Comparison Of Long-term Outcomes Research Articles

Comparison of Long-Term Postoperative Outcomes of the Subtypes of Chronic Rhinosinusitis with Nasal Polyps.

(1) Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory condition that significantly impacts the health-related quality of life (HRQOL) of patients. This study aims to investigate the disparities in preoperative examination findings, postoperative HRQOL, and disease control status based on CRSwNP subtypes. (2) Methods: A retrospective analysis was conducted on 202 patients who underwent endoscopic sinus surgery for CRSwNP. The study assessed clinical characteristics, blood eosinophil and immunoglobulin E (IgE) levels, modified Lund-Kennedy and Lund-Mackay scores, and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. HRQOL was evaluated using the Sino-nasal Outcome Test (SNOT-22) scores, and disease control status was assessed based on the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 guidelines. (3) Results: Of the 202 patients, Eosinophilic CRSwNP patients exhibited significantly higher preoperative peripheral blood eosinophil ratios and IgE levels, and JESREC scores (p < 0.05). Two years postoperatively, patients in the non-eosinophilic group showed significantly improved SNOT-22 scores compared to preoperative scores (p = 0.007). Notably, the proportion of patients with uncontrolled disease was significantly higher in the eosinophilic group (p = 0.035). Logistic regression analyses identified preoperative SNOT-22 scores and eosinophilic CRSwNP subtype as influential factors on disease control status (p < 0.05). (4) Conclusions: Patients with more severe preoperative symptoms and eosinophilic CRSwNP demonstrated poorer long-term treatment outcomes.

Comparisons of long-term clinical outcomes with left bundle branch pacing, left ventricular septal pacing, and biventricular pacing for cardiac resynchronization therapy

BackgroundLeft bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP) are referred to as left bundle branch area pacing. ObjectiveThis study investigated whether long-term clinical outcomes differ in patients undergoing LBBP, LVSP, and biventricular pacing (BiVP) for cardiac resynchronization therapy (CRT). MethodsConsecutive patients with reduced left ventricular ejection fraction (LVEF <50%) undergoing CRT were prospectively enrolled if they underwent successful LBBP, LVSP, or BiVP. The primary composite end point was all-cause mortality or heart failure hospitalization. Secondary end points included all-cause mortality, heart failure hospitalization, and echocardiographic measures of reverse remodeling. ResultsA total of 259 patients (68 LBBP, 38 LVSP, and 153 BiVP) were observed for a mean duration of 28.8 ± 15.8 months. LBBP was associated with a significantly reduced risk of the primary end point by 78% compared with both BiVP (7.4% vs 41.2%; adjusted hazard ratio [aHR], 0.22 [0.08–0.57]; P = .002) and LVSP (7.4% vs 47.4%; aHR, 0.22 [0.08–0.63]; P = .004]. The adjusted risk of all-cause mortality was significantly higher in LVSP than in BiVP (31.6% vs 7.2%; aHR, 3.19 [1.38–7.39]; P = .007) but comparable between LBBP and BiVP (2.9% vs 7.2%; aHR, 0.33 [0.07–1.52], P = .155). Propensity score adjustment also obtained similar results. LBBP showed a higher rate of echocardiographic response (ΔLVEF ≥10%: 60.0% vs 36.2% vs 16.1%; P < .001) than BiVP or LVSP. ConclusionLBBP yielded long-term clinical outcomes superior to those of BiVP and LVSP. The role of LVSP for CRT needs to be reevaluated because of its high mortality risk.

