Clinical Recurrence Rate Research Articles

Efficacy and safety of percutaneous microwave ablation for adenomyosis in the posterior uterine wall.

To evaluate the efficacy and safety of percutaneous microwave ablation (PMWA) for treating adenomyosis in the posterior uterine wall. Thirty-six patients with symptomatic adenomyosis in the posterior uterine wall who had been subjected to PMWA were retrospectively enrolled in this study. 20 patients who had no ideal transabdominal puncture path due to the retroverted or retroflexed uterine position were treated with PMWA combined with Yu's uteropexy (Group 1). The other 16 patients were treated with PMWA only (Group 2). The non-perfused volume (NPV) ratio, symptomatic relief rate, recurrence rate, changes in clinical symptom scores, economic cost, and complications were compared. The mean NPV ratio for the 36 patients was 90.2±18.3%, and the percentage of patients who obtained complete relief of dysmenorrhea and menorrhagia was 81.3% (26/32), and 69.6% (16/23) respectively. The recurrence rate was 11.1% (4/36). No major complication was observed. Minor complications included lower abdominal pain, fever, vaginal discharge, nausea, and/or vomiting after ablation, with incidences of 55.6%, 41.7%, 47.2%, and 19.4% respectively. Subgroup analysis showed no significant difference in the median value of NPV ratio, symptomatic relief rate of dysmenorrhea and menorrhagia, changes in clinical symptom scores, recurrence rate and economic cost between the two groups (all p > 0.05). PMWA is an effective and safe treatment for adenomyosis in the posterior uterine wall. This study focused on the ultrasound-guided PMWA treatment for adenomyosis in the posterior uterine wall. Yu's uteropexy, a new ancillary technique allowing safe PMWA for deep posterior uterine wall lesions in retroverted uterus, expanded the indications of PMWA for symptomatic adenomyosis.

MP80-19 ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR PROSTATE CANCER: 18-YEAR ONCOLOGICAL OUTCOMES FROM A BELGIAN HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP80-19 ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR PROSTATE CANCER: 18-YEAR ONCOLOGICAL OUTCOMES FROM A BELGIAN HIGH-VOLUME CENTER Luigi Nocera, Carlo Bravi, Marco Paciotti, Adele Piro, Eleonora Balestrazzi, Maria Peraire Lores, Federico Piramide, Angelo Mottaran, Luca Sarchi, Rui Farinha, Frederiek D'Hondt, Geert De Naeyer, Ruben De Groote, and Alexandre Mottrie Luigi NoceraLuigi Nocera More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Adele PiroAdele Piro More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Federico PiramideFederico Piramide More articles by this author , Angelo MottaranAngelo Mottaran More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Rui FarinhaRui Farinha More articles by this author , Frederiek D'HondtFrederiek D'Hondt More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its introduction in the treatment landscape of prostate cancer (PCa), robot-assisted radical prostatectomy (RARP) exhibited excellent short- and mid-term oncological outcomes. However, long-term oncological outcomes are still underreported. Here, we examined oncological outcomes of a single-center RARP cohort with the longest follow-up. METHODS: We retrospectively identified 2,451 PCa patients treated with RARP at a high-volume tertiary referral center between 2002 and 2020. Kaplan-Meier (KM) analyses examined biochemical recurrence (BCR), clinical recurrence (CR) and cancer-specific mortality (CSM) rates. Uni- and multi-variable Cox regression models assessed independent predictors of BCR, CR and CSM after stratification for age, year of surgery (YOS) and PSA level. RESULTS: Median (interquartile range [IQR]) age and preoperative PSA were 64 (59, 69) years and 7.3 (5.3, 10.6) ng/ml. Most patients harbored a cT1c disease (45%), followed by cT2a, cT2c, cT3, cT2b and cT1a-b, accounting for 21%, 17%, 10%, 5% and 2%, respectively. The vast majority of patients had biopsy ISUP group 1-2 (78%), followed by ISUP group 3 and 4-5 in 12% and 11%. On final pathology, most patients harbored pT2 disease (66%), followed by pT3a (20%), pT3b (6%) and pT4 (<1%) disease, whereas ISUP group 1-2 was the most frequent grade (69%), followed by ISUP group 3 and 4-5 in 21% and 11% of patients. pN1 disease was found in 7% of patients. A total of 425 (17%) patients had PSM. During follow-up, 584 patients experienced BCR, 286 CR and 41 CSM. The 15-year BCR-, CR- and CSM-free survival was 64% (95% confidence interval [CI]: 62%, 67%), 78% (95%CI: 75%, 81%) and 95% (95%CI: 92%, 97%) respectively (Figure 1). The 18-year BCR-, CR- and CSM-free survival was 64% (95%CI: 61%, 67%), 75% (95%CI: 71%, 79%) and 95% (95%CI: 92%, 97%) respectively. On multivariable Cox regression model, pathological stage, pathological ISUP grade group and PSM represented all independent predictors of BCR, CR and CSM (all p<0.01). CONCLUSIONS: Our study – with the longest follow-up in a series of RARPs – showed excellent oncological outcomes after surgery in individuals with favorable PCa characteristics, also after 18 years of follow-up. Further, multi-center validations are awaited to confirm these findings. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1160 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Nocera More articles by this author Carlo Bravi More articles by this author Marco Paciotti More articles by this author Adele Piro More articles by this author Eleonora Balestrazzi More articles by this author Maria Peraire Lores More articles by this author Federico Piramide More articles by this author Angelo Mottaran More articles by this author Luca Sarchi More articles by this author Rui Farinha More articles by this author Frederiek D'Hondt More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

