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1.
P.G. Calò G. Conzo M. Raffaelli F. Medas C. Gambardella C. De Crea L. Gordini R. Patrone L. Sessa E. Erdas E. Tartaglia C.P. Lombardi 《European journal of surgical oncology》2017,43(1):126-132
Background
Central neck dissection (CND) remains controversial in clinically node-negative differentiated thyroid carcinoma (DTC) patients. The aim of this multicenter retrospective study was to determine the rate of central neck metastases, the morbidity and the rate of recurrence in patients treated with total thyroidectomy (TT) alone or in combination with bilateral or ipsilateral CND.Methods
The clinical records of 163 clinically node-negative consecutive DTC patients treated between January 2008 and December 2010 in three endocrine surgery referral units were retrospectively evaluated. The patients were divided into three groups: patients who had undergone TT alone (group A), TT with ipsilateral CND (group B), and TT with bilateral CND (group C).Results
The respective incidences of transient hypoparathyroidism and unilateral recurrent nerve injury were 12.6% and 1% in group A, 23.3% and 3.3% in B, and 36.7% and 0% in C. Node metastases were observed in 8.7% in group A, 23.3% in B, and 63.3% in C. Locoregional recurrence was observed in 3.9% of patients in group A and in 0% in B and C.Conclusions
We found no statistically significant differences in the rates of locoregional recurrence between the three groups. Therefore, TT appears to be an adequate treatment for these patients; CND is associated with higher rates of transient hypoparathyroidism and cannot be considered the treatment of choice even if it could help for more appropriate selection of patients for RAI. Ipsilateral CND could be an interesting option considering the lower rate of hypocalcemia to be validated by further studies. 相似文献2.
J.A. Moody R.F. Ali A.C. Carbone S. Singh J.T. Hardwicke 《European journal of surgical oncology》2017,43(2):270-277
Purpose
The complications reported after sentinel lymph node biopsy (SLNB) for melanoma is highly variable in the worldwide literature; the overall complication rate varies between 1.8% and 29.9%. With heterogeneous reporting of morbidity data, no ‘average’ complication rates of this procedure have been reported. This systematic review aims to determine the complications rates associated with SLNB.Methods
A systematic review of English-language literature from 2000 to 2015, which reported morbidity information about SLNB for melanoma, was performed. The methodological quality of the included studies was performed using the methodological index for non-randomised studies (MINORS) instrument and Detsky score. Pooled proportions of specific post-operative complications were constructed using a random effects statistical model, and subgroups including lymph node basin and continent of origin of the study were compared.Results
After application of inclusion and exclusion criteria, 21 articles progressed to the final analysis. 9047 patients were included. The overall complication rate was 11.3% (95% CI: 8.1–15.0). The incidence of infection was 2.9% (95% CI 1.5–4.6); seroma 5.1% (95% CI: 2.5–8.6); haematoma 0.5% (95% CI: 0.3–0.9) lymphoedema 1.3% (95% CI: 0.5–2.6) and nerve injury 0.3% (95% CI: 0.1–0.6). There was no statistically significant difference in morbidity between the sites of SLNB or between continents.Discussion
This study provides information about the incidence of complications after SLNB. It can be used to counsel patients about the procedure and it sets a benchmark against which surgeons can audit their practice. 相似文献3.
Robert Maráz Tamás Zombori Éva Ambrózay Gábor Cserni 《European journal of surgical oncology》2017,43(11):2021-2028
Introduction
In the recent past, both clinically node-positive and node-negative but sentinel node-positive patients underwent axillary lymph node dissection (ALND), although the two groups seem to have substantially different degree of nodal involvement.Methods
Data on consecutive primary breast cancer patients with documented axillary ultrasound (AXUS) results who underwent ALND between January 2003 and December 2015 either because of AXUS-guided fine needle aspiration (A-FNAC) results or because of a positive sentinel lymph node were retrospectively analysed.Results
After exclusions, 316 patients staged by SNB and ALND with negative AXUS or A-FNAC (group A) were compared with 159 patients having positive A-FNAC results (group B). Tumour size and the proportion of mastectomies were greater, histological grade higher and lymphovascular invasion more frequent in Group B, where palpable lymph nodes were also more common. The proportion of cases with extensive nodal involvement (pN2 and pN3 cases) was about 3 times as much in Group B (63%) than in Group A (18%). Removal of the 50 patients with palpable lymph nodes from the analysis did not greatly influence these proportions: 60% and 19% extensive nodal involvements were noted, respectively. In this series, patients with suspicious AXUS and negative A-FNAC had more often extensive nodal involvement (25%) than AXUS negative patients (17%).Conclusions
Patients in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients, and therefore are likely to benefit from axillary treatment. 相似文献4.