MACE and Hyperthyroidism Treated With Medication, Radioactive Iodine, or Thyroidectomy

Excessive thyroid hormones from hyperthyroidism increase cardiovascular risks. Among 3 available treatments for hyperthyroidism, comparisons of long-term outcomes associated with antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery to treat newly diagnosed hyperthyroidism are lacking. To compare risks of major adverse cardiovascular events (MACE) and all-cause mortality among patients with hyperthyroidism treated with ATDs, RAI, or surgery. This nationwide cohort study used the Taiwan National Health Insurance Research Database. Patients aged 20 years or older with newly diagnosed hyperthyroidism between 2011 and 2020 were enrolled. Treatment groups were determined within 18 months from diagnosis, with follow-up until the development of MACE, death, or the end date of the database, whichever came first. Data were analyzed from October 2022 through December 2023. The ATD group received ATDs only. RAI and surgery groups could receive ATDs before treatment. Anyone who underwent thyroid surgery without RAI was classified into the surgery group and vice versa. The primary outcomes included MACE (a composite outcome of acute myocardial infarction, stroke, heart failure, and cardiovascular mortality) and all-cause mortality. Among 114 062 patients with newly diagnosed hyperthyroidism (mean [SD] age, 44.1 [13.6] years; 83 505 female [73.2%]), 107 052 patients (93.9%) received ATDs alone, 1238 patients (1.1%) received RAI, and 5772 patients (5.1%) underwent surgery during a mean (SD) follow-up of 4.4 (2.5) years. Patients undergoing surgery had a significantly lower risk of MACE (hazard ratio [HR] = 0.76; 95% CI, 0.59-0.98; P = .04), all-cause mortality (HR = 0.53; 95% CI, 0.41-0.68; P < .001), heart failure (HR = 0.33; 95% CI, 0.18-0.59; P < .001), and cardiovascular mortality (HR = 0.45; 95% CI, 0.26-0.79; P = .005) compared with patients receiving ATDs. Compared with ATDs, RAI was associated with lower MACE risk (HR = 0.45; 95% CI, 0.22-0.93; P = .03). Risks for acute myocardial infarction and stroke did not significantly differ between treatment groups. In this study, surgery was associated with lower long-term risks of MACE and all-cause mortality, while RAI was associated with a lower MACE risk compared with ATDs.

Comparative long-term outcomes of natural orifice specimen extraction surgery and conventional laparoscopic colectomy for left-sided colorectal cancer: a propensity score-matched analysis.

Natural orifice specimen extraction surgery (NOSES) is currently widely used in left-sided colorectal cancer. Some clinical comparative studies have been conducted, providing evidence of its safety and oncological benefits. However, these studies are typically characterized by small sample sizes and short postoperative follow-up periods. Consequently, in this research, the authors adopt the propensity score matching method to undertake a large-scale retrospective comparative study on NOSES colectomy for left-sided colorectal cancer, with the goal of further augmenting the body of evidence-based medical support for NOSES. This retrospective study involved patients who underwent NOSES colectomy and conventional laparoscopic (CL) colectomy for left-sided colorectal cancer between January 2014 and April 2021. In the NOSES group, specimens were extracted through the anus with the help of a Cai tube (homemade invention: ZL201410168748.2). The patients were matched at a ratio of 1:1 according to age, sex, BMI, tumor diameter, tumor location (descending and splenic flexure colon/ sigmoid colon/ middle and upper rectum), tumor height from anal verge, ASA grade, previous abdominal surgery, clinical pathologic stage, preoperative CEA. After matching, 132 patients in the NOSES group and 132 patients in the CL group were eligible for analysis. Compared with CL group, NOSES group was associated with decreased postoperative maximum pain score (2.6±0.7 vs. 4.7±1.7, P=0.000), less additional analgesia required (6.8 vs. 34.8%, P=0.000), faster time to passage of flatus (2.3±0.6 days vs. 3.3±0.7 days, P=0.000), less wound infection (0.0 vs. 6.1%, P=0.007), and longer operative time (212.5±45.8min vs. 178.0±43.4min, P=0.000). No significant differences were observed in estimated blood loss, time to resume regular diet, postoperative hospital stay, conversion to open surgery or conventional minilaparotomy, total morbidity, readmission, mortality, pathologic outcomes, and Wexner incontinence score between groups. After a median follow-up of 63.0 months, the 5-year overall survival rates were 88.3 versus 85.0% (P=0.487), disease-free survival rates were 82.9 versus 83.6% (P=0.824), and the local recurrence rates were 4.4 versus 4.0% (P=0.667) in the NOSES and CL groups, respectively. This study suggests that NOSES colectomy using a Cai tube for left-sided colorectal cancer is a safe and feasible option with better cosmetic results, less pain, faster recovery of gastrointestinal function, and comparable long-term clinical and oncologic outcomes to CL colectomy.