MP11-08 EXPLORING THE EFFECT OF METASTASIS DIRECTED THERAPY ON PROGRESSION PATTERNS OF PATIENTS WITH POSITIVE 68Ga-PSMA PET/CT AND BIOCHEMICAL RECURRENCE FROM PROSTATE CANCER

MP11-08 EXPLORING THE EFFECT OF METASTASIS DIRECTED THERAPY ON PROGRESSION PATTERNS OF PATIENTS WITH POSITIVE 68Ga-PSMA PET/CT AND BIOCHEMICAL RECURRENCE FROM PROSTATE CANCER

MP46-11 LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: UPDATE SERIES FROM A HIGH-VOLUME ROBOTIC CENTER BEYOND 10 YEARS OF FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023MP46-11 LONG-TERM ONCOLOGIC OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: UPDATE SERIES FROM A HIGH-VOLUME ROBOTIC CENTER BEYOND 10 YEARS OF FOLLOW-UP Angelo Mottaran, Carlo Bravi, Adele Piro, Luca Sarchi, Marco Paciotti, Maria Peraire Lores, Eleonora Balestrazzi, Luigi Nocera, Federico Piramide, Ruben De Groote, Frederiek D'hondt, Alberto Briganti, Francesco Montorsi, and Alexandre Mottrie Angelo MottaranAngelo Mottaran More articles by this author , Carlo BraviCarlo Bravi More articles by this author , Adele PiroAdele Piro More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Federico PiramideFederico Piramide More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Frederiek D'hondtFrederiek D'hondt More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) for non-metastatic bladder cancer (BCa) are limited. We here assessed long-term oncologic outcomes of patients receiving robotic radical cystectomy at a high-volume European Institution. METHODS: We analyzed data of 107 patients treated with RARC between 2003 and 2012 at a high-volume robotic center (OLV Hospital, Aalst, Belgium). All surgeries were performed by two high-volume surgeons. Clinical, pathologic, and survival data at the latest follow-up were collected. Clinical recurrence (CR)-free survival, cancer-specific mortality (CSM)-free survival, and overall survival (OS) were plotted using Kaplan-Meier survival curves. Cox proportional hazards models investigated predictors of CR and CSM. Competing risk regressions were utilized to depict cumulative incidences of death from BCa and death from other causes after RARC at long-term. RESULTS: Pathologic nonorgan-confined BCa was found in 40% of patients, and 7 (7%) patients had positive soft tissue surgical margins. Median (interquartile range [IQR]) number of nodes removed was 11 (6, 14), and 26% of patients had pN+ disease. Median (IQR) follow-up for survivors was 123 (117, 149) months. The 12-year CR-free, CSM-free and overall survival were 55% (95% confidence interval [CI]: 44%, 65%), 62% (95%CI: 50%, 72%), and 34% (95%CI: 24%, 44%) respectively. On multivariable competing risk analysis, nodal involvement at final pathology was associated with higher risk of both CR (hazards ratio [HR]: 1.82; 95%CI: 1.06, 3.13, p=0.030) and CSM (HR: 1.70, 95%CI 1.30, 2.22; p<0.0001). The cumulative incidence of non-cancer death exceeded that of death from BCa after approximately ten years after RARC (Figure 1). CONCLUSIONS: We provided relevant data on the oncologic outcomes of RARC at a high-volume robotic center, with acceptable rates of clinical recurrence and cancer-specific survival at long-term. In patients treated with RARC, the cumulative incidence of death from causes other than BCa is non-negligible, and should be taken into consideration for post-operative follow-up. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e635 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo Mottaran More articles by this author Carlo Bravi More articles by this author Adele Piro More articles by this author Luca Sarchi More articles by this author Marco Paciotti More articles by this author Maria Peraire Lores More articles by this author Eleonora Balestrazzi More articles by this author Luigi Nocera More articles by this author Federico Piramide More articles by this author Ruben De Groote More articles by this author Frederiek D'hondt More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical and laser treatment for juvenile psammomatoid ossifying fibroma in an oncological patient: a rare case report

