Compare Recurrence Rates Research Articles

A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

Abstract Background Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population. Methods Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates. Results Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40–680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups. Conclusion The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.

Which Technique is Preferable for Grade 2–3 Hemorrhoidal Disease: Laser vs. Rubber Band Ligation? A Retrospective Study

Abstract Background The aim of this study is to compare the short and long-term results (postoperative pain, complications, return to daily life, recurrence) between patients who underwent laser hemorrhoidoplasty (LH) and rubber band ligation (RBL) due to grade 2–3 hemorrhoidal disease. Methods The results of patients who underwent LH and RBL between June 2020 and June 2023 for grade 2–3 hemorrhoidal disease were evaluated retrospectively. The patient information was examined in terms of operation time, postoperative 1st, 7th and 14th day visual analog scale (VAS) values, the amount of analgesic used in the first 7 postoperative days, return to normal life (days), recurrence within 1 year and other complications (postoperative bleeding, thrombosis, urinary retention, infection/abscess, anal stenosis, deterioration in continence). Results A total of 260 patients were included in the study, 166 of whom underwent RBL and 94 LH. Operation time, VAS values, postoperative 7-day analgesic use (mg), worsening of incontinence, time to return to normal life (days), complications and recurrence within 1 year evaluated. LH has statistically significant lower postoperative 1st day pain and less analgesic use (mg) than RBL (p < 0.001). Conclusıons LH and RBL both offer effective treatment options for grade 2–3 hemorrhoidal disease, with comparable recurrence rates and time to return to normal life. However, LH is associated with significantly less postoperative pain and analgesic use on the first postoperative day, potentially enhancing patient satisfaction.

P-1470. Single-dose Aminoglycosides versus Carbapenems for the Treatment of Uncomplicated Urinary Tract Infections caused by Extended-spectrum Beta-lactamase-phenotype Enterobacterales

Abstract Background Carbapenems are often used for treatment of infections caused by extended-spectrum β-lactamase-producing (ESBL) Enterobacterales. Over utilization has led to carbapenem resistance and these infections can be difficult to treat. Limiting unnecessary carbapenem exposure has been shown to decrease the risk of carbapenem resistance and a 2023 Infectious Disease Society of America guidance document recommends non-carbapenem alternatives for the treatment of uncomplicated urinary tract infections (uUTI). A single dose of an aminoglycoside (AG) can be considered, however clinical trial data is lacking, especially for those with infections caused by drug-resistant pathogens. Methods A retrospective, multi-center, cohort study over 60-months evaluated hospitalized patients within the NYU Langone Health System ≥18 years of age who received a single dose of an AG for the treatment of an uUTI caused by an AG-susceptible, ESBL-phenotype (defined as ceftriaxone MIC ≥2 mcg/mL) gram-negative bacilli (GNB). Patients who received MEM for ≥72 hours were the active comparator. Clinical success, a composite of the following, was assessed at Day 7 (±2 days) post-therapy or at discharge, whichever occurred sooner: clinical cure, defined as complete resolution or significant improvement of baseline uUTI signs/symptoms; microbiological response, defined as reduction in baseline uropathogen to < 103 CFU/mL. To demonstrate non-inferiority, 352 patients were needed to achieve 90% power. Results Baseline characteristics can be found in Table 1. Clinical success occurred in 97% (N=37) vs. 86% (N=129) of patients treated with an AG vs. MEM, respectively (p=0.052). Non-inferiority was met with a 0.11 proportion difference in clinical success (90% confidence interval [-0.011, 0.25]) within the predefined non-inferiority limit. No statistically significant differences in secondary outcomes were observed (Table 2). Diarrhea was more common in those treated with MEM (p=0.049; Table 3). Conclusion Single dose AG demonstrated comparable clinical success and recurrence rates to MEM for the treatment of uUTI caused by ESBL-producing GNB. The study was underpowered, increasing the chance for type II error. A future prospective study is warranted to justify preliminary findings. Disclosures Michael Bosco, PharmD, BCIDP, AAHIVP, Shionogi Inc: Advisor/Consultant|Shionogi Inc: Grant/Research Support

