Staging Procedure Research Articles

Real-world treatment patterns, clinical outcomes, and health care resource utilization in advanced unresectable hepatocellular carcinoma.

400 Background: The incidence of advanced unresectable hepatocellular carcinoma (HCC) is increasing in several developed countries and the prognosis of advanced HCC remains poor. Real-world evidence of treatment patterns and patient outcomes can highlight the unmet clinical need within this population. Methods: We conducted a retrospective population-based cohort study of advanced unresectable HCC patients diagnosed in Alberta, Canada between 2008-2018 using electronic medical records and administrative claims data. A chart review was conducted among patients treated with systemic therapy to capture additional treatment information that is not available in the administrative data. The objectives of this study were to describe the treatment patterns, overall survival, and healthcare resource utilization of advanced HCC patients. Results: A total of 1,297 advanced HCC patients were included in this study, of which 555 (42.8%) were recurrent cases and the remainder were advanced unresectable cases at diagnosis. Median age at diagnosis was 64 (range: 21-94) and 82.1% were men. Only 274 patients (21.1%) received first-line systemic therapy and of those 32 patients (11.7%) initiated second-line therapy. Nearly all of the patients treated with systemic therapy received sorafenib (> 96.4%) in first-line and over half of these patients (55.8%) had a dose reduction during the course of treatment. Patients who received systemic therapy had considerably higher median overall survival (12.23 months; 95% CI: 10.72-14.10) compared to patients not treated with systemic therapy (2.66 months; 95% CI: 2.33-3.12; log-rank p-value < 0.001). Among patients who received first-line systemic therapy, the 2-year and 5-year survival rates were 17.9% (95% CI: 13.7-23.4) and 3.9% (95% CI: 1.8-8.6), respectively. Among patients treated with systemic therapy, overall survival was highest for recurrent cases, patients with Child-Pugh A, patients with hepatitis C virus or multiple known HCC risk factors, and for recurrent patients who received transarterial chemoembolization and ablation (separate procedures) in early stage (log-rank: p < 0.05). No significant differences in survival were observed for dose reduction in first-line therapy, age group, sex, the presence of cirrhosis, or the presence of metastatic disease (log-rank: p > 0.05). Among patients that received first-line systemic therapy, the average time spent in hospital was 9, 9, and 8 days per patient within years 1, 2, and 3, respectively. Conclusions: In a Canadian real-world setting, patients who received systemic therapy had considerably greater survival than those who did not, but the initiation rate was low and dose reductions were common. The low uptake of systemic therapy and the modest survival gains highlight the importance of earlier diagnosis and the need for novel and more effective first-line therapies.

Obesity, Comorbidities, and Prior Operations Additively Increase Failure in 2-Stage Revision Total Knee Arthroplasty for Prosthetic Joint Infection.

Prosthetic joint infection (PJI) of the knee carries significant morbidity, mortality, and economic cost. We hypothesize that obese and poor medical hosts will have a significant and additive increase in failure rate undergoing 2-stage revision total knee arthroplasty for PJI. All 2-stage revision total knee arthroplasty procedures for PJI performed at one institution were identified between 2005 and 2020. In total, 144 patients were included and defined as success or failure based on published criteria regarding infection eradication, further intervention, or mortality. The American Society of Anesthesiologists score and the Charlson Comorbidity Index were utilized to assess host grade. Patient, surgical, and microbiologic variables were investigated with univariable and multivariable analysis to explore association with risk of failure. In the cohort, 32.4% of patients failed with mean follow-up of 5.1 years. In multivariable analysis, the number of major operations requiring arthrotomy and implantation of new material between the primary and first stage, host grade, and elevated body mass index were the major contributors to failure. Combining these factors, with body mass index >30 and 2 or more major operations, the failure rate increased to 76.5% and 71.4% respectively for American Society of Anesthesiologists score 3 (P ≤ .001) and Charlson Comorbidity Index ≥2 (P ≤ .001). In this cohort, multiple major operations between the primary and first stage, host grade, and obesity were the major contributors to failure. When combining these factors, patients had an additive increase in failure rate. Treatments such as amputation or less invasive options and suppression should be discussed and considered in these patients.