BackgroundJuvenile psammomatoid ossifying fibroma is a rare variant of conventional ossifying fibroma that affects the maxillofacial complex in children and adolescents. It is a benign fibro-osseous neoplasm with aggressive clinical behavior and high recurrence rates, confirming the importance of early diagnosis and intervention to minimize undesirable aesthetic and functional possibilities resulting from surgical management, and added to the use of laser therapy, it can bring a better postoperative prognosis.AimTo present the surgical removal of a juvenile psammomatoid ossifying fibroma, with the associated use of low-intensity laser and photodynamic therapy in a oncological patient.Case presentationThis case describes a senile cancer patient diagnosed with rapidly progressive and painful juvenile ossifying fibroma involving the inter-radicular region of the right maxilla. The treatment was excision with total tumor resection, photodynamic therapy and low-intensity laser follow-up of 48 months.ConclusionsJuvenile psammomatoid ossifying fibroma is a lesion with a high rate of recurrence and aggressive growth. Thus, early detection and treatment are essential. In this case, the use of photodynamic therapy after surgery and long-term follow-up with low-intensity laser brought a favorable prognosis in an oncology patient.

Clinical outcomes of sinonasal inverted papilloma: a retrospective analysis of 139 cases.

Sinonasal inverted papilloma has a high tendency for recurrence, local bone destruction and risk of malignant transformation. Therefore, complete resection of the tumour is required, and close follow up is essential. This article describes the clinical outcomes, recurrence rate and malignant transformation rate of sinonasal inverted papilloma. In this study, 139 patients diagnosed with sinonasal inverted papilloma in our hospital from December 2010 to May 2022 were retrospectively analysed. All patients underwent endoscopic surgery. Sinonasal inverted papilloma occurred more often in males than in females. The mean age of patients with sinonasal inverted papilloma was 67.3 ± 5.7 years at diagnosis. The most prevalent site of origin was the maxillary sinus (50.4 per cent). The recurrence rate was 5.75 per cent, and the malignant transformation rate was 6.5 per cent. All patients in this study underwent endoscopic surgery. Meticulous resection and regular long-term follow ups are crucial to reducing sinonasal inverted papilloma recurrence after surgery.

Endoscopic Ultrasound-guided Radiofrequency Ablation Versus Surgical Resection for Treatment of Pancreatic Insulinoma

Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI). Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA. Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P< .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P= .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients). EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

