Minimally Invasive Treatments for Benign Prostatic Hyperplasia: Systematic Review and Network Meta-Analysis

PurposeTo review and to compare indirectly the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.Materials and MethodsA literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostatic artery embolization (PAE). Data on the following variables were included: International prostate symptom score (IPSS), maximum urinary flow rate, quality of life, and postvoid residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect.ResultsThere was no significant difference in outcomes between therapies for IPSS at the 3, 6, and 12-month follow ups. Although outcomes for Rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation versus PAE versus Rezum. TURP PVR was significantly better than Urolift at 3, 6, and 12 months. No significant differences in minor or major adverse events were noted.ConclusionAlthough significant differences in outcomes were limited, Aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while Aquablation has limited high quality data and has been associated with bleeding-related complications.     

Challenges in pathological assessment of endoscopic resections

Endoscopic resections (ERs) are performed for early (T1) cancers mostly of the esophagus, stomach and colorectum, offering a minimally invasive and tissue-preserving alternative to traditional surgical resection. Proper preparation and handling of these specimens is key to allow accurate histological assessment of parameters which will dictate the curative, or non-curative, nature of the procedure. Many histological features have been identified which correlate with risk of recurrence and/or nodal metastases, thereby dictating the need for further management. These include histological subtype of the lesion, grade, depth of invasion, margin status, tumor size, lymphovascular invasion and tumor budding [at least in the colon]. This review article will discuss the ideal specimen preparation and discuss each of these histological parameters in turn, as they pertain to the esophagus, stomach and colorectum, highlighting potential caveats and pitfalls to be aware of when reporting these specimens.     

Lingual lymph nodes: Anatomy,clinical considerations,and oncological significance

Lingual lymph nodes are an inconstant group of in-transit nodes, which are located on the route of lymph drainage from the tongue mucosa to the regional nodes in neck levels I and II. There is growing academic data on the metastatic spread of oral cancer, particularly regarding the spreading of oral tongue squamous cell carcinoma to lingual nodes. These nodes are not currently included in diagnostic and treatment protocols for oral tongue cancer. Combined information on surgical anatomy, clinical observations, means of detection, and prognostic value is presented. Anatomically obtained incidence of lingual nodes ranges from 8.6% to 30.2%. Incidence of lingual lymph node metastasis ranges from 1.3% to 17.1%. It is clear that lymph nodes that bear intervening tissues from the floor of the mouth should be removed to improve loco-regional control. Extended resection volume, which is required for the surgical treatment of lingual node metastasis, cannot be implied to every tongue cancer patient. As these lesions significantly influence prognosis, special efforts of their detection must be made. Reasonably, every tongue cancer patient must be investigated for the existence of lingual lymph node metastasis. Lymphographic tracing methods, which are currently implied for sentinel lymph node biopsies, may improve the detection of lingual lymph nodes.     

The detection and management of complications following the treatment of liver metastases

While once considered as incurable systemic disease, treatment options for liver metastases have increased over the last 30 years and safety has improved dramatically, such that for a selected group of patients the hope of cure can now be offered with radical treatment, and low morbidity interventions can be offered which prolong survival, even in patients with more widely disseminated disease. Advances have been made in selection and surgical technique for liver resection and several adjuncts to resection now exist in the form of portal vein embolization, thermal ablation and targeted drug or radiotherapy delivery options. A natural consequence of these developments has been the delivery of services within fewer specialist units, with the result that later complications of therapy may present to local hospitals, rather than directly to the specialist centres. This article will describe the current common liver-directed therapies and outline the presentation and management of their complications.     

高流量吸氧与面罩吸氧在胸腔镜辅助食管癌根治术后氧疗效果对比

目的观察高流量湿化吸氧与常规面罩吸氧在食管癌患者行胸腔镜辅助食管癌根治术后治疗的临床效果。方法将36例择期行胸腔镜辅助下食管癌根治术后患者随机分为常规面罩吸氧对照组(A组)和高流量湿化吸氧治疗组(B组),对两组患者治疗2 h、6 h和24 h后的呼吸频率、动脉血气分析等指标进行比较,了解两种吸氧方式在食管癌患者行胸腔镜辅助食管癌根治术后治疗上的优劣。结果两组患者治疗2 h、6 h和24 h的呼吸频率、动脉血气分析发现,A组动脉氧饱和度、动脉血氧分压较B组降低,动脉血二氧化碳分压、呼吸频率较B组增高,两组比较差异有统计学意义(均P0.01)。结论与常规面罩吸氧比较,高流量湿化面罩吸氧可以使胸腔镜辅助食管癌根治术后患者有更满意的氧合效果,值得在临床上推广。