Cryoballoon Pulmonary Vein Isolation in Obese Patients with Atrial Fibrillation Compared to Non-Obese Counterparts: A Meta-Analysis

Introduction: Obesity is an important risk factor for atrial fibrillation (AF) development. Data on cryoballoon ablation (CBA) outcomes in obese patients have so far been scarce. We reviewed the existing literature to compare the efficacy and safety of CBA in obese versus non-obese AF patients. Methods: A systematic literature search was conducted for studies comparing clinical outcomes (arrhythmia recurrence and/or procedural data and/or safety outcomes) between obese and non-obese patients undergoing CBA for AF. Statistical pooling was performed according to a random-effects model with generic inverse-variance weighting of relative risks (RRs) and standardised mean differences (SMDs) computing risk estimates with 95% confidence intervals (CIs). Results: Obese and non-obese patients had comparable arrhythmia recurrence rates (normal versus overweight, RR = 0.95, 95% CI: 0.82–1.11, p = 0.55, I2% = 91%; normal versus class I obesity, RR = 0.97, 95% CI: 0.82–1.13, p = 0.68, I2% = 87%; normal versus class II obesity, RR = 0.98, 95% CI: 0.91–1.07, p = 0.29, I2% = 65%). Procedure time was marginally increased in obese patients compared to non-obese counterparts (normal versus overweight, SMD = 0.05, 95% CI: −0.15–0.26, p = 0.62, I2% = 74%; normal versus class I obesity, SMD = 0.10, 95% CI: −0.00–0.19, p = 0.06, I2% = 2%; overweight versus class I obesity, SMD = 0.11, 95% CI: 0.01–0.21, p = 0.048, I2% = 25%). Regarding radiation exposure, fluoroscopy time was increased in patients with class I obesity compared to normal-weight or overweight patients and dose area product was also increased in obese patients compared to non-obese patients. Lastly, the risk of complications did not differ between obese and non-obese patients. Statistical heterogeneity and the small number of patients included are the main limitations of this study. Conclusion: CBA seems to be effective for obese patients suffering from AF, featuring also similar safety outcomes with non-obese individuals. Radiation exposure was increased in obese patients.

Development of a risk prediction model for personalized assessment of postoperative recurrence risk in colon cancer patients.

Colon cancer, a significant contributor to cancer-related mortality worldwide, exhibits a high recurrence rate in patients following surgical intervention, particularly when the disease has progressed to intermediate or advanced stages. This study undertakes a comprehensive analysis of the risk factors influencing postoperative recurrence in patients with middle- to late-stage colon cancer and subsequently develops a columnar graphical prediction model based on these findings. This model seeks to enhance the capability of identifying the risk of postoperative recurrence in patients with intermediate and advanced colon cancer, thereby providing a scientific foundation for the development of more personalized and effective prevention and management strategies. An analysis was conducted on a cohort of 209 patients diagnosed with colon cancer and treated at our hospital between 2020 and 2021. Clinical data were gathered to compare recurrence rates of postoperative colon cancer among patients with different influencing factors. Logistic regression analysis was utilized to determine independent factors affecting the recurrence rate of postoperative colon cancer. A nomogram risk prediction model was developed and assessed for its effectiveness. The results of the regression analysis indicated that "Tumor stage" (stage IV), "Lymph node metastasis" (presence), "the level of C-reactive protein", and "the level of carcinoembryonic antigen" were identified as independent risk factors for postoperative colon cancer recurrence in patients. Additionally, "Differentiation degree" (medium/high), "Chemotherapy (have)", and "the level of serum albumin" were found to be associated with a decreased risk of recurrence. A nomogram prediction model was created using the mentioned risk factors, showing a link between higher scores and higher postoperative colon cancer recurrence rates. The model had a C-index of 0.834 [95% confidence interval (CI): 0.776-0.892] and was internally validated for strong and consistent performance. This study developed a nomogram prediction model to forecast the recurrence rate of postoperative colon cancer by identifying independent influencing factors. The model demonstrates strong discrimination and consistency, offering valuable guidance in promptly assessing the likelihood of postoperative colon cancer recurrence in patients and implementing timely and effective preventive measures.