AXSANA: A European prospective multicenter cohort study to evaluate different surgical methods of axillary staging in clinically node-positive breast cancer patients treated with NACT

Background: The optimal surgical staging procedure of the axilla in breast cancer patients converting from a clinically positive (cN+) to a clinically negative node status (ycN0) through neoadjuvant chemotherapy remains controversial. Various techniques, such as Axillary Lymph Node Dissection (ALND), Targeted Axillary Dissection (TAD), Target Lymph Node Biopsy (TLNB) and Sentinel Lymph Node Biopsy (SLNB) are used but comparative data on oncological outcome and morbidity of these procedures are not available.

Oncological Prognosis and Fertility Outcomes of Different Surgical Extents for Malignant Ovarian Sex-Cord Stromal Tumors: A Narrative Review.

BackgroundMalignant ovarian sex-cord stromal tumors (MOSCSTs) are rare neoplasms that account for approximately 5–7% of all ovarian malignancies. The majority (70%) of patients had an early stage; thus, surgery is the predominant treatment. Patients were relatively young at the onset of the tumor. Moreover, the prognosis of patients with this tumor is better than that of malignant epithelial ovarian tumors and tends to recur late with an indolent clinical course. Thus, patients may be more inclined to conservative surgical procedures. There is, however, no objective criterion for selecting a suitable surgical procedure. Clinically, surgical extent depended on the preoperative evaluations, age, and willingness of patients, and gynecologists were relatively subjective when choosing surgery. The prognosis of patients with different surgical extents is still controversial. The review aimed to summarize the impacts of different surgical extents on oncological prognosis and fertility outcomes.MethodsThe literature search was performed in PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), and publications between January 2011 and December 2021 in English including clinical cohort studies and case reports were eligible for inclusion.ResultsWe finally identified 12 large-sample retrospective studies and 18 cases of MOSCSTs. The primary surgical procedures include fertility-spring surgery (FSS), total hysterectomy with unilateral or bilateral salpingo-oophorectomy (TAH-USO/BSO), FSS with complete staging procedure, complete staging surgery (CSS), and debulking surgery. FSS includes cystectomy (CYS), unilateral salpingo-oophorectomy (USO) or bilateral salpingo-oophorectomy (BSO) with uterine preservation that allows for potential future assisted reproductive approaches. Complete staging procedure includes peritoneal cytologic examinations, inspections of peritoneal surfaces, random peritoneal biopsies and omentectomy. FSS with complete staging procedure means surgical procedure with uterine preservation and complete staging procedure. And, generally, CSS means TAH-BSO with complete staging procedure.ConclusionIt can be concluded that USO can be done in young, fertility-desired patients with tumors confined to the ovary but avoid CYS. FSS with complete staging procedure is feasible among stage IC-III patients who have fertility desire. Patients can choose to have a complete surgery once their family is complete or without fertility requirements. CSS is recommended for patients with risk factors such as high stage, poor differentiation, and large tumor size and without fertility desire. A close follow-up is essential.

Development of social skills of high school students on virtual platforms, 2021

The objective of this study is the development of social skills of high school students in virtual settings. Methodology: Qualitative, phenomenological, hermeneutical study, developed in three stages. In the descriptive stage, planning activities and ethical procedures were socialized; In the structural setting, intervention protocols, contingency plans, methodological memory, approach to participants, and delimitation of roles were foreseen both within and outside the field of study. In the discussion stage, the results were contrasted with recent studies, arriving at definitive conclusions. The technique used was the semi-structured interview, and as an instrument, a guide of questions derived from the subcategories of the study was used. The participants were five students of the sixth cycle of Regular Basic Education (first and the second year of secondary education) with ages of 13 and 14 years, three men and two women volunteers, a teacher (director), and two teachers (without management positions). Experts validated the interview. Results: Reciprocal help in the affective sphere motivates the encounters in virtual settings in the participants. Virtual scenarios mediate effective relationships in a significant way. Conclusions: Reciprocity is a priority element that generates trust and allows participants to understand the needs of their colleagues, virtual spaces serve as emotional support for all their members, and as they all connect with the active cameras, scenarios very similar to those are generated.
 Keywords: Social Skills; Emotional Support; Affective Relationships; TIC

Update on surgical management of enteroatmospheric fistulae in intestinal failure patients.