Susana Roselló Matteo Frasson Eduardo García-Granero Desamparados Roda Esther Jordá Samuel Navarro Salvador Campos Pedro Esclápez Stephanie García-Botello Blas Flor Alejandro Espí Carlotta Masciocchi Vincenzo Valentini Andrés Cervantes 《Clinical colorectal cancer》2018,17(2):104-112.e2
Background
Adjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) was developed after VN to predict survival. We aimed to validate these tools in a retrospective cohort at an academic institution.Patients and Methods
VN and the NAR were applied to 158 consecutive patients with locally advanced rectal cancer treated with chemoradiation followed by surgery. According to the score, they were divided into low, intermediate, or high risk of relapse or death. For statistical analysis, we performed Kaplan-Meier curves, log-rank tests, and Cox regression analysis.Results
Five-year overall survival was 83%, 77%, and 67% for low-, intermediate-, and high-risk groups, respectively (P = .023), according to VN, and 84%, 71%, and 59% for low-, intermediate-, and high-risk groups, respectively (P = .004), according to NAR. When the score was considered as a continuous variable, a significant association with the risk of death was observed (NAR: hazard ratio, 1.04; P < .001; VN: hazard ratio, 1.10; P < .001).Conclusion
We confirmed the value of these scores to stratify patients according to their individual risk when designing new trials. 相似文献5.
I. Fleischmann R. Warschkow U. Beutner L. Marti B.M. Schmied T. Steffen 《European journal of surgical oncology》2017,43(10):1876-1885
Background
To evaluate the role of regional lymph node (RLN) retrieval on stage migration, overall (OS), and cancer-specific survival (CSS) in appendiceal cancer.Methods
Between 2004 and 2012, 1046 patients with primary stage I–III carcinoma of the appendix were identified in the Surveillance, Epidemiology and End Results database. The impact of the number of RLN removed on OS and CSS was assessed using joinpoint regression, Cox regression, and propensity score methods.Results
The rate of node-positive cancer increased with the number of retrieved RLN from 10.5% in patients with one RLN removed to 30.6% in patients with 10 RLNs removed. This leveling off at 10 RLN was confirmed by joinpoint regression analysis (p = 0.023). Despite the finding that retrieval of 10 RLN should be sufficient for appendiceal cancer, for the survival analysis the somewhat higher cutoff of 12 RLN was applied, since this cutoff is recommended by the guidelines for colorectal cancer. Retrieval of 12 or more RLN was beneficial compared to less than 12 RLN retrieved for OS (HR = 0.60, p < 0.001) and CSS (HR = 0.67, p = 0.020) in multivariable analysis, as well as in propensity score matched analysis (OS: HR = 0.58, p = 0.001, CSS: HR = 0.61, p = 0.005).Conclusion
The rate of node-positive cancer increased with the number of retrieved RLN up to about 10 RLN (95%CI: 3.6–16.3, p = 0.023). Over 10 retrieved RLN, the node-positive cancer rate no longer increased. This correlates with the recommended number of 12 RLN to be retrieved in colorectal cancer, but differs from the guideline for neuroendocrine tumors. 相似文献6.
