Association Of Surgical Treatment Research Articles

Some considerations of clinical aspects and treatment in digestive non-Hodgkin's lymphomas

The gastrointestinal tract is the most common primary location for extranodal non-Hodgkin lymphomas (NHL), and due to nonspecific symptoms, diagnosis may be delayed. Combined or complex treatment allows good tumor control. The purpose of the paper was to evaluate the clinical and treatment aspects of digestive NHL for the optimization of therapeutic tactics. Material and methods. The clinical and treatment aspects of 55 patients diagnosed with digestive NHL were studied. Results. It was determined that digestive NHLs developed more frequently in patients aged 51-60 years (34,5%). Gastric localization was found most frequently (76.4%). Although damage to the esophagus is exceptionally rare, a case was encountered during this period. According to the degree of spread of the tumor process, most patients were diagnosed in stage IV (61.8%), demonstrating a late addressability and an unfavorable prognosis in the future. The treatment carried out was more often constituted by chemotherapy, followed by the association of surgical treatment. Radiotherapy has been used to enhance the effect, with good tumor control, or palliatively. Conclusions. The combined and complex treatment can significantly increase the effectiveness of the treatment and decrease the frequency of relapses, which can improve the survival rate.

Association of surgical treatment with functional outcome in patients with spontaneous cerebellar hemorrhage

Objective: To investigate the relation of surgical treatment with patient’s 180-day outcome. Subject and method: Thirty-six patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were treated with operation from January 2017 to March 2022. This study aimed to identify potential clinical and computed tomography (CT) features influencing outcomes after 6 months from ictus, and the association of surgical treatment with SCH patients. Result: The mean age was 62.9 years (IQR 43–83 years). Hypertension was the most common underlying disease (31 patients, 86.1%), followed by smoking (15 patients, 41.7%). 63.9% (23/36) of patients showed loss of consciousness at the initial presentation. Among 36 patients, 25 patients (70%) underwent surgical hemorrhage evacuation with placement of an external ventricle drainage (EVD), 4 patients (10.4%) received an EVD only. The six-moth mortality rate was 33.33%, 12 patients (33.34%) had good outcome (modified Rankin Scale – mRS < 3). In multivariate analysis only the Glasgow coma scale (GCS) score and intracerebral hemorrhage (ICH) score on admission was significant predictor of six-month outcome ([odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.08-2.08, p=0.01; OR = 0.32, CI: 0.10–1.05, p=0.03), respectively. Conclusion: Surgical treatment can be effective for selected patients without lower GSC scores on admission. However, a higher ICH score on admission was associated with a 180-day outcome in patients with SCH.

Association of Surgical Treatment With Adverse Events and Mortality Among Medicare Beneficiaries With Proximal Humerus Fracture

Meta-analyses of randomized clinical trials suggest that the advantages and risks of surgery compared with conservative management as the initial treatment for proximal humerus fracture (PHF) vary, or are heterogeneous across patients. Substantial geographic variation in surgery rates for PHF suggests that the optimal rate of surgery across the population of patients with PHF is unknown. To use geographic variation in treatment rates to assess the outcomes associated with higher rates of surgery for patients with PHF. This comparative effectiveness research study analyzed all fee-for-service Medicare beneficiaries with proximal humerus fracture in 2011 who were continuously enrolled in Medicare Parts A and B for the 365-day period before and immediately after their index fracture. Data analysis was performed January through June 2019. Undergoing 1 of the commonly used surgical procedures in the 60 days after an index fracture diagnosis. Risk-adjusted area surgery ratios were created for each hospital referral region as a measure of local area practice styles. Instrumental variable approaches were used to assess the association between higher surgery rates and adverse events, mortality risk, and cost at 1 year from Medicare's perspective for patients with PHF in 2011. Instrumental variable models were stratified by age, comorbidities, and frailty. Instrumental variable estimates were compared with estimates from risk-adjusted regression models. The final cohort included 72 823 patients (mean [SD] age, 80.0 [7.9] years; 13 958 [19.2%] men). The proportion of patients treated surgically ranged from 1.8% to 33.3% across hospital referral regions in the United States. Compared with conservatively managed patients, surgical patients were younger (mean [SD] age, 80.4 [8.1] years vs 78.0 [7.2] years; P < .001) and healthier (Charlson Comorbidity Index score of 0, 14 863 [24.4%] patients vs 3468 [29.1%] patients; Function-Related Indicator score of 0, 20 720 [34.0%] patients vs 4980 [41.8%] patients; P < .001 for both), and a larger proportion were women (49 030 [80.5%] patients vs 9835 [82.5%] patients; P < .001). Instrumental variable analysis showed that higher rates of surgery were associated with increased total costs ($8913) during the treatment period, increased adverse event rates (a 1-percentage point increase in the surgery rate was associated with a 0.19-percentage point increase in the 1-year adverse event rate; β = 0.19; 95% CI, 0.09-0.27; P < .001), and increased mortality risk (a 1-percentage point increase in the surgery rate was associated with a 0.09-percentage point increase in the 1-year mortality rate; β = 0.09; 95% CI, 0.04-0.15; P < .01). Instrumental variable mortality results were even more striking for older patients and those with higher comorbidity burdens and greater frailty. Risk-adjusted estimates suggested that surgical patients had higher costs (increase of $17 278) and more adverse events (a 1-percentage point increase in the surgery rate was associated with a 0.12-percentage point increase in the 1-year adverse event rate; β = 0.12; 95% CI, 0.11 to 0.13; P < .001) but lower risk of mortality after PHF (a 1-percentage point increase in the surgery rate was associated with a 0.01-percentage point decrease in the 1-year mortality rate; β = -0.01; 95% CI, -0.015 to -0.005; P < .001). This study found that higher rates of surgery for treatment of patients with PHF were associated with increased costs, adverse event rates, and risk of mortality. Orthopedic surgeons should be aware of the harms of extending the use of surgery to more clinically vulnerable patient subgroups.