The surgical management of enteroatmospheric fistula (EAF) in patients with intestinal failure represents a major challenge for a surgical team and requires proficiency in sepsis management, nutritional support and prehabilitation, beside expertise in visceral and abdominal wall surgery. This review provides an update on the current recommendations and evidence. Reconstructive surgery should be performed at a minimum of 6-12 months after last laparotomy. Isolation techniques and new occlusion devices may accelerate spontaneous EAF closure in selected cases. Chyme reinfusion supports enteral and parenteral nutrition. Stapler anastomosis and failure to close the fascia increase the risk of EAF recurrence. Posterior component separation, intraoperative fascial tension and biological meshes may be used to accommodate fascial closure. Timing of reconstructive surgery and previous optimal conservative treatment is vital for favorable outcomes. Wound conditions, nutritional support and general patient status should be optimal before attempting a definitive fistula takedown. Single stage procedures with autologous gut reconstruction and abdominal wall reconstruction can be complex but well tolerated.

Outcomes and Complications of Buccal Mucosa Graft for Hypospaedia Repair

Objectives: Aim of current study is to determine the outcomes of buccal mucosa graft in Hypospaedia repair. Study Design: Retrospective Study. Place and Duration: The study is conducted at Urology ward Saidu Group of Teaching Hospitals, Swat for duration of six months form 1st July 2020 to 31st December 2020. Methods: This research includes 60 hypospaedia reconstruction patients in total. After obtaining written agreement from the patient's attendants/parents, demographic information such as age, sex, and domicile was collected. A surgeon on site performed physical exams on each participant. All patients had buccal mucosa grafts performed in two stages. There were reported complications on follow-up visits one week, three week and six weeks later. We used SPSS 22.0 version to analyze complete data. Results: In our study mean age of the patients was 6.56±7.51 years in which most of the patients 38 (63.3%) had age >5years. After the first stage surgery, there were no complications. At postoperative follow-up after two stage procedure complications were found in 10 (16.7%) cases in which wound infection and urethrocutaneous fistula were mostly. Post-operative success rate was found in 53 (88.3%) cases. Conclusion: After careful consideration, it should be concluded that buccal mucosa transplant in Hypospaedia correction provides superior functional and aesthetic benefits with a lower incidence of problems. Keywords: Fistula formation. Buccal Mucosa Graft, Hypospaedia Repair,

Consideration of the Optimal Surgical Procedure Based on the Risk of Recurrence in Clinical Stage 0 or IA Lung Adenocarcinoma.

Sublobar resection is widely performed for early-stage non-small cell lung cancer in the clinical setting. This study evaluated the optimal surgical procedures of clinical stage 0 or IA adenocarcinoma from the perspective of recurrence. A total of 508 lung adenocarcinoma patients diagnosed as c-stage 0 or IA were retrospectively investigated. The types of surgical procedures were lobectomy (n=328), segmentectomy (n=73), and wedge resection (n=107). Clinical T descriptors were cTis in 74, cT1mi in 68, cT1a in 94, cT1b in 181 and cT1c in 91 patients. Recurrence was observed in 46 cases (9%), including 3 (3.1%) with cT1a, 23 (12.7%) with cT1b and 20 (22.0%) with cT1c. The patients who received sublobar resection developed recurrence more often than the patients who received lobectomy among cT1b cases (10.1% vs. 21.4%) and cT1c cases (18.0% vs. 46.2%) (p=0.053 and p=0.023). The cT1b and cT1c cases should be considered for lobectomy to prevent recurrence.