Comparing recurrence rates between endoscopic mucosal resection and endoscopic submucosal dissection in Barrett's endoscopic therapy: timing and definitions matter!

Comparing recurrence rates between endoscopic mucosal resection and endoscopic submucosal dissection in Barrett's endoscopic therapy: timing and definitions matter!

Comparing Recurrence Rates and the Cost-Effectiveness of Arthroscopic Labral Repair and Nonoperative Management for Primary Anterior Shoulder Dislocations in Young Patients: A Decision-Analytic Markov Model-Based Analysis

Background: Value-based decision-making regarding nonoperative management versus early surgical stabilization for first-time anterior shoulder instability (ASI) events remains understudied. Purpose: To perform (1) a systematic review of the current literature and (2) a Markov model–based cost-effectiveness analysis comparing an initial trial of nonoperative management to arthroscopic Bankart repair (ABR) for first-time ASI. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1000 simulated patients (mean age, 20 years; range, 12-26 years) with first-time ASI undergoing nonoperative management versus ABR. Utility values, recurrence rates, and transition probabilities were derived from the published literature. Costs were determined based on the typical patient undergoing each treatment strategy at the authors’ institution. Outcome measures included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Results: The Markov model with Monte Carlo microsimulation demonstrated mean (± standard deviation) 10-year costs for nonoperative management and ABR of $38,649 ± $10,521 and $43,052 ± $9352, respectively. Total QALYs acquired over the 10-year time horizon were 7.67 ± 0.43 and 8.44 ± 0.46 for nonoperative management and ABR, respectively. The ICER comparing ABR with nonoperative management was found to be just $5725/QALY, which falls substantially below the $50,000 willingness-to-pay (WTP) threshold. The mean numbers of recurrences were 2.55 ± 0.31 and 1.17 ± 0.18 for patients initially assigned to the nonoperative and ABR treatment groups, respectively. Of 1000 samples run over 1000 trials, ABR was the optimal strategy in 98.7% of cases, with nonoperative management the optimal strategy in 1.3% of cases. Conclusion: ABR reduces the risk for recurrent dislocations and is more cost-effective despite higher upfront costs when compared with nonoperative management for first-time ASI in the young patient. While all these factors are important to consider in surgical decision-making, ultimate treatment decisions should be made on an individual basis and occur through a shared decision-making process.

Meta-Analysis of Long Term Prognosis of Non-Operative Active Surveillance vs Completion Thyroidectomy after Hemithyroidectomy for Pathologically Proven Low Risk Papillary Thyroid Carcinoma

Abstract Background Differentiated thyroid cancer (DTC) includes papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) and encompasses approximately 94% of all thyroid cancers. The majority of DTC carries an excellent prognosis, with 10-year survival rates of over 90% and when examining the subset of low risk DTC (approximately 48% of all thyroid cancers), 10-year survival rates are in the order of 98%, irrespective of management algorithms. Aim of the Work The goal of the current study was to evaluate active surveillance versus total thyroidectomy in patients with low papillary thyroid carcinoma. Patients and Methods These studies included 35579 cases who were divided into 2 group: 15929 cases in hemithyroidectomy group and 19650 cases in thyroidectomy completion group. About 1265 articles were identified and after exclusion of article which did not fulfill the inclusion criteria, 18 research articles were enrolled in the current study. Results The patients' age range was between 40 and 50 years, with a higher incidence of PTC reported in the 3rd and 4th decades of life. Most patients were females, with no significant differences between the two groups. The mean tumor size was approximately 0.5 cm, and most tumors were smaller than 3 mm. Only two studies reported a significant difference in tumor size between the two groups, with larger tumors found in the TT group. Other studies reported no significant difference between the two groups. Conclusion Hemithyroidectomy with active surveillance is a good option for treatment low risk papillary thyroid cancers with lower postoperative complications rate, comparable recurrence rate and overall mortality rate. In spite that, 10- year DFS rates were lower with hemithyroidectomy.