Pelvic Exenteration Surgery Outcomes Following Establishment of a Complex Pelvic Surgery Multidisciplinary Tertiary Unit

Background: Pelvic exenteration surgery (PES) is a complex operation associated with significant morbidity. PES requires sub-specialised multidisciplinary input along with expertise in complex pelvic surgery and anatomy. The majority of published data on PES comes from high volume units, however there is emerging evidence of comparable short and long-term outcomes in lower volume units where dedicated multidisciplinary teams are established. This study reports outcomes of PES in a lower volume centre with a collaborative multidisciplinary surgical approach. Methods: A retrospective review of patients who underwent PES for benign or malignant pathology at Liverpool and Macquarie University Hospitals between September 2015 and June 2022. Descriptive statistics were performed and KaplanMeier survival analysis for patients treated for malignancy with curative intent. Results: A total of 67 patients undergoing pelvic exenteration were included (53.8% female; with mean age 59 years). Indications for PES were colorectal cancer (56.7%), gynaecological cancer (22.4%), other malignancy (9.0%) and complex benign pathology (11.9%). Posterior or total pelvic exenteration was performed in 88.1%. Median hospital stay was 16 days. Clavien-Dindo grade III or IV complications occurred in 34.3%. There were two post-operative deaths (3.0%; one palliative intent). For patients treated with curative intent (n=51), R0 resection margin was achieved in 92.2%, and R1 margin in 7.8%. Estimated five-year disease-free survival was 57.1%, and five-year overall survival was 65.5%. Conclusion: Short and long-term outcomes of PES in a low volume unit with appropriate multidisciplinary expertise are comparable to published data on pelvic exenteration from higher volume units.

Comparison of long-term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE-CRUSH II registry.

Double kissing (DK)-crush and T-stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long-term outcomes of DK-crush and TAP techniques in patients with complex bifurcation lesions. A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single-center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. The initial management strategy was DK-crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK-crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK-crush group compared to the TAP group. The long-term TLF was significantly higher in the TAP group compared to the DK-crush group (unadjusted HR: 1.974, [95% CI: 1.044-3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232-5.061], p = 0.011). The present study showed that the DK-crush technique of bifurcation treatment was associated with lower long-term TLF and TLR rates compared to the TAP technique.

Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation.

Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow-low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow-low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow-high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow-high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918-0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645-5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106-1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.

A Single-Center Experience in Low Ejection Fraction Coronary Artery Bypass Surgery

Background. Coronary artery bypass graft (CABG) in patients with an ejection fraction (EF) ≤ 35% predisposes them to higher complications and mortality risks. Given the usually compromised status of other end organs in low EF patients, ONCAB, involving cardiopulmonary bypass (CPB) and aortic cross-clamping, might intuitively pose more complications than OPCAB. Objective. To explore short- and long-term outcomes between ONCAB and OPCAB procedures in patients with EF ≤ 35%. Methods. A retrospective and observational analysis was conducted in 196 patients with EF ≤ 35% who underwent ONCAB (n = 58) or OPCAB (n = 138) procedures at a single center between January 2015 and May 2023. Baseline characteristics were well matched using the stabilized inverse probability treatment weighted matching technique. Results. After matching, ONCAB and OPCAB had comparable 30-day mortality and 30-day cardiac mortality. OPCAB exhibited significantly shorter length of hospital and ICU stays, with a trend towards more discharges to home. Rates of composite complication and its individual components such as acute kidney injury, reoperation bleeding, stroke, pneumonia, GI disease, and atrial fibrillation were similar between the two groups. Rates of sepsis, liver dysfunction, and blood transfusion were significantly lower in the OPCAB group. As assessed by EF and LVDD, neither procedure showed superiority in improving cardiac function. Median follow-up time was 4.9 (interquartile range: 2.1–7.2) years. After matching, long-term overall survival (1, 3, 7 years) and cardiac mortality rates were comparable between OPCAB and ONCAB. Cumulative rates of cardiac arrest, heart failure, myocardial infarction (MI), atrial fibrillation (Afib), renal disease, and readmission (overall and cardiac) at 7 years were similar. Conclusion. This study demonstrates comparable short-term and long-term outcomes between ONCAB and OPCAB in patients with reduced EF, with OPCAB favoring faster recovery. OPCAB appears as a safer and equally effective option for low EF CABG patients. Larger samples and longer follow-ups are needed for conclusive clinical evidence.

