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1.
A. N. Krepline K. K. Christians K. Duelge A. Mahmoud P. Ritch B. George B. A. Erickson W. D. Foley E. J. Quebbeman K. K. Turaga F. M. Johnston T. C. Gamblin D. B. Evans S. Tsai 《Journal of gastrointestinal surgery》2014,18(11):2016-2025
Background
Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction.Methods
From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up.Results
VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16 %) or saphenous vein patch (9, 21 %); segmental resection with splenic vein division and either primary anastomosis (10, 23 %) or internal jugular vein interposition (8, 19 %); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7 %) or interposition grafting (6, 14 %). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9 %) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16–238).Conclusions
Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation. 相似文献2.
Kai Liao Huaizhi Wang MD PhD Qilong Chen MD PhD Zheng Wu MD PhD Leida Zhang MD PhD 《Journal of gastrointestinal surgery》2014,18(8):1452-1461
Background
The use of prosthetic grafts for superior mesenteric-portal vein reconstruction (SMPVR) after pancreaticoduodenectomy (PD) with venous resection remains controversial. We evaluated the effectiveness and safety of using polytetrafluoroethylene (PTFE) interposition grafts for SMPVR after PD.Methods
We identified 76 patients who underwent PD with segmental vein resection for pancreatic head and periampullary neoplasms at three centers between January 2007 and June 2012. The venous reconstruction technique depended on the length of venous involvement. Forty-two and 34 patients underwent SMPVR with primary anastomosis and SMPVR with PTFE interposition grafts, respectively. The postoperative morbidity, mortality, and patency were compared. For the patients with pancreatic ductal adenocarcinoma (n?=?65), survival was compared between the SMPVR with primary anastomosis (n?=?36) and SMPVR with PTFE interposition graft groups (n?=?29).Results
Patients undergoing SMPVR with PTFE grafts had larger tumor sizes (3.4?±?0.9 cm, 2.9?±?0.9 cm, P?=?0.016), longer operative durations (492.9?±?107.5 min, 408.8?±?78.8 min, P?<?0.001), and greater blood loss (986.8?±?884.5 ml, 616.7?±?485.5 ml, P?=?0.040) compared to those undergoing SMPVR with primary anastomosis. However, 30-day postoperative morbidity and mortality did not differ (29.4 and 2.9 %, respectively, for PTFE grafts and 33.3 and 7.1 %, respectively, for primary anastomosis). There were no cases of graft infection. The estimated cumulative patency of SMPVR 6 and 12 months after surgery did not differ (87.9 and 83.5 % after PTFE grafts, respectively, and 94.4 and 86.4 % after primary anastomosis, respectively). For patients who underwent surgery for pancreatic ductal adenocarcinoma, there were no significant differences in the median survival time (11 vs. 12 months) or the 1-, 2-, and 3-year survival rates (35.7, 12.5, and 4.2 vs. 36.4, 17.3, and 8.7 %, respectively) for the PTFE and primary anastomosis groups.Conclusions
PTFE grafts could provide a safe and effective option for venous reconstruction after PD in patients with segmental vein resection. 相似文献3.
Takanori Morikawa Tohru Onogawa Shimpei Maeda Tatsuyuki Takadate Keiichi Shirasaki Hiroshi Yoshida Kazuyuki Ishida Fuyuhiko Motoi Takeshi Naitoh Toshiki Rikiyama Yu Katayose Shinichi Egawa Michiaki Unno 《Surgery today》2013,43(1):26-32
Purpose
This study investigated the clinicopathological features and surgical management of solid pseudopapillary neoplasms at a single institution in Japan.Methods
Seventeen patients (the largest series in Japan) those underwent surgery for pathologically confirmed solid pseudopapillary neoplasms were retrospectively reviewed.Results
Sixteen patients were women and their mean age was 34.1 years. Most patients were asymptomatic (n = 11), and the average tumor diameter was 51.8 mm. The most common imaging characteristic was tumors of solid and cystic type (n = 10), which were most commonly located in the pancreatic body (n = 7). All patients underwent surgical exploration, i.e., distal pancreatectomies in 7 patients (laparoscopically performed in 2); middle pancreatectomies, 4; pancreaticoduodenectomies, 4; enucleation, 1; and liver resection, 1. No surgical mortalities occurred, and postsurgical complications occurred in 9 patients. Four patients had malignant tumors. One patient with liver metastases experienced recurrence, which was well controlled by paclitaxel. The remaining patients were disease free at a median follow-up of 51 months.Conclusions
Solid pseudopapillary neoplasms can be treated by complete tumor resection with limited resection or a minimally invasive approach when applicable. The combination of surgical resection and chemotherapy may therefore prolong survival, even in malignant cases. 相似文献4.