Recurrence rates after healing in patients with neuroischemic diabetic foot ulcers healed with and without sucrose octasulfate-impregnated dressings: A 1-year comparative prospective study.

To compare recurrence rates after a 1-year follow-up period of healed neuroischemic diabetic foot ulcers after treatment with or without sucrose octasulfate impregnated dressing. A 1-year prospective study with two arms was conducted between April 2021 and April 2023 on 92 patients with healed neuroischemic diabetic foot ulcers. Patients were divided into two groups; the treatment group, that includes patients healed with a sucrose octasulfate-impregnated dressing, and the control group, which includes patients treated with other local treatments different from sucrose octasulfate-impregnated dressings. After healing, patients were prospectively followed up during 1-year and assessed monthly in the specialised outpatient clinics. The main outcome of the study was ulcer recurrence after wound healing within 1 year follow-up. Secondary outcomes were minor or major amputation and all causes of death. Fifty patients in the treatment group and 42 patients in the control group were included. Fourteen (28%) patients suffered from a reulceration event in the treatment group compared to 28 (66.7%) in the control group, p < 0.001. Time to recurrence in the treatment group was 10 (16.26-2.75) and 11.50 (30.75-5.25) weeks in the control group, p = 0.464. There were no observed differences in the minor amputation rates between the two groups: 15.2% (n = 7) in the treatment group and 7.1% (n = 3) in the control group (p = 0.362). Major amputations and death outcomes were exclusively observed in the treatment group. Specifically, four major amputations (8.7%) in the treatment group were complications arising from recurring events complicated by infection during the SARS-CoV-2 period. Seven patients died due to complications not related with local therapy. The relative risk of recurrence was 20.18 times higher in the control group compared with those treated with octasulfate dressing (p < 0.001). Treatment with sucrose octasulfate-impregnated dressings can decrease recurrence rates of neuroischaemic diabetic foot ulcers more effectively than neutral dressings. Besides, it may enhance the foot's clinical properties in patients with poor microcirculation, which could aid in preventing future recurrences.

Influence of procedural timing on the preventive yield of percutaneous patent foramen ovale closure

BackgroundThe benefit of patent foramen ovale closure (PFOC) ≤9 months after a cryptogenic stroke has been demonstrated in several randomised clinical trials. There is, however, insufficient data to support PFOC...

Exploring versatile applications of a vacuum-assisted bone harvester in orthopedic surgery

BackgroundOrthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions.MethodsA retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio.ResultsThe study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%.ConclusionThe vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device's performance. It is crucial to acknowledge that isolating the device's contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.

Recurrent Laryngeal Papillomatosis in Denmark from 1994 to 2021: A Nationwide Register Study.