Vertebral and pelvic echinococcosis in northwestern China

PurposeEchinococcosis remains a major economic and severe public health problem in endemic areas. Bone echinococcosis is rare, and the vertebra and pelvis are the most common sites of echinococcosis involving the skeletal. Because of the clinical severe symptoms and high recurrence rate, it brings excellent trouble to patients.MethodsThis study retrospectively analyzed the clinical manifestations, laboratory tests, radiological findings, and treatment of 44 patients with vertebral and pelvic echinococcosis during a period of 16 years (2005–2020).ResultsThe mean age was 43 years (25 males, 19 females; 19–68 years). The most common symptom was pain, followed by numbness, weakness, activity limitation, and progressive paraparesis. Enzyme-linked immunosorbent assay test (ELISA) results were positive in 18 cases (75%). There are 24 cases of hydatid infection of the spine, 14 hydatid infection of the pelvis, and six hydatid infection of both vertebra and pelvis. The site of infection was 13 (29.5%) thoracic, five (11.4%) lumbar, four (9.1%) lumbosacral, seven (15.9%) sacral, 19 (43.2%) ilium, seven (15.9%) hip, six (13.6%) ischium, five (11.4%) pubis, and two (4.5%) femur, respectively. The imaging findings were cystic dilatancy, septal, and irregular bone destruction. MRI has a special value in showing the relationship between the surrounding tissues and organs of cystic bone echinococcosis. All patients were followed up for at least one year. The mean follow-up time was 3.6 years.ConclusionsEven in epidemic areas, the incidence of bone echinococcosis is relatively rare. However, when encountering the vertebral and pelvic destruction, consider bone echinococcosis’s possibility, especially for the herdsmen in endemic regions.

Penile cancer: 20 years of experience in a reference oncology center in Mexico.

6 Background: Penile cancer is a rare neoplasm (&lt;1%), being more common in underdeveloped countries, 10-20% of male neoplasms, with a mean age at diagnosis of 60 years. The number of annual cases in Mexico is only 660 cases, 0.35% of all neoplasms. Its initial symptomatology as a palpable or ulcerated lesion must be differentiated from infectious processes. From 30 to 60% of cases debut with inguinal lymphadenopathies and distant metastases in 1 to 10%. Methods: Cross-sectional, retrospective cohort study of patients diagnosed with penile cancer, who received medical care at the medical oncology service of the University Cancer Center from January 1, 1999 to December 31, 2019. Results: Of the 103 patients analyzed in this study, the mean age was 55 years (27-91 years), the highest level of schooling obtained was primary in 18.5%, being mostly from the state of Nuevo León in 61.1%. of the cases. The duration of symptoms was 17 months on average, and the time interval between diagnosis and receiving medical or surgical treatment was 97 days. Regarding the pathological characteristics of penile cancer, the average tumor size was 41.4mm, the most frequent histological type was squamous in 91.3%. Regarding the classification by clinical stages, patients in clinical stage I was 8%, II 10.6%, III 26.2% and IV 32%, not being recorded accurately in 23.3% of cases. The initial medical treatment was surgical in 81.5% of the cases, with partial phallectomy being the procedure of choice in 57.2% of the patients, with the presence of positive margins in 9.5% of the patients. Lymph node involvement was 71.2% of the cases and lymph node dissection was only performed in 31% of the patients. Those who received chemotherapy were 27.1% of the patients, the majority, 57.1% in the adjuvant setting, the most commonly used scheme was cisplatin with 5-fluoroacyl in 60.7%. Radiotherapy was used in 25.2% of the patients, being the adjuvant modality in 65.4% and in the palliative context in 34.6%, with an average dose of 46.5 Gy and 8 fractions. Conclusions: A diagnosis at an earlier age was observed in our court, being 55 years old vs 60 years old reported in the literature. A delay in diagnosis of up to 12 months has been reported in 15-50% in the literature, being higher in our population with a mean of 17.7 months. Poor adherence to treatment and clinical follow-up was observed, since one in 4 patients only goes to oncology once and loses follow-up. Penile cancer is a rare, psychologically devastating neoplasm with delayed diagnosis, advanced clinical disease, decreased survival, and high recurrence rates despite bimodal or trimodal treatment. A multidisciplinary team approach should be sought to achieve better oncological results and timely detection of cancer in earlier stages.

Pulsed field ablation in real-world atrial fibrillation patients: clinical recurrence, operator learning curve and re-do procedural findings.