Huisong Lee MD Dong Wook Choi MD PhD Yong Beom Cho MD PhD Seong Hyeon Yun MD PhD Hee Cheol Kim MD PhD Woo Yong Lee MD PhD Jin Seok Heo MD PhD Seong Ho Choi MD PhD Kyung Uk Jung MD Ho-Kyung Chun MD PhD 《Annals of surgical oncology》2014,21(5):1641-1646
Background
The veins from the lower rectum drain into the systemic venous system, while those from other parts of the colon drain into the portal venous system. The aim of this study was to investigate recurrence pattern and survival according to the anatomical differences in patients with colorectal liver metastases (CRLM).Methods
From October 1994 to December 2009, synchronous CRLM patients who underwent surgery were identified from our prospectively collected database. The patients were excluded if there had been extrahepatic metastases. The patients were divided into two groups according to the location of the primary colorectal cancer: lower rectal cancer (group 1) and upper rectal or colon cancer (group 2). The recurrence patterns and survival were investigated.Results
A total of 316 patients were included: 53 patients in group 1 and 263 patients in group 2. After a median follow-up of 37 months, the extrahepatic recurrence curve of group 1 was superior to that of group 2 (P < 0.001), although there was no difference between the hepatic recurrence curves (P = 0.93). The disease-free and overall survival curves of group 1 were inferior to those of group 2 (P = 0.004) (P < 0.001). Lower rectal cancer was a significant risk factor for extrahepatic recurrence in Cox proportional hazard model analysis (hazard ratio = 1.7, P = 0.04).Conclusions
The extrahepatic recurrence rate is high in lower rectal cancer patients after surgical treatment for synchronous CRLM. 相似文献5.
Background
Survival after pancreatic head adenocarcinoma surgery is determined by tumor characteristics, resection margins, and adjuvant chemotherapy. Few studies have analyzed the long-term impact of postoperative morbidity. The aim of the present study was to assess the impact of postoperative complications on long-term survival after pancreaticoduodenectomy for cancer.Methods
Of 294 consecutive pancreatectomies performed between January 2000 and July 2011, a total of 101 pancreatic head resections for pancreatic ductal adenocarcinoma were retrospectively analyzed. Postoperative complications were classified on a five-grade validated scale and were correlated with long-term survival. Grade IIIb to IVb complications were defined as severe.Results
Postoperative mortality and morbidity were 5 and 57 %, respectively. Severe postoperative complications occurred in 16 patients (16 %). Median overall survival was 1.4 years. Significant prognostic factors of survival were the N-stage of the tumor (median survival 3.4 years for N0 vs. 1.3 years for N1, p = 0.018) and R status of the resection (median survival 1.6 years for R0 vs. 1.2 years for R1, p = 0.038). Median survival after severe postoperative complications was decreased from 1.9 to 1.2 years (p = 0.06). Median survival for N0 or N1 tumor or after R0 resection was not influenced by the occurrence and severity of complications, but patients with a R1 resection and severe complications showed a worsened median survival of 0.6 vs. 2.0 years without severe complications (p = 0.0005).Conclusions
Postoperative severe morbidity per se had no impact on long-term survival except in patients with R1 tumor resection. These results suggest that severe complications after R1 resection predict poor outcome. 相似文献6.
