (MCN) and invasive intraductal papillary mucinous neoplasms (IPMN) in patients who underwent pancreatic resection.Methods
The Surveillance, Epidemiology, and End Results (SEER) database (1996–2006) was queried for cases of resected invasive MCN and IPMN. Demographics, tumor characteristics, and overall survival were examined using log-rank analysis and multivariate Cox regression model.Results
Of 185 MCN cases and 641 IPMN cases, 73% and 48%, respectively, were women (P < 0.0001). Most (73%) IPMN were in the head of the pancreas; most (64%) MCN were in the tail/body (P < 0.0001). Lymph node metastasis was more common for IPMN than MCN (46% vs. 24%, P < 0.0001). Overall survival after resection was better for patients with stage I MCN vs. stage I IPMN (P = 0.0005), and it was better for patients with node-negative MCN vs. node-negative IPMN (P = 0.0061). There was no significant difference in survival of patients with stage IIA MCN vs. stage IIA IPMN (P = 0.5964), stage IIB MCN vs. stage IIB IPMN (P = 0.2262), or node-positive MCN vs. node-positive IPMN (P = 0.2263). Age older than 65 years (hazards ratio (HR) 1.71, P = 0.0046), high tumor grade (HR 2.68, P < 0.0001), higher T stage (HR 2.11, P < 0.0001), and IPMN histology (HR 1.90, P = 0.0040) predicted worse outcome in node-negative patients.Conclusions
Our findings suggest that survival is better after resection of invasive MCN versus invasive IPMN when disease is localized within the pancreas, but this difference disappears in the presence of nodal metastasis or extrapancreatic extension. 相似文献5.
Yanming Zhou Xiaofeng Zhang Zuobing Zhang Xiaobin Liu Lupeng Wu Yumin Li Bin Li 《World journal of surgery》2013,37(12):2899-2910
Background
With the increase in average life expectancy in recent decades, the proportion of elderly patients requiring liver surgery is rising. The aim of the meta-analysis reported here was to evaluate the safety and efficacy of hepatectomy in elderly patients.Methods
An extensive electronic search was performed for relevant articles that compare the outcomes of hepatectomy in patients ≥70 years of age with those in younger patients prior to October 2012. Analysis of pooled data was performed with RevMan 5.0.Results
Twenty-eight observational studies involving 15,480 patients were included in the analysis. Compared with the younger patients, elderly patients experienced more complications (31.8 vs 28.7 %; P = 0.002), mainly as a result of increased cardiac complications (7.5 vs 1.9 %; P < 0.001) and delirium (11.7 vs 4.5 %; P < 0.001). Postoperative major surgical complications (12.6 vs 11.3 %; P = 0.55) and mortality (3.6 vs 3.3 %; P = 0.68) were comparable between elderly and younger patients. For patients with malignancies, both the 5-year disease-free survival (26.5 vs 26.3 %; P = 0.60) and overall survival (39.5 vs 40.7 %; P = 0.29) did not differ significantly between the two groups.Conclusions
Postoperative major surgical complications, mortality, and long-term results in elderly patients seem to be comparable with those in younger patients, suggesting that age alone should not be considered a contraindication for hepatectomy. 相似文献6.
Kerem Bilsel Mehmet Erdil Deniz Gulabi Mehmet Elmadag Omer Cengiz Cengiz Sen 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2013,23(8):895-900
Purpose
To determine the effect of patient and surgical factors on mortality after hip fracture surgery.Design
Retrospective study.Setting
Level-one trauma and tertiary referral centers.Methods
Patients were eligible if they were aged 65 years or older and had undergone surgery for a non-pathological femoral neck or intertrochanteric hip fracture between 2008 and 2011. The primary outcome was mortality: within the first year after surgery, after the first year, and survival as of the last questioning date. Of the 578 eligible patients, 399 (69 %) were women; mean age was 79 years; and mean follow-up was 17 months.Results
Mortality during the first year was significantly more frequent in patients aged 80 years or older (67 vs. 33 %; P < 0.001). Estimated overall survival was significantly longer in women (43 vs. 37 %; P = 0.01). The type of fracture had no impact on mortality (P = 0.96). Patients with high ASA class had a significant effect on mortality (P < 0.001). Surgery timing did not affect mortality in univariate analysis (P = 0.25). The mortality rate for hemiarthroplasty was higher than osteosynthesis options (P = 0.03). The effect of the type of anesthesia on mortality was not significant (P = 0.74).Conclusions
Older men had the highest risk of mortality within the first year. Patients with ASA ratings of class 3 or 4 need to be evaluated carefully because they appear to be at higher risk of early mortality. Osteosynthesis has a lower mortality than does arthroplasty for hip fracture and thus should be preferred if either treatment is possible.Level of evidence