Pulsed field ablation (PFA) is a novel method of cardiac ablation demonstrated in early pre-clinical and clinical settings. The aim of this study was to report the safety and clinical efficacy of pulmonary vein isolation (PVI) with PFA for real-world atrial fibrillation (AF) patients. All-comer AF patients (n = 121, 59% paroxysmal) were prospectively included and underwent PFA with 100% high-density voltage maps performed after PVI. Clinical outcomes were gathered by chart review. PVI was achieved with PFA-only in 119 (98%) of the cases. During the implementation phase the mean procedure and fluoroscopy time was reduced from 85 ± 34 to 72 ± 18min (p = 0.044) and 22 ± 9 to 16 ± 4 (p = 0.034). We observed one phrenic nerve palsy with only partial remission at follow-up. Other adverse events were numerically comparable to standard PVI procedures. Over a mean follow-up of 308 ± 87days, a total of 22/121 (18.2%) cases experienced clinically significant recurrence or initiation of anti-arrhythmic drugs with Kaplan-Meier event-free estimate at 365days of 80% (88% for paroxysmal versus 69% for persistent). In five of eight re-do procedures, gaps were primarily located at the right pulmonary veins. PFA was a highly efficient method to achieve PVI with reductions in procedure time and fluoroscopy over the implementation period. The procedural data and clinical recurrence rates from initial trials were confirmed in real-life non-selected AF patients. More data is needed to establish lesion durability and limitations of PFA.

Evaluation of Arthroscopic Bankart Repair and Open Latarjet Technique for Treatment of Recurrent Shoulder Dislocation

Background: Arthroscopic Bankart repair and open Latarjet procedures are the most frequent surgical treatments for shoulder instability and recurrent shoulder dislocation. Objectives: Therefore, we performed research to assess the clinical outcomes and recurrence rate of instability between both Arthroscopic Bankart repair and open Latarjet techniques. Methods: A cross-sectional study was performed at Lahore General Hospital, Lahore from 2021-23, comprising 74 patients, managed surgically for the condition of recurrent shoulder dislocation. The patients were allocated into two groups viz Group A and B comprising 37 patients in each, who were managed through Arthroscopic Bankart repair and open Latarjet techniques, respectively. Post-operative complications, re-occurrence and success rate were measured in terms of SSV scores. Results: Average age of patients in Arthroscopic Bankart group was 28.34+5.31 years while in open Latarjet group; it was 29.09+6.19 years. 14 (37.83%) patients of Arthroscopic Bankart repair group revealed recurrent shoulder dislocation, while no such complaint was found in the open Latarjet technique. Twenty-seven patients of Arthroscopic Bankart group showed satisfaction with the procedure and 33 out of 37 patients (89.18%) were satisfied with open Latarjet technique. Patients in open Latarjet technique group showed successful recovery of shoulder dislocation and their SSV was 87.91%, while the patients in Arthroscopic Bankart repair group showed less SSV score of 59.76%. Conclusion: Open Latarjet group patients had a greater rate of functional satisfaction, while the arthroscopic Bankart repair group showed a trend for more recurrence. Open Latarjet operation had a higher success rate and patients had a better rate of return to previous top-level sports than Arthroscopic Bankart technique. Keywords: Latarjet; Re-occurrence; Shoulder dislocation; Sports medicine; Surgical complications.

Recurrence of ischaemic stroke using epidemiology and neuroimaging: A retrospective study in Gansu Province

ObjectivesThis retrospective study aimed to investigate the clinical and imaging recurrence of ischaemic stroke (IS), and to evaluate the risk factors for recurrence. A combined clinical and imaging diagnostic model is important for stroke prevention and management. Methods and materialsIn accordance with the inclusion and exclusion criteria, we retrospectively analysed consecutively hospitalised patients with acute IS at the Affiliated Hospital of Gansu University of Chinese Medicine. Based on the epidemiological and imaging results, stroke episodes were divided into four categories: clinical first episode (CFE), clinical recurrence (CR), imaging first episode (IFE), and imaging recurrence (IR). Based on the above categories and clinical practice, a joint diagnostic system for IS was established for the first time, including the following five types: IFE, IR, CFE and IFE, CFE and IR, and CR and IR. A binomial logistic regression analysis was conducted to determine the factors which contributed to CR and IR. ResultsIn total, 280 patients were assessed. The CR rate was 22.9% (64/280) and the IR rate was 62.9% (176/280). The only predictor of CR was hypertension (P = 0.019, odds ratio [OR] = 3.041, 95% confidence interval [95%CI] = 1.200–7.704). The factors of hypertension (P < 0.001, OR = 3.551, 95%CI = 1.781–7.080) and age (P = 0.031, OR = 1.031, 95%CI = 1.003–1.060) were predictors of IR. ConclusionThe IR rates for IS were three times higher than the CR rates. The key to preventing IR and CR in IS was the management of blood pressure. Neuroimaging examinations were important for the early detection of IFE and IR in elderly patients with hypertension. A combined clinical imaging diagnostic model was developed for the first time.