Post - Excisional Defect of Middle Third of Helix Reconstructed by Antia-Buch Helical Chondrocutaneous Advancement Flap

The Antia-Buch flap is a chondrocutaneous helical advancement flap done as a single stage procedure to reconstruct the helix. Here, we present a 62 year old male patient with basal cell carcinoma of the middle 3rd of the helix of the left pinna. He underwent local excision with a 0.5cm margin and the resulting defect was reconstructed with an Antia-Buch chondrocutaneous helical advancement flap.

Open paediatric laryngotracheal reconstruction: a five-year experience at a tertiary referral centre.

Laryngotracheal reconstruction with costal cartilage graft is a cornerstone procedure in treatment of multiple paediatric airway pathologies. The current study aimed to report on the experience of laryngotracheal reconstruction and document post-operative outcomes and complications. Records of laryngotracheal reconstruction procedures performed between 2016 and 2020 were retrospectively reviewed. Primary indication, clinical data, decannulation rate, voice assessment, need for revision surgery and possible complications were analysed. A total of 41 patients were treated with laryngotracheal reconstruction. Subglottic stenosis formed the largest percentage of cases followed by congenital glottic web (20 and 14 patients, respectively). Three patients (7.3 per cent) underwent single stage surgery, and the remaining cases had a double stage procedure. Revision laryngotracheal reconstruction was needed in a single case, and 38 out of 39 tracheostomised patients were successfully decannulated. Favourable outcomes were reported with costal cartilage laryngotracheal reconstruction as a definitive treatment for a large range of paediatric airway problems.

Contrast-Enhanced Ultrasound for Monitoring Treatment Response in Different Stages of Hepatocellular Carcinoma.

Simple SummaryThe evaluation of tumor response to anti-cancer therapy is critical in oncology for the prompt determination of subsequent treatment and follow-up strategies. Historically, response criteria have been based on tumor size changes; however, since the development of locoregional and molecular-targeted therapies in HCC (which act by disrupting tumor vascularization rather than tumor cells), changes in tumor vascularity and enhancement patterns have been considered to be more reliable. Contrast-enhanced ultrasound (CEUS) and dynamic CEUS, which allow microvessel perfusion studies, are emerging as promising tools for early tumor response evaluation. This article provides a general review of the current literature regarding the usefulness of CEUS in monitoring HCC response to therapy, highlighting the role of the procedure at different stages of the disease.The capacity of contrast-enhanced ultrasound (CEUS) to detect microvessel perfusion has received much attention in cancer imaging since it can be used to evaluate the enhancement patterns of the lesions during all vascular phases in real time, with higher temporal resolution as compared other imaging modalities. A rich body of literature has demonstrated the potential usefulness of CEUS in the assessment of HCC in response to both locoregional and systemic therapies. It is useful to evaluate the efficacy of ablation immediately after treatment to provide guidance for the retreatment of residual unablated tumors. In patients treated with transarterial chemoembolization (TACE), CEUS showed a high degree of concordance with computed tomography and magnetic resonance for the differentiation of responders from non-responders. Dynamic CEUS (D-CEUS) has emerged as a promising tool for the depicting changes in tumor perfusion during anti-angiogenetic treatment that can be associated with tumor response and clinical outcome. This article provides a general review of the current literature regarding the usefulness of CEUS in monitoring HCC response to therapy, highlighting the role of the procedure in different stages of the disease.

Risk for Pelvic Metastasis and Role of Pelvic Lymphadenectomy in Node-Positive Vulvar Cancer-Results from the AGO-VOP.2 QS Vulva Study.