Shuichi Morizane Hideto Iwamoto Toshihiko Masago Akihisa Yao Tadahiro Isoyama Takehiro Sejima Atsushi Takenaka 《International urology and nephrology》2013,45(1):99-106
Purpose
To evaluate the clinical significance of preoperative biomarkers such as laboratory data, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and clinicopathological factors in patients undergoing radical nephroureterectomy for upper urinary tract urothelial carcinoma.Methods
Between 1995 and 2011, a total of 99 patients treated at our institution for upper urinary tract urothelial carcinoma were enrolled in this study. The prognostic significance of various preoperative data and clinicopathological factors were analyzed. Univariate and multivariate analyses were performed using the Kaplan–Meier method with the log-rank test and a Cox proportional hazards regression model.Results
Median patient age was 73 years (range 44–86 years), and the median follow-up period after radical nephroureterectomy was 37.9 months (range 6.6–171.4 months). The 5-year intravesical recurrence-free survival and cancer-specific survival estimates were 47.1 and 70.0 %, respectively. On multivariate analysis, concomitant bladder carcinoma was an independent predictor of intravesical recurrence (hazard ratio 3.689; P = 0.002), and infiltration (hazard ratio 14.842; P = 0.002), preoperative serum creatinine level (hazard ratio 9.992; P = 0.005), preoperative serum hemoglobin level (hazard ratio 6.370; P = 0.018) and ECOG PS (hazard ratio 4.326; P = 0.037) were associated with worse cancer-specific survival. This study is limited by biases associated with its retrospective design.Conclusions
This study indicates that not only clinicopathological factors, but also preoperative biomarkers, such as serum creatinine and hemoglobin levels and ECOG PS, predict a poor survival in patients with upper urinary tract urothelial carcinoma. 相似文献7.
Andrew J. Lindford Elina T. Siponen Tiina A. Jahkola Marjut H. K. Leidenius 《World journal of surgery》2013,37(12):2872-2882
Background
The goal of the present study was to evaluate the impact of delayed autologous breast reconstruction on disease relapse in breast cancer patients treated with mastectomy.Material and methods
The study was based on 503 consecutive patients younger than 70 years of age who underwent mastectomy between January 2000 and December 2003. Overall, 391 (78 %) received mastectomy alone and 112 (22 %) underwent a delayed breast reconstruction. The median time from mastectomy to delayed breast reconstruction was 34 months. The median duration of follow-up was 102 months.Results
There were no locoregional recurrences (LRR) in patients who underwent delayed reconstruction (0.0 %); 21 LRR developed in patients treated with mastectomy only (5.4 %), P = 0.011. Distant metastases occurred less frequently in the reconstruction group (12.5 %) than in the patients who underwent mastectomy alone (21.5 %); P = 0.0343. The 8-year breast cancer specific survival in the reconstruction group was 98.2 and 85.7 % for the mastectomy only group, P = 0.000.Conclusions
Delayed autologous breast reconstruction does not appear to adversely influence disease progression when compared to patients treated with mastectomy only. 相似文献8.
J. J. Tosoian J. L. Cameron M. E. Allaf R. H. Hruban C. B. Nahime T. M. Pawlik P. M. Pierorazio S Reddy C. L. Wolfgang 《Journal of gastrointestinal surgery》2014,18(3):542-548
Purpose
This study aims to assess outcomes and characteristics associated with resection of metastatic renal cell carcinoma (mRCC) to the pancreas.Materials and Methods
From April 1989 to July 2012, a total of 42 patients underwent resection of pancreatic mRCC at our institution. We retrospectively reviewed records from a prospectively managed database and analyzed patient demographics, comorbidities, perioperative outcomes, and overall survival. Cox proportional hazards models were used to evaluate the association between patient-specific factors and overall survival.Results
The mean time from resection of the primary tumor to reoperation for pancreatic mRCC was 11.2 years (range, 0–28.0 years). In total, 17 patients underwent pancreaticoduodenectomy, 16 underwent distal pancreatectomy, and 9 underwent total pancreatectomy. Perioperative complications occurred in 18 (42.9 %) patients; there were two (4.8 %) perioperative mortalities. After pancreatic resection, the median follow-up was 7.0 years (0.1–23.2 years), and median survival was 5.5 years (range, 0.4–21.9). The overall 5-year survival was 51.8 %. On univariate analysis, vascular invasion (hazard ratio, 5.15; p?=?0.005) was significantly associated with increased risk of death.Conclusions
Pancreatic resection of mRCC can be safely achieved in the majority of cases and is associated with long-term survival. Specific pathological factors may predict which patients will benefit most from resection. 相似文献9.