IV. 相似文献7.
Luca Stocchi MD Victor W. Fazio MD Ian Lavery MD Jeff Hammel MS 《Annals of surgical oncology》2011,18(2):405-412
Background
Insufficient lymph node harvest in presumed stage II colon carcinomas can result in understaging and worsened cancer outcomes. The purpose of this study was to evaluate factors affecting the number of lymph node examined, their corresponding impact on cancer outcomes, and the optimal number of examined nodes with reference to the standard of 12.Materials and Methods
We evaluated all patients undergoing surgery alone for stage II colon cancer included in our colorectal cancer database since 1976.Results
A total of 901 patients were included. Mean follow-up exceeded 8 years. The individual pathologist had no statistically significant association with the number of lymph nodes examined. Harvest of at least 12 nodes was related to surgery after 1991 (85% vs 69%, P < 0.001), right vs left colon carcinomas (85% vs 72%, P < 0.001), individual surgeon (P = 0.018), and length of specimen at different cutoffs of at least 30, 25, and 20 cm (P < 0.001). Increasing age was associated with fewer examined lymph nodes (Spearman correlation = ?0.22, P < 0.001). Fewer than 12 nodes and T4N0 staging independently affected overall survival (P = 0.003 and P = 0.022, respectively), disease-free survival (P = 0.010 and P = 0.09, respectively), disease-specific mortality (P = 0.009 and P < 0.001, respectively), and overall recurrence (P = 0.13 and P = 0.023, respectively). A minimal number of more than 12 examined nodes had no significant effect on cancer outcomes.Conclusions
A number of factors influenced lymph node harvest in stage II colon cancer. However, lymph node assessment of at least 12 nodes was the only modifiable factor optimizing cancer outcomes. 相似文献8.
Ichiro Yamato Tadatoshi Takayama Yutaka Midorikawa Tokio Higaki Hisashi Nakayama Masamichi Moriguchi Yoshiyuki Nakajima Shunichi Matsuoka Masahiro Ogawa Mitsuhiko Moriyama 《Surgery today》2013,43(8):865-870
Purpose
The outcomes of patients with resectable hepatocellular carcinoma (HCC) negative for all virus-related markers have not yet been characterized. This study investigated the outcomes of such patients in comparison to those who had virus-related resectable HCC.Methods
A total of 398 patients with HCC were divided into 2 groups, comprising patients in which all virus-related markers (HBs-Ag, HBs-Ab, HBe-Ag, HBe-Ab, HBc-Ab, HCV-Ab) were negative (all-negative group, n = 63) and those with at least 1 positive virus-related marker (virus-related group, n = 335). The clinical characteristics, surgical data, and survival rates were compared between the groups.Results
The serum AST (30 vs. 45 IU/l, P < 0.0001) and ALT (21 vs. 42 IU/l, P < 0.0001) levels were significantly lower in the all-negative group than in the virus-related group. The tumor size (4.3 vs. 3.1 cm, P < 0.0001), the prevalence of DM (46.8 vs. 25.4 %, P = 0.001), and BMI (24.8 vs. 22.9, P = 0.0023) were significantly higher in the all-negative group than in the virus-related group. HCC arose from a cirrhotic liver in a significantly higher proportion of patients in the virus-related group than in the all-negative group (20.6 vs. 44.8 %, P = 0.0002). The survival outcomes were not significantly different in the 2 groups (all-negative vs. virus-related: 5-year overall survival rate, 58.2 vs. 55.2 %, P = 0.27), despite such differences in the patients’ characteristics.Conclusions
The postoperative outcomes of patients with HCC are independent of the presence or absence of hepatitis viral infection. 相似文献9.