The aim of this study is to describe the incidence and demographics of laryngeal papillomatosis (LP) in Denmark, including sex and age distribution, recurrence rates, and HPV subtypes, using a new method of register identification. The data were extracted from the Danish Pathology Data Bank using SNOMED codes instead of the usual method using ICD codes from the Danish National Health Register. The derived pathology records were manually verified by three medical doctors. The study period was 1994-2021. Patients were categorized according to age as either juvenile-onset RRP (JoRRP) if <18 years or adult-onset RRP (AoRRP) if 18 years or older. We identified 1819 RRP patients (JoRRP: 56; AoRRP:1763). The overall incidence per 100,000 inhabitants were 0.17 for JoRRP and 1.45 for AoRRP. The vast majority (72%) of the patients were male, but there was no significant difference in age at onset of RRP or recurrence rates between the sexes. Children below 3 years of age had the highest recurrence probability. Extracting data using SNOMED codes resulted in a positive predictive value of 99% regarding total number of biopsies and 98% regarding individuals. The incidence decreased throughout the study period. Comparable incidence and recurrence rates of RRP were found between Denmark and Norway. In this study, the Danish Pathology Register was found to be a highly valuable method for identifying LP patients. The effect of the nationwide HPV vaccination program can be evaluated using this method as the vaccinated cohort is starting to grow older and reproduce. Retrospective registry-based national cohort study, 3 Laryngoscope, 134:5047-5053, 2024.

Comparison of Outcomes Between Partial and Radical Laparoscopic Nephrectomy for Localized Renal Tumors Larger Than Four Centimeters: A Systematic Review and Meta-Analysis.

Earlier studies have juxtaposed different laparoscopic methods for treating renal tumors; however, extensive evidence with a particular focus on large kidney tumors remains lacking. The objective of this meta-analysis was to assess the perioperative outcomes, kidney performance, and cancer-related results of laparoscopic partial nephrectomy (LPN) versus laparoscopic radical nephrectomy (LRN) for treating extensive, localized, non-metastatic kidney tumors (cT1b-cT2N0M0). We systematically searched multiple databases from database inception until December 2023 for relevant studies. Selected data were analyzed with the Cochrane Collaboration's Review Manager 5.4 software using a random-effects model. Outcomes were expressed as odds ratios and weighted mean differences with 95% confidence intervals, considering a P value of < 0.05 as significant. Data from nine studies encompassing 1,303 patients (529 LPN, 774 LRN) revealed that LPN was associated with lengthier surgeries and increased blood loss compared to LRN. While LPN exhibited higher postoperative complication rates, the disparity did not reach statistical significance. LPN led to improved postoperative renal function, manifesting as a reduced estimated glomerular filtration rate (eGFR) decline and fewer incidents of new chronic kidney disease cases. Both groups demonstrated comparable tumor recurrence and overall mortality rates, but LPN exhibited significantly lower cancer-specific mortality rates. LPN, despite longer operative times and greater intraoperative blood loss, was found to be superior to LRN in preserving postoperative renal function. Oncologically, LPN and LRN have comparable overall mortality rates, but LPN showed a significant advantage in terms of lower cancer-specific mortality rates.

Exploring uterine involvement in hysterectomy samples following conization for adenocarcinoma in situ of the uterine cervix: Insights from a multicenter study by the FRANCOGYN group

BackgroundAdenocarcinoma in situ (AIS) of the cervix can progress to invasive adenocarcinoma. While hysterectomy is standard, conservative management may be considered for women desiring future pregnancies. This study aimed to determine the prevalence of residual disease in hysterectomy specimens following excisional therapy with clear margins for AIS. MethodsA retrospective FRANCOGYN cohort study was conducted on patients who underwent a hysterectomy after conization with clear margins for AIS between 2008 and 2021. The primary goal was to assess the prevalence of residual disease in the hysterectomy specimens. Secondary objectives included identifying preoperative predictors of residual disease and comparing recurrence rates between patients with and without residual disease. ResultsOf 53 hysterectomies performed after conization with negative margins for AIS, 20.8% (11/53) showed residual disease in the final histology. None of the patients had invasive cancer. In the residual disease group, 18% (2/11) had persistent CIN 3, and 82% (9/11) had persistent AIS. These patients tended to have higher BMI (27.5 kg/m² vs. 23.6 kg/m², p=0.04) and shorter endocervical margins (2mm vs. 5mm, p=0.01). No recurrences were observed during follow-up. ConclusionDespite clear margins on the initial conization for AIS, 20% of patients had residual disease in their hysterectomy samples, though no invasive cancer was found. A hysterectomy should be considered after completing childbearing, even if initial margins are clear.