Comparison of long-term outcomes between a single versus a multiple stent brand strategy during �full metal jacket� procedures

Comparison of long-term outcomes between a single versus a multiple stent brand strategy during �full metal jacket� procedures

Comparison of long-term oncological outcomes after central lumpectomy versus nipple-sparing breast-conserving surgery for centrally located breast cancer: a propensity score-matched study.

To compare the oncological safety of nipple-sparing breast-conserving surgery (BCS) versus central lumpectomy for centrally located breast cancer (CLBC). Patients who underwent BCS for CLBC at Asan Medical Center from 2007 to 2018 were reviewed retrospectively. The oncological outcomes of nipple-sparing BCS (NS-BCS) and central lumpectomy were compared using univariate and multivariate Cox regression analyses and compared again after 1:1 propensity score matching (PSM). The study included 306 patients who underwent NS-BCS and 106 patients who underwent central lumpectomy (median follow-up: 111months). On multivariate analysis, central lumpectomy had a lower risk of local recurrence compared to NS-BCS, albeit without statistical significance (HR 0.14, 95% CI 0.02-1.24; p = 0.077). There was no significant difference in the risk of death (HR 0.14, 95% CI 0.01-1.68, p = 0.12). After PSM, each group had 106 patients. The 5-year and 10-year local recurrence-free survival rates were 94.2% and 92.9% for NS-BCS, and 99.1% and 99.1% for central lumpectomy, respectively (p = 0.031). There were no significant differences in overall survival, regional recurrence-free survival, or distant recurrence-free survival. Fifteen patients (4.9%) who underwent NS-BCS had ipsilateral breast tumor recurrence (IBTR), of which 40% were in the nipple-areolar complex and previous surgical sites. One patient (0.9%) who underwent central lumpectomy experienced an IBTR in a different quadrant. NS-BCS showed more local recurrence than central lumpectomy. When deciding whether to spare the nipple during BCS in CLBC, patients should be sufficiently informed about the risk of IBTR.

Comparison of long-term outcomes between imatinib and dasatinib prophylaxis after allogeneic stem cell transplantation in patients with Philadelphia-positive acute lymphoblastic leukemia: A multicenter retrospective study.