Yuji Miyamoto Toshimasa Ishii Jo Tashiro Takahiro Satoh Masayuki Watanabe Hideo Baba Shigeki Yamaguchi 《Surgery today》2014,44(7):1293-1299
Purpose
This study evaluated the feasibility and safety of laparoscopic colorectal surgery for cancer in obese patients based on the short-term outcomes.Methods
We conducted a retrospective analysis of 561 patients with colorectal cancer treated from April 2007 to October 2010. The surgical outcomes were compared between non-obese (BMI <25 kg/m2) and obese (BMI ≥25 kg/m2) patients.Results
All of the enrolled patients were classified as non-obese (n = 421) or obese (n = 140). The obese group had a significantly higher proportion of male patients (72.1 vs. 57.0 %; P = 0.002), a higher incidence of left colon cancer (49.3 vs. 36.8 %; P = 0.033), and more systematic comorbidities (P < 0.001) than did the non-obese group. The length of the surgery was significantly longer in obese than in non-obese patients (221 vs. 207 min; P = 0.025). There was no significant difference in the overall incidence of postoperative complications between the two groups; however, surgical wound infections were more common in obese patients (12.1 vs. 5.2 %; P = 0.005). Obesity was not a significant-independent risk factor for total postoperative complications (odds ratio 1.330; P = 0.289).Conclusion
Laparoscopic colorectal surgery is technically feasible and safe for obese patients and provides all the benefits of a minimally invasive approach. 相似文献10.
Luigi Cormio Glenn Preminger Christian Saussine Niels Peter Buchholz Xiaochun Zhang Helena Walfridsson Andreas J. Gross Jean de la Rosette 《World journal of urology》2013,31(6):1563-1568
Purpose
To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL).Methods
The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year period at 96 participating centers worldwide. This report focuses on the 3,968 patients who received a NT of known size. Preoperative, surgical procedure and outcome data were analyzed according to NT size, dividing patients into two groups, namely small-bore (SB; nephrostomy size ≤ 18 Fr) and large-bore (LB; nephrostomy size > 18 Fr) NT.Results
Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/dL; P < 0.001), overall complications (15.8 vs. 21.4 %; P < 0.001) and a trend toward a lower rate of fever (9.1 vs. 10.7 %). Patients receiving a LB NT conversely had a statistically, though not clinically significant, longer postoperative hospital stay (4.4 vs. 4.2 days; P = 0.027). There were no differences in urinary leakage (0.9 vs. 1.3 %, P = 0.215) or stone-free rates (79.5 vs. 78.1 %, P = 0.281) between the two groups.Conclusions
LB NTs seem to reduce bleeding and overall complication rate. These findings would suggest that if a NT has to be placed, it should better be a LB one. 相似文献11.
Heung-Kwon Oh MD Sung-Bum Kang MD PhD Sung-Min Lee MD Soo Young Lee MD Myoung Hun Ihn MD Duck-Woo Kim MD PhD Ji Hoon Park MD Young Hoon Kim MD PhD Kyung Ho Lee MD PhD Jae-Sung Kim MD PhD Jin Won Kim MD Jee Hyun Kim MD PhD Tae-Young Chang MD Sung-Chan Park MD PhD Dae Kyung Sohn MD PhD Jae Hwan Oh MD PhD Ji Won Park MD Seung-Bum Ryoo MD Seung-Yong Jeong MD PhD Kyu Joo Park MD PhD 《Annals of surgical oncology》2014,21(7):2280-2287
Background
Although lateral pelvic node dissection (LPND) is recommended for rectal cancer with clinically metastatic lateral pelvic lymph nodes (LPNs), LPNs may respond to neoadjuvant chemoradiotherapy (nCRT). Our aim was to determine the optimal indication for LPND after nCRT for mid/low rectal cancer.Methods
Of 2,263 patients with clinical stage II/III mid/low rectal cancer who were managed at three tertiary referral hospitals, 66 patients underwent curative surgery including LPND after nCRT were included in this study. Risk factors for LPN metastasis were retrospectively analyzed and oncologic outcomes determined according to LPN response to nCRT.Results
Persistent LPNs greater than 5 mm on post-nCRT magnetic resonance imaging were significantly associated with residual tumor metastasis, unlike responsive LPN after nCRT (short-axis diameter ≤5 mm) (pathologically, 61.1 % [22 of 36] vs. 0 % [0 of 30], P < 0.001). Multivariable analysis revealed post-nCRT LPN size as a significant and independent risk factor for LPN metastasis (odds ratio 2.390; 95 % confidence interval 1.104–4.069). Over a median follow-up of 39.3 months, the recurrence rate was lower in patients with responsive nodes than in patients with persistent nodes (20 % [6 of 30] vs. 47.2 % [17 of 36], P = 0.012). The 5-year overall survival and 5-year disease-free survival rates were lower in patients with persistent LPN than in patients with responsive LPN (44.6 % vs. 77.1 %, P = 0.034; 33.7 % vs. 72.5 %, P = 0.011, respectively).Conclusions
In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT. 相似文献12.