Simple SummaryIn node-positive vulvar squamous cell cancer, questions of when and how to perform pelvic lymphadenectomy (LAE) as well as the optimal extent of pelvic treatment in general have been surrounded by considerable controversy. In Germany, systematic pelvic LAE is currently recommended as a staging procedure in patients at risk for pelvic nodal involvement in order to prevent morbidity caused by pelvic radiotherapy (RT) in patients without histologically-confirmed pelvic involvement. However, the population at risk for pelvic metastases remains insufficiently described, resulting in the potential overtreatment of a considerable proportion of patients with groin-positive disease. This applies to the indication to perform surgical staging but also to adjuvant RT of the pelvis without previous pelvic staging. Our study aims to describe the risk for pelvic lymph node metastasis with regard to positive groin nodes and to clarify the indication criteria for pelvic treatment in node-positive vulvar cancer.The need for pelvic treatment in patients with node-positive vulvar cancer (VSCC) and the value of pelvic lymphadenectomy (LAE) as a staging procedure to plan adjuvant radiotherapy (RT) is controversial. In this retrospective, multicenter analysis, 306 patients with primary node-positive VSCC treated at 33 gynecologic oncology centers in Germany between 2017 and 2019 were analyzed. All patients received surgical staging of the groins; nodal status was as follows: 23.9% (73/306) pN1a, 23.5% (72/306) pN1b, 20.4% (62/306) pN2a/b, and 31.9% (97/306) pN2c/pN3. A total of 35.6% (109/306) received pelvic LAE; pelvic nodal involvement was observed in 18.5%. None of the patients with nodal status pN1a or pN1b and pelvic LAE showed pelvic nodal involvement. Taking only patients with nodal status ≥pN2a into account, the rate of pelvic involvement was 25%. In total, adjuvant RT was applied in 64.4% (197/306). Only half of the pelvic node-positive (N+) patients received adjuvant RT to the pelvis (50%, 10/20 patients); 41.9% (122/291 patients) experienced recurrent disease or died. In patients with histologically-confirmed pelvic metastases after LAE, distant recurrences were most frequently observed (7/20 recurrences). Conclusions: A relevant risk regarding pelvic nodal involvement was observed from nodal status pN2a and higher. Our data support the omission of pelvic treatment in patients with nodal status pN1a and pN1b.

Single stage versus two-stage orthoplastic management of bone infection

IntroductionBone infection cases with major soft tissue loss have conventionally been treated with a staged orthoplastic approach, addressing the infection first followed by definitive management to achieve bony stability and soft tissue cover. In the last few decades, specialist centers have advocated for single stage bony stabilization with soft tissue coverage. We aimed to investigate the outcomes of patients that underwent a single stage versus a two-stage orthoplastic intervention. MethodsUsing an existing 2009–2019 database from a single major trauma centre, we identified all adults with a diagnosis of fracture related infection (FRI) or osteomyelitis (OM). The primary outcome was resolution of infection. Secondary outcomes included time to bony union, amputation, failure of orthopaedic fixation, mortality, and return to theatre. ResultsA total of 96 patients were included. 71 patients (74%) underwent a single stage procedure; out of which 61 were FRI. 25 patients (26%) underwent a two-stage procedure; out of which 24 were FRI. The average follow up for the single stage and two-stage cohorts was 32.1 and 30.3 months, respectively. Resolution of infection without the need for an amputation was achieved in 67 (94.4%) patients in the single stage cohort and in 23 (92%) patients in the two-stage cohort. When compared to the two-stage group, the single stage cohort had less recurrence of infection (9.9% versus 12%, p = 0.72), lower rates of amputation (8.5% versus 12%, p = 0.69), lower rates of failure of orthopaedic fixation (11.1% versus 13%, p = 0.82), but higher average time to bony union (15.25 months versus 12.35, p = 0.42). The differences were not statistically significant. A total of 37 patients (52.1%) had an unplanned return to theatre in the single stage compared to 12 (48%) in the two-stage cohort. In subgroup analysis of FRI cases, open fractures had a longer time to bony union when compared to closed fractures (19.7 versus 11.6 months, p = 0.01). No mortality was observed in both cohorts. ConclusionsThe single stage orthoplastic approach to bone infection is effective if planned carefully with clinical outcomes comparable to the two-stage approach. Further research should examine factors associated with unplanned return to theatre and any variation in treatment of bone infection across regions.