Rati Chkheidze Mary Ann G. Sanders Barbara Haley A. Marilyn Leitch Sunati Sahoo 《Clinical breast cancer》2018,18(4):298-304
Background
Breast cancer metastases to an ipsilateral supraclavicular lymph node is assigned a N3 status in the TNM system and thus classified as stage III disease in the American Joint Commission on Cancer staging manual. Breast cancer metastatic to contralateral axillary lymph node (CAM) without metastases to any other distant organ is currently assigned M1 status (stage IV) instead of N3 (stage III).Patients and Methods
We retrospectively reviewed the medical records of breast cancer patients diagnosed with CAM for their clinical presentation, pathologic diagnoses, treatment, and follow-up data. Patients who had distant metastases at the time of CAM diagnosis were excluded from the study.Results
We report 12 breast cancer patients who developed CAM but no evidence of metastases in any other distant organ documented with extensive imaging workup. Imaging studies and thorough pathologic evaluation of the prophylactic total mastectomy specimen did not reveal a primary in the breast to account for the metastases in the axillary node.Conclusion
Findings of our study as well as previous studies support that lymph node metastases in the contralateral axilla represents a locoregional spread of the tumor from the index breast via lymphatics rather than hematogenous spread. Therefore, isolated CAM in breast cancer patients should not be classified as stage IV disease. 相似文献7.
Jeffrey Reha Shiva Kumar Reddy Mukkamalla Ritesh Rathore Ponnandai Sadasivan Somasundar 《European journal of surgical oncology》2018,44(1):148-156
Background
Lymph node involvement (LNI) is an important prognostic factor in colon cancer. But, variations in LNI among different age groups are less known. Adequate lymph node evaluation (LNE) requires assessment of ≥12 nodes. In our previous study, using Surveillance, Epidemiology and End Results (SEER) data, we demonstrated that older patients are less likely to have LNI (Khan et al. 2014). Our current study validates those findings using National Cancer Data Base (NCDB).Methods
NCDB was queried for patients diagnosed with stages I–III colon adenocarcinoma from 2004 to 2008 who underwent surgical resections. Pearson Chi-square test and Cox proportional hazards regression model were utilized for statistical analysis.Results
A cohort of 97,831 patients was identified for analysis. Among patients belonging to 18–64, 65–74 and >75 years age groups, frequency of adequate LNE was 73.6%, 69% and 67.4% respectively, with pathologically confirmed LNI rates being 44.7%, 37.8% and 29.3% respectively (p < 0.0001). Adequate LNE was associated with improved 5-year overall survival (OS) regardless of age, gender, race, comorbidity index, insurance, income, year of diagnosis, pathologic tumor status, stage, grade, type of colectomy, adjuvant chemotherapy or academic level of facility. Rates of adequate LNE increased from 2004 to 2008, with a corresponding increase in survival outcomes (p < 0.0001).Conclusion
Adequate LNE is very crucial for appropriate staging of colon cancer, and carries a high prognostic value. This study validates our previous findings of lower rates of LNI in elderly and reiterates the importance of adequate LNE, which is associated with improved survival. Also identified were increasing rates of adequate LNE over the years, with corresponding improvement in OS. 相似文献8.
John R. Sims Travis E. Grotz Barbara A. Pockaj Richard W. Joseph Robert L. Foote Clark C. Otley Amy L. Weaver James W. Jakub Daniel L. Price 《Surgical oncology》2018,27(1):11-17
Background
Merkel cell carcinoma (MCC) is a rare cutaneous malignancy of neuroendocrine origin with a high propensity for lymph node metastasis. Sentinel lymph node (SLN) status is important for accurate staging; however, the optimal treatment following SLN biopsy, regardless of nodal status, remains unclear.Methods
150 patients with MCC who underwent SLN biopsy from 1995 to 2011 at 3 Mayo Clinic sites were reviewed.Results
Of 150 patients with MCC who underwent SLN biopsy, 39 (26%) were positive and 111 (74%) were negative. There was no significant difference between the sex, age, tumor location, or size of primary in the positive and negative SLN groups. While there was no difference in the cumulative incidence of any regional recurrence between SLN groups, the rate of in-transit recurrences was significantly higher in patients with a positive SLN (p = 0.022). The disease-specific survival for MCC was 97.0%, 82.4%, and 82.4% at 1, 3, and 5 years with a positive SLN and 99.0%, 94.9%, and 86.8% with a negative SLN (p = 0.31). Among those alive at last follow up, the median follow up was 3.8 years (IQR, 2.1–8.4) and 2.9 years (IQR, 1.8–6.1) for positive and negative SLN cohorts respectively.Conclusions
Occult nodal metastasis is common in MCC(26%). No tumor or patient characteristics were identified to predict SLN positivity. Patients with a positive SLN have a higher risk of in-transit recurrence and may benefit from adjuvant radiation with inclusion of the in-transit field in amenable cases. When patients with a positive SLN receive additional treatment to the at-risk nodal basin, both OS and DSS are similar to patients with a negative SLN. 相似文献9.