Stefano Partelli Stefano Crippa Paola Capelli Anna Neri Claudio Bassi Giuseppe Zamboni Giuliano Barugola Massimo Falconi 《World journal of surgery》2013,37(6):1397-1404
Background
The aim of the present study was to determine the optimal number of lymph nodes (LN) examined to stage pN0 tumors after surgery for ampulla of Vater carcinoma (AVC).Methods
We reviewed retrospectively 127 patients with AVC who underwent pancreaticoduodenectomy (1990–2008). Univariate and multivariate analysis was performed.Results
Fifty-nine patients (46.5 %) were pN0, whereas 68 patients (53.5 %) were pN1. The 5-year disease-specific survival (DSS) was worse for pN1 patients than for pN0 patients (46 vs. 77 %; P < 0.0001). In the pN0 cohort, the optimal cut-off number of LN analyzed was found to be 12. The 5-year DSS for patients with ≤12 LN was 50 %, compared with 89 % in those with >12 LN (P = 0.001). By multivariate analysis, a LN count >12 was the only independent predictor associated with improved survival (HR 0.16, P = 0.003) among pN0 patients. Among pN1 patients, a LN count >12 was associated with a significantly better 5-year DSS (59 vs. 22 %; P = 0.027). Patients with a lymph node ratio (LNR) >0.20 had a 5-year DSS of 24 %, compared with 58 % in those with 0 < LNR ≤ 0.20 (P = 0.038).Conclusions
Removal of more than 12 LN for examination is associated with improved survival rate after surgery for AVC in both pN0 and pN1 patients. 相似文献13.
Marlin W. Causey Doug Stoddard Eric K. Johnson Justin A. Maykel Matthew J. Martin David Rivadeneira Scott R. Steele 《Surgical endoscopy》2013,27(2):603-609
Introduction
The surgical management of ulcerative colitis (UC) often involves complex operations. We investigated the outcome of patients who underwent surgery for UC by analyzing a nationwide database.Methods
We queried the American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP, 2005–2008) for all UC patients who underwent colectomy. To analyze by operation, groupings included: partial colectomy (PC; n = 265), total abdominal colectomy (TAC; n = 232), total proctocolectomy with ileostomy (TPC-I; n = 134), and total proctocolectomy with ileal pouch-anal anastomosis (IPAA; n = 446) to analyze 30-day outcomes.Results
From 1,077 patients (mean age, 44 years; 45 % female; 7 % emergent), a laparoscopic approach was used in 29.2 %, with rates increasing 8.5 % each year (18.5 % in 2005 to 41.3 % in 2008, P < 0.001). Complications occurred in 29 %, and laparoscopy was associated with a lower complication rate (21 vs. 32 % open, P < 0.001). On multivariate regression, postoperative complications increased when patients were not functionally independent [odds ratio (OR) = 3.2], had preoperative sepsis (OR = 2.0), or prior percutaneous coronary intervention (OR = 2.8). A laparoscopic approach was associated with a lower complication rate (OR = 0.63). When stratified by specific complications, laparoscopy was associated with lower complications, including superficial surgical site infections (11.4 vs. 6.7 %, P = 0.0011), pneumonia (2.9 vs. 0.6 %, P = 0.023), prolonged mechanical ventilation (3.9 vs. 1.3 %, P = 0.023), need for transfusions postoperatively (1.6 vs. 0 %, P = 0.016), and severe sepsis (2.9 vs. 1.0 %, P = 0.039). Laparoscopy was also was associated with a lower complication rate in TACs (41.7 vs. 18.8 %, P < 0.0001) and IPAA (29.9 vs. 18.2 %, P = 0.005) and had an overall lower mortality rate (0.2 vs. 1.7 %, P = 0.046).Conclusions
Results from a large nationwide database demonstrate that a laparoscopic approach was utilized in an increasing number of UC patients undergoing colectomy and was associated with lower morbidity and mortality, even in more complex procedures, such as TAC and IPAA. 相似文献14.