Although the prognosis of Philadelphia-positive acute lymphoblastic leukemia (Ph+ALL) has improved with the introduction of tyrosine kinase inhibitors (TKIs) and stem cell transplantation, prevention of relapse after transplantation remains a concern. The aim of this study was to compare the impact of TKI prophylaxis with imatinib and dasatinib on long-term outcomes after transplantation. Patients with Ph+ALL who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at first complete remission (CR1) and received TKI prophylaxis after allo-HSCT were included in this retrospective analysis. Two cohorts were established based on the choice of TKI prophylaxis: the imatinib (Ima) and dasatinib (Das) cohorts. The survival and safety outcomes of these cohorts were compared. Ninety-one patients in the Ima cohort and 50 in the Das cohort were included. After a median follow-up of 50.6months, the 5-year cumulative incidence of relapse, nonrelapse mortality rate, and overall survival in the Ima and Das cohorts were 16.1% and 12.5%, 5.2% and 9.8%, and 86.5% and 77.6%, respectively, with no statistical differences. The cumulative incidence of mild chronic graft-versus-host disease was higher in the Das cohort. The most common adverse event was neutropenia (64.7% vs. 69.5%). The Das cohort had a higher incidence of gastrointestinal bleeding (25.5% vs. 2.3%) and gastrointestinal reaction (48.9% vs. 31.4%) than the Ima cohort. The proportion of patients treated on schedule was significantly lower in the Das cohort than in the Ima cohort, and drug intolerance was the main reason for protocol violation. For patients with Ph+ALL undergoing allo-HSCT in CR1, imatinib prophylaxis achieved long-term outcomes similar to those of dasatinib.

Simultaneous Versus Staged Surgery for Double Crush Syndrome of Cervical Radiculopathy and Peripheral Nerve Compression at the Wrist: A Retrospective Single-Center Study.

Retrospective single-center study. To evaluate the results of surgical treatment in patients with double crush syndrome associated with cervical radiculopathy and upper limb peripheral nerve compression after staged and simultaneous operations. Currently, choosing the optimal diagnostic and therapeutic modalities for treating patients with double crush syndrome remains unresolved. The study included 79 patients with double crush syndrome (cervical radiculopathy and syndrome of Guyon's canal or Carpal tunnel syndrome). Two independent groups were studied: In the Staged Group (n=35), we performed a cervical decompression with stabilization and peripheral nerve decompression at separate days due to ongoing clinical symptoms (average interval between interventions being 22 (18;26) days). In the simultaneous group (n=33), we performed both the cervical spine surgery as well as the peripheral nerve procedures in one surgical session. Total operative time, estimated blood loss, length of hospitalization, complications, and clinical data (NDI score, SF-36, VAS neck pain score, VAS arm pain score, Disabilities of Arm, Shoulder, and Hand (DASH) score, and Macnab scale) were compared. We used the Mann-Whitney (MW) test for intergroup comparisons, the Wilcoxon criterion for dependent samples, and the Fisher exact test for binomial parameters. There was a significantly lower operative time, duration of inpatient treatment, and temporary disability in the simultaneous group (P=0.01, P=0.04, and P=0.006, respectively). Comparative analysis did not reveal significant intergroup differences using NDI, VAS, and DASH ( P >0.05), whereas, at discharge, significantly better clinical parameters were appreciated for the simultaneous group using SF-36 and Macnab scores ( P =0.04 and P =0.03, respectively). At the last follow-up, an intra-group analysis revealed comparable clinical effectiveness between the two approaches ( P >0.05). Comparison of the effectiveness of simultaneous and staged surgery revealed comparable long-term clinical outcomes. However, simultaneous surgery conveys clinically important advantages in terms of surgical time, anesthesia duration, length of hospitalization, and patient disability. 3.

Comparison of long-term outcomes between ileal conduit and transuretero-cutaneostomy urinary diversion after radical cystectomy: a systematic review and meta-analysis.