Background
Recently there are efforts to use sentinel lymph node biopsy (SLNB) techniques after neoadjuvant chemotherapy (NAC) to minimize axillary surgery. However, studies have shown higher false negative rates in this scenario, which might result in inaccurate assessment of treatment response and patient prognosis as well as leaving residual disease behind. In this study, we describe the use of reflector-guided excision of the percutaneously biopsied node (PBN) as an aid to conventional SLNB and its predictor of the axillary status after NAC.Patients and Methods
This was a single-institution analysis of patients who underwent axillary fiducial-reflector placement and subsequent SLNB compared with conventional SLNB.Results
Nineteen patients in the reflector group were matched with 19 patients who underwent conventional SLNB (conventional group). The PBN was identified in the SLNB in 19 patients (100%) in the reflector group and in 9 patients (47.3%) in the conventional group (P = .002). In the remaining 10 patients in the conventional group, the PBN was identified in the axillary lymph node dissection specimen in 4 patients (21%) and not identified in 6 patients (31.7%). Among the 38 patients, traditional mapping failed to identify the PBN in 13 patients (34.2%). The PBN was negative in 10 patients (36%) and positive in 18 patients (64%); no additional positive nodes were identified among patients with a negative PBN, correctly reflecting the status of the axilla in 100% of cases.Conclusion
Mapping failure after NAC might compromise SLNB. Reflector-guided excision of the PBN is not only facile and feasible, but more accurately reflects the status of the axilla after NAC. 相似文献10.
Maíra Teixeira Dória Jonathan Yugo Maesaka Raymundo Soares de Azevedo Neto Nestor de Barros Edmund Chada Baracat José Roberto Filassi 《Clinical breast cancer》2018,18(5):e805-e812
Background
Approximately 30% of ductal carcinoma in situ (DCIS) cases have an invasive component discovered on the final analysis that could affect surgical management. The aims of the present study were to determine the risk factors associated with the underestimation of DCIS and to develop a model to predict the probability of invasiveness.Materials and Methods
A retrospective analysis was performed on the data for all patients with a diagnosis of DCIS found by percutaneous biopsy from January 2008 to February 2016. Thirteen potential predictors of invasiveness were examined. The statistical analysis of the present study was improved using Nagelkerke’s R2, the area under the receiving operating characteristic (AUC) curve, and the Hosmer-Lemeshow goodness-of-fit test.Results
Of 354 biopsy specimens deemed to be DCIS on initial biopsy, 100 (28.2%) were recategorized as invasive carcinoma after surgery. On multivariate analysis, the strongest predictors of invasiveness were comedonecrosis, size on mammography, suspected microinvasion, histologic grade, and younger patient age. The model had a good discriminative ability, with an AUC of 0.764. The overall performance of the model was fair, with a Nagelkerke’s R2 of 40.9%. A separate analysis performed on 274 specimens obtained through vacuum-assisted biopsy revealed different variables were associated with underestimation; however, a similar AUC (0.743) and Nagelkerke’s R2 (45.7%) were obtained.Conclusion
Our model had the best AUC for predicting DCIS invasiveness reported to date. However, further statistical analysis showed only a fair overall performance. The currently known clinical, radiographic, and pathologic features might be insufficient to identify which patients with DCIS have underestimated disease. 相似文献11.