Long-Term Outcomes of Esophageal Squamous Neoplasia with Muscularis Mucosa Involvement after Endoscopic Submucosal Dissection.

Ambiguity exists over treatment and surveillance strategies after endoscopic submucosal dissection (ESD) for esophageal squamous cell neoplasia (ESCN) with unfavorable histologic features. This study investigated the long-term outcomes of ESD in high-risk ESCN patients. We retrospectively included early ESCN patients treated with ESD at two medical centers in Taiwan between August 2010 and December 2023. Demographic, endoscopic and pathological data were collected. Among 146 patients (mean age 59.17 years) with 183 lesions, 73 (50%) had a history of head and neck cancer (HNC). En bloc and R0 resections were achieved in 100% and 95.6% of the lesions, respectively. The 5-year overall survival (OS), disease-specific survival (DSS) and local recurrence rates were 42.7%, 94.7% and 11%. R0 resections were significantly associated with recurrence in a univariate analysis (HR: 0.19, 95% CI: 0.06-0.66, p = 0.008). Alcohol abstinence was independently associated with lower recurrence (HR: 0.34, 95% CI: 0.16-0.73, p = 0.006). Patients with pT1a-MM (muscularis mucosa invasion) had comparable OS (p = 0.82), DSS (p = 0.617) and recurrence (p = 0.63) rates to those with pT1a-EP/LPM (epithelium/lamina propria invasion). The long-term outcomes of ESCN patients after ESD for expanded indications were satisfactory. ESD could be considered in selected ESCN patients involving the muscularis mucosa, notably among high-risk HNC patients.

Outcomes of SWI/SNF complex-deficient sinonasal carcinomas in a Southeast Asian cohort.

SWI/SNF complex-deficient sinonasal carcinomas are rare, genetically distinct, and aggressive entities. SMARCB1 and SMARCA4 immunohistochemistry was retrospectively performed on a cohort of undifferentiated, poorly differentiated, and poorly defined sinonasal carcinomas. Survival outcomes were compared between SMARCB1/SMARCA4 (SWI/SNF complex)-deficient and -retained groups. Eight SWI/SNF complex-deficient (six SMARCB1-deficient, two SMARCA4-deficient) cases were identified among 47 patients over 12 years. Triple-modality treatment was more frequently utilized in SWI/SNF complex-deficient carcinomas than in SWI/SNF complex-retained carcinomas (71.4% vs. 11.8%, p = 0.001). After a median follow-up of 21.3 (IQR 9.9-56.0) months, SWI/SNF complex-deficient sinonasal carcinomas showed comparable recurrence rates (57.1% vs. 52.9%, p = 0.839), time-to-recurrence (7.3 [IQR 6.6-8.3] vs. 9.1 [IQR 3.9-17.4] months, p = 0.531), and overall survival (17.7 [IQR 11.8-67.0] vs. 21.6 [IQR 8.9-56.0] months, p = 0.835) compared to SWI/SNF complex-retained sinonasal carcinomas. Triple-modality treatment may improve survival in SWI/SNF complex-deficient sinonasal carcinomas.

Paper 10: 5-Year Outcomes: Arthroscopic Anatomic Glenoid Augmentation is Superior to Bankart Repair