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Total Aortic Arch Replacements With a 4 Branched Frozen Elephant Trunk (FET) Graft in Acute Aortic Dissection (DeBakey type I)

Management of stage I occult uterine leiomyosarcoma: effects of morcellation, second-look surgery, and adjuvant treatments on survival

BackgroundThis study sought to analyze the risk of morcellation in patients who underwent surgery for leiomyoma and had a final pathological diagnosis of uterine leiomyosarcoma (uLMS), and evaluate the survival benefits of second-look surgery and chemotherapy in patients with stage I occult uLMS.MethodsA retrospective analysis of the data of patients with occult stage I uLMS in the Peking Union Medical College Hospital database between 2005 and 2018 was conducted. The recurrence rate and progression-free survival (PFS) were compared between patients who underwent morcellation or not. Univariate analyses were used to evaluate the survival impact of lymphadenectomy, oophorectomy and adjuvant chemotherapy. Propensity-score matching methods were used to evaluate the effect of morcellation on recurrence while adjusting for baseline confounding factors using Poisson regression fitted by inverse probability weighting (IPW) estimation.ResultsA total of 96 patients with uLMS were identified among the 31,679 surgeries performed for leiomyomas (incidence: 0.303%). Hysterectomy was performed in 60 patients, and myomectomy was performed in 36 patients (power morcellation n=20). There were 36 (37.5%) patients underwent lymphadenectomy, and 76 (79.2%) patients underwent oophorectomy. Among them, 47 (52.8%) patients received postoperative chemotherapy. The median follow-up time was 40 months (range, 12–146 months), and there were 43 cases of recurrence (44.7%). No differences in recurrence were found between the hysterectomy and myomectomy groups (hazard ratio 0.839, P=0.701). The 3-year PFS rates for patients with hysterectomy, power morcellation, and non-power morcellation were 64.3%, 53.8%, and 59.8%, respectively. No survival differences were identified between patients with/without lymphadenectomy [PFS: P=0.513; overall survival (OS): P=0.413] and oophorectomy (PFS: P=0.162; OS: P=0.815). Postoperative chemotherapy was associated with better PFS (P=0.047), but not OS (P=0.36).ConclusionsNo survival differences were observed among the initial surgical procedures in stage I patients with occult uLMS. No survival benefits were observed between lymphadenectomy and oophorectomy patients. Compared to continued observation, postoperative chemotherapy was associated with improved PFS, but not OS.

POSB296 Cost Efficiencies for Spinal Cord Stimulation in Denmark: Impact of Battery Longevity for Non-Rechargeable Devices and a 1-Stage Approach

Spinal cord stimulation (SCS) is a treatment for chronic intractable pain, with non-rechargeable (NR) devices a choice for patients who prefer a recharge-free option. Whilst SCS is a 2-stage procedure with a trial phase followed by permanent device implantation, a 1-stage approach can be used with equivalent safety and clinical outcomes. This analysis explores the costs of both approaches, incorporating battery longevity improvements amongst newer devices in Denmark (2021). Since 2019, three leading NR SCS devices have been launched: Device A (2019); Device B (2020); Device C (2021). Battery longevity of Devices A and B were obtained from product manuals. Longevity of the newest Device C was estimated at comparable stimulation settings for Device A (4.5 years vs. 8.31 for Device C) and Device B (5.1 years vs. 9.27 for Device C). A Markov model simulated individual patients across four scenarios: A vs. C and B vs. C with both a 2-stage and 1-stage approach. A cycle length of one month and a 15-year time horizon was used, with a Danish national payer perspective. Registry data informed withdrawal and adverse event probabilities. Unit costs were taken from national DRGs. Using a standard 2-stage SCS approach, undiscounted total per-patient costs for Device A vs. Device C were DKK 1,153,794 and DKK 863,493, respectively; for Devices B vs. Device C were DKK 1,039,492 and DKK 847,696, respectively. Employing a 1-stage approach saved DKK 237,420 in all scenarios. The cost savings driver was fewer expected device replacements afforded by increased battery longevity of the newest device. Increases in SCS battery longevity can translate into cost savings for healthcare payers, which can be extended by employing a 1-stage approach. Understanding the potential cost benefit of device choice and procedural optimisation may inform budgetary decisions for long-term cost management of SCS.