P522 Kono-S anastomosis reduces endoscopic and surgical post-operative recurrence in Crohn’s disease. The SuPREMe-CD Trial Update.

Abstract Background Recently, a new antimesenteric, functional, end-to-end, hand-sewn ileocolic anastomosis (Kono-S) has shown a significant reduction in endoscopic recurrence (ER) and surgical recurrence (SR) rate in Crohn’s disease (CD). This trial aimed to provide randomized controlled data comparing Kono-S anastomosis and conventional stapled ileocolic side-to-side anastomosis. Methods Randomized controlled trial (RCT) at a tertiary referral centre. The primary endpoint is ER rate (Rutgeerts score ≥ i2) after 6 months and surgical recurrence at 60 months. Secondary endpoints are clinical recurrence (CR) rate after 24 and 36 months, and SR after 24 and 36 months. Statistics was performed by using standard analyses. Furthermore, a sample size able to consent the detection of a reduction &amp;gt;30% in total endoscopic recurrence (when assuming a 60% to 65% ER expected rate in the control group and a 30% in the case group) was calculated; to allow a 10% drop-out of patients, 36 patients per group were needed (72 patients in the entire population). Results A total of 119 CD patients were included in the study. In all, 51 ileocolic CD patients were randomized in the Kono group and 68 in the conventional side-to-side group. At 6 months, 17 (33.3%) patients in the Kono group and 51 (75%) patients in the conventional group presented an ER (Rutgeerts score≥i2) at colonoscopy (p&amp;lt;0.001). A severe post-operative ER (Rutgeerts score≥i3) was found in 8 (15.7%) patients in the Kono group versus 23 (33.8%) patients in the conventional group (p=0.03). At 24 months, CR rate was 19.6% in the Kono group versus 30.9% in the conventional group (p=0.2), while SR rate was 0% in the Kono group versus 4.4% (3 patients) in the standard group (p=0.2). At 36 months, CR rate was 19.6% in the Kono-s group versus 33.8% in the conventional group (p=0.1). At 36 months, no patients (0%) in the Kono group experienced SR, while 6 patients (8.8%) in the conventional group did (p=0.03). Furthermore, when considering a median follow-up of 54 (42-60) months at interim analysis of SR, the difference between the two groups was confirmed to be significant (0% vs 8.8%; p=0.02). Conclusion This is the first RCT comparing Kono-S anastomosis and conventional side-to-side anastomosis in CD. The results demonstrate a significant reduction in postoperative endoscopic and surgical recurrence rates, no safety issues, and a favourable trend for lower clinical recurrence rate in patients who underwent Kono-S anastomosis compared to the conventional side-to-side anastomosis.

P455 Comparison of two strategies for the management of post-operative recurrence in Crohn’s disease patients with one clinical risk factor: a multicentre IG-IBD study