Objectives: Arthroscopic anatomic glenoid reconstruction (AAGR) is an increasingly popular treatment approach for shoulder instability. AAGR shows a promising short-term safety profile and clinicoradiological outcomes, suggesting its efficacy is comparable to Bankart repair. Recurrence rates reported in the literature are up to 30% following Bankart repair, however, there is a lack of literature comparing the long-term outcomes of AAGR versus Bankart repair. The purpose was to compare recurrence rates and patient-reported outcomes in patients who received AAGR to patients who received Bankart repair with a minimum of 5-year follow-up. Methods: This was a retrospective study comparing 73 patients who underwent AAGR and 76 patients who underwent Bankart repair consecutively between 2012 and 2018. Patients who had a minimum 5-year follow-up were included in the final analysis. Data collected included demographics, pre- and postoperative Western Ontario Shoulder Instability (WOSI) Index and Disabilities of the Arms, Shoulders, and Hands (DASH) Scores, postoperative complications and recurrence. The primary outcome measure was dislocation recurrence, with secondary outcome measures of patient-reported outcomes and postoperative complications. Results: The demographics and preoperative outcome scores were similar between groups. Patients in the AAGR group presented with significantly higher bone loss (&gt;10%, p&lt;0.05) than those in the Bankart group. There were fewer incidences of recurrence in the AAGR group (1.4%) than the Bankart group (18.4%). There was a significant difference in pre-to-post operative WOSI (p=0.02) and DASH (p=0.01) scores between groups, as well as a significant difference in the number of patients who met the WOSI (p&lt;0.001) and the DASH (p&lt;0.001) minimum clinically important difference threshold, with the AAGR group showing a greater improvement pre- to postoperatively. Conclusions: AAGR has better long-term outcomes and fewer incidences of recurrence compared to Bankart repair.

Postoperative complications and hernia recurrence after the use of various ventral hernia repair techniques

Prosthetic hernioplasty (HP) for ventral hernias (VH) has a complication rate of up to 27% and a hernia recurrence rate up of to 37%, depending on the chosen technique. The use of laparoscopic HP techniques allows for a shorter hospital stay and a lower risk of wound infection. There is a wide range of data on the superiority of laparoscopy over the open technique in terms of recurrence rates and various types of complications. The results of comparing HP with and without suturing of the hernia defect are controversial. Objective — to study the structure and incidence of postoperative complications, as well as the frequency of hernia recurrences after the use of open and laparoscopic HP for VH. Materials and methods. A multicenter prospective study, which included 482 patients diagnosed with VH, was conducted at the clinical base of the Department of General Surgery No. 2 at Bogomolets National Medical University. A total of 279 (57.9%) patients had primary VH, while 203 (42.1%) had incisional VH. The patients were divided into two groups, comparable in terms of age, sex, and hernia size distribution. Group 1 included 250 (51.9%) patients who underwent open HP with suturing of the hernia defect: subgroup 1a — open sublay (n=243; 50.4%), and subgroup 1b — open intraperitoneal onlay mesh technique (IPOM) (n=7; 1.5%). Group 2 included 232 (48.1%) patients who underwent laparoscopic HP using the IPOM technique: subgroup 2a — IPOM without suturing of the aponeurosis defect (n=81; 16.8%), subgroup 2b — IPOM with suturing of the aponeurosis defect (n=108; 22.4%), and subgroup 2c — IPOM+ with open aponeurosis defect suturing (n=43; 8.9%). Follow‑up evaluations were carried out at intervals of 2 weeks, 1 month, 6 months, and 1 year to assess the presence of complications, recurrence, and satisfaction with the cosmetic effect of the operation. Results. The overall frequency of complications after HP was 15.6%, while after open sublay it was 21.2%, and after laparoscopic IPOM it was 9.9%. All cases of complications belonged to Grades I—IIIb according to the Clavien‑Dindo classification. In both groups, there were no fatalities. In group 1, the frequency of seroma was 11.6% and hematoma was 5.6%, and in group 2, it was 7.3% and 0.9%, respectively. A statistically significant increase in the frequency of hematoma development was observed after open HP techniques compared to laparoscopic ones (p=0.004), while the frequency of seroma detection was comparable (p=0.148). Non‑suturing of the aponeurosis defect after laparoscopic IPOM in patients with VH did not result in an increase in the total number of complications or the percentage of recurrence (p &gt;0.05). Laparoscopic IPOM with hernia suturing demonstrated significantly higher patient satisfaction with the appearance of the anterior abdominal wall compared to other HP techniques (р &lt;0.05). Conclusions. The open sublay and laparoscopic IPOM HP procedures have a comparable recurrence rate of VH (p &gt;0.05). The incidence of infectious complications and hematomas is significantly higher after open operations compared to laparoscopic ones (p=0.041 and p=0.004, respectively).