Wan-jun Zhao Han Luo Yi-mei Zhou Wen-yu Dai Jing-qiang Zhu 《European journal of surgical oncology》2017,43(11):1989-2000
Background
The effectiveness of prophylactic central neck dissection (pCND) following total thyroidectomy (TT) in patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) is still controversial. The aim of this meta-analysis is to evaluate the outcome of pCND and to provide quantitative evidence.Method
A detailed literature search of PubMed, EMBASE, ClinicalTrails.gov and Cochrane Library electronic databases for articles published up to October 2016 was carried out. This meta-analysis was performed by the random method (Mantel–Haenszel) model. Locoregional recurrence (LRR) and surgical complications were analyzed.Results
Twenty-two studies comparing pCND + TT (combined) and TT alone in cN0 PTC patients were analyzed. A total of 6930 cases were enrolled, including 2381 cases in the combined group and 4009 cases in the TT-alone group. Compared with TT alone, patients in the combined group showed a significantly lower rate of overall LRR (OR = 0.66, 95% CI = 0.48–0.89) and central compartment recurrence (OR = 0.40, 95% CI = 0.22–0.73). There was no statistical difference in the rate of lateral compartment recurrence. However, the combined group showed a significantly higher rate of temporary and permanent hypoparathyroidism (OR = 2.28, 95% CI = 1.92–2.27/OR = 1.84, 95% CI = 1.15–2.95) and temporary recurrent laryngeal nerve injury (LNR) (OR = 1.53, 95% CI = 1.08–2.16). There was no statistical difference in the rate of permanent LNR, hematoma, hemorrhage or wound infection.Conclusions
This meta-analysis revealed that pCND with TT was a significantly efficient way to reduce the risk of LRR. However, pCND + TT increased the incidence rate of temporary and permanent hypoparathyroidism and temporary LNR. 相似文献12.
K. Armstrong J. Ward N.M. Hughes A. Mihai A. Blayney C. Mascott R. Kileen J. Armstrong 《Clinical oncology (Royal College of Radiologists (Great Britain))》2018,30(12):773-779
Aims
Postoperative radiotherapy is the standard of care for resected major salivary cancers that are at risk of locoregional recurrence. Of the various histological subtypes, perineural invasion is most common in adenoidcystic carcinomas of the three major salivary glands – parotid, submandibular and sublingual. The clinical target volume (CTV) for these cases must include the relevant cranial nerve pathways at risk. A contouring atlas was devised for delineation of the CTV of the nerves supplying the major salivary glands.Materials and methods
Using standard anatomy texts and e-anatomy sources the nerves supplying the major salivary glands were identified. Subsequently the pathways of the nerves were drawn on an archived patient's planning computed tomography scan.Results
The innervation of the major salivary glands has been identified and studied.Both bone and soft tissue CTVs have been delineated. A full set of images and CTVs of all the relevant transverse computed tomography slices has been archived, a number of which are printed in this article.Conclusions
Variation in CTV delineation is a recognised problem in a variety of anatomic sites. Guidelines and atlases can standardise practice and may improve the safety and efficacy of therapy. An atlas has been generated to guide clinicians in delineating the CTVs for perineural spread in major salivary gland cancers. 相似文献13.
Masaomi Ikeda Kazumasa Matsumoto Takahiro Hirayama Dai Koguchi Yasukiyo Murakami Daisuke Matsuda Norihiko Okuno Takuji Utsunomiya Yoshinori Taoka Akira Irie Masatsugu Iwamura 《Clinical genitourinary cancer》2018,16(3):e669-e675
Background
No definitive evidence exists regarding use of adjuvant chemotherapy (AC) for high-risk cases after radical nephroureterectomy (RNU), and the benefit of AC remains controversial. The aims of this study were to evaluate the efficacy of AC in patients with upper tract urothelial carcinoma (UTUC) and to determine those who qualified for AC.Patients and Methods
From 1990 to 2015, 449 patients with nonmetastatic UTUC underwent RNU at 6 Kitasato University-affiliated hospitals. Eight patients who received neoadjuvant chemotherapy were excluded from this study. One hundred patients (23%) received platinum-based AC for a median of 3 courses. Disease-free survival and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method. Multivariate analyses were performed with the Cox proportional hazards regression model, controlling for the effects of clinicopathological factors.Results
The median age was 69 years, and the median follow-up period was 35.7 months. In multivariate analyses, factors independently predictive of poorer survival included pT stage (≥pT3), lymph node status (pN+), tumor grade (Grade 3), lymphovascular invasion, and soft tissue surgical margin. For the risk stratification model, patients were categorized into 3 groups on the basis of these 5 risk factors. In the high-risk group (at least 3 risk factors, 83 patients), 41 patients (49%) were treated with AC, and the 5-year CSS rate was higher in the AC group compared with the non-AC group (P = .02).Conclusion
Having more than 3 risk factors defined the high-risk group among UTUC patients after RNU. AC was associated with improved CSS in patients with high-risk UTUC. 相似文献14.