Extended Ulaanbaatar Procedure with Preputial Skin Graft for Proximal Hypospadias.

Two stage urethroplasty for proximal penile hypospadias is time consuming, expensive and; traumatic both for parents and phallus. On the other hand, single stage procedure technically demanding. We would like to describe Extended Ulaanbaatar Procedure (EUP) which is not a two stage procedure. Rather, might be called as 'extended single stage' procedure. In EUP we have done orthoplasty along with urethroplasty with preputial skin graft at same sitting as primary procedure keeping urination diverted through proximal hypospadiac meatus as "controlled fistula" which was closed after six months as secondary procedure. We operated on 35 patients of proximal penile hypospadias with moderate to severe chordee. Chordee was excised till correction of curvature. Two distracted cut ends of native plate was bridged with preputial skin graft (PSG) in between. Following that, silastic tube was placed over glandular plate as scaffold, on both cut ends of native plate and PSG. All the urethral plates and PSG were buried with tunica vaginalis flap before glanuloplasty. After six months, proximal "controlled fistula" was closed with scrotal dartos fascia and skin to join distal to proximal urethra. Vertical meatus in glans was found in 32 patients. One patient had glans dehiscence, two patients had medium sized fistula, another two patients had stenosis in neourethra and six had suture track fistula. Twenty-nine patients had satisfactory curve with good flow in uroflowmetry as per nomogram at sixth month of follow up. In classic Ulaanbaatar procedure authors do distal urethroplasty and glanuloplsaty in 1st stage following orthoplasty to avoid repeat trauma in glans in repeat procedures. Left over urethroplasty in classic Ulaanbaatar was done in 2nd stage. However, in EUP; we did urethroplasty for full length following orthoplasty as primary procedure. This procedure is less invasive than two staged as we avoided repeat degloving and repeat dissection on operated tissues. Urethroplasty done as primary procedure shunned the need of repeat degloving, decreased the period of morbidity, stay, and cost of surgery. We also avoided problems of urination through not matured, long, neo-urethra. Similarly complications i.e disruption, stenosis in neo-urethra can be managed utilizing the advantages of urinary diversion.

SURGICAL TREATMENT IN CLINICAL STAGE IV GASTRIC CANCER: A COMPARISON OF DIFFERENT PROCEDURES AND SURVIVAL OUTCOMES.

ABSTRACT - BACKGROUND:Even in clinical stage IV gastric cancer (GC), surgical procedures may be required to palliate symptoms or in an attempt to improve survival. However, the limited survival of these patients raises doubts about who really had benefits from it.AIM: This study aimed to analyze the surgical outcomes in stage IV GC treated with surgical procedures without curative intent.METHODS: Retrospective analyses of patients with stage IV GC submitted to surgical procedures including tumor resection, bypass, jejunostomy, and diagnostic laparoscopy were performed. Patients with GC undergoing curative gastrectomy served as the comparison group.RESULTS: Surgical procedures in clinical stage IV were performed in 363 patients. Compared to curative surgery (680 patients), stage IV patients had a higher rate of comorbidities and ASA III/IV classification. The surgical procedures that were performed included 107 (29.4%) bypass procedures (partitioning/gastrojejunal anastomosis), 85 (23.4%) jejunostomies, 76 (20.9%) resections, and 76 (20.9%) diagnostic laparoscopies. Regarding patients’ characteristics, resected patients had more distant metastasis (p=0.011), bypass patients were associated with disease in more than one site (p<0.001), and laparoscopy patients had more peritoneal metastasis (p<0.001). According to the type of surgery, the median overall survival was as follows: resection (13.6 months), bypass (7.8 months), jejunostomy (2.7 months), and diagnostic (7.8 months, p<0.001). On multivariate analysis, low albumin levels, in case of more than one site of disease, jejunostomy, and laparoscopy, were associated with worse survival.CONCLUSION: Stage IV resected cases have better survival, while patients submitted to jejunostomy and diagnostic laparoscopy had the worst results. The proper identification of patients who would benefit from surgical resection may improve survival and avoid futile procedures.