Sajida Ahad Chad Gonczy Vriti Advani Stephen Markwell Imran Hassan 《Surgical endoscopy》2013,27(6):1865-1871
Background
By virtue of the benefits associated with minimally invasive approaches, laparoscopic splenectomy (LS) is believed to have better patient-related outcomes compared to open splenectomy (OS). However, there are limited data directly comparing the two techniques.Methods
Patients who underwent elective LS and OS between 2005 and 2010 were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology codes 38120 and 38100. Patients who had concomitant procedures were excluded. Because of the nonrandom assignment of surgical techniques, a selection bias could have been responsible for the differences in patient outcomes. Therefore, patient characteristics and comorbidities that were available and could have been potential confounders were compared and regression analysis was performed to determine independent risk factors associated with serious and overall morbidity as well as mortality.Results
During the study period 1,644 and 851 patients underwent LS and OS, respectively. Compared to patients who underwent LS, patients who had OS had a longer median length of hospital stay (3 vs. 6 days, P < 0.0001) and higher incidences of serious (7 vs. 17 %, P < 0.0001) and overall morbidity (12 vs. 25 %, P < 0.0001) and mortality (1.4 vs. 3.3 %, P = 0.02). However, there were certain significant differences in the characteristics and comorbidities of the patients that could have confounded outcomes. On regression analysis, OS was not associated with higher mortality (OR = 1.43, 95 % CI 0.7–2.7, P = 0.28) but was associated with higher serious morbidity (OR = 1.8, 95 % CI 1.4–2.3, P = 0.001) and overall morbidity (OR = 2.0, 95 % CI 1.6–2.4, P = 0.0001).Conclusion
After adjusting for available confounders, patients who underwent LS had lower morbidity and similar mortality rates. Although certain confounders such as previous surgical history, underlying pathology, and spleen size could still have potentially influenced outcomes, the data suggest that patient outcomes after LS are excellent and when technically possible a minimally invasive technique should be the preferred approach for splenectomy. 相似文献15.
Laparoscopic repair of primary versus incisional ventral hernias: time to recognize the differences?
Purpose
To elucidate the differences in the pathology of incisional and primary ventral hernias and the outcomes of their laparoscopic repair.Methods
An operating room database of all laparoscopic ventral hernias performed between 2001 and 2009 was analyzed retrospectively. Patients were divided into two main groups: Group 1 (incisional hernias) and Group 2 (primary hernias). All P-values < 0.05 were considered to be significant.Results
There were 121 patients in Group 1 (mean age: 60.35 years) and 100 patients in Group 2 (mean age: 51.94 years). There was a significantly higher percentage of females in Group 1 (70 vs. 28%, P < 0.0001). There were significantly more complex hernias (defined as multiple points of weakness on the anterior abdominal wall) in Group 1 (37 vs. 10%, P < 0.0001). A total of 89% of patients required lysis of adhesions in Group 1 as compared with 73% in Group 2 (P = 0.007). There was a significantly higher percentage of conversions in Group 1 (9%) compared with Group 2 (2%, P = 0.02). The mean mesh size was significantly larger in Group 1 (243.22 vs. 131.46 cm2). The mean length of procedure (LOP) was significantly longer in Group 1 (113.94 min) as compared with Group 2 (70.96 min). The overall morbidity rate was not significantly different between the two groups (23 vs. 16%). The mean length of stay (LOS) was significantly longer for Group 1 (2.2 vs. 0.75 days, P < 0.0001). Finally, 22.3% of the patients in Group 1 were discharged on the same day as compared with 59% of the patients in Group 2 (P < 0.0001).Conclusions
The LOP and LOS are longer after the laparoscopic repair of incisional than for primary ventral hernias. This disparity should be kept in mind when counseling patients and while designing trials investigating laparoscopic ventral hernia repairs (LVHRs). 相似文献16.