Outcome of Chronic Myeloid Leukemia-Chronic Phase Patients Treated With Imatinib: A Local Experience
Ali M. Al-Amri 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(3):199-203
Background
Imatinib was the first tyrosine kinase inhibitor that has revolutionized the therapy of chronic myeloid leukemia. It binds breakpoint cluster region–Abelson kinase domain inducing apoptosis of the leukemic cells. In this study, we assessed the efficacy and toxicity of imatinib therapy in patients with chronic myeloid leukemia in chronic phase (CML-CP) in our hospital.Patients and Methods
We retrospectively analyzed the outcome of 17 patients with CML-CP treated with imatinib.Results
The median age at the time of presentation was 35 years with male preponderance. The most common presenting clinical features were fatigue, abdominal distention, and discomfort. Forty-seven percent of patients had fever at presentation whereas 35.29% were referred to our hospital because of incidental findings of high blood cell counts. With a median follow-up of 8 years (range, 2-16 years) the overall survival is 100% and progression-free survival 85%. Two patients had acceptable adverse effects.Conclusion
After a median follow-up of 8 years, imatinib was found to induce long survival with manageable side effect in adult Saudi patients with CML-CP. 相似文献15.
Jia-Bin Wang Man-Qiang Lin Ping Li Jian-Wei Xie Jian-Xian Lin Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Chao-Hui Zheng Chang-Ming Huang 《European journal of surgical oncology》2017,43(12):2333-2340
Background
The purpose of this study was to evaluate the prognosis of patients with Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) with parapyloric lymph node (No. 5 and 6 lymph nodes, PLN) metastasis and to determine the need for PLN dissection for patients with type II/III AEG.Methods
A total of 1008 patients with type II/III AEG who underwent a transabdominal total gastrectomy were enrolled. The long-term surgical outcome of PLN-positive patients and the therapeutic value of PLN dissection were analyzed.Results
There was no significant difference in the incidence of PLN metastasis between type II and III cancers (5.7% vs. 8.5%, P > 0.05). PLN metastasis was a significant prognostic factor for type II/III cancers (HR 1.63; P = 0.001). Among type II/III cancers, the 5-year survival of patients with PLN-positive cancers was much lower than that of patients with PLN-negative cancers (21.3% vs. 60.8%, P < 0.001). Even after radical resection, the 5-year survival of patients with stage I–III PLN-positive cancers was similar to that of patients with stage IV cancers without PLN metastasis (23.5% vs. 23.1%, P > 0.05). In the analysis of the therapeutic value of lymph node dissection in each station for type II and III cancers after radical resection, lymph nodes with the lowest therapeutic value index after No. 12a were No. 5 and 6 lymph nodes.Conclusions
Patients with type II/III AEG with PLN metastasis have a poor prognosis, similar to patients with stage IV disease. PLN dissection offers marginal therapeutic value for patients with type II/III AEG. 相似文献16.
17.
C.M.S. Hassing T.F. Tvedskov N. Kroman T.L. Klausen J.B. Drejøe J.F. Tvedskov T.-L. Lambine H. Kledal G. Lelkaitis L. Langhans 《European journal of surgical oncology》2018,44(5):725-730
Background
Radioactive seed localisation (RSL) is a preoperative localisation method using a small titanium seed containing iodine-125. The method is increasingly applied for localising non-palpable lesions in the treatment of breast cancer. We believe that RSL has the potential to be used in various surgical specialties. The aim of this feasibility study was to test RSL as a preoperative localisation of non-palpable lymph nodes.Methods
Between November 24, 2015 and October 26, 2016, 15 patients with suspicious lymph nodes on imaging were included in the study. The lymph nodes were located in the axillary region (n = 9), the head and neck region (n = 5) and the inguinal region (n = 1). The seeds were placed in the centre of the lymph node, in the capsule or just outside the capsule guided by ultrasound. During surgery, incision and localisation of the lymph nodes were performed based on the auditory signal of the gamma probe. After excision, lymph nodes including iodine seeds were sent for pathologic examination and the seeds were returned to the Department of Nuclear Medicine.Results
The non-palpable lymph nodes were all successfully marked using ultrasound. The lymph nodes were successfully localised and excised during surgery, and the procedure was performed without complications in the majority of the cases.Conclusion
Localisation of suspicious non-palpable lymph nodes using RSL is feasible. RSL may ease the surgical procedure, minimise trauma to the surrounding tissue and ultimately benefit the patient. Future prospective studies are necessary to determine the further use of RSL within different surgical specialties. 相似文献18.