Abstract Background Prevention of postoperative recurrence (POR) in Crohn’s disease (CD) after ileo-colonic (IC) resection is still a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in presence of at least one clinical risk factor (RF). Due to drug-related adverse events and the relative high cost of biologics, we aimed to determine whether prevention of POR can be postponed and guided by endoscopy in CD patients with only one RF. Methods A multicentre retrospective study was conducted in 12 IG-IBD Italian centres. CD patients with only one RF for POR, including previous intestinal resection, extensive small intestine resection (&amp;gt;50 cm), fistulising phenotype, history of perianal disease, or active smoking were considered. Patients who performed a colonoscopy between 6 to 12 months after curative IC resection were included. Two groups were formed based on whether immunosuppressive therapy was started immediately after surgery (prophylaxis group) or guided by endoscopy (observation group). Primary endpoints were the rates of any endoscopic recurrence (Rutgeerts ≥i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence (HBI≥5) rates at 6, 12 and 24 months after surgery. Results A total of 195 patients were enrolled. Out of all, 61 (31.3%) received immunoprophylaxis at a median time of 32 days [IQR 26-55] after surgery (n=14 infliximab, n=37 adalimumab, n=7 azathioprine, n=3 ustekinumab). Baseline patient characteristics are detailed in Table 1. Particularly, risk factors for POR were homogeneously distributed between the 2 groups. Colonoscopy was performed after a median time of 8 months [IQR 6-11]. No differences between immunoprophylaxis and endoscopy-driven approach was found regarding any endoscopic recurrence (36.1% in prophylaxis group vs 45.5% in observation group, p=0.10) and severe endoscopic recurrence (9.8% in prophylaxis group vs 15.7% in observation group, p=0.15). In 32 patients with a second colonoscopy at a median time of 30.5 months [IQR 22-43.75] after surgery, any recurrence and severe recurrence rates were also similar (p=0.55 and p=0.43, respectively). Early clinical recurrence at 6 months was reported in 23.4% of patients on immunoprophylaxis vs 31.5% who were not (p=0.43). Clinical recurrence rates between prophylaxis and observation group were also similar at 12 months (17.9% vs 34.8%, respectively, p=0.09) and at 24 months (17.9% vs 24.1%, respectively, p=0.63). Conclusion In CD patients with only one RF for POR, immediate immunoprophylaxis after curative IC resection does not decrease the rate of early clinical and endoscopic recurrence. Prospective and larger studies are needed to confirm our results.

SARS-CoV-2 vaccination in inflammatory bowel disease patients with different biological agents: correspondence.

We would like to discuss "Impact of SARS-CoV-2 vaccination in inflammatory bowel disease patients with different biological agents: a systematic review and meta-analysis". The serological responses, breakthrough infections, and clinical relapse of IBD patients treated with biological drugs after SARS-CoV-2 immunization were the subject of a thorough study and meta-analysis. The total seroconversion rate following SARS-CoV-2 immunization in IBD patients receiving biological therapy is high, according to Dai et al. In IBD patients receiving biological therapy, the overall rate of breakthrough infections and the rate of clinical recurrence were both low.

Comparing adalimumab and infliximab in the prevention of postoperative recurrence of Crohn's disease: a systematic review and meta-analysis.

Crohn's disease is a relapsing disease that often requires operative management. Prevention of postoperative recurrence (POR) is critical to maintain remissions. Biologic agents have proven to be most successful in remission maintenance. We made a direct head-to-head comparison of the 2 anti-tumor necrosis factor agents, infliximab (IFX) and adalimumab (ADA), to compare endoscopic and clinical POR of Crohn's disease. We conducted a comprehensive literature search in 7 databases, including Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI-Korean Journal Index, SciELO, and Global Index Medicus. Odds ratios (OR) were calculated with 95% confidence intervals (CI) and P-values (<0.05 considered significant). We evaluated the total rates of endoscopic recurrence, endoscopic recurrence at 1 year, and clinical recurrence rates of IFX and ADA in a direct head-to-head comparison. The search strategy yielded a total of 393 articles. Three studies with a total of 268 participants were included. Our meta-analysis showed no statistically significant difference in total endoscopic recurrence rate between ADA and IFX (27.1% vs. 32.3%, OR 0.696, 95%CI 0.403-1.201; P=0.193; I 2=0%). Nor was there any significant difference between the drugs in endoscopic recurrence rate at 1 year (OR 0.799, 95%CI 0.329-1.940; P=0.620) or clinical recurrence rate (OR 0.477, 95%CI 0.477-1.712; P=0.755). ADA and IFX show comparable efficacy in preventing POR endoscopically and clinically. The clinical decision should be based on cost, side-effects, tolerability, and patient preferences. Additional studies, particularly randomized controlled trials, are needed to determine generalizability.

Added Value of Computed Tomography Angiography Prior to Bronchial Artery Embolization for Hemoptysis: A Retrospective Two-Center Study.