B. B. Pultrum MD PhD D. J. Bosch BSc M. W. N. Nijsten MD PhD M. G. G. Rodgers MD H. Groen MD PhD J. P. J. Slaets MD PhD J. Th. M. Plukker MD PhD 《Annals of surgical oncology》2010,17(6):1572-1580
Background
Elderly patients who undergo esophagectomy for cancer often have a high prevalence of coexisting diseases, which may adversely affect their postoperative course. We determined the relationship of advanced age (i.e., ≥70 years) with outcome and evaluated age as a selection criterion for surgery.Methods
Between January 1991 and January 2007, we performed a curative-intent extended transthoracic esophagectomy in 234 patients with cancer of the esophagus. Patients were divided into two age groups: <70 years (group I; 170 patients) and ≥70 years (group II; 64 patients).Results
Both groups were comparable regarding comorbidity (American Society of Anesthesiologists classification), and tumor and surgical characteristics. The overall in-hospital mortality rate was 6.2% (group I, 5%, vs. group II, 11%, P = 0.09). Advanced age was not a prognostic factor for developing postoperative complications (odds ratio, 1.578; 95% confidence interval, 0.857–2.904; P = 0.143). The overall number of complications was equal with 58% in group I vs. 69% in group II (P = 0.142). Moreover, the occurrence of complications in elderly patients did not influence survival (P = 0.174). Recurrences developed more in patients <70 years (58% vs. 42%, P = 0.028). The overall 5-year survival was 35%, and, when included, postoperative mortality was 33% in both groups (P = 0.676).The presence of comorbidity was an independent prognostic factor for survival (P = 0.002).Conclusions
Advanced age (≥70 years) has minor influence on postoperative course, recurrent disease, and survival in patients who underwent an extended esophagectomy. Age alone is not a prognostic indicator for survival. We propose that a radical resection should not be withheld in elderly patients with limited frailty and comorbidity. 相似文献17.
Frank Vicini MD Chirag Shah MD J. Ben Wilkinson MD Martin Keisch MD Peter Beitsch MD Maureen Lyden MS 《Annals of surgical oncology》2013,20(4):1275-1281
Purpose
To analyze outcomes in patients with ductal carcinoma-in-situ (DCIS) treated with accelerated partial breast irradiation (APBI) within a pooled set of patients.Methods
A total of 300 women with DCIS underwent APBI between April 1993 and November 2010 as part of American Society of Breast Surgeons MammoSite Registry Trial (n = 192) or at William Beaumont Hospital (n = 108). Patients with pure DCIS <3 cm (n = 125) were assigned to the cautionary risk group per American Society of Radiation Oncology consensus panel guidelines for off-protocol use of APBI and analyzed compared to a pooled invasive suitable (n = 653) risk group and pooled invasive suitable/cautionary (n = 1,298) risk group.Results
The rate of ipsilateral breast tumor recurrence (IBTR) for all 300 DCIS patients was 2.6 % at 5 years with no regional recurrences, while cause-specific survival was 99.5 % and overall survival (OS) was 96.4 %. When comparing the cautionary DCIS group to the invasive suitable/cautionary group, no difference in IBTR was noted (2.6 vs. 3.1 %, P = 0.90) with significant improvements in distant metastases (0 vs. 2.5 %, P = 0.05), disease-free survival (98.5 vs. 94.4 %, P = 0.05), and OS (95.7 vs. 90.8 %, P = 0.03) noted for DCIS patients. When comparing cautionary DCIS patients to invasive suitable patients, no difference in IBTR were noted (2.6 vs. 2.4 %, P = 0.76), while improved OS for DCIS patients was noted (95.7 vs. 90.9 %, P = 0.02).Conclusions
This analysis of the largest cohort of patients with DCIS treated with APBI supports previously reported excellent outcomes; as a result of small numbers of events, further data are necessary to confirm these findings. 相似文献18.