Walter Y Tsang Argyrios Ziogas Bruce S. Lin Tara E. Seery William Karnes Michael J. Stamos Jason A. Zell 《Journal of gastrointestinal surgery》2014,18(3):592-598
Introduction
The benefit of an operation to remove the primary tumor among patients with synchronous stage IV colorectal cancer is controversial. This study analyzed the survival benefits associated with primary tumor resection among chemotherapy-treated stage IV colorectal cancer patients.Methods
The study analyzed 11,716 chemotherapy-treated stage IV colorectal cancer patients in the California Cancer Registry between 1996 and 2007, with follow-up through 2009. Patients were stratified into operation and non-operation groups. Estimates of median overall and colorectal cancer-specific survival were generated.Results
Patients undergoing operation compared to those who are not had higher median overall and colorectal cancer-specific survival, 21 versus 10 months (p?<?0.0001) and 22 versus 12 months (p?<?0.0001), respectively. Patients who were offered surgery but refused had decreased median overall and colorectal cancer-specific survival when compared to patients who underwent resection, 8 versus 21 months (p?<?0.001) and 7 versus 22 months (p?<?0.001), respectively. In multivariate regression models, patients who underwent resection of primary tumor had improved overall (hazard ratio (HR), 0.42; 95 % confidence interval (CI) 0.40–0.44, p?<?0.0001) and colorectal cancer-specific survival (HR, 0.43; 95 % CI, 0.41–0.45; p?<?0.0001).Conclusion
Primary tumor resection is associated with improved survival among stage IV chemotherapy-treated colorectal cancer patients. 相似文献10.
F. Wang MClinEpid FRACS A. J. Gill MD FRACP M. Neale MM FRACS V. Puttaswamy MBBS FRACS S. Gananadha MS FRACS N. Pavlakis PhD FRACP S. Clarke MD FRACP T. J. Hugh MD FRACS J. S. Samra DPhil FRACS 《Annals of surgical oncology》2014,21(6):1937-1947
Background
Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.Patients and Methods
Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD?VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.Results
Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD?VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD?VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD?VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.Conclusions
PD with VR has similar morbidity but worse OS compared with a PD?VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features. 相似文献11.
Po-Ming Chow Jui-Shan Hsu Shuo-Meng Wang Hong-Jheng Yu Yeong-Shiau Pu Kao-Lang Liu 《World journal of urology》2014,32(3):729-736
Purpose
To provide short-term result of the metallic ureteral stent in patients with malignant ureteral obstruction and identify radiological findings predicting stent failure.Materials and methods
The records of all patients with non-urological malignant diseases who have received metallic ureteral stents from July 2009 to March 2012 for ureteral obstruction were reviewed. Stent failure was detected by clinical symptoms and imaging studies. Survival analysis was used to estimate patency rates and factors predicting stent failure.Results
A total of 74 patients with 130 attempts of stent insertion were included. A total of 113 (86.9 %) stents were inserted successfully and 103 (91.2 %) achieved primary patency. After excluding cases without sufficient imaging data, 94 stents were included in the survival analysis. The median functional duration of the 94 stents was 6.2 months (range 3–476 days). Obstruction in abdominal ureter (p = 0.0279) and lymphatic metastasis around ureter (p = 0.0398) were risk factors for stent failure. The median functional durations of the stents for abdominal and pelvic obstructions were 4.5 months (range 3–263 days) and 6.5 months (range 4–476 days), respectively. The median durations of the stents with and without lymphatic metastasis were 5.3 months (range 4–398 days) and 7.8 months (range 31–476 days), respectively.Conclusion
Metallic ureteral stents are effective and safe in relieving ureteral obstructions resulting from non-urological malignancies, and abdominal ureteral obstruction and lymphatic metastasis around ureter were associated with shorter functional duration. 相似文献12.
Mauro Signorelli Andrea Alberto Lissoni Gennaro Cormio Dionyssios Katsaros Antonio Pellegrino Luigi Selvaggi Fabio Ghezzi Giovanni Scambia Paolo Zola Roberto Grassi Rodolfo Milani Raffaella Giannice Giovanna Caspani Costantino Mangioni Irene Floriani Eliana Rulli Roldano Fossati MD 《Annals of surgical oncology》2009,16(12):3431-3441
Background
Five percent to 20% of stage I endometrial cancer patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy develop vaginal and pelvic recurrences. Adjuvant radiotherapy can improve locoregional control but not survival. This randomized trial aimed to determine whether a modified radical (Piver–Rutledge class II) hysterectomy can improve survival and locoregional control compared to the standard extrafascial (Piver–Rutledge class I) hysterectomy.Methods
Eligible patients (n = 520) with stage I endometrial cancer were randomized to class I or class II hysterectomy. Primary endpoint was overall survival.Results
The median length of parametria and vagina removed were 15 and 5 vs. 20 mm and 15 mm for class I and class II hysterectomy, respectively (P > 0.001). Operating time and blood loss were statistically significantly higher for class II hysterectomy. At a median follow-up of 70 months, 51 patients had died. Five-year disease-free and overall survival were similar between arms (87.7 and 88.9% in the class I arm and 89.7 and 92.2% in the class II arm, respectively). The unadjusted hazard ratios for recurrence was 0.91 (95% confidence interval, 0.55–1.51, P = 0.72), and the hazard ratio for death was 0.77 (95% confidence interval, 0.44–1.33, P = 0.35).Conclusions
Class II hysterectomy did not improve locoregional control and survival compared to class I hysterectomy, but when an adequate vaginal cuff transection is not feasible with class I hysterectomy, a modified radical hysterectomy allows to obtain an optimal vaginal and pelvic control of disease with a minimal increase in surgical morbidity. 相似文献13.