Urinary diversion in bladder cancer treatment has been a distinguished topic of interest due to varying approaches available. Amongst them, ileal conduit (IC) and transuretero-ureterostomy (TUU) have been popular options in clinical practice. This study would like to compare the long-term outcomes of IC and TUU in patients undergoing RC procedures. Literature searches were conducted in MEDLINE, CENTRAL, and EMBASE. Duration of hospitalization, complication rate, quality of life, and survival rate were selected as outcomes. Risk of bias was assessed using the ROBINS-I tool. Outcome measure was pooled using forest plot in Review Manager V.5 for Macintosh. Heterogeneity was measured using the DerSimonian and Laird random-effects model. Eighteen matching interventional studies were included, 3 were prospective studies. The total number of included samples was 3,689; 1,172 patients of the TUU and 2,517 of IC group. The IC procedure associates with longer hospitalization [mean difference 3.80 [95% confidence interval (CI): 2.27-5.32), p < 0.001, I2 = 92%]. Duration of intensive care did not differ significantly. There were no differences in major complication rates [odds ratio (OR) = 1.45, 95% CI: 0.74-2.84, p = 0.27, I2 = 54%]: stone formation (OR = 1.07, 95% CI: 0.51-2.23, p = 0.48, I2 = 0%), and renal function deterioration (OR = 0.81, 95% CI: 0.39-1.68, p = 0.57, I2 = 0%) between the TUU and IC groups. Quality of life decreased in both groups, and only occurred in the early days after the stoma placement phase. Survival rates were not different among the groups. TUU is a better UD option as it offers shorter time of hospitalization, with the similar major complications, quality of life, and survival rate compared to IC.

P526 Handsewn versus Stapled Ileocolic Anastomosis for Crohn's: Comparable Outcomes Despite More Severe Disease Profile in the Handsewn Group

Abstract Background Stapled anastomosis is the most common anastomotic method after ileocolic resection for Crohn's disease, whereas handsewn end-to-end (HS-ETE) anastomosis is less frequently performed. The optimal technique for ileocolic anastomosis in Crohn's patients remains controversial. Some studies have suggested potential benefits of HS-ETE over SSTS, including lower recurrence rates, whereas others have found no difference. We aimed to compare short-term postoperative outcomes and long-term recurrence-free survival between the HS-ETE and SSTS groups at our center. Methods This retrospective study included consecutive patients who underwent ileocolic resection for Crohn's disease between 2012-2022 with either HS-ETE or SSTS anastomosis. The primary outcomes were perianastomotic recurrence and need for surgical/endoscopic intervention. Cox regression and Kaplan-Meier curves were used to compare recurrence-free survival. Results A total of 764 patients were included: 162 (21%) with HS-ETE and 602 (79%) with SSTS anastomosis. The median age of the HS-ETE and SSTS groups was 39 and 38 years, respectively. Males comprised 43% of the HS-ETE group and 51% of the SSTS group. The median BMI was 24 kg/m2 in both groups. The HS-ETE group had a longer median disease duration (10 vs. 7 years, p=0.02) and a higher rate of previous abdominal surgery (35% vs. 22%, p=0.01) than the SSTS group did. The ileocolonic location (78% vs. 66%, p=0.03) and perforating disease (45% vs. 35%, p=0.04) were also more common in the HS-ETE group. The median operative time (207 min vs. 147 min, p&amp;lt;0.001) and estimated blood loss (150 mL vs. 75 mL, p&amp;lt;0.001) were greater in the HS-ETE group. There were no differences in 30-day outcomes between the groups. Perianastomotic recurrence rates were similar between the HS-ETE and SSTS groups (29.6% vs. 28.9%, p=0.93). The 5-year recurrence-free survival rates were also comparable (HS-ETE, 56.4% vs. SSTS, 59%; p=0.94). Also, we found that the risk of requiring surgical or endoscopic intervention for recurrence between HS-ETE and SSTS was comparable (HS-ETE, 65.2% vs. SSTS, 74.2%; p=0.273) Conclusion Although the HS-ETE group had worse baseline disease characteristics, including longer disease duration, higher previous surgery rates, and more aggressive disease location and behavior, HETE and SSTS anastomosis after ileocolic resection for Crohn’s disease yielded comparable perioperative and long-term outcomes in our patient cohort.

Short-term and Long-term Outcomes of Robotic Enucleation of Tumors Located in the Pancreatic Head and Uncinate Process.