Suk-Joon Chang MD PhD Tae Wook Kong MD Woo Young Kim MD Seung-Chul Yoo MD PhD Jong-Hyuck Yoon MD Ki-Hong Chang MD PhD Hee-Sug Ryu MD PhD 《Annals of surgical oncology》2011,18(1):58-64
Background
The purpose of this study was to investigate various pathologic risk factors associated with para-aortic lymph node metastasis (LNM) in surgically staged patients with endometrial cancer.Materials and Methods
We performed a retrospective analysis of 203 consecutive patients with endometrial cancer who were surgically staged from 2000 to 2009. The association among the various pathologic variables for para-aortic LNM was determined with univariate and multivariate analyses.Results
Of 203 patients, 29 patients (14.3%) had LNM. Also, 10 patients (4.9%) had only pelvic LNM, 14 (6.9%) had both pelvic and para-aortic LNM, and 5 (2.5%) had para-aortic LNM without pelvic LN involvements. Histologic type (P = .001), tumor grade (P < .001), tumor size (P = .003), depth of myometrial invasion (P < .001), cervical invasion (P < .001), parametrial invasion (P = .002), lymph-vascular space invasion (LVSI) (P < .001), serosal/adnexal invasion (P < .001), positive cytology (P = .002), peritoneal seeding (P < .001), and pelvic LNM (P < .001) were significant pathologic factors for para-aortic LNM. On multivariate analysis, cervical invasion (P = .032), LVSI (P = .018), and positive pelvic LNs (P = .002) were independent factors for para-aortic LNM. With regard to isolated para-aortic LNM, tumor grade (P = .017) and LVSI (P = .002) were significant factors for LN involvements. On multivariate analysis, LVSI (P = .004) was the only significant independent factor.Conclusions
LVSI correlates significantly with the risk of isolated para-aortic LNM in endometrial cancer patients. 相似文献19.
V. Mainardi K. Rando D. Olivari G. Rey J. Castelli G. Grecco A. Leites M. Harguindeguy S. Gerona 《Transplantation proceedings》2018,50(2):465-471
Background
Acute liver failure (ALF) is a syndrome with high mortality.Objective
Describe characteristics and outcomes of patients with ALF in Uruguay, and identify factors associated with mortality.Methods
A retrospective analysis of 33 patients with ALF was performed between 2009 and 2017.Results
The patients' median age was 43 years, and 64% were women. Average Model for End-Stage Liver Disease (MELD) score at admission was 33. The median referral time to the liver transplant (LT) center was 7 days. The most common etiologies were viral hepatitis (27%), indeterminate (21%), autoimmune (18%), and Wilson disease (15%). Overall mortality was 52% (71% of transplanted and 46% of nontransplanted patients). Dead patients had higher referral time (10 vs 4 days, P = .008), higher MELD scores at admission (37 vs 28) and highest achieved MELD scores (42 vs 29; P < .001), and higher encephalopathy grade III to IV (94% vs 25%, P < .001) than survivors. Patients without LT criteria (n = 4) had lower MELD score at admission (25 vs 34, P = .001) and highest achieved MELD score (27 vs 37, P = .008) compared with the others. Patients with LT criteria but contraindications (n = 7) had higher MELD scores at admission (38 vs 31, P = .02), highest achieved MELD scores (41 vs 34, P = .03), and longer referral time (10 days) than those without contraindications (3.5 days) or those without LT criteria (7.5 days, P = .02). Twenty-two patients were listed; LT was performed in 7, with a median time on waiting list of 6 days.Conclusions
ALF in Uruguay has high mortality associated with delayed referral to the LT center, MELD score, and encephalopathy. The long waiting times to transplantation might influence mortality. 相似文献20.
Charles C. Hsu MD PhD Joseph M. Herman MD MSc Michele M. Corsini MD Jordan M. Winter MD Matthew D. Callister MD Michael G. Haddock MD John L. Cameron MD Timothy M. Pawlik MD MPH Richard D. Schulick MD Christopher L. Wolfgang MD PhD Daniel A. Laheru MD Michael B. Farnell MD Michael J. Swartz MD Leonard L. Gunderson MD MS Robert C. Miller MD 《Annals of surgical oncology》2010,17(4):981-990