Jung-Hoon Park MS Ho-Young Song MD Soo Hwan Kim BS Ji Hoon Shin MD Jin Hyoung Kim MD Byung Sik Kim MD Jeong Hwan Yook MD 《Annals of surgical oncology》2014,21(6):2036-2043
Purpose
The purpose of this study was to assess the technical feasibility and clinical effectiveness of expandable metallic stent placement in 196 patients with recurrent malignant obstruction in their surgically altered stomach.Methods
The 196 patients were treated using five different types of gastric surgery performed for gastric cancer: total gastrectomy (type 1) in 73 patients; distal gastrectomy with gastroduodenostomy (type 2) in 39 patients; distal gastrectomy with a Roux-en-Y gastrojejunostomy (type 3) in 21 patients; distal gastrectomy with a gastrojejunostomy (type 4) in 49 patients; and palliative gastrojejunostomy for unresectable gastric cancer (type 5) in 14 patients. The technical and clinical success rates, complications, dysphagia score, and influence of chemotherapy were evaluated and the complications compared between the two stent types. The overall survival and stent patency were calculated using the Kaplan–Meier method.Results
Stent placement was technically successful in 192 of 196 patients (97.9 %), with 184 of the 192 patients (95.8 %) showing symptomatic improvement. The mean dysphagia score improved from 3.24 ± 0.64 to 1.48 ± 0.82 (p < 0.001). The complication rate was 25 %. The incidence of stent migration was significantly higher in fully covered stents and in patients who underwent chemotherapy (p < 0.001 and p = 0.005, respectively). Chemotherapy was significantly associated with an increase of survival (p < 0.001). The median survival and stent patency were 131 and 90 days, respectively.Conclusion
Placement of expandable metallic stents in patients with recurrent cancer after a surgically altered stomach is technically feasible and clinically effective. Chemotherapy was associated with increased stent migration and prolonged survival. 相似文献14.
Kizer NT Gao F Guntupalli S Thaker PH Powell MA Goodfellow PJ Mutch DG Zighelboim I 《Annals of surgical oncology》2011,18(5):1419-1424
Background
The clinicopathologic significance of lower uterine segment involvement (LUSI) in endometrial cancer patients remains unclear. Although LUSI has been reported to be a prognostic indicator, literature is limited.Methods
We studied 481 surgically staged endometrioid endometrial cancers with disease confined to the uterus (FIGO 1988 stage I or II). Primary outcomes were overall survival (OS) and disease-free survival (DFS). The relationships between LUSI and OS and DFS were assessed using the Kaplan–Meier method and Cox proportional hazard models. The t test or Fisher exact test was used for evaluating relationships between variables of interest.Results
LUSI was present in 223 cases (46.4%), and was associated with both decreased disease free survival (P = 0.02) and overall survival (P = 0.01) in univariate analysis. Multivariate analysis confirmed the association between LUSI and increased risk for recurrence [hazard ratio (HR) 2.27; 95% confidence interval (95% CI) 1.09–4.7; P = 0.03] and increased mortality (HR 1.76; 95% CI 1.12–2.78; P = 0.01).Conclusions
LUSI in patients with early-stage endometrioid endometrial cancer is associated with decreased survival. 相似文献15.