Quality of life following laparoscopic totally extraperitoneal repair of a unilateral reducible inguinal hernia.

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair has become increasingly favored over open Lichtenstein tension-free mesh repair owing to its associated benefits, including reduced postoperative pain, early return to normal activities, and a comparable recurrence rate. In recent years, emphasis has been placed on patient-reported outcomes, particularly health-related quality of life (QOL), as a critical metric for evaluating surgical success. This study aimed to evaluate the overall QOL following laparoscopic TEP repair of unilateral inguinal hernia. This prospective study enrolled patients aged 18 years or older who underwent elective laparoscopic TEP hernia repair for unilateral inguinal hernia from April 2020 to March 2022. Data collected include demographic details, hernia characteristics, postoperative complications, and postoperative QOL assessment. The Short Form 36 Health Survey Version 2 (SF-36v2), a validated general QoL questionnaire, was administered preoperatively and at 1 month, 6 months, and 1 year postoperatively. Statistical analysis utilized paired t-tests for comparisons, with significance set at a p-value <.05. A cohort of 49 patients, with a mean (standard deviation) age of 56.7 (14.0) years, predominantly comprising 47 men, was available for evaluation. Complications were observed in three (6.1%) of cases, with seroma/hematoma occurring in two patients and a wound infection necessitating antibiotic treatment in one patient. Notably, there were no instances of recurrence during the study period. Postoperative assessments revealed significant improvements in both physical and mental health at 1 month, with continued improvement noted up to 12 months. Laparoscopic TEP inguinal hernia repair has been shown to improve both physical and mental health in patients with unilateral reducible inguinal hernia, with the majority of the improvement typically occurring within the initial month following surgery. It is crucial to communicate these improvement trends to patients undergoing hernia repair to help manage their expectations effectively.

Rates of Recurrent Intestinal Metaplasia and Dysplasia After Successful Endoscopic Therapy of Barrett's Neoplasia by Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection and Ablation: A Large North American Multicenter Cohort.

Endoscopic eradication therapy (EET) combining endoscopic resection (ER) with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) followed by ablation is the standard of care for the treatment of dysplastic Barrett's esophagus (BE). We have previously shown comparable rates of complete remission of intestinal metaplasia (CRIM) with both approaches. However, data comparing recurrence after CRIM are lacking. We compared rates of recurrence after CRIM with both techniques in a multicenter cohort. Patients undergoing EET achieving CRIM at 3 academic institutions were included. Demographic and clinical data were abstracted. Outcomes included rates and predictors of any BE and dysplastic BE recurrence in the 2 groups. Cox-proportional hazards models and inverse probability treatment weighting (IPTW) analysis were used for analysis. A total of 621 patients (514 EMR and 107 ESD) achieving CRIM were included in the recurrence analysis. The incidence of any BE (15.7, 5.7 per 100 patient-years) and dysplastic BE recurrence (7.3, 5.3 per 100 patient-years) were comparable in the EMR and ESD groups, respectively. On multivariable analyses, the chances of BE recurrence were not influenced by ER technique (hazard ratio 0.87; 95% confidence interval 0.51-1.49; P = 0.62), which was also confirmed by IPTW analysis (ESD vs EMR: hazard ratio 0.98; 95% confidence interval 0.56-1.73; P = 0.94). BE length, lesion size, and history of cigarette smoking were independent predictors of BE recurrence. Patients with BE dysplasia/neoplasia achieving CRIM, initially treated with EMR/ablation, had comparable recurrence rates to ESD/ablation. Randomized trials are needed to confirm these outcomes between the 2 ER techniques.