Association of Surgical Treatment, Systemic Therapy, and Survival in Patients With Abdominal Visceral Melanoma Metastases, 1965-2014

Systemic therapy for metastatic melanoma has evolved rapidly during the last decade, and patient treatment has become more complex. To evaluate the survival benefit achieved through surgical resection of melanoma metastatic to the abdominal viscera in patients treated in the modern treatment environment. This retrospective review of the institutional melanoma database from the John Wayne Cancer Institute at Providence St Johns Health Center, a tertiary-level melanoma referral center, included 1623 patients with melanoma diagnosed as having potentially resectable abdominal metastases before (1969-2003) and after (2004-2014) advances in systemic therapy. Overall survival (OS). Of the 1623 patients identified in the database with abdominal melanoma metastases, 1097 were men (67.6%), and the mean (SD) age was 54.6 (14.6) years. Of the patients with metastatic melanoma, 1623 (320 [19.7%] in the 2004-2014 period) had abdominal metastases, including 336 (20.7%) with metastases in the gastrointestinal tract, 697 (42.9%) in the liver, 138 (8.5%) in the adrenal glands, 38 (2.3%) in the pancreas, 109 (6.7%) in the spleen, and 305 (18.8%) with multiple sites. Median OS was superior in surgical (n = 392; 18.0 months) vs nonsurgical (n = 1231; 7.0 months) patients (P < .001). The most favorable 1-year and 2-year OS was seen after surgery for gastrointestinal tract (52% and 41%) and liver (51% and 38%) metastases, respectively. Multivariable analysis found increasing age (hazard ratio [HR], 1.01; 95% CI, 1.00-1.01; P = .02) and the presence of ulceration (HR, 1.21; 95% CI, 1.01-1.45; P = .04) were associated with a worse OS. Alternatively, treatment with metastasectomy (HR, 0.59; 95% CI, 0.46-0.74; P < .001) and metastases involving the gastrointestinal tract (HR, 0.65; 95% CI, 0.48-0.87; P = .004) were associated with a better OS. The systemic treatment era did not significantly affect outcomes (HR, 0.82; 95% CI, 0.67-1.02; P = .15). Overall, patients with gastrointestinal tract metastases undergoing complete, curative resection derived the greatest benefit, with a median OS of 64 months. To our knowledge, this series is the largest single-institution experience with abdominal melanoma metastases, demonstrating that surgical resection remains an important treatment consideration even in the systemic treatment era.

Abstract P4-01-15: Impact of Preoperative MRI on the Surgical Treatment of Breast Cancer: A SEER-Medicare Analysis

Abstract Background: Preoperative magnetic resonance imaging (MRI) use has increased for women with invasive breast cancer and ductal carcinoma in situ (DCIS). Prior studies have disputed whether preoperative MRI is associated with increased rates of mastectomy. We evaluated the rates of mastectomy versus breast conserving surgery (BCS) and their association with preoperative MRI in older women. Methods: We identified women in SEER-Medicare 66 years or older diagnosed with DCIS or invasive breast cancer between 2002 and 2007 treated within 6 months of diagnosis with mastectomy or breast conserving surgery (BCS) with or without radiotherapy (RT). Preoperative MRI was defined as MRI occurring before a woman's first surgery after her initial diagnosis. We looked for surgical treatment (BCS or mastectomy) and radiotherapy, age at diagnosis, year of diagnosis and cancer type, overall and separately by receipt of MRI. We examined the association of surgical treatment with MRI using multivariable logistic regression adjusting for age at diagnosis, year of diagnosis, cancer type and radiotherapy. Results: Among the 70,758 women identified, 5,126 (7.2%) had a preoperative MRI. The overall use of MRI increased from 1.2% in 2002 to 18.0% in 2007 (p &amp;lt; 0.0001). Women with MRI were more likely to undergo mastectomy than those without MRI (331 per 1000 vs. 314 per 1000; respectively, p &amp;lt; 0.0001) and more likely to undergo BCS RT (432 per 1000 vs. 354 per 1000; respectively, p &amp;lt; 0.0001). Conclusion: The use of preoperative MRI has increased in recent years and is significantly associated with increased rates of BCS RT and mastectomy. Limitations of this study include that it is an observational analysis and that selection bias may exist for MRI and aggressive treatment that is not related to what is observed on MRI. Further studies are needed to understand how patient characteristics and information obtained from MRI influence treatment choices. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-01-15.

Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study

Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4–15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O2 therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O2/hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O2 hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.

Choriocarcinome tubaire: à propos d'un cas et revue de la littérature

The authors describe a case report of a tubal choriocarcinoma occurring in women of 32 years old, 2 years after her last pregnancy. The patient was treated by laparoscopic salpingectomy and polychemotherapy. Metastatic pulmonary micronodules were diagnosed at thoraco-abdomino-pelvic tomodensitometry. Patient's recovery was complete with an uneventfull follow-up at 3 years. The association of surgical treatment and chemotherapy used under the guidelines of the FIGO score improves patient's outcome.