To assess short-term and long-term outcomes following robotic enucleation (REn) of tumors in the proximal pancreas. Despite the advantages of preserving function via pancreatic enucleation, controversies persist, since this can be associated with severe complications, such as clinically relevant postoperative pancreatic fistula, especially when performed near the main pancreatic duct. The safety and efficacy of REn in this context remain largely unknown. A retrospective analysis was performed of all patients who underwent REn for benign and low-grade malignant neoplasms in the pancreatic head and uncinate process between January 2005 and December 2021. Clinicopathologic, perioperative, and long-term outcomes were compared with a similar open enucleation (OEn) group. Of 146 patients, 92 underwent REn with a zero conversion-to-open rate. REn was superior to OEn in terms of shorter operative time (90.0minutes vs 120.0minutes, P<0.001), decreased blood loss (20.0mL vs 100.0min, P=0.001), and lower clinically relevant postoperative pancreatic fistula rate (43.5% vs 61.1%, P=0.040). Bile leakage rate, major morbidity, 90-day mortality, and length of hospital stay were comparable between groups. No post-REn grade C POPF or grade IV/V complication was identified. Subgroup analyses for uncinate process tumors and proximity to the main pancreatic duct did not demonstrate inferior postoperative outcomes. In a median follow-up period of 50 months, REn outcomes were comparable to OEn regarding recurrence rate and pancreatic endocrine or exocrine function. REn for pancreatic head and uncinate process tumors improved clinically relevant outcomes without increased major complications compared to OEn, while demonstrating comparable long-term oncological and functional outcomes.

Comparison of long-term outcomes after first HLA-mismatched unrelated donor transplantation with single unrelated cord blood transplantation using reduced-intensity or reduced-toxicity conditioning

BackgroundNo comparative data have shown significant survival differences between HLA-mismatched unrelated donor (MMUD) transplantation and cord blood (CB) transplantation, each with reduced-intensity/reduced-toxicity conditioning (RIC/RTC). However, advances in graft-versus-host disease (GVHD) prophylaxis might help update current strategies. MethodsWe retrospectively compared the outcomes of first allogeneic hematopoietic cell transplantation from MMUDs (n = 15) or single unrelated CB (n = 35) after RIC/RTC. ResultsThe median age was 60 years. The MMUD group had a numerically lower 100-day incidence of grade III–IV acute GVHD (7% vs. 29%, P = 0.079) and non-relapse mortality (0% vs. 40%, P = 0.12). Eight MMUD recipients received anti-thymocyte globulin, bortezomib, or posttransplant cyclophosphamide for GVHD prophylaxis. They did not develop grade III–IV acute GVHD. The MMUD group had significantly better 5-year overall survival than the CB group (62% vs. 31%, P = 0.021), although relapse rates were similar. A multivariable analysis and sensitivity analysis also showed trends toward higher overall survival in the MMUD group. ConclusionMMUD with better GVHD prophylaxis might be preferred over CB in patients with older age and comorbidities.

Comparison of long-term clinical outcome after endovascular versus neurosurgical treatment of ruptured intracranial anterior circulation aneurysms: A single-centre experience

IntroductionIn patients with anterior circulation aneurysmal Subarachnoid Haemorrhage (aSAH), endovascular coiling is currently practiced more frequently than neurosurgical clipping. However, despite multiple previous studies, it is still uncertain whether coiling is favourable in terms of long-term clinical outcome. Research questionWhat is the effect of clipping versus coiling on long-term functional outcome of patients with an aSAH? Material and methodsAll anterior circulation aSAH patients (2012–2015) treated with clipping or coiling in two hospitals in the Netherlands were studied up to five years after treatment. Functional outcome, survival, retreatment- and complication rate were measured. Survival analysis was performed in both groups. A multivariable regression model with covariate adjustment was performed to investigate the likelihood of unfavourable outcome (modified Rankin Scale >2). ResultsOut of 204 patients, 75 patients were clipped (37%) and 129 received coiling (63%). Coiling had a higher retreatment rate compared to clipping (7.8% vs. 0.0%). Unfavourable outcome at six, 12, 24 and 60 months after treatment was higher for patients after clipping compared to coiling, but was not significant after correcting for clinical severity as represented by the WFNS grade. In 60 months, no difference in survival was found between clipping and coiling. Discussion and conclusionNo differences between clipping and coiling in survival and long-term functional outcome have been found in this study. More research with prospective design and large cohorts is needed to identify possible differences between the two treatments.