Sentinel Lymph Node Biopsy Efficacy in Breast Cancer: A 4-year Experience Report

Sentinel lymph node biopsy has been one of the most important advances in oncologic surgery, especially in breast cancer, since it decreases the high morbidity associated with radical axillary dissection, and allows treatment personalization. The staging of axillary nodes in breast cancer is fundamental as it is a prognostic indicator and determines the need for adjuvant therapy. Sentinel lymph node is detected by injecting a radioisotope and dye through the periareolar area that consequently travels through mammary glands to axillary lymph nodes. We conducted a retrospective study that included 57 women with a histopathological diagnosis of breast cancer, and underwent sentinel node biopsy. Transoperative pathology analysis reported metastases in 24% of the patients, requiring radical axillary dissection. Sensitivity was 97%, and specificity was 85%, reflecting high efficacy of the sentinel lymph node biopsy, and thus benefitting patients by decreasing morbidity. Sentinel node biopsy is the standard procedure for correct staging of patients with early breast cancer, and no clinical evidence of lymph node involvement. Further, it decreases morbidity in these patients by preventing radical axillary dissection, a previously standard approach, without compromising the diagnosis and hence, the prognosis of the patients. We demonstrated that with the correct technique for sentinel lymph node biopsy, the prognosis for patients is much better than for those patients that undergo radical axillary dissection.

Sentinel Lymph Node Biopsy for Oral Cancer – When to use it?

Introduction: Sentinel lymph node biopsy (SLNB) for staging tool for oral squamous cell carcinoma (OSCC) was recommended in the 2016 NICE guidance for patients presenting with early (T1 and T2 N0) disease. However, when to deploy SLNB as opposed to elective selective lymphadenectomy (ELND) to detect occult regional metastases remains controversial and is the focus of this study. Methods: A retrospective analysis of 145 patients who had had sentinel lymph node biopsy for a previously untreated primary T1 or T2 oral cancer between 2010 and 2020 was performed. The primary outcome measures of interest were predictors of occult metastases, accuracy of SLNB, disease specific and overall survival. Results: This study reported97% NPV, 7.8% FNR, 2.7% FOR and 92% Sensitivity based on our 145-patient cohort. Depth of invasion (DOI) was a significant predictor of N status, overall survival and disease specific survival.There was a significant difference in the incidence of the neck node metastasis (17.5% vs 36.4%) in patients with DOI <5mm compared to those with DOI >5mm. Conclusions: The selection of SLNB as the preferred staging procedure over ELND requires discussion with patients and should include an estimate of the probability of requiring re-admission for a more complete lymphadenectomy procedure. Introduction: Sentinel lymph node biopsy (SLNB) for staging tool for oral squamous cell carcinoma (OSCC) was recommended in the 2016 NICE guidance for patients presenting with early (T1 and T2 N0) disease. However, when to deploy SLNB as opposed to elective selective lymphadenectomy (ELND) to detect occult regional metastases remains controversial and is the focus of this study. Methods: A retrospective analysis of 145 patients who had had sentinel lymph node biopsy for a previously untreated primary T1 or T2 oral cancer between 2010 and 2020 was performed. The primary outcome measures of interest were predictors of occult metastases, accuracy of SLNB, disease specific and overall survival. Results: This study reported97% NPV, 7.8% FNR, 2.7% FOR and 92% Sensitivity based on our 145-patient cohort. Depth of invasion (DOI) was a significant predictor of N status, overall survival and disease specific survival.There was a significant difference in the incidence of the neck node metastasis (17.5% vs 36.4%) in patients with DOI <5mm compared to those with DOI >5mm. Conclusions: The selection of SLNB as the preferred staging procedure over ELND requires discussion with patients and should include an estimate of the probability of requiring re-admission for a more complete lymphadenectomy procedure.