Dimitrios Moris Diamantis I. Tsilimigras Ioannis D. Kostakis Ioannis Ntanasis-Stathopoulos Kevin N. Shah Evangelos Felekouras Timothy M. Pawlik 《European journal of surgical oncology》2018,44(7):927-938
Objective
The relative benefit of anatomic resection (AR) versus non-anatomic resection (NAR) of HCC remains poorly defined. We sought to evaluate the available evidence on oncologic outcomes, as well as the clinical efficacy and safety of AR versus NAR performed as the primary treatment for HCC patients.Material and methods
A systematic review and meta-analysis was conducted using Medline, ClinicalTrials.gov and Cochrane library through April 15th, 2017. Only clinical studies comparing AR versus NAR were deemed eligible.Results
A total of 43 studies were considered eligible (total 12,429 patients: AR, n = 6839 (55%) versus NAR, n = 5590 (45%)). Blood loss was higher among patients undergoing AR (mean difference: +229.74 ml, 95% CI: 97.09–362.38, p = 0.0007), whereas resection margin was slightly wider following AR versus NAR (mean difference: +0.29 cm, 95% CI: 0.15–0.44, p < 0.0001). No difference was noted for perioperative complications (RR: 0.95, 95% CI: 0.81–1.11, p = 0.49) and perioperative mortality (RR: 0.91, 95% CI: 0.43–1.95, p = 0.82). AR was associated with a disease-free survival (DFS) benefit at 1- (HR: 0.79, 95% CI: 0.68–0.92, p = 0.002), 3- (HR: 0.87, 95% CI: 0.78–0.95, p = 0.004) and 5-years (HR: 0.87, 95% CI: 0.82–0.93, p < 0.0001). AR also was associated with a decreased risk of death at 5-years (HR: 0.88, 95% CI: 0.79–0.97, p = 0.01).Conclusion
Despite the high heterogeneity among studies, the data demonstrated that AR had comparable perioperative morbidity and mortality versus NAR. AR seemed to offer an advantage versus NAR in terms of DFS and OS among patients undergoing resection of HCC – especially among patients without cirrhosis. Thus, AR should be considered the preferred surgical option for patients with HCC when feasible. 相似文献19.
Jose F. Falantes Francisco J. Márquez-Malaver Cristina Calderón-Cabrera Begoña Pedrote María L. Martino Jose González Ildefonso Espigado Jose A. Pérez-Simón 《Clinical Lymphoma, Myeloma & Leukemia》2018,18(7):469-474.e1
Background
The prognosis of patients with lower-risk myelodysplastic syndrome (LR-MDS) is very heterogeneous. In addition to survival estimates, identification of factors related to the probability of leukemic progression might help prognosis assessment.Patients and Methods
The present study is a retrospective analysis of 409 patients with primary LR-MDS. The probability of leukemic progression was estimated in the competing risk framework by the cumulative incidence method considering death without acute myeloid leukemia (AML) as a competing event.Results
Sixty-six patients (16.1%) progressed to AML. The following covariates influenced the probability of leukemic progression in a multivariate competing risk regression model: intermediate karyotype versus diploid or chromosome 5 deletion, 5% to 9% bone marrow blast percentage, platelet count <50 × 10e9/L and age younger than 75 years.Conclusion
According to these, a predictive model is proposed, which categorizes patients with different probability of leukemic progression (P < .001). Validation of these results might help prognostic refinement of patients with LR-MDS. 相似文献20.
Muhammed A. Kedilioglu Paul G. Bos Kim De Jong Niels A. Noordzij Robby E. Kibbelaar Oren Lapid Chantal M. Mouës 《European journal of surgical oncology》2018,44(1):157-162