Comparison of Short-term and Long-term Outcomes after Different Reconstructions between Totally Laparoscopic Distal Gastrectomy and Laparoscopic-assisted Distal Gastrectomy for Gastric Cancer: a Retrospective Analysis at a High-volume Center.

Background: The short-term and long-term outcomes of laparoscopic-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) have been subject to controversy with various reconstruction techniques of Billroth-I, Billroth-II, Roux-en-Y, and Uncut. This study aims to compare the short-term and long-term outcomes of LADG and TLDG as well as the outcomes of different anastomoses. Methods: This study enrolled patients with gastric cancer at the First Affiliated Hospital of Nanjing Medical University (NMUH) between 2017 and 2021. Postoperative complications were classified according to the Clavien-Dindo grade. Exclusion criteria included metachronous and synchronous malignancy and palliative surgery. The Kaplan-Meier analysis was applied to assess 5-year prognosis between two groups. Results: This study included 1221 cases with an overall complication rate of 17.37% for LADG, which was significantly higher than TLDG's 10.72%. The incidence of anastomosis-related complications was 4.79% for LADG and 1.13% lower for TLDG. LADG and TLDG did not show significant difference for Grade III-V complications and resected lymph nodes. The postoperative stay was shorter for TLDG than LADG, and R-Y had a longer postoperative stay than B-II and Uncut after combining LADG and TLDG. The operation time was shorter in TLDG cases than that in LADG cases. The 5-year OS of the TLDG group was not significantly better than that of the LADG group. Conclusion: TLDG is superior in overall complication rate, anastomosis-related complication rate, postoperative stay and operation time to LADG. No difference of OS was observed between LADG and TLDG. Four anastomoses had no convincing evidence of being superior in complications rates, post-op stay, and harvested lymph nodes to each other.

Clinical Outcomes of Intracardiac Echocardiography-Guided Contrast Agent-Free Cryoballoon Ablation in Atrial Fibrillation Patients With Renal Insufficiency.

Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA. A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA. In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHA2DS2-VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group. ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.

Oncologic Outcomes of Immediate Breast Reconstruction in the Setting of Neoadjuvant Chemotherapy: A Long-term Follow-up Study of a Matched Cohort.

Despite the increasing use of immediate breast reconstruction (IBR), its oncologic safety in the setting of neoadjuvant chemotherapy (NACT) needs to be comprehensively clarified in breast cancer management. The objective of the present study was to analyze the oncologic safety of IBR following NACT. In total, 587 patients with breast cancer who underwent a total mastectomy (TM) with IBR after NACT between 2008 and 2017 at a single institution were retrospectively reviewed. The reviewed patients with IBR following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) were matched 1:3 to patients who underwent TM alone after NACT. Matching variables included age, clinical T and N stages before NACT, response to NACT, pathologic T and N stages, and molecular subtypes. After propensity score matching, 95 patients who underwent IBR following SSM/NSM after NACT (IBR group) and 228 patients who underwent TM alone after NACT (TM group) were selected. The median follow-up period was 73 (range, 5-181) months after matching. After matching, there were no significant differences between the two groups in 5-year locoregional recurrence-free survival (88.8% vs. 91.2%, p = 0.516), disease-free survival (67.3% vs. 76.6%, p = 0.099), distant metastasis-free survival (71.9% vs. 81.9%, p = 0.057), or overall survival (84.1% vs. 91.5, p = 0.061) rates. In multivariate analyses, conducting IBR was not associated with increased risks for locoregional recurrence, any recurrence, distant metastasis, or overall death. Our findings suggest that IBR following SSM/NSM elicits comparable long-term oncologic outcomes to those of TM alone in the setting of NACT.