The aim of this retrospective study was to evaluate the added value of pre-procedural computed tomography angiography (CTA) prior to bronchial artery embolization for patients presenting with hemoptysis. In this retrospective study, we evaluated patients admitted for hemoptysis from 2010 to 2021 and treated by catheter-directed embolization. After establishing quality criteria for pre-procedural computed tomography (CT), patients were divided into two groups depending on their pre-procedural imaging assessment: Quality CT-angiography (QCTA group) and suboptimal pre-procedural imaging (suboptimal CTA, unenhanced or no CT evaluation; control group). Groups were compared based on radiological success, procedure-related complications, and clinical success, including cessation of hemoptysis, recurrence rates, and overall mortality. We included 31 patients in the QCTA group, and 35 in the control group. Clinical success was n = 24/31 (77.4%) in the QCTA group and n = 27/35 (77.1%) in the control group (p = 0.979). Technical success was n = 37/42 (88.1%) in the QCTA group and n = 39/42 (92.86%) in the control group (p = 0.820). Overall recurrence was 10.6%. Minor complications occurred in 27.3%, and one major complication was reported.The concordance between the affected bleeding lung and the identification of pathological arteries during angiography was better in the QCTA group (p = 0.045).The average number of culprit arteries (bronchial, non-bronchial systemic arteries [NBSA] or pulmonary) in the QCTA group was not significantly higher than that in the control group. Preprocedural QCTA better identifies the affected bleeding lung and bleeding vessels compared to direct angiography. No difference in clinical success, complications, recurrence rates, or mortality was observed.

Clinical value and potential mechanisms of BUB1B up-regulation in nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) has insidious onset, late clinical diagnosis and high recurrence rate, which leads to poor quality of patient life. Therefore, it is necessary to further explore the pathogenesis and therapy targets of NPC. BUB1 mitotic checkpoint serine/threonine kinase B (BUB1B) was found to be up-regulated in a variety of cancers, but only two previous study showed that BUB1B was overexpressed in NPC and the sample size was small. The clinical role of BUB1B expression and its underlying mechanism in NPC require more in-depth research. Immunohistochemical samples and public RNA-seq data indicated that BUB1B protein and mRNA expression levels were up-regulated in NPC, and summary receiver operating characteristic curve indicated that BUB1B expression level had a strong ability to distinguish NPC tissues from non-NPC tissues. Gene ontology and Kyoto Encyclopedia of genes and genomes were performed and revealed that BUB1B and its related genes were mainly involved in cell cycle and DNA replication. Protein- Protein Interaction were built to interpret the BUB1B molecular mechanism. Histone deacetylase 2 (HDAC2) could be the upstream regulation factor of BUB1B, which was verified by Chromatin Immunoprecipitation Sequencing samples. In summary, BUB1B was highly expressed in NPC, and HDAC2 may affect cell cycle by regulating BUB1B to promote cancer progression.

Open Retromuscular Lateral Abdominal Wall Hernia Repair: Algorithmic Approach and Long-Term Outcomes at a Single Center.

Lateral abdominal wall hernias are relatively rare and present unique challenges to repair. Our group has developed an algorithm for repair based on several anatomic characteristics identified on preoperative imaging. Herein, we report our algorithm and outcomes of a large series of open retromuscular lateral abdominal wall hernia repairs. Open retromuscular lateral abdominal wall hernia repairs performed at our institution from August 2014 through April 2021 were identified in the Abdominal Core Health Quality Collaborative. Hernia characteristics, etiology, operative techniques, postoperative outcomes, and long-term patient-reported outcomes were extracted from the Abdominal Core Health Quality Collaborative database, chart review, and telephone follow-up. Of 464 patients who underwent hernia repair, 121 with isolated lateral abdominal wall hernias (L1-4) and mean follow-up of 34 ± 24 months had a clinical recurrence rate of 0.9% (n = 1) and bulge rate of 37% (n = 42). The median Hernia-Related Quality of Life Survey and PROMIS pain intensity scores improved 37 and 9 points, respectively. Another 343 patients with lateral (L1-4) and midline (M1-5) abdominal wall hernias and mean follow-up of 29 ± 21 months had a clinical recurrence rate of 6% (n = 20) and bulge rate of 35% (n = 117). The median Hernia-Related Quality of Life Survey and PROMIS pain intensity scores improved by 43 and 16 points, respectively. We present an algorithm for open retromuscular lateral abdominal wall hernia repair with relatively low anatomic recurrence rates and substantial improvement in patient-reported quality of life and pain. Notably, postoperative bulging is commonly reported by patients, likely due to underlying denervation injuries from the original incision.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.