Eiji Shinto Hitoshi Tsuda Hideki Ueno Hideyuki Shimazaki Junji Yamamoto Kazuo Hase 《World journal of surgery》2014,38(12):3257-3264
Background
Although venous invasion is reportedly a clinically useful prognostic marker for colorectal cancer, suitable grading criteria have not been established.Objective
This prospective observational study aimed to investigate the prognostic value of the number and size of venous invasions in patients with pT3 colorectal cancer.Methods
We recruited 139 consecutive patients with pT3 colorectal carcinomas resected between October 2001 and August 2003. We used slides of whole-tissue sections stained with Elastica van Gieson. Venous invasion was classified according to the number of veins with carcinoma infiltration per slide with most venous invasions (V-number classification): V(n)-low 0–3 and V(n)-high ≥4. Additionally, the findings were classified according to the maximal size of veins containing carcinoma infiltration (V-size classification): V(s)-low <1 mm and V(s)-high ≥1 mm. The grades of venous invasions were evaluated just after surgery.Results
The 5-year survival rate of V(n)-low and V(n)-high were 89.9 and 59.1 %, respectively (p < 0.0001). Comparisons between overall survival curves revealed that V-number classification (but not V-size classification) had a significant prognostic value in patients with pT3 cancer, especially in stage II patients (98.2 and 64.2 %, respectively; p < 0.0001). Multivariate analysis revealed distant metastasis, age, and V-number classification (hazard ratio 3.1; p = 0.0071) as independent prognostic indicators.Conclusions
V-number classification may be a useful prognostic system when evaluating and sub-grouping patients with pT3 colorectal cancer. 相似文献16.
Adam C. Yopp MD John C. Mansour MD Muhammad S. Beg MD Juan Arenas MD Clayton Trimmer MD Mark Reddick MD Ivan Pedrosa MD Gaurav Khatri MD Takeshi Yakoo MD Jeffrey J. Meyer MD Jacqueline Shaw BSN Jorge A. Marrero MD Amit G. Singal MD 《Annals of surgical oncology》2014,21(4):1287-1295
Purpose
To evaluate differences in overall survival in patients with hepatocellular carcinoma (HCC) after the establishment of a multidisciplinary clinic (MDC) for HCC.Methods
Patient demographic and tumor characteristics of 355 patients diagnosed with HCC were collected between October 2006 and September 2011. Patients diagnosed after the initiation of the HCC MDC on October 1, 2010, were compared to patients diagnosed in the 4 years before. Patient demographics, tumor characteristics, treatment regimens, and overall survival were analyzed between the groups.Results
A total of 105 patients were diagnosed in the time period after HCC MDC initiation compared to 250 patients in the previous 4 years. Patients diagnosed with HCC after the HCC MDC had fewer symptoms at presentation (64 vs. 78 %, p = 0.01) and earlier stage of tumor presentation [Barcelona Clinic for Liver Cancer (BCLC) A stage, 44 vs. 26 %, p = 0.0003; tumor, node, metastasis classification system stage 1, 44 vs. 30 %, p = 0.003) compared with patients diagnosed before MDC formation. The median time to treatment after diagnosis in the later period was significantly shorter than in the earlier time period (2.3 vs. 5.3 months, p = 0.002). On multivariate analysis, being seen in the HCC MDC remained independently associated with better overall survival (hazard ratio 2.5, 95 % confidence interval 2–3), after adjusting for BCLC stage and recipient of curative treatment. Patients diagnosed after HCC MDC initiation had a median survival of 13.2 months compared to the 4.8 months observed in patients diagnosed before MDC formation (p = 0.005).Conclusions
The implementation of a MDC for the evaluation and treatment of patients with HCC is associated with improved overall survival. 相似文献17.
Roberto L. Meniconi Giuseppe M. Ettorre Giovanni Vennarecci Pasquale Lepiane Marco Colasanti Andrea Laurenzi Lidia Colace Roberto Santoro 《Journal of gastrointestinal surgery》2013,17(7):1233-1239
Introduction
Venous resections and reconstructions of portal vein and/or superior mesenteric vein in course of pancreaticoduodenectomy are becoming a common practice and many surgical options have been described, from simple tangential resection and venorrhaphy to large segmental resections followed by interposition grafting. The aim of this study was to report the first experience of using fresh cadaveric vein allografts for venous reconstruction during pancreaticoduodenectomy focusing on technical feasibility and postoperative outcomes.Methods
From January 2001 to October 2012, out of 151 patients undergoing pancreaticoduodenectomy for pancreatic head tumor, 22 (14.5 %) received a vascular resection of the mesentericoportal axis. In five of these patients, vascular reconstruction was accomplished by using cold-stored venous allografts of iliac and femoral veins from donor cadaver. Patients’ data, surgical techniques, and clinical outcomes were analyzed.Results
Five patients undergoing pancreaticoduodenectomy were selected to receive a vascular reconstruction using a fresh venous allograft for patch closure in three cases, conduit interposition in one case and a Y-shaped graft in the last case. No graft thrombosis or stenosis occurred postoperatively and at long-term follow-up. Mortality rate was zero.Conclusion
The use of fresh vein allografts is a feasible and effective technique for venous reconstruction during pancreaticoduodenectomy. However, prospective surveys including large cohorts of patients are necessary to confirm these results. 相似文献18.
Dmitriy Nikolavsky Stephen A. Blakely David A. Hadley Paul Knoll Andrew P. Windsperger Ryan P. Terlecki Brian J. Flynn 《International urology and nephrology》2014,46(11):2147-2152
Objectives
To determine the outcomes of open vesicourethral anastomotic reconstruction (VUAR) for outlet stenosis following radical prostatectomy (RP).Methods
Review of all cases of VUAR within an IRB-approved database was performed. Preoperative factors assessed included cancer treatment modality, duration of symptoms, prior treatments, and length of defect. Outcomes reviewed included length-of-stay (LOS), complications, maintenance of patency, continence, and need for additional procedures.Results
Twelve cases of VUAR performed by a single surgeon (BJF) from 2004 to 2012 were identified. Surgical approaches were either abdominal (7), perineal (3), or abdominoperineal (2). All patients underwent prior RP, with 25 % having subsequent radiotherapy. Among patients with stenosis, 43 % were completely obliterated. Two cases had prior anastomotic disruption in the early postoperative period after RP. The median length of stenosis was 2.5 cm (range 1–5 cm) and median LOS was 3.0 days (range 1–7 days). At a median follow-up of 75.5 months (range 14–120 months), 92 % of men retained patency; only 25 % were continent.Conclusion
In experienced hands, VUAR can restore durable patency for men afflicted with outlet stenosis after RP. Despite anatomic restoration, incontinence is likely. 相似文献19.
Shigeru Marubashi Shogo Kobayashi Hiroshi Wada Koichi Kawamoto Hidetoshi Eguchi Yuichiro Doki Masaki Mori Hiroaki Nagano 《World journal of surgery》2013,37(11):2671-2677
Background
In partial liver transplantation, reconstruction of the hepatic artery is technically highly demanding and the incidence of arterial complications is high. We attempted to identify the risk factors for anastomotic complications after hepatic artery reconstruction and examined the role of multidetector-row computed tomography (MDCT) in the evaluation of the reconstructed hepatic artery in liver transplant recipients.Methods
A total of 109 adult-to-adult living donor liver transplantations (LDLT) were performed at our institute between 1999 and July 2011. Hepatic artery reconstruction was performed under a surgical microscope (MS group, n = 84), until we began to adopt surgical loupes (4.5×) for arterial reconstructions in all cases after January 2009 (SL group, n = 25). A dynamic MDCT study was prospectively carried out on postoperative days 7, 14, and 28, and at postoperative month 3, 6, and 12 after April 2005 (n = 60).Results
There were no cases of hepatic artery thrombosis and six cases (5.5 %) of interventional radiology-confirmed hepatic artery stenosis (HAS). Risk factor analysis for HAS showed that ABO-incompatible LDLT was associated with HAS. Use of surgical loupes provided superior results as compared to anastomosis under a surgical microscope, and it also provided the advantage of reduced operative time. The MDCT procedure was useful for detecting HAS; however, the false positive rate was relatively high until 3 months after the LDLT (100 % sensitivity and 72.8 % specificity at 3 months).Conclusions
Hepatic arterial anastomosis using surgical loupes tended to be time-saving and to yield similar or better results than traditional microscope-anastomosis. The use of MDCT aided the diagnosis of HAS, although the substantial false positive rate should be borne in mind in clinical practice. 相似文献20.
Arash Momeni Mina Ghaly Deepak Gupta Yvonne L. Karanas David M. Kahn Geoffrey C. Gurtner Gordon K. Lee 《European journal of plastic surgery》2013,36(10):633-638